Friday, July 06, 2007

'Sicko'-- It's Enough to make you ill

Michael Moore, our current resident agent provocateur and gadfly is at it again, and this time he really hits you where it hurts-- in the pocketbook. His bright searchlight of investigation casts it glare on the health care industry, and more specifically on the health insurance and HMO juggernaut. I have to tell you that even if only a minority of what is said in this docu-drama is true, it confirms most of our suspicions that we are being had by our insurance companies and health care providers. It is of course always possible to complain about the odd injustice when someone falls between the cracks. But Moore is dealing not with the abuses of the system but rather its inherent and systemic problems.

When you peel away the shiny veneer of the health care industry and discover that 'managed care' has as its main goal the making of money and thereby the limiting of care, even to those who most need it, then the situation is grave indeed. Moore takes various of those folks who were involved in the rescue efforts in NY at ground zero, and not merely chronicles their on going health woes-- losing jobs, losing homes, losing faith in the American way, but he takes these folks on a journey to Gitmo in Cuba and eventually to a hospital in Havana where they get much better and very much cheaper help for what ails them than they had been able to get in America. Shameful. Call this demagoguery if you like, but it makes the point. Our system is screwed up.

Some of the more devastating revelations of this docu-drama are: 1) we owe to Tricky Dick in collusion with Mr. Kaiser (of Kaiser Permanente fame) in 1971 the rise of the HMO for profit scheme. The White House Tapes do not lie when they tell us that the specific goal of the new health care system was to make money, and minimize care when it was not profitable to give care. So much for the hypocratic oath; 2) Moore documents how every single major Western nation except the US has a universal health care system of some sort which has not bankrupted the nation, nor prevented doctors from making a good living, nor caused rampant anti-democracy notions. Indeed he documents how universal health care was a natural outgrowth of democracy not socialism, a natural effort after WWII in Europe to do a better job as a society of looking after all its citizens, because the cries of many, including the least and the last in society were finally being heard, and their votes were making a difference. 3) One of the more telling remarks was that in European democracies the government is afraid of the power of the people and listens to their protests and legitimate cries for health care, whereas in the U.S. the people are afraid of the government, of it becoming too controlling and the like, and this then inhibits even legitimate national programs like the Postal Service, or Public Libraries, or Police and Firefighters or interstate roads and highways being adequately funded. It is this same fear of 'big brother' that has made a universal health care system a hard sell in America, whilst by and large it is a runaway success in Canada. It is just heartbreaking to hear some of the stories of people refused treatment who either die, or remain maimed or become homeless because the cost of their health care either prevented them from getting treatment or alternately bankrupted them when they got treatment anyway.

The film is under two hours, but it has more of a clear flow and direction than Moore's previous films. It uses the same montage kind of approach, allowing people to tell their personal stories and allowing that in itself to generate the pathos of the movie. We watch a man sow up his own wound caused by a work accident because he has no health insurance. We see a woman dumped in front of the Salvation Army, having been put in a taxi and sent there by a hospital who decided not to complete treating this woman who needed antibiotics and stitches for a head wound. We see a woman lose her daughter because in her panic she took her to the nearest hospital which refused her care, even though the mother herself worked for a hospital in town. Care was refused because it was an 'out of network' hospital closer to where her daughter became ill that she had first taken her child. We hear the testimony before Congress of a woman who was in health care management and was promoted time and again because she 'saved' the health care provider so much money by refusing care to patients in need. And the beat goes on. We see Americans driving across the border to Canada because they can't afford their heart medicine, their cancer treatment, their surgeries in the U.S.

Some 50 million Americans today are without any kind of health care or health insurance. I mean None. Of the 250 million insured, most have health insurance which has so many exclusions for pre-existing conditions, or just recurring conditions that the insurance does not help them when they most need it. It's a national scandal to say the least. And then we are regaled with those who lobby our Congressmen and Senators for the health care industry-- giving out enormous pay offs to both Republicans and Democrats so the health care industry and its pharmaceutical allies can keep making huge profits.

Some of this comes pretty close to home for me. The cost of my cholesterol and blood pressure medicine (both hereditary issues in my case) are very steep and are not covered by my health insurance. Some days you just ask-- what good is it, this whole system? It doesn't even work well for those who can afford to pay for health insurance.

Say what you will about Michael Moore, love him or hate him, he knows how to make us think about what needs to be changed about our society. Certainly the health care industry would be a good place to start. When you realize that the Great Physician himself could not have afforded health care in this system, and would have been censured by the AMA for practicing medicine without their approval, you realize something is wrong with this picture. To say the least.


Bob MacDonald said...

See also

Allan R. Bevere said...


I have not seen "Sicko," and I must confess, I am not crazy about Michael Moore. I certainly agree that managed health care in our country is a disaster for patients, but his portrayal of the health care situation in Cuba is not as he makes it seem.

I have been to Cuba six times in the last three years and have been in hospitals and clinics in Havana and elsewhere. I have also taken health care workers from the U.S. with me. While it is indeed the case that the doctors are very well trained and that in some ways (certainly not all) Cuba is on the cutting edge of medical research, the equipment and treatments available to the citizens are often quite out-of-date. One nurse told me that stepping into one of their hospitals was like walking back in time to just after the Second World War.

When I lead a group there, we bring in medicines that you and I take for granted because they cannot get them (such as insulin, asthma medications, and even Tylenol). We have also brought in penicillin, which they have been unable to get.

Two years ago, I stayed at the same place where a team of nurses from the United States were staying. They were finishing a medical mission trip and were telling me of the primitive conditions and the unavailability of medicines.

So, whatever is happening in Cuba in reference to health care, it is often not getting to the common folk.

Let's us certainly not put it past the Cuban government to give its best available care to Americans, knowing that it will be part of a movie that will be shown in the United States.

Whatever the problems with health care in this country, and there are indeeds problems, Cuba is not a shining example of an alternative.

Ben Witherington said...

Hi Allan:

Well Moore does not suggest Cuban medicine is a shining example having all the latest medicine and equipment. The issue was free and decent quality care by good doctors and nurses, and oh yes, one lady got her 120 dollar inhalers for 5 cents a piece in Havana.

They did X rays, MRIs, and diagnosis, just basic stuff, but it was more than these folks could afford in the U.S., which is the whole point. Even basic care is not affordable to many in the U.S.-- and it is morally wrong.


Ben W,

ChrisB said...

It is this same fear of 'big brother' that has made a universal health care system a hard sell in America, whilst by and large it is a runaway success in Canada.

Ben, have you talked to any Canadians about that runaway success? The ones with money come here because in Canada the line to get even diagnostic tests is around the block. I read in just the last couple of weeks that more private hospitals are opening in Canada and Britain because people just can't depend on the state ones.

Some 50 million Americans today are without any kind of health care or health insurance.

They may not have insurance, but they have access to health care. I work for a public hospital. We get plenty of patients who simply cannot pay. They get the same treatment as anybody else.

Two sad truths about health care. 1) Some, not all, but some of the costs of health care come from the fact that Medicare rules give you the best reimbursement for doing things as inefficiently as possible.

2) Many of our nations health care woes would go away if, rather than pass new laws, Washington would un-pass a few. There are laws on the books that prevent simple, low cost solutions from being implimented.

Ben Witherington said...

Hi Bob:

I read your post, and frankly you are wrong about several things you said. I have lived in the U.K. for some years of my life, and it is untrue to say it has a huge bureaucracy that is dragging the whole health care system down. This is simply false. I don't see any real evidence it is true in France or Germany or Canada either all of which places I have spent time.

When we had our daughter in the U.K., they would not even let us pay for the care. The doctor came to the house afterwards as well to check up on Christy. And furthermore, the medicines cost only pennies.

Most doctors I encountered there were very dedicated and not in it for the money etc. They knew they too were taken care of by the health care system and it was good. On any given day I could simply walk into my clinic in Durham and be seen in 15 minutes. Perhaps not by my favorite doctor but by one or another competent ones. I did not have to wait for weeks for treatment or an appointment. It is true that in the British system if you have a chronic condition and you want treatment on the National Health you may have to be on a waiting list, but you can always get immediate care for the chronic things as well if you are prepared to pay and not wait. Ordinary and emergency things you can get treatment for right away.

If this is socialized medicine, then I am all for it. They have the private option if you want to pay for it, but no one gets left behind since there is the National Health option.

I realize Moore is a pundit to be sure, but he is not doing pure polemics without evidence. That would be a very unfair critique.

