"Undermining my electoral viability since 2001."

Sicko (or, my adventures without insurance)

So, you know, you can get this off the internet the same way I get most of my video entertainment (savvy?), and I just watched it and it was really good. I don't go for Moore's coy, "gee mister, don't people in Cuba have to pay for healthcare" character, but his films can be quite thoughtful, and this is some of his best work. The assembled stores really speak for themselves.

One thing that stuck out for me was this bit from France, where they make sure that if you're poor and you need to take a cab home you can walk out with some cash. There's a line where the French doctor says, when asked about paying bills, something along the lines of, "the only qualification for walking out is that you're healthy enough and are going someplace safe."

That hit home for me, reminded me of the bike crash that got me wearing a helmet:

Actually, the stitches are not that much of a pain. There were a few woozy moments in the ER, but the real damage is muscular. I righteously pulled out my groin and jammed by elbow, both on the left side. Heading in I could walk and move pretty well. Walking out of the hospital took me a full five minutes gimping along, coming close to out and out crying on the ramp leading to the street. It’s a hell of a thing to be totally incapacitated.

That was a real fucked-up five minute walk down a 40-foot hallway. I was scared that I wouldn't be able to make it, moving literally one foot in front of the other out to the street to get a car to take me back to Brooklyn. The way the hospital staff would look away as they passed by, or give this kind of sheepish "good luck" grin, still sticks with me. I believe the system we have is evil on a kind of spiritual level for creating moments like that.

Another thing that stuck with me was the first thing Dr. Miller (he was good; I remember his name) asked when he saw my head was whether or not to send me up to a plastic surgeon. I did a double-take and told him I didn't have any coverage and he paused a beat and then said "I'll do the absolute best I can."

head wound

As like I said, he did good. Those stitches healed up straight and true and unless I've gotten a lot of sun you can barely tell they were there. And anyway, chicks dig scars, right?

I've lived largely without insurance since graduating from college, all except for the year I worked for MFA, and for the most part it's been ok. I'm lucky to be strong and healthy in spite of my breakneck lifestyle and questionable diet. One time I got a bad flu and went to the San Francisco Free Clinic, which is a leftover from the 60s, but where I got penicillin for $3. The first time I really wrecked in NYC it was late and there was no traffic cop to see me go down and hustle me into an ambulance, and I didn't need stitches or anything, so I biked home and just gutted it out.

I've done allright. I've been lucky. As I get a little older I get to feeling a bit more risk-averse. Soon we'll have insurance through work, and that'll be nice; but the truth is, as this film makes abundantly clear, an insurance-based, profit-driven health care system will always be extremely problematic, as it's paradigmatically oriented away from providing treatment. Even for those with coverage.

I've said before that I want my first new car to be an alternative fuel or electric vehicle. Similarly, I'd really like it if by the time I have kids we've gotten our shit together to where health care isn't such a humongous clusterfuck. Here's hoping.

Responses

So, about health care - my personal feeling is that the feedback loop is way too long. Bringing that back in line will, in my opinion, bring the greatest improvements in quality and (more importantly) cost.

About the cars though, I could talk for hours. And I think you should ditch the hybrid for a gas sipping "regular" car. Sure hybrid tech is neat and the way of the future. But have you seen how bad batteries are? I mean really really bad.

See slashdot's take on the Prius vs. Hummer report done earlier this year. Bottom line: Hummer and Prius are about equally bad (though the flawed science in the report makes it look otherwise) while the best car is the scion XB. Yeah baby. Being cheap is so often the best way to being an eco-nut.

I walked away from that Slashdot story with a different take. The report is pretty deeply flawed -- they calculate an operating cost for a Prius of about $3 per mile, and about $2 per mile for the Hummer, but they base this on a 109,000 mile lifetime for the Prius vs. the 197,000 miles for the Hummer. The 109,000 mile number seems completely arbitrary, especially given that you can get a 150,000 mile warranty on the car in California. If the Prius actually has an operational life of 200k miles, then it's cheaper to operate than the Hummer.

