SICKO misrepresents the NHS

Comment from Britain

The film is Sicko, a two-hour take-down of the mighty US healthcare industry directed by and starring the potato-faced Michael Moore (he of Bowling for Columbine, Fahrenheit 911 and subject of too many right-wing diatribes to count). In it, Rick is an uninsured sadster who loses two fingers to a chainsaw and has to talk hard cash with an accountant before his general anaesthetic. It'll be $12,000 to reattach the easy finger, he is told; $60,000 for the pair. Rick goes for the budget option.

Fully half of Sicko is devoted to envious glimpses of better-run, more equitable and more compassionate healthcare systems in other countries, such as Canada (where another power-saw victim gets all five digits reattached for nothing) and Britain, where Moore would clearly choose to live if he didn't have such an avid following and such comprehensive health insurance at home. "Keep your British health system," he told one of our reviewers after a screening on Skid Row in LA. "Never get rid of it. It's a wonderful thing." He has also made the mistake of calling British healthcare "free".

Let us be clear: Michael Moore is amiable, fearless and funny, especially when provoked. He is also a brilliant film-maker who has transformed his genre in the US, where documentaries now pack out cinemas from coast to coast. You can take this as official. I have met him and liked him and am entirely trustworthy. The same cannot be said of Moore, of course. He is routinely denounced as a misleading, self-serving propagandist by critics who fail entirely to grasp that these are his great strengths.

When Moore barged his way into General Motors headquarters, and American culture, while making Roger & Me in 1988, it was about time. Here at last was a booming, populist, shamelessly blinkered voice from the American Left to answer those that had boomed unanswered from the Right throughout the Reagan years. Small wonder that he found a far-from-fringe constituency and became embarrassingly rich.

Moore's European critics, in particular, continue to misunderstand his challenge and his audience. They delight in exposing his crafty way with "facts", as if the corporate interests he attacks weren't just as crafty. They worry that the millions of Americans who pay to see his output might actually believe everything he says, as if, being Americans, they lack the power of critical thinking. And they forget that many of those millions of Americans do in fact, quite reasonably, share Moore's view that GM ignored its social responsibilities when Japanese competition hit home; that Kmart never had any business selling lethal handgun ammo to kids; and that when Charlton Heston raised a rifle in defiance a few days after the Columbine high-school massacre, he was a berk.

Moore, by contrast, was the man-grizzly who stood up to the idiot president of the NRA and lived to tell the tale. He was my hero. But now he has started spouting nonsense about the NHS, and he should know it's nonsense, and know that we know. It goes without saying that healthcare on the NHS isn't free. But just how unfree it is gets too little attention. We pay for it through our noses, every month.

Next year's NHS budget will be about 104 billion. That's roughly 1,733 pounds per man, woman and child. Multiplied by four for a typical two-child family, then divided by 12, that equates to median monthly family healthcare expenditure of 577, or $1,155 in American money. I can buy some very respectable US health insurance for $1,155 a month. In fact, on a quick and painless stroll through the website for Kaiser Permanente, a leading nonprofit US healthcare provider, entering my basic family details and the Beverly Hills zipcode, the most expensive family policy I can find that does not depend on contributions from the state or an employer costs $400 less than the sum Gordon Brown currently chooses to spend from my taxes, each month, on the NHS.

Being honest, I must add a few hundred to my US bill to cover "deductibles" and the portion of my US taxes going to federal schemes like Medicare and Medicaid. But I must also cop to earning more than the UK average, which means I pay more than average for my NHS care; through the nose, as I say.

American roadworks tend to be adorned with signs announcing, "Your Tax Dollars at Work". There should be signs saying "Your Tax Pounds at Work" at the entrance to every NHS hospital and surgery, and whenever "at work" fails to describe what goes on inside them, taxpayer-patients should whinge like hell. They may not like it. They may not think it British, but nothing else is working and in the meantime they are being royally ripped off.

Really? But aren't waiting lists down, as Mr Blair used to tell us every Wednesday? I would refer the Right Honourable gentleman to a recent ruling by the Canadian Supreme Court in favour of a man who sued to be allowed to buy insurance to speed up an operation. "Access to a waiting list," the court found, "is not access to healthcare."

Forty-seven million Americans are uninsured. This is a problem. Several million more are inadequately insured. Another problem. But that leaves more than 200 million fully insured Americans who've never heard of waiting lists. I envy them.

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NHS shuffles the deckchairs again

The Government sought to regain the initiative over the NHS yesterday by announcing another review. It was heralded by Alan Johnson, the Health Secretary, as "unprecedented", and will be conducted by Sir Ara Darzi, a distinguished surgeon who has been drafted into the Department of Health as a junior minister. The main aim of the review seems to be to win over NHS staff to the reform agenda, but critics are interpreting it as a sign of weakness.

Mr Johnson promised that the review would be different from the one two years ago that led to the White Paper Our Health, Our Care. He acknowledged that staff morale was low and affecting the public's perception of the NHS. "We've put a lot of money in, but that hasn't led to a lot of happy bunnies," he said. "If there's a problem with morale, it's our responsibility, and it's our responsibility to put it right. The bit that has gone wrong is taking the public with us." Sir Ara, who will travel round the country gathering information, has been given four tasks:

* Putting clinical decisions at the centre of NHS care;

* Improving patient care, particularly for those with long-term and life-threatening conditions;

* Making care more accessible and convenient;

* Establishing a vision for the next decade based "less on central direction and more on patient control".

His problem will be that the reforms of Tony Blair were not intended to make staff happy, but to change the NHS culture, inctroducing market forces and the private sector. Persuading staff that further reforms are in their interests may be difficult. In a statement to the House of Commons, Mr Johnson said that Sir Ara's review represented a "once-in-a-generation opportunity to ensure that a properly resourced NHS is clinically led, patient-centred and locally accountable". But the announcement provoked a sceptical reaction.

The British Medical Asociation and the Unison union welcomed the review. The pressure group Keep Our NHS Public said that it did not go far enough. Nick Bosanquet, Professor of Health Policy at Imperial College, London, and consultant director of the Reform think-tank, said: "It is not clear why another review is needed to go over these general issues again which have been well covered in two reviews in the last five years. A year-long review risks damaging delay when practical solutions are needed now. "Urgent problems include the redefinition of [the Private Finance Initiative] to a more local programme, the need to empower local staff to get value for money and the [removal of] barriers to the involvement of independent sector companies. All these issues need clear action and a way forward in weeks rather than years."

Andrew Haldenby, director of Reform, said: "This is exactly the wrong moment to kick health policy into the long grass. The evidence is mounting that the Department of Health's reform drive has lost momentum just as the service's big funding increases come to an end. "The focus of government should now be on delivering reform rather than reopening a debate on the direction of policy that was actually resolved years ago."

Niall Dickson, chief executive of the King's Fund think-tank, said that the proposed review must be not be a signal to reverse important reforms to the service and that the terms of engagement must be clear. "It is important that the Government does not raise expectations among staff or the public that cannot be met," he said.

Andrew Lansley, the Shadow Health Secretary, told the Commons: "The only thing the Secretary of State seems to have understood is that morale in the NHS is at rock bottom. Where is the autonomy and accountability that the NHS is so calling out for? Where is the leadership and direction that the NHS so badly needs?"

* Mr Johnson also announced another 50 million pounds to help to tackle infections such as MRSA and Clostridium difficile. This will be used to double the size of the department's infection improvement team [More bureaucracy is going to solve anything?], groups of experts who advise NHS trusts on developing plans to cut infections.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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