And frankly its time to stop calling any sort of nationalized program which benefits the masses (of whatever sort) socialism. Our U.S. Postal service has nothing to do with socialism.

I do not think our HMO system can be fixed by tweaking precisely because its main objective is making lots of money, not serving the health needs of the people. I think it needs a complete overhauling and this includes the health insurance industry which is a disaster even for millions who have coverage.

At the bottom of all this is the larger debate as to whether a country should be judged on the basis of how it treats its most vulnerable citizens. I think it should and I for one would be happy to pay more taxes if it resulted in universal health care, or at least a system where we took care of those who cannot afford to take care of themselves.


Ben W.

Allan R. Bevere said...


Just to weigh in one last time here: I certainly agree that it is a travesty that so many people find basic and decent health care unavailable, but I fear the Moore propaganda factor is also at work here.

When our church, and other churches I have associated with in Cuban mission, have brought Cuban pastors and laypersons to this country to visit and speak, one of the things we do is pay out of our pockets to have them visit dentists and doctors to receive care for rather minor conditions that, for whatever reason, cannot be handled in Cuba.

Whenever I travel into Cuba, I take inhalers to one of our interpreters who has a terrible case of asthma, and who is unable to get them. So where the woman in the movie got hers, I do not know, but I suppose it is amazing what becomes available when the camera is rolling.

I could tell of other situations have I encountered (like the doctor who started crying when she saw an antibiotic we had brought in, saying that if she would have had it a week before, she could have saved someone's life), but I have already gone on too long.

It just seems to me that if some form of socialized medicine, that gives all persons affordable and basic health is a better answer, Cuba is not the place to make the case. Moore's account just does not square with my experience and what I have heard from our brothers and sisters in Cuba, some of them physicians.

Medical care in this country is an important issue that needs to be discussed, not simply for discussion's sake, but that we might work toward a better situation.

I, therefore, appreciate your convictions on this matter and your post.

It is good to interact with you again, albeit in the blogosphere.

Luken said...

I pray Mr. Witherington that the information that you are relying on to come to your conclusions on the state of health care in the US is more reliable than Michael Moore and your anecdotal evidence of your personal experience in Great Britain.......

Perhaps, in the future before you start tossing around your moral outrage you should become more fully informed about the subjects in which you speak.

(This article gives a nice overview of the failings in Sicko and is a nice starting point that hopefully will lead you to deeper inquires. check it out)

This post of yours further illustrates why I do not put a lot of credence in the opinions of those who speak outside of their area of expertise.

I am a big "fan" of your biblical scholarship and that is why I am continually flabbergasted by your sloppy and undisciplined adherence to these untenable political ideologies.



Luken said...

One further comment I would like to make and that is in regards to this idea of socialized medicine.

Why is it that greater government intervention is the answer so readily given to this or any societal problem??? What is that those of you that advocate this solution see in the US or any governmental body in the world that causes you to think that this is a good solution for... well nearly anything?
If that really seem to be a good solution to you than you apparently are looking at a Governmental body that I am totally unfamiliar with.

For nearly a century socialist economic policies have been soundly discredited by noteworthy economists' world wide. Yet those same policies are continually advocated by those of you who seem to love the idea of a mothering nanny State.
Where are the churches that should be stepping up to combat this problem? For instance the Vineyard church which I used to attend before I moved is setting up a medical team whose salaries will be paid in the same manner as the pastor and will provide medical service to anyone within or without the church body.
Instead of the knee-jerk reaction to look to a deified nanny state to solve the problem this church is taking real positive steps to fix it themselves. If more churches or cooperatives of local churches did this instead of hoping or demanding that the secular government does it we would not even need to have this discussion. We all seem to want socialism as long as its 10,000 miles away in some faceless government bureaucracy and then close our ears when we are told that this has been proven time and again that it does not work. However when it comes to actually enacting a socialism that actually is social (meaning local, nongovernmental, communities comprised of individuals that actually get their hands dirty and which HAS been shown to actually work because they are actually accountable to the people they serve) well then we just can't have that because we all know the nanny government will solve all our problems if we only gave them a little more money right? This frees up our guilty conscience and also keeps us from actually having to get our hands dirty. Let the government handle the sick heaven forbid the church actually do anything.

Think on THESE things.


Mike W said...

I live in Australia and have no health insurance. Last week I broke my ankle, it needed surgery, and my wife and I were worried about what it would cost. It cost nothing... I certainly didn't mind the government intervening there. I was treated initially in one hospital, and then transferred to a hospital closer to where I live for surgery. No cost.
My mother has a degenerative kidney disease which required a multi-million dollar machine in her home to keep her alive. No cost. She has since had a transplant and months of hospitalised care. No Cost. Nanny state? Well Good!
I love living in a country that demands everyone to pay up, so that the weakest are not left behind. Sure our system has it's problems, but I have no idea how you guys live in the US system. Or maybe thats the point... the weak don't

David Johnson said...

Could you present yourself as somewhat more arrogant, omniscient, and insulting? Maybe we'd listen to what you have to say then.

This communique was steeped in sarcasm. Reader discretion is discouraged.

How many churches run soup kitchens or other food ministries and Dorcas ministries and homeless shelters? Is the problem that the church has not taken enough upon itself in attempting to deal with such human misery? If even our best efforts fail to feed all who are hungry and clothe all who are naked and house all who are homeless, if indeed our enormous expenditures of effort on such matters often seem to put hardly a dent in the problem, how can we possibly conclude that churches have all the resources available to provide decent quality medical care to all of America's hurting? Many complain of the leftist tendency to see government as having the power and ability to solve every social problem, but why should we accept that the solution to every social problem be "Work harder, church!"? Yes, the church should certainly redouble her efforts on behalf of the medically excluded, but that doesn't mean that she has the power or resources to solve the problem.

I think that the point of Dr. Witherington's post is that this is a systematic societal injustice that requires a broad societal solution, not that America should jump head-first into the shallow end of socialized medicine. For we must be heartily ashamed that impoverished, Communist, human-rights-abusive Cuba has a greater life expectancy and lower infant mortality than we do.

Ben Witherington said...

Hi David:
Thanks for your thoughtful post.
You are quite right about what I am suggesting, and quite clearly Luken doesn't get that. And please Luken, let's not use that artful dodge-- "you're outside you're expertise, so you couldn't possibly know anything about this problem and shouldn't be listened to on this subject". You don't have to be an expert to recognize a disaster when it happens-- you just need to be a reasonably intelligent and awake person! I have various friends in health care including one that manages six hospitals in Dallas. I do know something about these problems.

Perhaps the most important point I would like to stress is this----
Some ills of society are so widespread, and so systemic that they require a systemic response. Health and accident care is one of those ills.

I wish it were the case that local churches all ran clinics and did the hospital work that the church did do in the Middle Ages, but this sort of spotty 'local church' approach is neither systemic nor adequate-- not even remotely so. Why not?

Because of course the church is a badly divided, splintered, 'every church or denomination for himself' kind of organization, especially in the Protestant world. In fact, if the Protestant church was a business it would have closed a long time ago due to incredible duplication of services, shoddy mismanagement and the like--- judged on the basis of a purely business model (which is not entirely fair of course since it is a living organism, not an organization).

So while we are busy waiting for the church to become One, and get its organizational act together, and every Christian pitch in to help the needy and the ill, what should we do? Should we rant and rave about big government and socialism? This isn't even remotely appropriate-- see the response from our Australian blogger Mike.

And a couple of more things should be said. I quite agree with Alan that Michael Moore is not offering us a scientific survey of the problem and its possible solutions. He is appealing more to the emotions than anything else. But it serves well to get people involved in the discussion and looking for real solutions. Hooray for that if it makes people upset about gross injustice!

Of course I am glad there are public hospitals who treat the poor. Some hospitals have a credo which commits themselves to 10% of their clients being treated pro bono. Its a help, but its not a solution, any more than having a particular local church have doctors is a systemic solution.

Let's take a non-hypothetical situation. In the 50s we had the vaccine for polio. How was it distributed to the masses since it was needed by everyone? Well guess what-- it was given to children at public school-- a system wide public institution and so far as I can tell, we all got it for little or no cost. Nobody I ever heard of at the time said-- "nope that's big government at work messing with medicine, we shouldn't do it that way". We just went and got our shots, indeed our parents insisted. We've all got the vaccine scar to prove it.

