Robert Winer, M.D.


Science of Sleep

I recently discussed dream analysis in an interview about the film Science of Sleep, directed by Michel Gondry. You can read Vicky Hallet's review at Read Express

Michael Moore's "Sicko"

“Sicko” is a missed opportunity. I can’t understand why it has been lionized by the critics (the San Francisco Chronicle critical consensus rating has had it at or near the top of the pile for weeks). I thought it was glib, painfully cutesy, arguing by anecdote, riddled with editorializing music that was telling us what to feel. Moore is treating us like four-year-olds. Among the critics, the Washington Post’s Stephen Hunter was one of the very few who complained.

It’s not that Moore is wrong about the problem. Our health care system is hugely inadequate. The current issue of Consumer Reports details the state of our HMO’s and PPO’s and it’s a discouraging story. Corporate America could make a companion piece to this film filled with anecdotes of people who received life-saving health care in a timely way, interspersed with highlights of the weaknesses in the delivery systems in England, France, Canada, and Cuba, and we would feel moved by that too.

Moore is arguing for a single-payer system, like those in the aforementioned countries. While this may well be the direction in which we need to move, I’m aware that France and England have private care practitioners also (and that there are brokers in Canada who facilitate traveling to the States for medical care). If the system works so well, why do those doctors get used? What gaps in coverage are they closing? I’d like to hear a balanced account that argues why a state financed system, despite its limitations, is the way for us to go.

The problem, as I see it, is that the free market system doesn’t work well when it comes to health care. If you’re buying a home, you can be clear about what you’re getting and what you should be paying for it – you can have an inspector check out the structure and you can look at the pricing of comparable houses. If you’re purchasing a car, you can read Consumer Reports and learn about the vehicle’s repair track record and get their impartial take on the road worthiness of the options you’re considering.

But health care plans are much harder to appraise. As the Consumer Reports article points out, the people who are reasonably happy with their plans are those who haven’t been seriously ill. Consumer dissatisfaction rises sharply for those who’ve been sick and have had to use their plans in consequential ways. It is very hard to know in advance how good your coverage will be if you’re in trouble, and this makes it difficult to choose a health plan in an informed way. And so we respond to the sales pitch, the pricing, the convenience. Our employers may only have a single choice to offer us, and that choice will likely have been influenced by cost considerations that are not in the workers’ best interests.

As Moore effectively points out in “Sicko,” the incentives in for-profit health care are on the wrong side: the company, and its doctors, are rewarded for denial of care. In contrast, in some of the state-run systems, doctors get bonuses for effective care. If car manufacturers tried to increase profits by cutting corners, we’d see the consequences clearly in rate of repair data, and that would immediately have consequences for the manufacturer. But it’s not possible, and it will never be possible, to get this sort of information when it comes to health care. The inability of the free market to respond effectively to the quality of care may be the single best reason for us to have a single-payer system (with or without a private care alternative).

For a different Michael Moore, check out his very engaging confrontation with Wolf Blitzer on CNN.