What if Michael Moore had not made "Sicko"?

[Rolfe]

Absolutely, it is easy to conclude that the USA has the best system. Outcomes are much better, most new drugs and medical technology are invented here, etc.

Citations for that? Common overall outcome indicators such as longevity and infant mortality are not "much better". The USA is also very short of all-population statistics to allow true comparisons. Merely looking at the outcomes of people who have access to healthcare is not a true comparison.

Contrarily, mMany newspapers in many places like England and Australia are rife with articles for many years now describing how bad the medical system is there. I have cited but just a few examples in my previous posts.

Well since I don't take either an English or an Australian newspaper, maybe you know more about that....

Bear in mind that in Britain, moaning about the NHS is a national pastime. Expressing gratitude for good care, not so much. There are a couple of reasons for this. One is that the horror stories are actually news. Another is that people to whom these things happen are outraged, because they know that they should be getting better care - it seems to me that many Americans who fall through the net just accept it, because they aren't entitled to anything. Another is that publicity actually changes things. Make a big enough splash in the papers, and Something Will Be Done.

But, European style health care comes with European style taxes, which are quite high.

If we do have higher taxes, it isn't the healthcare that's causing it. The amount of tax money we spend on healthcare for everyone is proportionately a bit less than the amount you in American spend on Medicare and Medicaid alone. You just get terrible value for money.

But in return for that extra money, you get worse outcomes, longer wait times, poorly trained medical staff. No thanks, the US system is clearly better. Plus, we take a hard stance against personal irresponsibilty, unlike the Nanny State so prevalent in Europe.

What extra money? You're paying more in taxes to fund a socialised health system you can't access, than we are to fund the system that provides all of us with care. Then you have to pay for insurance over and above this. We're certainly not spending any extra money.

And there's those "worse outcomes" again. You can cherrypick, as can anyone, but overall health outcomes don't support you.

Wait times? Indeed, unless you pay to go into the private system, you may well wait longer for non-urgent treatment. But at least you'll get the treatment. Waiting times published in the USA don't include the people excluded from treatment, for whom the waiting time is essentially infinity.

Poorly trained medical staff? I think I'll let the medical people come and smack you for that one.

I wonder if you'd be so certain that America is the best place to be if you found yourself the victim of recission, or unable to find affordable insurance with a pre-existing condition after you lost your job?

But then we always seem to come back to this hard, cold, judgmental ideology. Just let that girl with lupus die, that'll teach her not to be so irresponsible!

No, clearly, everyone is worse off. Much evidence shows that. Yea, you might have your regular GP visits taken care of, for a lousy $50 or $100, but once you get into MRI's and CT scans and drugs and procedures, you are clearly worse off.

Well, GP visits don't cost anything, and neither do MRIs or CT scans or "procedures", and they're taking the prescription tax off next year as well (which never applied to children, the elderly or pregnant women anyway). The only things we have to put our hands in our pockets for are dental treatment and glasses.

All that for a bit less in tax than you pay for Medicare and Medicaid....

No, from what I've read, the vast majority of denials in the US are from experimentals, whereas the NHS denials seem to also include more normal type of drugs and procedures, already approved.

You're misinformed. Once a drug is approved by the NHS, everyone gets it if their doctor thinks they would benefit. You might find misleading rhetoric within astroturf campaigns, but that's the fact.

There are so many negative news articles emanating from Australia and England that they can hardly be considered cherry picked. I couldn't find ANY articles saying how good it was.

I don't think you've been trying too hard. Try this one, from an American.
http://www.salon.com/opinion/feature/2009/08/22/nhs/

Have a couple of case examples.
http://www.theherald.co.uk/news/new...made_history_now_abigail_is_ready_to_play.php
http://www.timesonline.co.uk/tol/news/uk/scotland/article6725161.ece

It seems to me that you're quite happy so long as you think you yourself are well covered, and the people who are not so fortunate are unimportant because they're not you, and you can always dismiss them as "irresponsible". If you believe that providing healthcare for everyone is unimportant so long as the better-off are OK, then that's your prerogative.