We live in America today in a dark age of the breakdown of our major public institutions, like public schools, and public health care. Many have lost faith and trust in most such institutions, except of course for the military! We still cheer them on and wave the flag for them. Isn't that an odd thing?

The military is the ultimate example of what Luken calls socialism at work at a governmental level. Who pays the National Guard? Where do they get their equipment and weapons and uniforms? Who sends them to New Orleans or Afghanistan? The government does of course!!! Why? Because it is deemed necessary that we have a systemic response to evil and military threats to our country. Local police isn't enough. And while we are at it-- the military hardly runs like a democracy at all. It runs like a dictatorship.

What's my point? While I could vent about the fact that the money we have wasted on Iraq could have solved health care issues for millions in America if it had been spent that way, and I would be right, my point is that our country cannot survive without major public institutions that respond to urgent situations and profound evil.

But what is more urgent on a day to day basis for average Americans than health care issues? Doctors and clinics and pharmacies are overtaxed all over the place. Do we really want to be a nation that protects its people from Al Quaeda in a systemic way, but not from dread diseases that are right here in our midst? I for one do not want that.


Ben W.

What has in fact happened over the course of my life time is that a greater percentage of the population today cannot afford good health care than when I was born. Of course there have been many advances in medicine and drugs, which is a grand thing, but in the meantime an increasing percentage are left behind.

What shall we do about this? I pray that we look at all the solutions. Some laws need to be passed, and some need to be revoked. But something system wide needs to be done, and hit and miss local solutions will not be enough or adequate-- unless of course we have a massive repentance and revival in the American church and we all get on with taking care of the least fortunate around us as Jesus suggested we should do. Take another look at the parable where Jesus tells us that "in as much as we have fed, clothed, and visited the least of these, we have done this to him." There's a thought.



SJBedard said...

I have not seen Sicko, but I get nervous when people hold up Canada as something to emulate. While I appreciate free halthcare (although they are cutting back what is covered all the time), there are challenges. A Canadian friend of mine who lives in the U.S., tells me he would never want Canadian health care again. He prefers getting treatment when he needs it and not months later. Also, we have a severe shortage of doctors here. Many of the doctors we train, move to the U.S. where they can make more money. I am not saying that the Canadian system is bad and the U.S. good, but that we should be careful in our comparisons.

Ben Witherington said...

Thanks Steve: We need this report as well. There are no perfect health care systems, and the Canadian one, like the British has a hard time servicing chronic conditions in a timely fashion.


PamBG said...

Thank you for this post, Ben.

I'm a US and UK citizen, living in the UK for the last 18 years. My elderly and frail parents live in the US. As a minister, I have (very) regular contact with the healthcare system here in the UK. So I have some familiaritiy with both healthcare systems and know the area to be a complex one.

Our system in the UK is not perfectly run by any means. I understand from a friend who is a very senior person in the NHS that part of the problem is the increasing cost of new medications and new technology. For example, there is much discussion currently over the NHS's decision not to allow patients to take new drugs for Alzheimers because of the cost and to limit the use of a new drug for breast cancer because of the cost.

Pharmaceutical companies claim to spend 30% of their revenue (the money they take in before accounting for any costs whatsoever) on research. I also know that profit margins (profits after all costs, research, administration, etc. are taken into account) about about 30%. This is lower than it's been in the past for pharmaceutical companies, but outrageously high compared to the profit margins in many other industries.

From a Christian theological perspective, I believe it is a shameful thing to run a society's healthcare with the sole goal of maximising profits. From a pragmatic perspective, is a healthcare system better run by the public or private sector? I don't actually know. I suppose if I were very rich, I'd prefer the US's system, because I could buy any healthcare I wanted. On balance, I prefer our system in the UK, warts and all.

It is hard to understand how, as a Christian, one can justify a society run on the basis of maximizing profit. Jesus told the goats that they were being sent to 'outer darkness' for not visiting the sick and the imprisoned; he didn't tell them they were being banished because they had failed to make money.

Luken said...

ouwn1.) I never said that you should not be listened to. I was simply pointing out that what you say on this subject is to be taken with a grain of salt.

There are quite obviously some major differences between you and I Mr. Witherington. You have clout and can speak as if you do have authority on a subject simply because you have a public and semi-famous persona. You have a far greater responsibility to monitor what you say on any subject because it inevitably can a will be taken as authoritative, whether it is or not. The weight of this responsibility can not be clearer than when you treat this subject with obvious shallowness. You're most definitely twisting what I said to place your self as the "victim" of an attempt on my part to silence your opinion. However that was and is not my intent.
You are comparing apples to oranges when you compare my "public" stance on an issue and your very real public stance.
So I say to you that your dodge on this issue is the real dodge because you do not acknowledge your far greater influence.

-"I have various friends in health care including one that manages six hospitals in Dallas. I do know something about these problems."

As do I, and those friends come to far different conclusion than you do so once again this is a case of anecdotal reasoning that holds no weight.

-"so systemic that they require a systemic response."

A systemic response does not necessitate Government intervention. You are assuming that it does. Your conclusion still does not logically follow from the premise.

-"but this sort of spotty 'local church' approach is neither systemic nor adequate-- not even remotely so.?"

I did not say that the "local Church" approach was an end all answer to this very real problem. What I was simply trying to illustrate is that there are always solutions to problems that do not require a governmental body's interference.

-"I wish it were the case that local churches all ran clinics and did the hospital work that the church did do in the Middle Ages,"

Any solution to a wide spread and deeply ingrained problem also requires patience and perseverance. Emotionally it would be very gratifying for the government to pass sweeping reform with the swipe of a pen but this rarely solves any deep societal problem. In fact it usually causes further infection in the social wound.

-"Because of course the church is a badly divided, splintered, 'every church or denomination for himself' kind of organization,… it would have closed a long time ago due to incredible duplication of services, shoddy mismanagement and the like--- "

Once again you are placing a presupposed notion that only a super-powerful centralized organization can solve the problem. Also, this description of the church sounds very much like the US government only the Gov' is far worse.

This statement is exactly at the heart of the leftists problem. You can not see any other solution that does not include the nanny state.

"Should we rant and rave about big government and socialism? This isn't even remotely appropriate—"

So you replace ranting and raving against big Gov' for ranting and raving against the health care industry? Where is the solution in Big Gov'???? Furthermore, attempting to categorize my contrary opinion to "ranting and raving" is very subtle slight of hand, well done. Right out of the Anointed's playbook.

-"Hooray for that if it makes people upset about gross injustice!"

Ya, lets forget about the gross inaccuracies running rampant throughout the film. Lets forget about the facts, as long as it makes people mad enough to commit further knee-jerk reactions. That is exactly what this country needs: More knee-jerk reactions.

-"any more than having a particular local church have doctors is a systemic solution."

I will again reiterate that systemic solutions have to begin locally in order to be effective and accountable.

-"Let's take a non-hypothetical situation. In the 50s we had the vaccine for polio."

The singular event of the 50's Polio vaccination is hardly analogous to an institutionalized and long term program such as socialized medicine.

-"Nobody I ever heard of at the time said-- "nope that's big government at work messing with medicine,"

Come now Mr. Witherington. Nobody says that there isn't a place for government action when it's needed. This is just not one of those times.

-"We live in America today in a dark age of the breakdown of our major public institutions,…"

And you want to add another one?

-"except of course for the military! We still cheer them on and wave the flag for them. Isn't that an odd thing?"

Not at all, since the institution of the Military is one of the few institutions that the founders had in mind.

-"Who pays the National Guard? Where do they get their equipment and weapons and uniforms?"

an example of a systemic organization properly localized. Thank you

-"military hardly runs like a democracy at all. It runs like a dictatorship."

LOL!!! Am I to be shock somehow by this statement?
Where do such silly statements originate in that otherwise brilliant mind Mr. Witherington.

"Do we really want to be a nation that protects its people from Al Quaeda in a systemic way, but not from dread diseases that are right here in our midst?

Begging the question. You assume we are not but I have yet to see the evidence of this.

"I for one do not want that."

Nor do I and it has yet to be shown that we are not.

Read Thomas Sowel's "The Vision of the Anointed" and "Conflict of Visions" or F.A. Hayek's "The Road to Serfdom" and The Fatal Conceit"
And then you will have an idea of where I am coming from.

