“Sicko” — Did Michael Moore Get It Right?

A Comparison of Emergency Rooms on Two Continents

December 2007 By Denny Hatch

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The guy nodded, asked for her passport and then produced a small plastic cup from a cupboard and pointed Joyce to the bathroom. Peggy and I retired to the waiting room where one of the publications on the coffee table was a medical journal (in German, of course) with a long feature story on aortic stents.

Joyce appeared five minutes later with two small boxes of pills—painkillers and enough sulfonamides to cure the condition. She thanked the technician, who handed back her passport and showed us to the door. We were on our way back to the hotel.

We were in the hospital for a total of 15 minutes.

Walking home, Joyce told us that the technician tested her urine sample and then took her in to see a doctor, who was out of central casting—tall, elegant with gray hair—and spoke perfect English. He noted the test results and asked her if she had ever had this before. She said yes. He asked if she were in pain. She said no, just discomfort. As he handed her the pills, he told her that the entire cost would be 15 euros (roughly US$21). Did she want to fill out forms or would she prefer to pay cash? She paid cash.

Back at the Kurcafe Hotel we saw Joyce to her room, wished her well and went off to bed.

The Next Morning
Joyce joined us in the dining room at breakfast. It had taken a while for the various pills to kick in, but she got a good night’s sleep and was fine. Whereupon she told us the harrowing tale of the same problem on a trip to Omaha the previous spring.

Feeling the symptoms coming on while changing planes at Detroit’s Metro Airport, she used her cell phone to call her colleague who was already in Omaha to alert him that she would need to get to a hospital right away, as soon as she landed.

He was at the airport to meet her in a rental car and had programmed the GPS system to get them straight to the hospital. Joyce was in pain and discomfort. As in any big city, the emergency room was crowded. Joyce gave her insurance card to the receptionist and was seen by a triage nurse, who gave her a plastic cup. She went into the women’s rest room and, with difficulty, produced the urine sample.

Then in severe pain and discomfort, she sat with her colleague in the waiting room.

Four hours later she got in to see a doctor, who noted the test results, prescribed Cipro—a painkiller—and sulfonamides. She was with the doctor for less than three minutes.

Back at the reception desk, she got her health insurance card back, signed several forms and spent five minutes getting directions to the all-night Wal-Mart pharmacy where she could get her prescription filled.

Later, she was billed $80 by an emergency physicians group in Omaha and still later received a bill for about $150 from the hospital.

German vs. American Health Care
Okay, the hospital in Füssen on a Sunday night was deserted, so Joyce did not have to wait. The scene in Omaha was very different—an early weekday evening in the crowded waiting room of a big city hospital.

But in my opinion, a four-hour wait by a patient in severe pain for a three-minute diagnosis and treatment is unconscionable.

Was part of the reason for that wait the need by the hospital staff to create a paper trail on her case in order to avoid a malpractice lawsuit?

Further, why were she and her colleague forced onto the streets of Omaha in search of an all-night pharmacy when the medication could have been dispensed by the hospital? Was this a conspiracy among the hospital, big pharma and retail drug outlets to enable each of them to get a piece of the action? Does anybody in the health care chain care about the comfort and welfare of the patient? Or is everything driven by cash?

Had Joyce been a German citizen with no insurance and shown up with cystitis at the Omaha hospital emergency room, she would have been presented with a bill for over $1,000. (According to Wellmark BlueCross and BlueShield, the average emergency room charge is $1,049. See link below.)

After “Sicko” was released at the Cannes Film Festival and in selected theaters in the United States, I saw Michael Moore grilled by a hostile interviewer. One of the adversarial statements was that American medicine is the best in the world because in every other country, patients had to endure long waits for services.

Moore’s retort was that 47 million Americans do not have health coverage. If they were added into the system, everyone would experience long waits.

Three statistics that provide a snapshot of a nation’s health care efficiency are:

* Infant Mortality Rate. According to “The World Factbook” published by the CIA, Singapore ranks highest with just 2.30 deaths per 1,000 live births, followed by Sweden (2.76), Japan (2.80), Hong Kong (2.94), Iceland (3.27) and France (3.41). The United States ranks 41st with 6.87 deaths per 1,000 live births, bracketed by South Korea (6.05) and Croatia (6.60).

* Life Expectancy at Birth. According to the same source, Andorra ranks #1 in the world with an average life expectancy of 83.52 years. This is followed by Macau (82.27), Japan (82.02), San Marino and Singapore (81.80) and Hong Kong (81.68). The U.S. (78.00) ranks 45th in the world, bracketed by Saint Helena (78.9) and Cyprus (77.98).

* Death Rate. “The World Factbook” reports that the lowest death rate occurs in the United Arab Emirates, with 2.16 deaths per 1,000 population. This is followed by the Northern Mariana Islands (2.29), Kuwait (2.39), Saudi Arabia (2.55), Jordan (2.68) and American Samoa (3.24). The United States ranks 118th in the world with 8.26 deaths per 1,000, bracketed by Cambodia (8.24) and San Marino (8.27).

Michael Moore just might be on to something.

P.S. A wonderful e-mail, received December 17:
Denny, At the holiday season we give thanks for many things, and one of them is your column. I enjoy your insight all year, and wish you and your family a wonderful 2008.

On another note, if you’re looking for a column idea, think about “stupidest marketing ideas of 2007” ... and I have a candidate. After years of being a Comcast customer, enduring frequent outages, fewer and fewer channels, and ever-rising prices, we switched to Verizon FIOS as soon as it was offered in our neighborhood.

Since we switched in the middle of a billing cycle and still owed Comcast for a couple weeks of our service, I called them to see how much money I needed to send.

After wading through the auto-attendant system, I finally had the chance to select an option to speak with a representative.

Here’s the clincher: the voice prompt said, “If you want to speak to a representative in person, the charge will be $4.95.”

I was floored. Since when do I have to pay to find out how much money to send Comcast? Clearly, this is a case of the bean counters running “customer service,” looking at this as a cost center, rather than an opportunity to touch customers, cross-sell and upsell.

Obviously, I hung up and did not pay the fee.

The crack customer win-back team from Comcast called a few days later, asking what it would take to get me to switch back.

I just started laughing and told them if they would like to know that answer, the charge will be $4.95.

They hung up.

Best regards,
Doug Morgan

P.P.S. This is the final “Business Common Sense” of 2007. I—and the entire team—wish you a joyous holiday season and a healthy, happy and prosperous New Year. See you January 8, 2008.