Sicko and health care: Guest post #3

Post by Dr. Kao-Ping Chua, M.D.

About the Canadian health care system:

Pros: Universality, administrative simplicity, equality, high quality, free choice of doctors and hospitals (not true in the U.S.)
Cons: Quickly escalating costs (because doctors are paid fee-for-service and have an incentive to over-order), rationing of health care results in wait lists for elective surgeries (but this is completely blown out of proportion by the American media - you don't wait for emergnecies).

Is it a better system? Depends on your definition of "better." If by better, you mean more affordable and equitable, then definitely. If by better, you mean more technology, then definitely not. By my criteria, I think Canada has a better health care system for the vast majority of diseases, but if I had a rare disease or needed super-specialized care, I'd opt for the U.S. As an average citizen, though, I'd much rather deal with the Canadian health care system than the American one. As a doctor, I'd also much rather deal with Canada since there'd be fewer insurance hassles and you wouldn't have to worry about your patient's financial status - they'd get the care they need.

About the British health care system:

The British health care system (NHS) is an incredibly inexpensive, economically efficient system. It has one of the strongest primary care/preventive care systems in the world. Unfortunately, it suffers from massive wait lists, old facilities, and a lack of specialists. This is mostly due to a lack of funding, though the recent British government has been putting a lot of money into the system. I think Sicko portrayed only the good parts of the NHS, but it portrayed them very well - virtually free care, strong popular support, good pay for doctors (not quite as good as the U.S. but not bad either).

About the French health care system:

I don't have first-hand knowledge of the French health care system, but it's regarded to be the best in Europe by the WHO [World Health Organization]. It's true that people pay taxes out the wazoo for the system, but on the other hand, they got extremely high quality care.

About the American health care system:

Obviously, this movie was up my alley since I worked on universal health care in DC for a year. I think it did a great job of humanizing the problem - the stories that I heard were all very familiar, but that didn't make them any less devastating. I don't think the movie was intended to give a fair comparison of the American health care system to other systems - I think Moore intended to just shatter some illusions that Americans have about third-world health care in socialized systems like England/France, and he did that very well. The best part of the movie in my mind was the end where Moore had a monologue about American values (e.g. why can't we be a place that's willing to take care of others). Changing values is the crux of all social change, and I was thrilled that Moore seemed to recognize that.

Did I think the movie is fair? Of course not - it's liberal propaganda, in some ways. But like I said, I don't think it wasn't supposed to be intellectually fair, but rather about raising awareness, changing perceptions, and hopefully chipping away at some of our misguided social values.

Kao-Ping received his medical degree from Washington University in St. Louis and is currently a resident at Boston Children's Hospital. Previously, he worked for the American Medical Student Association on the issue of universal health care.

Earlier: Sicko: Is Michael Moore right?
Earlier: Sicko and health care: Guest post #1
Earlier: Sicko and health care: Guest post #2