"The task of weaning various people and groups from the national nipple will not be easy. The sound of whines, bawls, screams and invective will fill the air as the agony of withdrawal pangs finds voice. "
--Linda Bowles

"Half the harm that is done in this world is due to people who want to feel important. They don't mean to do harm-- but the harm does not interest them. Or they do not see it, or they justify it because they are absorbed in the endless struggle to think well of themselves."
-- T. S. ELiot


J. K. Jones said...

Good post.

My father in law had been pasturing an English-speaking church in Japan next to a military base for about the last two years. He developed a rare form of Leukemia. He had been paying the proper taxes in Japan, so he received chemotherapy within three days in their partially socialized health care system.

Two people in the US health insurance system have commented that the medicines used to treat him would not have been available and approved that quickly in the US. The extra one-two weeks might well have cost him his life. He is back in the US now, and we are waiting to see if his treatment is administered as well here.

It made me re-think my politics.

Unknown said...

Instead of trashing our current system, which in most respects is the best in the world, we should make some reasonable changes. A mandatory health insurance program similar to what California is working on seems to be a fair, feasible and affordable solution.

Ben Witherington said...


You are quite right that I have more responsibility than you when I speak in public. Here I am speaking on my own personal blog, not in a national newspaper or other print publications, and of course I have every right to do so. Indeed, I feel I have a moral obligation as a Christian to reflect and wrestle with these questions and try and help us discern what a 'Christian' approach to them might be.

I see the blogosphere as a place where you can try out ideas and debate them, which is what I am doing here. Take it for what it is. This is why I am happy to have input from people whom I certainly disagree with-- its certainly possible I could be wrong, but your attempt to be dismissive without presenting evidence to the contrary is no more helpful than if I act in that way.

Obviously we will have to agree to disagree on various other things, but it is interesting that you say 'Systemic solutions must begin locally'. Why is that? Why is a top down solution so inherently repugnant to you? Isn't the passing of laws which then restrict everyone always a top down solution to problems, however much the impetus to pass them has been generated locally?

And why exactly have you apparently bought the myth that our medical system is working well and fairly for all of us?

I agree with Mr. Bennett that a mandatory health insurance as is being considered in California, could be a step in the right direction.

I have no illusions that any programs whether run by non-governmental or governmental groups will be perfect. But there is better and there is worse and privatization is not inherently better any more than governmentalization is inherently worse.

I want a system that does the most good, for the most persons. I don't see that happening through local initiatives that are hit and miss.

And just exactly who do you see as needing weaning from the National nipple? Would that be the poor and starving whom general charitable work is not currently helping? Would that be those who subsist on their Social Security Checks?

Why exactly do you find it so offensive, if you do, that the government would help the poor or the homeless? I find this especially puzzling.

You seem to have this distorted vision of America being some sort of giant welfare state with huge numbers of people being unfairly on the dole. Having worked with VISTA in America, and having a sister in law who is a life long social worker in Boston, I can tell you that while there are some people who abuse the system, there are many many who desperately need the help and are glad to get it, and often are able to recover and go on to being good contributing citizens in our society.

As for the works of Sowell and Hayek, give me a break. They may play well with the Fox Noise Channel crowd, and while they do have some valid critiques of liberalism especially in its secular forms, their alternatives are not persuasive or even reasonable. Hayek conjures up the specter of America lurching towards totalitarianism (which is just the opposite of where we seem to be headed) or even communism (this word just in-- most Americans have no love for communism, and neither do I) whereas Sowell has regaled us with such classic literature as "Black Red Necks and White Liberals".

Do these two men have sharp intellects? Yes they do. Are their opinions even remotely close to mainstream political or economic theory in America-- nope, and I am certainly not just talking about liberals economists and theorists. I mean even most conservative economists in our country. You need a better reading list to say the least.

Blessings on you anyway,


I was also very puzzled by your remark about the military. Are you actually claiming the military actually works like a democracy?

David Johnson said...

"Not at all, since the institution of the Military is one of the few institutions that the founders had in mind."

I'm calling you on that, man.

The founders did not wish for a large standing military--you can see this in the Second Amendment where the "right of the people to keep and bear arms" flows from the perception that "a well-regulated militia" is "necessary to the security of a free state." In other words, on the basis of reasoning that suggested that a free country might at some point need defending (and that there would need to be a well-regulated militia to do that) the Framers guaranteed the people's right to "keep and bear arms." This is not the sort of language used to express a vision of a professional military supplied with the most high-tech weapons imaginable and luring recruits with substantial bonuses to pay for college educations--all funded by taxpayer money.

The practice of keeping a large standing military only became standard in the first two decades of the 20th century. And whereas the United States had never really thrown any military weight around outside our present-day borders (with the exception of the Mexican-American War in the 1840s) before the Spanish-American War in 1898, all of a sudden Woodrow Wilson is landing troops all over Central America and the Caribbean--a total of 9 times in Mexico alone during his Presidency--to defend and protect the economic interests of American corporations. "Getting entangled in" foreign wars/affairs was precisely one of the things which the founders feared the most. Their "military vision" had nothing to do with the "socialized" military we accept today--they merely wanted to guarantee that men would have the right to organize into militias and to possess the means to defend American territory.

I find your historical perspective somewhat lacking.

Laura said...

Anecdotes are great when you want to change people's feelings or thinking, but I'd like public policy to be based on the cold hard facts.

Did you know that the 45 million uninsured that supporters of nationalized healthcare keep beating us on the head with are actually more like 8 million? If you can give Moore an hour of your time, please at least take ten minutes to watch this documentary debunking the uninsured statistic. While the current system is not perfect, it is by no means a crisis situation.

I have used the current public healthcare system, and while it is the lowest common denominator, it is also adequate. National healthcare puts everyone into the lowest common denominator. How is that better or more moral? And don't kid yourself - the programs proposed by our political leaders so far (except Romney's plan for MA which seems to be working well so far) outlaws private care. Like Canada, they don't want a "two-tiered" system because it's perceived to be unfair.

Please watch the video. Churches can easily serve those 8 million by supporting existing clinics or starting our own. We can also provide education to others on how to access public healthcare. For the difficulties insured people have in paying for expensive prescriptions, there are a variety of options, including asking the doctor for a cheaper one, or using one of the many programs for cheap or free medicine provided by pharmaceutical companies. The genuine problems our current system has can be solved in almost every case by the church or private industry - no need to throw the baby out with the bathwater.

PamBG said...

Did you know that the 45 million uninsured that supporters of nationalized healthcare keep beating us on the head with are actually more like 8 million? If you can give Moore an hour of your time, please at least take ten minutes to watch this documentary debunking the uninsured statistic. While the current system is not perfect, it is by no means a crisis situation.

It seems to me that implied in what you are saying is the suggestion that if only 'few' people are uninsured and cannot get medical attention, then there is no moral or ethical issue. Please correct me if you think my deduction is wrong.

Can you then make a Christian theological case for this kind of quantitative utilitarianism?

Did I miss the entire point of the original post? It sounded to me like the point was that the US healthcare system has as its goal the maximisation of profit and not the welfare of ill individuals.

I don't think a Christian ethical-theological argument can be based on the idea that there is an acceptable low number of individuals who we may willfully deprive of healthcare in a bid to make profit.

Laura said...

They are not deprived of healthcare. They can go into any hospital, just like I did, and be treated for emergencies. And every city has a charity or university hospital for chronic problems. I've used them. The difference is, I'm willing to spend tax dollars to ensure that everybody can take the bus. But I'm not willing to give tax dollars to make sure everyone has an Escalade.

As to the Christian argument, where in the bible does it say that the government should be using the tax dollars of unbelievers to do the work the church ought to be doing for the glory of God?

Laura said...

And let's dispense with the idea that healthcare is EVER free. It is not. Someone, somewhere, has to pay the bill - if not the recipient of the care, then the taxpayer. If you want tax rates like those in Canada, the UK, and the EU, then that's fine, but let's be realistic about what is being proposed.

Ted M. Gossard said...

This is a good post, and I'm more in sympathy with what you, Ben are saying, though the conversation here on such a difficult subject is why I like blogging.

I see too much an either/or solution here, though I'm not sure anyone here is really saying that. Why can't we have more government help as well as have more of the church factored in as well? God holds both accountable with reference to the poor.

The American dream drives too much of what goes on here, and is taken as an accepted norm that we're all to live by. That is in large part why this problem as named in the post exists. (Let's not forget the huge military machine we have to keep building up and running since after all we're the superpower in the world, and being that, we can let a few people fall through the cracks. I know that is an unfair statement, yet I fear that it has truth in it.)

