Wednesday, October 1, 2008

Critical Condition: The Human Cost of the U.S. Health Care System


Copyright © 2008 by Mark Gabrish Conlan for Zenger’s Newsmagazine • All rights reserved

On Sunday, October 5 at 10:30 p.m. KPBS-TV in San Diego (on-air channel 15, cable channel 11) will air Critical Condition, a documentary about the plight of Americans without health insurance. Produced and directed by Roger Weisberg for the PBS P.O.V. series, Critical Condition is a 10-hankie tear-jerker centering around four individuals:

• Joe Stornaiuolo, hotel doorman who gets diabetes and edema, can no longer do his job, then gets fired and loses his health coverage just before all the major conditions kick in;

• Karen Dove, who suspects she has cancer and spends several months just going from doctor to doctor looking for one who will see her even long enough to diagnose her instead of turning her away because she can’t pay for care, finally finds an oncologist willing to give her tests and finds — you guessed it — that in the meantime while she was going through the financial rigmarole the cancer spread from something that could have been treated relatively easy to one that has metastatized;

• Hector Cardenas, a warehouse manager in Los Angeles who gets diabetes and gangrene in his foot, tries desperately to hold on to his job because he knows that if he loses it he’ll lose health coverage, opts to have the foot amputated because his doctors promise him that if he does they’ll have him up and working in a month whereas if he lets them try to save his foot it’ll take several months and his boss will let him go in the meantime, only he loses the bet — he gets the foot cut off and still has to wait four or five months, loses his job and has to worry about the cost of his future care, including the succession of prostheses he needs to regain mobility (there’s a poignant scene in which he attends the wedding of his son — oddly, he’s a good-looking man and seems so much younger than he is that at first it’s a shock that he has a grown son — but in a wheelchair, so he can’t stand up for the ceremony or dance with the bride or his own wife); and

• Carlos Benitez, a documented immigrant from Mexico who’s taken U.S. citizenship and works in a restaurant but doesn’t get health insurance from his employer (actually he did originally, but he gave it up when all they were giving him was over-the-counter drugs and he figured he could save money by just buying them himself) and so is S.O.L. when the bones in his back start to fuse and put him in 15 years of unbearable pain (though not in so much pain that he can’t have sex: at the end of the program his wife is visibly pregnant), finds that the operation needed to fix him (he’s literally turning into a hunchback — the first real one I can ever recall seeing in the film — and losing several inches off his height) will cost over $150,000 and his doctors aren’t willing to perform it because his ability to pay is dubious; later he goes to Mexico and finds that there the drugs he needs costs about one-tenth of what they do on this side of the border and the operation would only cost $40,000 (which is still $40,000 more than he can spare for it, of course), and he finally gets the operation but only due to the persistence of a UCLA doctor he meets at a “health fair” and who finds two surgeons willing to do the operation on him for free as a community-service gesture.

Critical Condition is clearly propaganda for a single-payer health care system, though Weisberg is careful to keep it from being too in-your-face and only allow a couple of his subjects to hint that it would be nice if this country had a system where people were covered automatically as a right. He trots out the usual statistics that the U.S. spends more money on health care than any other country in the world but we do far worse in infant mortality, chronic disease rates and conventional measures of health outcomes than other countries that have single-payer or some other system (like the German “sickness funds,” which probably come closest of any country in the world to what Hillary Clinton infamously proposed in 1993-94) that ensures universal coverage and eliminates private profit.

When Michael Moore made Sicko — also a pro-single payer film and one considerably more in-your-face than Critical Condition — the story broke that several health insurance companies were trying to get his interviewees to recant what they’d told him on camera and, as a lure for them to do so, offering them one year’s free health care — a truly disgusting illustration of how much health care has become a commodity, and one from which insurance companies and HMO’s profit from not providing. At a preview screening at the San Diego Public Library on September 7, Critical Condition was introduced by nurse Hugh Moore, representing the pro-single payer organization Health Care for All, and at one point he said that we don’t ration police or fire services on the basis of ability to pay, so why should we ration health care that way?

Alas, if anything the U.S. is moving in the direction of rationing police and fire protection by ability to pay, thanks to the relatively new phenomenon of firms selling security and firefighting services on an insurance basis — “Well, if there’s a crime or a fire at your house, we’ll come out; we’ll just ignore your neighbors who aren’t paying us.” The trend, at least in this country, is against society-wide solutions like single-payer and towards the commodification of everything — the idea that The Market should rule all and those who don’t have the financial resources to pay for the basic necessities of life should just go without and, if need be, die and decrease the surplus population. (The reference to Charles Dickens’ A Christmas Carol — a story that, intriguingly, was just hijacked by Right-wing movie producer David Zucker of the Airplane! spoofs for An American Carol, the story of a Michael Moore-ish filmmaker who’s induced to “reform” after he proposes abolishing the Fourth of July holiday — was fully intentional.)

Many people at the library screening had horror stories of their own about the health-care system. While the film presented insurance as a sort of health-access panacea, anyone who’s had to battle with insurance companies and deal with their arbitrary denials of claims (sometimes after they’ve actually paid the service provider, so they seek reimbursement from the patient!) knows better. So do people like one woman in the audience who’s had exactly the opposite problem: she had such generous insurance that her doctors larded on procedure after procedure, some of them threatening to her health, just to worm more money out of the insurance companies. This is why it was it grimly amusing when John McCain said during his acceptance speech at the Republican convention, “My health care plan will make it easier for more Americans to find and keep good health care insurance. [Barack Obama’s] plan will force small businesses to cut jobs, reduce wages, and force families into a government run health care system where a bureaucrat stands between you and your doctor” — as opposed to all the private bureaucrats who stand between insured patients and their doctors now!