But that's just operational costs, which are a separate issue from how clean they are. Obviously the Prius is going to pollute less and consume less energy per mile than the Hummer. The supposed difference comes in the energy it takes to manufacture the cars, and the purported manufacture energy hog in the Prius is the battery pack. IIRC, the study ignored the fact that the nickel in the batteries can be recycled, which threw the numbers off considerably.

Batteries have a bad rap for being nasty. The cadmium in NiCad batteries is pretty toxic, and I don't think it's easily recycled, but NiCad batteries aren't used in electric vehicles or hybrids. Nickel metal hydride batteries (NiMH) are used in most production hybrids, and the nickel is pretty easily reprocessed. Homebrew EV builders generally don't have access to NiMH batteries though, and usually wind up using lead-acid batteries. Because there's a huge demand for lead, about 99% of the battery ends up being recycled when you exchange the cells. I have to admit that I don't know a lot about lithium ion batteries, but I think they're pretty green.

I'm a big proponent of plug-in hybrid vehicles. GM is working on one right now, but who knows if that will ever see the light of day. In the meantime, people like this guy are building them in their garages.

Ultimately I think it's pretty unlikely that a Hummer is equally as dirty as a Prius, but it's up in the air as to whether or not a Prius is cleaner than something like a Scion xB. The study calling out the Prius as being worse than a Hummer, though, is a complete joke.

-Mike

Interesting stuff. I'm a ways off from buying a new car; hoping for a plug-in hybrid, or maybe ethanol or biodiesel-burning 2nd generation pickup. Or maybe one of the downmarket Teslas. Really, it's not a real question for at least a year or three. Moamar, my plucky little Toyota has at least another 40,000 miles left in him.

Frankly, I'm happy to get less mileage if my fuel-source is organic. If you grow a bunch of switchgrass or poplar, then burn some of it to get heat to process the rest into ethanol, then burn the rest of it in your car, you're staying close to carbon neutrality because the carbon coming out of your tailpipe came from plant, which got it from the air. Ditto the same cycle if you can squeeze oil out of algae and burn that as biodiesel.

The problem has been that we've been hauling carbon out of mountains and sucking it up from underground puddles and then dumping it into the air. If we can align our energy production with a carbon-cycle that stays in equilibrium, and obviously start some programs to both drive efficiency and initiate corrective carbon capture projects, I'm actually fine with people who want to pay more for fuel to drive less efficient vehicles, for whatever reason.

It's a big "if" though. The whole Energy System is if anything more deeply entrenched than Health Insurance. Kaiser only got his start in the Nixon Administration. Big Oil goes back to the dawn of the 20th century.

but what about the nasty batteries!

I totally agree about biofuels though.

If I could change one thing in the world right now it would be to remove all of the tariff and non tariff barriers to sugar importing. Ethanol from sugar is competitive with petroleum already - no subsidies needed, no miracle switchgrass enzymes needed, done. Also, sugar grows really well in central and south america. So, we'll trade petro-fascists for sugar-fascists, but certainly there will also be some development and kuznets curve action going on that will raise the standard of living in those countries. Also, it gives a viable crop to a part of the world that has so far only chosen between rock-bottom commodities and drugs (which we then kill with non-specific herbicide from planes).

So, embracing sugar/ethanol means:

  1. carbon neutral fuel (at least reducaed impact for sure)
  2. bringing latin america further in its development
  3. providing alternative crops for coca farmers
  4. reducing US dependence on petro-fascists that hate us (which reduces our needs for much of the jingoism and interventionist policies of the last 30 years)

What is there to dislike about it? It hurts the US corn farmer. So, agrarian workers make up less than 2% of the US workforce. Corn farmers make up even less. Frankly, their livelihoods are not as important to me as the other 4 items above.

It hurts big oil. Well, let's just shake the "windfall profits" stick at them again and they'll sit back down about creating an ethanol-mixed future.

viable crop to a part of the world that has so far only chosen between rock-bottom commodities and drugs

Cotton subsidies to our cotton farmers have driven cotton out of competition in South America.