No perfect system exists, but let's be open to the possibility that there are better solutions elsewhere than in America. I am.

Laura said...

Serious question, because I'm trying to grasp the rationale behind all this: If we are entitled to taxpayer-funded healthcare on demand because our lives may well depend on it, are we also entitled to taxpayer-funded groceries on demand since food is a requirement of life? Why or why not?

By on demand, I mean without going through the process of applying for Medicare/Medicaid and showing financial need before getting access to free care on demand. (I have been on welfare and on Medicaid.)

Chris Larimer said...

I was in the UK when Sicko was released. A national health official was on SkyNews laughing at the inaccuracies of the mockudrama. He asked if Moore could have taken some of the time he spent hamming up the couple's inability to pay anyone for the delivery of their baby to speak to one or two of the 70,000 people that would be turned away that day for routine treatment.

Our system is broken. But socialization isn't the answer. Tort reform, less governmental interference, and making other countries pay a fair market price for the medicines WE research, develop, and manufacture for them would go a long way to solving the problem.

LGM#3 said...

Hey Ben. I tried to contact u all day friday at the seminary, but to no avail. I'll try again on monday. Sorry for all the confusion. Oh, by the way, i love this blog, and wish that all christians would frequent it. It's so accessible even to the unlettered. Moreover, jokes aside, i think u have a brain very much like einsteiin's, except that u get theology better.

(Gretting sent to me by a. plantin)

LGM#3 said...

Hey Dr. Ben. I tried to call u at the seminary on friday, but to no avail. Hopefully, i'll be able to talk with u on monday at some point. I love ur blog. It's sophisticated yet lettered for the unrefined and unlettered. You do a great job on it. Moreover,jokes aside, i think you DO have a mind like einstein's, except that u get theology a more than he did.

(Greetings from a friend: A. PLant...)


LGM#3 said...

hi dr. ben, just trying to contace u.

LGM#3 said...

Hi dr. ben, it seems this thing will not allow me to post on ur blog.


CP said...


I am an Australian and when i look at the American Helath system I see enormous injustice. Australia does not have a perfect system at all,however it does assure each 'citezen' is the right to be treated (for free) when needed without discrimination of any kind (race, sex, culture, age etc). As an 'outsider' what strikes me the most about the many responses to Bens post is the very narrow and self-obsessed American 'filter' many of you have responded with. I do not say this as a way to slander or mock the American culture, i use it as a way to let many of you know that the rest of the 'western'(and beyond) world do not think the same way as America. There is a fundamental issue that is much deeper than simply a 'systemic' solution, it is the need to shift from a national thinking that suggest that everything within the United States is the best, smartest, greatest, biggest, strongest, most advanced in the whole world and that the rest of the world is wrong if we do not follow your morally declining social ways and accept your 'leadership'. I love alot of things about the States, however, when i hear (and see)of people being refused health care of any sort at anytime because they don't have 'insurance' it makes me sick in the stomach.
If America calls herself a 'christian' nation than tell me what is so christian about NOT looking after the poor and the widows and those who are marginalized? Australia is having issues with our own indigenous people and we have a government who is trying to take us down the same health system road as the US and ripping funding out of the 'system'. I am sure that almost 100%(maybe 90%) of the people who have posted here have never been refused health treatment in their lives or the lives of their children. Kind of makes it hard to see those who want to hide under 'capitalistic christianinty' views a little hard to side with when they have never walked in the others shoes. How do you really know how broke the 'system' is if it has never refused you care for your cancer or denied care for your childs asthma? Empathy is what is needed. In my opinion no policy will change the American Health System, only a societal shift from an inward focused unteachable America, to a outward embracing teachable society. Anyway Ben keep posting mate, it is good to have these discussion, it helps us all to think about real issues, real people in our real world. I think as christians we miss the point that we are supposed to care about all people. I agree with your statement about other countries being afraid of the peoples protest, people are what matters and we have lost this in our world.
My apologies if i have offended anyone, i was just making an opinion as an 'outsider'. I am well aware of the enormous issues within Australia and we do nto have it all perfect either.
Peace be with you all.

Laura said...

I am sure that almost 100%(maybe 90%) of the people who have posted here have never been refused health treatment in their lives or the lives of their children.

Well, I haven't. But then, when I was pregnant and my husband died and I had no insurance, I received free prenatal care from the local charity hospital. I had a long wait - half the day, each visit - but other than that it the same care I had received when I had insurance. I applied for and received welfare and Medicaid, which is government-paid insurance for those who have demonstrated a financial need, and then I was cared for by a private doctor at a private hospital again. So as an uninsured person, I did just fine, thanks to the generosity of American taxpayers.

Jeff Kerr said...

Dr. Witherington,

I'm a long-time reader of this blog and first-time poster. I'm an MDiv student at Covenant Seminary but I am Canadian. I moved to St. Louis from Niagara Falls, ON. As a Canadian, I can speak about Canadian health care with first-hand experience.

It's not perfect. It's not even close. Wait-times are a problem and it is a problem that is being taken very seriously right now. In each election, health care is almost always the dominating issue. However, the average Canadian is whole-heartedly committed to universal health care and movements for additional privatization are met with heavy resistance.

Not having seen the movie, I can still say with some confidence that the rosy picture Moore will paint of Canadian health care will be overblown. However, comments coming from the other side about universal health care being detrimental to a country's economy are equally unfounded.

Love to talk with you about this a little bit more.

kamatu said...

Dr Witherington, I'd suggest that you do a bit more in depth on the subject to get to the root causes. You are correct that there is a problem, but other posters are also correct that everyone gets care if they go to the emergency room and it will be the same care that a paying patient gets. They may have to wait longer, but you pointed out that was part of the UK system also. Why do they get the same care? There is a legion of lawyers ready to make the "cannot pay" patient (and themselves) some bucks by suing for malpractice. Which raises the costs for the medical facility, something that supposedly isn't in the "plan".

Now, is there a problem at the governmental level? Yep. Look at the history of how Medicare paid for medical care and notice when it went from simply paying the bills submitted, to setting the prices for services, which the insurance companies followed along with. Does this mean that the hospitals charge what they can? Yep.

Oh yeah, what about the crackdown on the "unethical" practice of charging a lower price to cash customers, sometimes a much lower price? Oops, nice federal intervention again.

There are a great many problems in our society and they have a number of causes, but invariably, federal control increases the problem. Look at public education and chart its quality against more and more centralized control. Examine the USDA's NAIS program in some depth, which is directly aimed at putting the smaller "buy local" farmers out of business (along with the local businesses that support them) and make the slightly larger ones conform to the practices of the giants of the meat industry. Actually, to survive, you would pretty much have to become a client to one of the big chains and we know how well that works for the farmers getting pennies on the dollar.

While agree that there are problems, I don't think you will find many of them lodged in the economic system itself, but in manipulations of the system by politicos, bureaucrats and corporate lobbyists.

IMO, you have made yourself vulnerable to the "outside the field" line since that silliness you posted with Jesus on the raptor. Especially when you acknowledge that Moore is directly going for the emotional rather than the rational appeal.

Ben Witherington said...

Dear All:

What all this shows is just how complex an issue this whole matter is. I quite agree with the sentiment that both the church and the government need to do more.

I know of way too many cases of where people HAVE been refused treatment in emergency rooms including my own daughter once, because they could not produce evidence of insurance or money on the spot.

I am sorry but our nation has some very serious health care problems, and sticking our head in the sand will not solve the problem any more than wishful thinking about purely local initiatives. Guess what-- the majority of our towns in America have nothing like a charity hospital.

I would urge you all to go see the movie and make up your own mind.

Focus on the stories of real people with real problems who have been refused care or treatment, or allow ed to waste away with inadequate care. These stories are far too frequent to be considered minor blips on the radar screen.



Laura said...

I know of way too many cases of where people HAVE been refused treatment in emergency rooms including my own daughter once, because they could not produce evidence of insurance or money on the spot.

We already have a law against that. You should sue, because you'd win.

I've seen Sicko, and it's a very effective movie. As were Leni Riefenstahls. My point is that we need to base our decisions about health care on facts, not anecdotes. I can provide an unlimited supply of anecdotes of how bad the Canadian system is. I just posted a video on my blog of a guy who was told to wait four months to get an MRI to learn about his brain tumor, and other of a woman who lost her bladder because of long delays.