America is a nice place to visit, but I'm certainly glad I don't have to live there.

Rolfe.

 

[Rolfe]

Wow. Just wow. It is now down to 49 days. Because of increased spending. Just think, if you spend more per capita, like the US does, you can get the wait time down to just a few days, like we have! Heck, here in the US, you can get operated on the very next day if you have a very serious diagnosis. Think of how many extra lives you'll save! Outcomes will be better! Malignant cancerous growths will be excised sooner.

You know what? Many British people would agree with you. Leaving aside the USA, which spends massively more than any other country for overall no better outcomes, increasing the spend a bit more to achieve these aims would be popular.

What would never be countenanced is providing these things only for the privileged and the elite - even if the privileged and the elite is quite a high proportion of the population. Neither would it be countenanced that people would be forced into unmanageable debt and bankruptcy to achieve these aims.

Maybe some day the British system will be as good as the US as measured by the metrics that really matter. maybe..sigh.

We seem to have different views on which metrics matter. You may be happy if the statistics for the privileged look good. We prefer to include even the poorest and the least privileged as part of the population, and see their outcomes as mattering too.

Rolfe.

 

[Dymanic]

deleted

 

[Kevin_Lowe]

There are so many negative news articles emanating from Australia and England that they can hardly be considered cherry picked. I couldn't find ANY articles saying how good it was. I'm still waiting for you to show me any articles detailing how good the conditions are in Australia.

This is a data-gathering error akin to assuming that because you never read about a bank not being robbed, that all banks are therefore robbed. If someone in Australia needs medical treatment and gets it, it's not news.

Again, I have made MANY citations, you just choose to ignore them. Not much of a skeptic, are you?

I explained in some detail why the statistics you were presenting did not answer the questions you had been asked. Spotting when people present irrelevant statistics seems to me to be a useful part of the skeptical tool kit.

You also ignore statistics when they don't suit you. For example the USA is far from having the best life expectancy, lagging behind many countries with socialised medicine, including Australia. I mention Australia specifically because of our vast rural areas and highly disadvantaged indigenous population, because a stock response from US defenders of the US health care system is "Oh well, that's just because we have backwoods hicks and black people skewing the numbers. European countries are all urbanised complexes the size of a postage stamp and full of white people".

Similarly the USA's infant mortality rate is far from the best in the world. Hey, look at Cuba down there in dark blue! Despite their terrible "two tier" system they're achieving better health outcomes than the USA, who seem to be coming in 33rd. At least you're still just ahead of Croatia.

That's why I (and I think others) are skeptical of the inferences you draw from the statistics you present. Yes the cancer survival rate is higher, but why do you focus on that one statistic out of context, when the overall survival rate is lower?

Yet US citizens pay more for this health care system which achieves demonstrably poorer outcomes.

 

[Rolfe]

I'm not even sure how to interpret "the cancer survival rate is higher". If that's simply a longer time from diagnosis to death, you can do that two ways. You can do it by delaying the death, or you can do it by making the diagnosis earlier. Only if we are sure that the former has been achieved, it it really a better outcome.

We also have to beware of US statistics, which sometimes exclude those excluded from the healthcare system and so just don't get counted, and which even at best seem to present only the more affluent states.

And as I think we already noted, I would always suspect "we have fewer deaths from cancer" from anyone. It merely raises the question, well, what did these people die of, that they didn't live long enough to get cancer?

Interpretation of these statistics is not easy, but it's certailny not a shoo-in that the US is doing demonstrably better than anyone else, for all the money it pours into it.

Rolfe.

 

[Rolfe]

I also wonder what the people who think the US healthcare system is so superior think about events like this?

http://www.latimes.com/news/local/la-me-health-forum12-2009aug12,0,2168511.story

A homeless man spent the night camped outside the Forum, hoping to finally get glasses to help him see better. An unemployed grocery clerk waited in desperate need of root canal surgery. A former auto mechanic came with an aching back.

