"Sicko" premise

[KMATTOX at aol.com]

I waited until the film was actually shown and reviewers have cited their  
initial reaction to this film.   
 
In the producers own words the premise of the film is "A comedy about 45  
million people with no health care in the richest country on earth.  "    
 
Now for my own righteous indignation.   I have been listening to  the false 
assumptions relating to no health care, lack of access, etc. because  we have 
40 million people in the US with no health insurance.   The  later phrase is a 
political sound bite and has nothing to do with the first  incorrect 
assumption.    
 
I will admit that the major focus on M. Moore's film is NOT the indigent  and 
un-insured of America.   He focuses on those with insurance or  some health 
plan, but problems with access because of administrative  denial.   EVERYONE in 
the US on this list server deals with that  problem EVERY DAY.   It is not a 
problem of doctors, nurses, or even  hospitals, but of those who hold the 
middle man money to pay for the needed  services, be they an insurance company, 
HMO, or some form of  government.   
 
I live in the 4th largest city in the United States.  I live in the  state, 
Texas, with the HIGHEST rate of uninsured in the nation (>25%), and  Houston 
has the highest rate of any city in the state with 33% of the population  being 
uninsured, indigent, and below the federal poverty  level.    If there was to 
have been a problem in health care,  health care access, or quality of care 
for the uninsured, the unemployed, and  the under-insured employed patient, it 
would be Houston.   The Houston  data would give a totally different story, if 
anyone, ANYONE (politician, TV  reporter, newspaper reporter, or movie maker) 
would take the time to look at the  public health system (HCHD - LOCAL Tax 
based) and the support for many uninsured  in the private and not for profit 
hospitals of the region (Cost Shifting - a  mechanism as old as medicine itself).  
 It is not the physicians who  limit the access as in EVERY hospital in 
Houston the physicians will treat  anyone that gets through the doors of the clinic 
or hospital and for long as  their emergency condition exists.   It is in the 
public system and in  the FQHC and many many other faith based clinics that 
much of the remaining  access exists.   One needs only to look as far as the 
program "Gateway  to Care." to see what the non-tax based HCHD has developed.   
_http://www.gatewaytocare.org/_ (http://www.gatewaytocare.org/) 
 
While we all abhor use of the emergency department as a primary care,  
non-emergency site for access, we have developed a program of personal  
responsibility and required sliding scale payment called  "Right  Care."   We try to only 
bring to the EC those with IMMEDIATE LIFE  THREATENING emergencies, as EMTALA 
intended.    Even those  patients are told they are expected to pay for their 
portion of care based on a  sliding scale determined by formula on their "gold 
(HCHD identification)  card.      Yes, they do have a financial provider, it  
is the taxpayer of Harris County, with new taxing plans on the drawing  
board.    Additional income comes from Medicare (<8% of the  patient load), 
Medicaid (<10% of the patient load), DisPro Share, UPL, and  other funding sites.    
Some patients who present to the  emergency room actually have great insurance 
while others have insurance and  still others (believe it or not) actually 
pay  cash.       
 
This LOCAL mechanism of providing "insurance" exists in most every major  
city in the United States, a FACT that is infrequently cited by the politicians  
or the movie makers like Mr. Moore, or the TV reporters like Peter Jennings 
(an  interview with me about the HCHD and Houston was the last show on TV w Mr.  
Jennings, shown after his death).   He used only 5 minutes of a more  than 2 
hour interview and he used almost none of the material and information  which 
I cited above.     He kept trying to get me to give  some sound bite about how 
good the Canadian system or a single payer Federal  system would be.    I 
simply do not believe that to be a  fact.    
 
Our indigent catchment was cited in today's Houston Chronicle to be 1.7  
million people, although I believe it to be over 2.4 million once one factors in  
the indigent, under-insured, uninsured, unemployed, and our emergency and 
trauma  responsibilities.   Our annual budget is less than $1 billion/year for  
ALL:health costs, from doctors, home health care, HIV care, heart surgery,  
trauma surgery, cancer treatment, etc.    Thus our costs are less  than $40/member 
(potential patients-our enrollees)/month.   Our  published results in almost 
any area one wishes to analyze are comparable to  other area, regional, and 
national hospitals, and in some areas our outcomes are  the standard for the 
country.     Does this mean we treat  anyone who presents with total health care. 
  OF COURSE NOT.   Unless they have an immediate life threatening emergency, 
they must establish  eligibility and the amount of co-pay required.   One of 
those  requirements in residency in our county, or else there is an expectation 
of  payment.    So a patient presenting to HCHD from NYC or Mexico  for 
treatment of chronic renal failure, diabetes, or a hernia will need to  determine 
elgibility and get a gold ard before we can give them a clinic  appointment or 
admit them for elective surgery.    
 
Now back to "Sicko"   One of the patients in the movie was a  worker from 
ground zero during 9-11.   He was taken to Cuba where he  was given an 
examination for his pulmonary symptoms.  The doctors in Cuba  found NOTHING different 
from those in NYC pertaining to his pulmonary  symptoms.   They did find some 
element of esophageal reflux (which of  us does not have some reflux at some 
time) and given (free) medicine for this  condition.  For this (very expensive) 
second opinion showing that he did  get quality care for his symptoms in NYC he 
became a movie star.    This patient DID and still DOES have access to 
afordable health care in  NYC.    
 
Thus the foundation for the "Sicko" movie is faulted in the  beginning.   It 
states views not really supported by fact.  It  does lead one to think that 
health care should be "free" but does not cite who  should pay for the expensive 
care of today's technologically driven health  care.    Throughout the United 
States, and in most countries of  the world, we have had and currently do 
have an excellent group of physicians  who understand the ethics and morality of 
health care delivery.   The  financing and the regulatory harrassments make 
such difficult, but  possible.    In many ways, the indigent, the un-insured, 
the  under-insured, the unemployed have easier access to high quality health 
care in  Houston, Los Angeles, Seattle, New York City, Miami, New Orleans, San 
Francisco,  and on and on, than does the worker who belongs to an expensive 
regulated  insurance plan or HMO.     
 
Kenneth L. Mattox, MD
Houston. 



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