These stories are far too frequent to be considered minor blips on the radar screen.

We need to fix, not replace, our current system.

David Johnson said...

"You should sue, because you'd win."

Is that the Christ-like thing to do?

Gary said...

Mr. Witherington, this is completely off topic, but I couldn't find an email address with which to contact you, so I thought I'd put it here.

On 2/13 you posted an email forward that listed things Garrison Keillor said about Methodists. I was curious about it at the time, and since have found out that it was a fake. Keillor wrote something similar about Lutherans, and someone else just did a find/replace Methodist edit.

One blogger who put the edit up has been contacted by Prairie Home Companion
and asked to remove his version, which was apparently reprinted in UMMen magazine.

I am always leery of anything forwarded in email. This is another example of why.

Grace and Peace

Laura said...

"You should sue, because you'd win."

"Is that the Christ-like thing to do?"

Is it *more* Christlike to observe an injustice for which we already have a law, (and by law, it's posted in every ER so that people are informed of their rights) and instead of demanding that the existing law be enforced, subscribe to the policy that we need to dismantle a system upon which hundreds of millions depend, and which is working fine for the vast majority?

If it's the right, moral, Christian thing to do to demand universal healthcare by law, then how is it not the right, moral, Christian thing to do to demand that *existing* health care laws be enforced in order to achieve the same goal?

Percival said...

I personally do not like our medical system, partially because it is so top heavy. By top heavy I mean that it excels at doing the difficult things but stinks at doing the easy things. My hypothesis is that there must be some disincentives and barriers to providing basic medical care. Not enough profit in it maybe? Well, why not? Malpractice insurance? Government red tape? Unnecessary tests being done? And why does an overnight stay in a hospital cost so much?
Surely, people of imagination in the US can find ways around these problems IF they were allowed to. However, there are huge entrenched powers who are protecting their turf. And they protect it with propaganda and statistics. (Side rant: Just like public schools and teachers unions protect their turf from vouchers!)
I would bet that low cost care for all would be a profit-making venture for medical providers if they were allowed to.
However, since all medical care has now become a basic human right, we will always want more and more for less. I'm afraid we will never be able to deny any treatment to anyone, no matter how expensive it is. Our moral sensabilities no longer allow it.
By the way, after we remove the profit motive from running our churches (or writing Christian books, or worship songs, etc) then I think we should feel free to attack people who meet needs in order to make profit.

scott said...

The sad point that MM misses (on purpose??) and BW3 misses about Cuba is that it is free. When I go to Cuba, I am there a lot as a Short-term missionary, I can get anything I need done cheaply. I have never needed or used this benefit PTL but it is there if I need it. In fact, people from all over the Carribbean go there and get dental/medical care cheaply. Everyone, that is, except the Cubans themselves.They do without so that their "care" can be sold to others. The tylenol given to MM patients in Cuba was taken from Cuban citizens who cannot get even TYLENOL. I work with a neurosurgeon in Cuba. He gets 24.00 a month USD. He hitchhikes three hours to work 1 way. You paid a nickle for an inhaler....and you think that is "good"...better think again.
And medical care in other places is free....where is it free...? Where is it that doctors and nurses do not need salaries, medical companies do not pay their workers, R&D on new drugs is done by scientist as a hobby??? An what about the malpractice insurance burden caused by MM's buddy John Edwards, who "humbly" lives on a gigantic estate, in a 28000 square foot mansion, with his 1250.00 haircuts all paid for by suing OBGYN's and others who quite often are innocent. And many places in my home state-Mississippi-cannot get doctors because of ambulance chasers. "jackpot" justice it is called here. Sue is Mississippi and get rich. Law suits until tort reform was a cottage industry here.
The health care situation is more than what "sicko" and his ilk are preaching in their propaganda film.

Ben Witherington said...


Thanks for these reflections. There is no comparison between making a killing off of someone's misery and illness, and making a basic living by writing and teaching, so think of a better comparison.

What most people find so repugnant about the health care system is not that people make a living in the industry, but that insurance companies and drug companies and some health care providers of HMOs who shall remain nameless get stinkin' rich off other people's misery and disease.

The 30% profit rate of various parts of this industry is not unusual and it goes well beyond anything most of us will ever see for our hard work.

So something is rotten in the system, and it has to do with greed, and a lack of human compassion among other things, neither of which are Christian virtues. I completely reject the notion that "nothing ever gets done well in the world without the profit motive." Were that the case, most ministries would have to be defined as "things not done well".


Ben W.

Dorcas (aka SingingOwl) said...

I am among those who must take everything Mike Moore says and does with a very LARGE grain of salt. He is not known for his unbiased, factual reporting after all. Nonetheless, I agree that the entire system must be changed, not tweaked, that it is a national disgrace that so many are NOT given decent health care, and that we seem to think that it is no big deal if just a few poor folks get left out.

Emergency care is NOT health care! It is nice that in most cases care can be received in the ER, but this does absolutely nothing for those with chronic illness such as diabetes.

I have done without, as have my children, at times. It is a very frightening thing to be afraid to get sick because you can't get help. Not everything is an emergency.

That said, I'm concerned about universal health care in the USA because in my life and employment before full-time ministry I became very familiar with bureaucrats. Medicare is a large-scale monster of problems, as is Medicaid. I can't even begin to discuss it in a blog comment, but I was a legal advocate for poor elderly. The problems were often the fault of too much regulation, too much paperwork, too much inefficiency. Have you known government programs ever to be models of excellence and efficiency? I have not.

That said, everything I've heard about Australia's health care has been positive. A friend visiting here in the USA had a medical problem and went home completely shocked and dismayed at the state of American health care.

Makes me wonder...

Anonymous said...

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Laura said...

I haven't studied Australia's system yet, but I've spent considerable time on Canada's and some on the UK's NHS.

For those who think that it's really something we ought to try here, I give you this quote from the NHS website:,-admission/Pages/Policy-guidelines.aspx
Inpatients should expect to wait no longer than 18 months for a bed, but more than three out of four inpatients are admitted to hospital within three months of referral. If your doctor or dentist refers you urgently with suspected cancer, you will be seen by a specialist within two weeks. If you are suffering from chest pains and angina is suspected, you will be admitted to specialist chest pain clinic within two weeks.

Think of waiting *months* or even over a year to be admitted to the hospital for treatment/surgery your doctor deems necessary. Think of waiting - by government decree - up to two weeks while you are waiting to find out if you have cancer. When my husband's doctor thought he had cancer, he was in the specialist's office the same afternoon, and in surgery the next day. That's not uncommon in America; I know several people with similar experiences. (I live in "Cancer Alley" in Louisiana.)

And this one from a news article last year:
Hospitals across the country are imposing minimum waiting times - delaying the treatment of thousands of patients.

After years of Government targets pushing them to cut waiting lists, staff are now being warned against “over-performing” by treating patients too quickly. The Sunday Telegraph has learned that at least six trusts have imposed the minimum times.

In March, Patricia Hewitt, the Secretary of State for Health, offered her apparent blessing for the minimum waiting times by announcing they would be “appropriate” in some cases. Amid fears about £1.27 billion of NHS debts, she expressed concern that some hospitals were so productive “they actually got ahead of what the NHS could afford”.

Deliberate, government imposed wait times because the bill just got to e too high. Rationing in Canada can get so severe that people mortgage their homes and sell things in order to be "medical tourists" in the US where care is available immediately. Mexicans come over on a regular basis on "compassion" visas for medical care courtesy of the US taxpayer. Where will Americans go for care when the wait times are too long here?

Singing Owl is quite right about government inefficiency. The worst disgraces in American medical care are the government run organizations like Medicare/Medicaid and the VA, followed by non-profits like Moore's example of Kaiser Permanente. As to not everything being an emergency you're quite right there too. But every city has a charity or university hospital or a public clinic funded by grants. I've used them to treat chronic problems when I had no insurance, for vaccinations for my daughter, and my mother in law was treated for cancer there. They bill you if you can afford it, but if you show financial need, the bill is reduced or wiped out entirely.

Peter Kirk said...

I'm glad you and (implicitly) Moore have faith in the British National Health Service. Not many of us here in the UK have much faith left in it. But at least, from what I have read here, we have a better service than yours, and for that we should be grateful.

Scott said...

Another tough issue... I have to admit that though I've been sympathetic to Michael Moore's stances in Bowling and Fahrenehit, I find his approach to discourse slanted and uncompromising, which makes it difficult for me to respect his reasoning.