One by one, about 1,500 people made their way through the Inglewood sports arena, where dozens of volunteer doctors, dentists, nurses and other healthcare professionals are providing free medical services this week.

Remote Area Medical Foundation is a trailer-equipped service that has staged health clinics in rural parts of the United States, Mexico and South America. It brought its health camp to urban Los Angeles County on Tuesday to begin an eight-day stint that the group's officials described as its first foray into a major urban setting.

Organizers expected big crowds, in a county with high unemployment and an estimated 22% of working-age adults lacking health insurance.

On Tuesday, the turnout was so large that hundreds had to be turned away.

To anyone in Britain, this is deeply shocking. We expect to see scenes like these in third world countries when western charity groups send an aid expedition. We don't expect to see it in the USA. If this were happening in my country, I would be deeply ashamed.

I don't see how anyone can describe American healthcare in glowing terms when things like this are part of it, no matter how many rich people can have gold-plated artificial hips fitted.

Rolfe.

 

[sugarb]

I'm not even sure how to interpret "the cancer survival rate is higher". If that's simply a longer time from diagnosis to death, you can do that two ways. You can do it by delaying the death, or you can do it by making the diagnosis earlier. Only if we are sure that the former has been achieved, it it really a better outcome.

We also have to beware of US statistics, which sometimes exclude those excluded from the healthcare system and so just don't get counted, and which even at best seem to present only the more affluent states.

And as I think we already noted, I would always suspect "we have fewer deaths from cancer" from anyone. It merely raises the question, well, what did these people die of, that they didn't live long enough to get cancer?

Interpretation of these statistics is not easy, but it's certailny not a shoo-in that the US is doing demonstrably better than anyone else, for all the money it pours into it.

Rolfe.

Hello, Rolfe. I'm glad you wrote this, because I was thinking, as I was trying to catch up on this thread, about the many people in the US who never get treated for cancers...because they aren't insured. They don't show up on the statistics. When they are found dead in their homes or elsewhere, the cause of death is generally "natural causes", or the stresses their bodies undergo eventually lead to a fatal heart attack or some kind of death that won't be related to cancer itself.

In a country where so many go untreated, it is hard to rely on many of the statistics. In a country where even so many insured people go without care, it is hard to rely on "cause of death", particularly since most people are not autopsied and the cause of death is assumed or presumed.

"Causes" of certain things are even questionable. We've had three relatives die from lung diseases. One was due to asbestos, one due to pesticide poisoning, and one due to smoking. Every physician dealt with seemed to prefer to assume smoking was the cause, and those two deaths totally unrelated to smoking now probably fall under the "death by cigarette" statistics, because it is assumed that all lung cancers and emphysema cases are the same. I have a pet theory that, in a few years, we'll see less deaths from lung cancer, as the generations that worked in asbestos and with the more dangerous pesticides are passing away. Only time will tell...but even if that is the case, it will be assumed that the decreasing cases are due to campaigns against smoking, rather than improvements in other environmental factors.

 

[BeAChooser]

I was thinking, as I was trying to catch up on this thread, about the many people in the US who never get treated for cancers...because they aren't insured. They don't show up on the statistics. When they are found dead in their homes or elsewhere, the cause of death is generally "natural causes", or the stresses their bodies undergo eventually lead to a fatal heart attack or some kind of death that won't be related to cancer itself.

I challenge you to prove this assertion. Any sources? Because when a coroner rules a death "natural causes", that doesn't preclude his finding it was due to the effects of cancer. That's what postmortems are for, sugarb.

For example ...

http://www.irishtimes.com/newspaper/ireland/2009/0522/1224247111132.html

Dr Geraghty concluded Mrs Keeley died of natural causes. Based on the pathologist’s evidence he stated she had died from metastatic (disseminated) cancer secondary to breast cancer.

http://www.al.com/news/birminghamnews/index.ssf?/base/news/1208938578226240.xml&coll=2

Department of Corrections spokesman Brian Corbett said a formal investigation will determine the cause of death, but "Siebert died of apparent natural causes while suffering from terminal cancer."