I just wanted to throw in a few observations to gauge your reaction.

1) Most uninsured in America are young working folks who do not receive employee benefits and choose not to get a plan. The elderly and disabled qualify for insurance, though one can debate the adequacy of it.

2) The American pharmaceutical industry is the principal driver of medical progress throughout the world. Consider for instance the arsenal of cardiac medicines and chemotherapies, developed in the U.S. and distributed overseas at significantly discounted rates; consider antiretrovirals for HIV, developed in the U.S. and distributed in many areas of sub-Saharan Africa for free.

3) The difficulty with instituting universal healthcare in this country has more to do with our culture than it has to do with our healthcare costs. Simply put, Americans want maximal options with minimal cost, and they want those options even at the point of futility. We spend most of our healthcare dollars in the last 6 months of patients' lives, while comparatively little is devoted to well-care and disease prevention.

**Universal healthcare could easily be accomplished in this country if 1) the government controlled the price and delivery of medical care and if 2) the American taxpayer was willing to pay up across the board. The trouble with the first condition is that the government must place a dollar value on a human life in order to effectively ration healthcare, a concept that threatens individual autonomy. By price-controlling pharmaceuticals, the government also threatens the future of medical technology by curtailing the profit margins that drive research and development. The trouble with the second condition is that Americans don't want to pay the necessary taxes, and we show that in the way that we vote.

Exiled in mainstream said...

The most accurate thing that I have seen written about Michael Moore was in the NYT review of his film. "The film is unashamedly one-sided, superficial, overstated and occasionally suspect in its details. But on the big picture — the failure to ensure that everyone who needs medical care gets it — Mr. Moore is right."

Which is what makes his ons-sidedness, overstatement and suspect details so unfortunate, he gives a get out for those who want to deny what's going on.

This is a great debate and there are some statements here which I want to respond to. The trouble with this subject is that there are so many polemicists like Moore, many of whom are still less conscientious about accuracy so I will limit my sources to peer-reviewed journals and reputable, non-partisan, research institutes.

That the worst disgraces in US healthcare are the government run systems like the VA, Medicare and Medicaid is simply untrue. The VA, in fact, has an international reputation for excellence. It is way cheaper than the US norm and has better outcomes than most US healthcare despite treating a far sicker population. The transformation in care that the VA has achieved in the last 15 years is such that it is about one of only four US healthcare systems that are widely studied internationally (the other three are all non-profit HMOs). Medicare and Medicaid are not, of course, provider systems, so they generally have to purchase care from the normal US systems - who make them a low priority, and therefore they tend to get lower quality care. That said the experiments with Pay for performance are being driven largely by Medicare and Medicaid, and its fascinating how often

References: Jha A, Perlin J Kizer K. (2003) Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care. New England Journal of Medicine 348, 2218-2227

Kizer K (1999) The 'New VA': A national laboratory for health care quality management . American Journal of Medical Quality 14, 3-20

Second that the US pharmaceutical industry is the driver of international medical development is simply pharma propaganda. First pharmaceutical companies spend less than half on R&D what they do on marketing - which almost uniquely in the US is spent largely on direct to consumer TV advertising, which does not properly inform consumers, but inflates your medicines bill. Second, most pharma R&D spend is on the so-called "me-too" drugs, which are more about maintenance of patent than finding new cures. Oddly, most of the pure science that drives innovation comes from publicly funded university programs.

reference: Marcia Angell (2004): The truth about drug companies: how they deceive us and what to do about it (Dr Angell is a former editor in chief of the New England Journal of Medicine).

Finally, I worked long enough in the UK's socialised system to know that it's far from perfect, but also that some of the criticisms here are misinformed and misleading. Unusually long waits are taken to be the norm, two failing hospitals are imagined to be the whole system. At the same time, long waits for primary care in the US are ignored. But the fact remains that the UK, like nearly every other english-speaking country spends less than half what the US does on healthcare per capita, and has results across healthcare as a whole every bit as good if not better. This is demonstrated in this very recent study by the Commonwealth Fund. It also shows that using Canada as an example to convince yourself everything's OK might not be the best strategy.

Scott said...

Dang, we've got a Harkness fellow in the mix. you're undoubtedly the best informed on the subject exiled, so i'm all ears.

correct me if i'm wrong, but it seems that you identify the inefficiency and high overhead costs of the American healthcare system as its prime faults. the advantage of a socialized system thus primarily lies in its ability to institute a uniform and clearly understood basis for healthcare rationing, as the latter is absolutely necessary given high technology costs.

i'm inclined to think that if efficiency is the end, then the private sector always does it better than the government. despite all the criticisms leveled against hmo's, they have been able to curb to a great degree the exorbitant abuses of the single-payer fee-for-service reality that previously existed. presently though, the hmo's and their providers have been squeezed to the point where further efficiency is simply not possible. it's hard to imagine that the government--with all of its competing internal interests--could do much better.

if transparency is the issue, i would once again argue that competition makes for better consumer service. a behemoth single-payer system might be able to impose a single set of rules on the playing field; but the playing field is so nuanced and complex that it would conversely require a sensitivity and responsiveness that government bureaucracy simply is not built for. competing businesses have to prioritize consumer satisfaction over the long haul if they are going to survive. if i need arbitration at a higher level to overturn a denial of a necessary surgery, i doubt that the government would be more likely to lend me a sympathetic ear; on the other hand, negative publicity aimed toward a smaller organization like a regional HMO could be punishing enough to force true accountability.

i don't think that there's any reason to believe from our history that consolidation under a government auspice will make healthcare delivery more efficient or more transparent in this country. I think that the major difference between America's health system and those of the rest of the world lies almost entirely in the technology costs we are subjected to in this country. in other countries, there is either price control or health system negotiation of technology costs which markedly reduces the price of drugs and tests that are utilized. in america, no such negotiation occurs, and the onus is placed on the doctors and health providers to choose cost-effective options for their patients. big pharma's advertising necessarily pits the consumer (the patients) against the gatekeepers (the docs), and who can blame them for doing this? they are targeting the pivotal doctor-patient relationship upon which the responsibility for every cost is placed.

i'm inclined to think that regional health systems ought to have more power to negotiate prices with pharmaceutical companies; this would apply market pressure where it could make a vital difference. moreover, evidence-based professional guidelines focused on cost-effective care should be made available to providers and patients alike, with a cost-sharing requirement for any prescription, hospital test, or other patient request that does not explicitly fall within the guidelines. such a system preserves options but requires patient contribution for anything that is not standard of care. such an approach would hopefully change family decision-making with regard to interventions in medically futile situations, where intensive care and heroic measures are both costly and fruitless.

Falantedios said...

>We already have a law against >that. You should sue, because >you'd win.

While there is nothing inherently unChristian about this suggestion, it proposes a ludicrously American solution. How on earth does winning a legal battle solve anything? Do you really think cash heals the wounded heart of a helpless parent? What a joke. "Making them pay for what they've done" only gets mid-level people fired and EVEN MORE poor people ignored when the costs rise higher. So the HMOs and the pharmaceutical companies only show a 25% profit that quarter. Do you really think being sued is going to make them change?

The Zealots thought "suing" the Romans with knives would change things for the better. Look what happened to them.

in HIS love,

Falantedios said...

A few ideas:

1) While we dwell in a broken world where the profit motive rules, those who control the supply for a high-demand product will always charge as much as they believe the demanders will pay. Do you really think gas prices are ever going to come down? Of course not, because the oil companies finally discovered that Americans will pay whatever they have to pay to drive their SUVs. Same thing is true with health care.

2) Consolidation under government control sounds cool, but how do we know that POTENTIAL CARE for all will work out to be ACTUAL CARE for all who need it? What I'm hearing from our Canadien, British, and Australian contributors turns out to be a lot like the real problem here as well, only the commodity in question is different. In America, we pay for health-care with money. No money, bad care. In the socialized medicine world, you pay for health care with TIME. No time to wait, bad care.

3) Ben's point about charity hospitals bears consideration. Not everyone lives within minutes, or even hours, of a city with a charity hospital.

more later, maybe...

Nick Gill
Frankfort, KY

nblaw said...

Dr. Witherington, I enjoyed reading your review. I've seen the movie too, and offer my comments in the following review:

preacherman said...

I agree with Micheal Moore. Something needs to change in America. Thank you Ben for bring this topic and Micheal Moore's film to attention.

Terry Hamblin said...

jmvilbyI see my son has made his usual erudite contribution to this debate. SICKO has not reached the UK yet, but from what I gather from the reviews, Moore has employes Hogarthian exaggeration to emphasize his point. The truth is that all health care systems have their drawbacks and their benefits. Slogans like 'socialized medicine' and '41 million uninsured' do not really inform the debate. Although there are many without health insurance in the US, they are not necessarily without care. Government spending on Medicare, Medicaid, County hospital ER rooms and the VA is about the same per head of population as the British government spends on the whole NHS. The NHS is not really socialised medicine. Each family doctor partnership is in reality a small business, which owns its own property, employs its own staff and bids to supply services. Most of the large hospitals are owned by the state, but they have to compete with the private sector to supply services.

Although many developments in healthcare are brought to the market by big Pharma, it is wrong to think of them as American companies. Some are, but giants like Astra-Zeneca, Glaxo-Smith-Kline, Bayer and Roche are European and others like Chugai are Japanese. Many of the discoveries on which the new treatments are developed are made in American Universities, but many are also made in British, German, Swiss, Austaralian, Japanese and increasingly Chinese universities. The whole monoclonal antibody revolution came from Cambridge University, England and neither of the inventors was English by birth (nor were they American). Medical science is international.

What is often not appreciated is how much minor tinkering with a system can affect patients. An example from America would be an anti-leukemia drug which for the rest of the world is available as a tablet, but in America must be given by an intravenous infusion because the reimbursement system favors that. In the UK the rule that patients with suspected cancer must be seen by a specialist within two weeks has meant that clinics are flooded with women with benign breast lumps, squeezing out patients with more serious non-malignant conditions.
I have expanded on all this at

Finally, Anybody in the UK is free to take out private health insurance. That only 13% of teh population do so is testimony to the fact that the NHS provides pretty good health care.

Unknown said...

Dr. Witherington: do you have a/any comment/s on the Pope's recent news-splash? Thanks

James Gibson said...

Suppose Paul would have made the following statement:

"Say what you will about Hymenaeus and Philetus, love them or hate them, they know how to make us think about whether or not the resurrection has already happened."

Suffice it to say, Christian history would have been decidedly different if a Christian leader of Paul's stature would have lent his approval to a couple of scam artists.

Jeremiah Bailey said...

Dr. Witherington,

I'm curious as to why any time a thing upsets your moral compass your immediate response is to suggest a legislative fix. I am a bit baffled by this, especially when in many of these issues (like the gun control article for example) there is plenty of room for people to hold a view opposite of your own and still be good Christians. If it is your contention that this is not the case, then it follows a failure to believe in socialized medicine or the removal of gun right is in fact sinful. I don't think you are saying that, so why act as if your proposed legislative fixes are a moral imperative?

Jeremiah Bailey

José Solano said...

Thanks Dr. Witherington for bringing this issue to mind and for emphasizing that something must be done to improve health coverage in the US.

I’ll avoid the numbers and data arguments since I’ve not made a study of the subject. What I can offer are some personal anecdotes and reflections.

I had a molar abscess when I was in England and was able to see a dentist immediately who took care of the problem for $4.00! It sometimes takes months for my dentist in the US to fit me in and sometimes days even when I have a toothache.

I had a simple foreign object in my eye and was charged over $400 to remove it. To cover a small cut on my daughter’s chin the bill was $1,200. We waited for over two hours in the emergency room and my daughter was treated for 5-6 minutes.

In Spain I did have terrible service from the free Red Cross clinic for my daughter’s rash that was diagnosed as mumps, but I took her to a private doctor who correctly diagnosed it as hives that was quickly cured with antihistamines. His bill, around $12. We can compare the error in Spain with my daughter receiving the wrong immunization injections here in the US. Fortunately no adverse effect.

Many years ago a friend of mine needed a heart operation. He could not afford it on his salary or insurance as a lifeguard. He had to quit his job and somehow managed to cheat and get himself on welfare so that his operation would be paid for. Otherwise he would simply have died.

On the other hand a five-year-old child we sponsored in the US for treatment would have died in Mexico because they did not have the facilities or expertise for the heart surgery he needed. One of the great heart surgeons and his team volunteered their services at a Catholic hospital that freely offered its facilities and he was completely healed.

Another child from Guatemala that we sponsored had badly burned and deformed feet and he also obtained free and successful care.

In Costa Rica one of the persons I take on tours became ill and I took him to the emergency room where he was treated. The charge $25. It would have been free had he not left his passport at the hotel! All natives and foreigners receive free treatment.

Has anyone talked about the quality of mental health care we have here in the US? Have we observed the number of mentally ill people wondering around the streets homeless, or the number in our jails? In England they have comparatively fabulous mental health care and the hospitals will take the mentally ill in for months if necessary without any charge whatsoever. I know several people who have benefited from these services.

I pay over $1,000 a month for Kaiser Permanente health insurance to cover my family. I’m told that’s pretty cheap. How does that compare with the English taxation system considering that in addition to the $1,000 plus I pay a month I also pay a lot more in general taxes? And we are willing to pay more to attain universal health coverage. Among those that can afford it, who isn’t? Unfortunately, too many could care less.

The US as the riches nation on earth has the greatest facilities and the greatest technology and for those that can afford it there is no better health care in the world. We have the means to provide universal health care that is superior to that of any other country. Where though is the will? Will it and the way will be found.

Light said...

Much of our health care crisis lies with two facts:
1) doctors are not taught about proper nutrition and diet, which is the foundation of wellness (most doctors get four classroom hours of nutrition in all of medical school)

2) Doctors' ignorance of basic nutrition and diet allows Big Pharma to push pills when there are many, many natural and dietary solutions that are far cheaper and far safer. For instance, Dr. Witherington, for your high cholesterol, has a doctor ever suggested fish oil and B-complex vitamins to you? You'll get as good, if not better results than statin drugs, and without the horrible side effects.

Through their lobbyists, Big Pharma does everything it can to muzzle alternative medicine. For instance, there are proven natural cures that work better than Vioxx (remember that disaster?) in clinical trials - but the makers of these natural supplements are forbidden by law to even cite the scientific studies on it.

Heart disease, diabetes, even cancer - they are ALL reversible with proper diet and nutrition, but you will seldom hear anything intelligent on the subject from your doctor. That's because they've been educated (and wined and dined) by drug sales reps to push pills on you.

Must reading: Overdose: The Case Against the Drug Companies, by Jay Cohen, MD

Anonymous said...

Wow, people are getting so angry over this, it's crazy. Mr. Witherington, I am so happy you blogged about this...I think Christians should be involved in these discussions and debates...and they should be concerned about what is happening in our country. Now, for everyone who has not seen the movie, please, go see the movie before you comment. Because I feel like Michael Moore was trying to make a much bigger point than one just about healthcare. He was making a point about America as a whole... and how we all (the 99% of middle class and poor)... are just slaves to living our lives everyday. Between college loans...and healthcare costs...and the stress of not being able to see our families because we are working so hard...well this is just no life at all.
This movie was very eye opening.
I know that the universal healthcare systems are not as perfect as they seem in "sicko"...and I will say that the life within a universal healthcare system is different than what we can have in America. One of the doctors made a good point in the movie. He was living in a million dollar home, with a couple cars and a big screen TV. Well, yes, if he worked out here in the US...he would most likely be able to afford double of everything he had. But he was comfortable...he didn't want all that. His main concern was that he lived in a place where no one was left behind. No one was told to go to a different hospital because there insurance wasn't accepted one was being treated like an animal. He was unselfish.
We are selfish people. We are only concerned with ourselves and no one else. Everyone else would never even think of any other way then helping people. And as Christians, we should be the first ones to stand up and demand that at the LEAST, people should not have their baby girls die in their arms from cardiac arrest because they were kicked to the curb...we should demand that people with broken ribs should not be put in a taxi and driven to skid row...we should demand that the US government should stop lying to us...we need to stand up for righteousness.

Unknown said...
This comment has been removed by the author.
Unknown said...

I was until recently a Canadian citizen. One of the many reasons I left was health care there. It is the HMO from hell. When the government runs health care, you get what they will pay for. They have long waiting lines for most care including heart surgery. They are 20 years behind in technology and short of all equipment. Doctors are grossly underpaid and leave to come here. They have a chronic shortage of Doctors. They are moving to a 2 tier (user pay system). I am sick that anyone would take a propagandist like Michel Moore seriously.