Furthermore, any percentage that don't show up in cancer statistics are bound to be a problem not only in the US but in UHC countries, thus making the point moot. The fact remains that what statistics there are indicate the US is a much better place to live than the UK as far as cancer is concerned.

 

[sugarb]

I challenge you to prove this assertion. Any sources? Because when a coroner rules a death "natural causes", that doesn't preclude his finding it was due to the effects of cancer. That's what postmortems are for, sugarb.

For example ...

http://www.irishtimes.com/newspaper/ireland/2009/0522/1224247111132.html



http://www.al.com/news/birminghamnews/index.ssf?/base/news/1208938578226240.xml&coll=2



Furthermore, any percentage that don't show up in cancer statistics are bound to be a problem not only in the US but in UHC countries, thus making the point moot. The fact remains that what statistics there are indicate the US is a much better place to live than the UK as far as cancer is concerned.

Well, you make the point moot without giving anyone time to show evidence. So, then I guess the challenge falls to you to show that the majority of deaths in the United States result in a post mortem being performed (since, as a general rule, they only happen with crimes, suspicious deaths, and if a family requests it). In all my years of living, only one family member was subject to a post mortem at the request of the family...because her lifestyle as a drug abuser made her parents suspicious of her boyfriend.

So, perhaps you aren't aware of this, but autopsies are not "sop". In fact, it has been argued for a few decades now that the continual decrease in autopsies is actually hindering research in the United States. It isn't hard to find information about, and it is enlightening to study, particularly for those who are confident in the level of care they receive with their insurance provider.

You'll not find that information, so don't bother trying. Most deaths are not autopsied. Unless you just feel like trying...

 

[BeAChooser]

So, perhaps you aren't aware of this, but autopsies are not "sop".

I realize that. But is the rate of autopsy any different between the US and UK? Because if it isn't, then comparing cancer mortality statistics between the two countries is still valid and thus the issue is moot.

 

[sugarb]

I realize that. But is the rate of autopsy any different between the US and UK? Because if it isn't, then comparing cancer mortality statistics between the two countries is still valid and thus the issue is moot.

I am unsure about the rate of autopsy in the UK. Perhaps another member can enlighten us both. I think, though, the Scandinavian countries have the highest rates of autopsy.

 

[DC]

most new drugs and medical technology are invented here [USA]

source?
evidence?

 

[Rolfe]

Not statistics, but my father died in hospital of lung cancer caused by asbestos. The diagnosis had already been made by biopsy. However, the consultant asked permission for a post mortem because of the research that was going on into the effects of the use of asbestos in the shipbuilding industry (where my father had worked for a short time 60 years earlier).

That's a point! Who pays for post mortems in a privatised healthcare system?

I work in veterinary medicine, and while we do numerous post mortems on farm animal species because the farmer is concerned about the implications for the rest of the herd (and even so, this is heavily subsidised by the government as part of its support for agriculture), we're often denied what could be a very informative post mortem on a pet, because from the owner's point of view that's not gong to bring their darling Snuffles back, and it costs money.

So who pays the pathologist in America?

I don't know a great deal about SOP in the NHS in this regard, but I think a post mortem is mandatory if anyone dies without a doctor having seen them in the previous two weeks. And pretty much for any unexplained death. And then again, if it's thought that useful information might be obtained, as was the case with my father. Since the NHS is funded to do this work, there's no cost disincentive.

(The reason Shipman got away with his murders for so long was that he was the doctor who had seen these patients within the past two weeks, and he had his story well thought out about why there really was no need for a post mortem.)

Rolfe.

 

[Undesired Walrus]

One of the biggest problems accelerating the waiting lists in the NHS is not nationalisation but instead privitisation, massively implemented by the Labour Government since 1997. Selling off the ownership to private companies, the hospitals have been essentially held hostage by a bunch of wealthy businessmen, who buy up the rent of the hospital for close to 2000 years (No joke). Because of this, they are understandably reluctant to spend much money on expanding hospitals to account for additional beds and pay for additional cleaners (Doctors and nurses are still funded by the NHS).

Of course, they followed on the shoulders of Thatcher, who thought it would be a good idea to bring in suits from companies who had absolutely nothing to do with health and handing over the management to them. Seeing a hospital that was only 50% occupied seemed like a waste of money, so they brought down the size of the hospitals to make better use of the cash. That is partly the reason NHS hospitals are 98% occupied.

It hasn't helped that people are pushing for less immigration from Africa, where many fine doctors often come to work in the NHS.

 

[sugarb]

Not statistics, but my father died in hospital of lung cancer caused by asbestos. The diagnosis had already been made by biopsy. However, the consultant asked permission for a post mortem because of the research that was going on into the effects of the use of asbestos in the shipbuilding industry (where my father had worked for a short time 60 years earlier).

That's a point! Who pays for post mortems in a privatised healthcare system?

I work in veterinary medicine, and while we do numerous post mortems on farm animal species because the farmer is concerned about the implications for the rest of the herd (and even so, this is heavily subsidised by the government as part of its support for agriculture), we're often denied what could be a very informative post mortem on a pet, because from the owner's point of view that's not gong to bring their darling Snuffles back, and it costs money.

So who pays the pathologist in America?

I don't know a great deal about SOP in the NHS in this regard, but I think a post mortem is mandatory if anyone dies without a doctor having seen them in the previous two weeks. And pretty much for any unexplained death. And then again, if it's thought that useful information might be obtained, as was the case with my father. Since the NHS is funded to do this work, there's no cost disincentive.

(The reason Shipman got away with his murders for so long was that he was the doctor who had seen these patients within the past two weeks, and he had his story well thought out about why there really was no need for a post mortem.)

Rolfe.

As I understand it, Rolfe, *some* insurance companies will pay for a post mortem...before they'll pay out the benefit. Some. Not most. I've been covered by four plans throughout my life. None paid for post mortems. For the most part, if a family requests one, the family pays for it. If there is a crime, the state or county pays for it (which means there is a limited amount of funds).

Interstingly enough, current figures estimate between 30-50% of causes of death are proven wrong by post mortem. As well, many are skeptical about the prevalence of "heart disease" causing deaths, because those were one of the main causes determined wrong by post mortem, as well as, if I recall correctly, cancer and lung disease.

I have read that veterinary medicine performs more post mortems than human medicine, and I've also read that part of the reason for the decline of hospital deaths being autopsied is due to fear of litigation (missed diagnoses being another problem revealed by autopsy).

I shudder to think, were my insurance to require a post mortem before final payout of my expenses, of what they'd do if a misdiagnosis were found...because odds are, they'd refuse to pay and my family would be stuck with a massive bill.

I think that if people were more aware of the problems with death certificates and the lack of post mortems, more would request them and be willing to pay for them...and initiate some serious lawsuits. Until that happens, I don't think we'll have the standard of care we're paying for. It's astonishing what post mortems can reveal. Another reason I don't feel "safe" just because I'm insured.

 

[Rolfe]

I don't know why this point didn't occur to me before. It's always a problem in pet animal medicine that you can't have a post mortem when you'd really like to know. Sometimes the veterinary practice will pay for the procedure themselves but you can't sustain that for any numbers. Even if you do get a post mortem, sometimes you're not authorised to do the follow-up tests you'd need to confirm your suspicions. Frankly, it can get expensive, and I understand the client's point of view. They've just spent a lot on care for their pet, nothing is going to bring it back, and they'd rather try to move on rather than spend even more.

Contrast farm animal medicine. OK, it's private medicine still, but some of it is subsidised as part of agricultural subsidies. The bit that is subsidised up to its eyeballs is the post mortem examinations. When I look at the price list for cattle and sheep post mortems, it's unbelievable. Farmers are getting maybe £300 worth of work done for £25. If I post mortem a dog, I have to charge the basic price, then get authorisation for every extra test I want. If I post mortem a lamb, I have carte blanche within very wide limits to do whatever the hell I judge necessary to get the diagnosis. Comprehensive histopathology? Neuropathology? Complex virus isolation tests? Detailed trace element analyses of tissues? Just tick the box, send off the sample - it's all inclusive. The government believes it's a bargain, to have a proper handle on the disease status of the national herd. Put together with the stats for the rest of Britain and you end up with a comprehensive picture of farm animal health.

It gets better. We're especially charged with spotting "new and emerging diseases". We've got a live one right now. (Here's the first "respectable" report.) The PtB are concerned because this could be a threat to animal health. We've got an investigation underway, there's an all-points bulletin out for cases, and we've got a budget so that all the work we're doing is entirely free to the farmers.

I much prefer the farm animal post mortems because of the lack of financial constraints. And of course in Britain the human pathologists are in that happy position all the time. Their main constraint is getting family permission for a post mortem in cases where it's not legally mandated, but of course it's legally mandated in the important ones anyway. And once they've started, they're funded to do whatever is necessary.

If I thought about it at all, I assumed the US government would fund the pathology services from a public health point of view. But if they don't? I'm sure there are some mandatory post mortems, but if it doesn't go very far and if it's not approached from a public health standpoint, then does this affect the quality of the statistics coming out of the country?

I wonder what percentage of US causes of death are confirmed by PM compared to Britain? If it isn't comparable, I wonder just how much we can rely on any of the detailed statisitcs at all?

Rolfe.

 

[sugarb]

I don't know why this point didn't occur to me before. It's always a problem in pet animal medicine that you can't have a post mortem when you'd really like to know. Sometimes the veterinary practice will pay for the procedure themselves but you can't sustain that for any numbers. Even if you do get a post mortem, sometimes you're not authorised to do the follow-up tests you'd need to confirm your suspicions. Frankly, it can get expensive, and I understand the client's point of view. They've just spent a lot on care for their pet, nothing is going to bring it back, and they'd rather try to move on rather than spend even more.

Contrast farm animal medicine. OK, it's private medicine still, but some of it is subsidised as part of agricultural subsidies. The bit that is subsidised up to its eyeballs is the post mortem examinations. When I look at the price list for cattle and sheep post mortems, it's unbelievable. Farmers are getting maybe £300 worth of work done for £25. If I post mortem a dog, I have to charge the basic price, then get authorisation for every extra test I want. If I post mortem a lamb, I have carte blanche within very wide limits to do whatever the hell I judge necessary to get the diagnosis. Comprehensive histopathology? Neuropathology? Complex virus isolation tests? Detailed trace element analyses of tissues? Just tick the box, send off the sample - it's all inclusive. The government believes it's a bargain, to have a proper handle on the disease status of the national herd. Put together with the stats for the rest of Britain and you end up with a comprehensive picture of farm animal health.

It gets better. We're especially charged with spotting "new and emerging diseases". We've got a live one right now. (Here's the first "respectable" report.) The PtB are concerned because this could be a threat to animal health. We've got an investigation underway, there's an all-points bulletin out for cases, and we've got a budget so that all the work we're doing is entirely free to the farmers.

I much prefer the farm animal post mortems because of the lack of financial constraints. And of course in Britain the human pathologists are in that happy position all the time. Their main constraint is getting family permission for a post mortem in cases where it's not legally mandated, but of course it's legally mandated in the important ones anyway. And once they've started, they're funded to do whatever is necessary.

If I thought about it at all, I assumed the US government would fund the pathology services from a public health point of view. But if they don't? I'm sure there are some mandatory post mortems, but if it doesn't go very far and if it's not approached from a public health standpoint, then does this affect the quality of the statistics coming out of the country?

I wonder what percentage of US causes of death are confirmed by PM compared to Britain? If it isn't comparable, I wonder just how much we can rely on any of the detailed statisitcs at all?

Rolfe.

I'm having a hard time finding any stastics. From what I can gather, there's no minimum anymore (?) and statistics are no longer kept in our country? I did find one site that, in '91, I think, put the rate in the UK as lower than in the US (though neither were impressive). I also found one which suggested that Switzerland still had about a 90% rate of autopsy, which would be interesting, if true.

This is truly something that I wish MM would have covered in Sicko. Someone needs to address this issue in a public venue.

I read one site in which a physician suggested that the error rates in diagnosis, based on autopsies, hadn't improved since 1938! How astounding would that be, if true? Just...wow.

Your post was very interesting, to me. It does seem we learn more about animals through post mortems than people. And in agriculture we see the value in this, but not in people. It is just very...strange, and does make me question the validity of statistics. If the rate of autopsy in Switzerland is that high, or if any nation reaches beyond 50%, I'd tend to find those statistics more reliable than those relying on 11-24% rate of autopsy.

 

[Rolfe]

I note nobody has commented on this. Come on, BaC, tell us why this is an acceptable way of delivering healthcare in the richest nation on earth in the 21st century?

I also wonder what the people who think the US healthcare system is so superior think about events like this?

http://www.latimes.com/news/local/la-me-health-forum12-2009aug12,0,2168511.story

A homeless man spent the night camped outside the Forum, hoping to finally get glasses to help him see better. An unemployed grocery clerk waited in desperate need of root canal surgery. A former auto mechanic came with an aching back.

One by one, about 1,500 people made their way through the Inglewood sports arena, where dozens of volunteer doctors, dentists, nurses and other healthcare professionals are providing free medical services this week.

Remote Area Medical Foundation is a trailer-equipped service that has staged health clinics in rural parts of the United States, Mexico and South America. It brought its health camp to urban Los Angeles County on Tuesday to begin an eight-day stint that the group's officials described as its first foray into a major urban setting.

Organizers expected big crowds, in a county with high unemployment and an estimated 22% of working-age adults lacking health insurance.

On Tuesday, the turnout was so large that hundreds had to be turned away.

To anyone in Britain, this is deeply shocking. We expect to see scenes like these in third world countries when western charity groups send an aid expedition. We don't expect to see it in the USA. If this were happening in my country, I would be deeply ashamed.

I don't see how anyone can describe American healthcare in glowing terms when things like this are part of it, no matter how many rich people can have gold-plated artificial hips fitted.

Rolfe.

 

[EeneyMinnieMoe]

One last word about Michael Moore, the person. I only mention this because it is interesting.

I had the chance to meet Michael Moore once, when he was promoting F 911. And he was the last thing you'd expect (or maybe not.)

He was shy.

I'm serious.

And withdrawn. And seemed to dislike being at the center of attention.

Yes, I'm serious.

You'd think someone as loud and obnoxious as he is, who has done as many wacky stunts as he's done for the past 30 years, who stars himself as the main character in every movie he makes would be in heaven at any event where he's the main attraction and hundreds of people are there to see him and talk about his new movie.

Guess not.

Another few observations. He also apparently doesn't like being hugged, is amazingly charismatic and (not to be mean) is somehow even fatter in person.

 

[Rolfe]

Interesting. I was reading Stupid White Men, and that aspect of his personality really does come out in the book too. He obviously likes being outrageous, and since he manages to do it in such an entertaining way, I tend to laugh rather than be outraged. I think you're right that he's naturally quite insecure and unsure of himself behind all that.

I was just saying in the Sick Around America thread, that is seems as if, when the exact same material as in Sicko is presented straight without Moore's presentational spin, it pretty much sinks without trace. I can't quite explain that, but it seems as if the anti-universal-healthcare lobby is drawn to Moore's presentational style in order to badmouth it, and if that is taken out of the equation they just don't want to comment at all. And yet, maybe the presentational style is actually necessary to get anyone's attention in the first place. I note that the most obnoxious propaganda of the anti lobby uses exactly the same techniques of emotional scenes and emotional music.

I still maintain it is necessary to look beyond the presentational gambits and examine what the material presented does or does not prove.

Rolfe.