Brutal tactics in the Coffee market have led to slash and burn as opposed to tri-level sustainable agriculture.

Why should I think sugar is going to magically give South and Central America a better chance at this? They turn to the drug front because we effectively make it impossible for them to do anything but smuggling. So if you're gonna smuggle anyway, isn't it more profitable to do it with cocaine, than with cotton?

...and when there's more demand for something then the value of it goes up. So, adding in sugar among the other crops can only help improve the options for the farmers.

I agree it's not a panacea, but if we attached the SUVs of our nations to farmers in central america instead of wells in the sand and rigs in the ocean it can only lead to those SUVS pulling at least some folks a little bit out of poverty.

Yeah, the study is flawed, but the thing is that batteries get a bad rap because they're bad. There's a big difference between the ideal scenario "people CAN recycle many parts of batteries" and the reality of "people throw away batteries in land fills".

It's not just operational costs in the (unpublished) study but cradle to grave taking care of everything. The batteries die between 100,000 and 150,000 so while the car doesn't die the batteries do need to be replaced.

The study does undervalue emissions (like not counting them at all afaik). However, the XB is a LEV. So, given the enormous difference in prius costs to XB costs the value of LEV vs. SULEV would have to be something like $1/mile to make them even. That seems unlikely.

Car parts, because they are disposed of not through dumping but through mechanics, are much more readily recycled. E.g. most catalytic converters are recycled safely because most people need a mechanic to remove them. I can only imagine this is much more true of the very large and very embedded battery packs in hybrid vehicles. It's not like a laptop or a used-up D-cell.

The catalytic converter example is a good one. I'd be surprised if any significant proportion of lead-acid car batteries are ending up in landfills -- when your car battery dies and you buy a new one at the parts store, you typically exchange the old one and get a small credit for it. The parts store then sells the battery to recyclers, who reprocess the lead for new batteries. People who build homemade EVs do the same thing with the large lead-acid battery backs that they typically use to power their cars. And once hybrids start coming off the road in significant numbers, I imagine the process will probably be (or already is) similar for things like NiMH batteries.

The study was self-published, and you can view it here (PDF link). FWIW this is a slightly newer version of the study than the one that I've read.

Biofuels have promise, but I'm still a bit skeptical. I've read that in Brazil, large tracts of rainforest are being cleared to grow the sugarcane that gets processed into alcohol. Anyway, sorry if I'm beating a dead horse here; mainly I just wanted to share the link for that study.

And only in America....Sicko and iPhone released on the same day.

I started a comment this morning and it got too long so I made it a post on my site http://www.treslervania.com/node/380 . At which point I got sidetracked fixing my Captcha's Its now 2:00 and I blame you Joshman.

That and I think we also need to look into a better transportation infrastructure in general in America.

Cheers

can't breathe, so funny... "too many OBGYN's arent's able to practice their -their love with women all across this country"

Thank you for devoting some of your blog to this important issue of health care. Please allow me to comment against Mr. Moore’s work. I believe the market failures Sicko addresses are not due to a failed government but to an epidemic of unhealthy lifestyles that cannot be supported economically. Preventable illness comprises 80% of the burden of illness and 90% of all healthcare costs. Preventable illnesses account for eight of the nine leading categories of death. No medicine, surgery or treatment can reverse the damage caused by a lifetime of smoking, poor eating and lack of exercise. By simply increasing treatment that buys time, ignores the inevitable need to align patient’s economic incentives toward healthy living. This is the innovation needed in the economic system of health care, not just more health care.

While Americans' eating and exercise habits are certainly germane, obesity is a global phenomena, as are drug and alcohol use/abuse. The central thesis is about the paradigmatic orientation of a health care system. A system which drives millions to forestall or avoid treatment -- as the US's does -- increases the costs (human and economic) of chronic and preventable ailments.

Have you watched the film? Your comment "against Mr. Moore" is very much in-line with the point of the film, actually.

I haven't seen the movie yet, but I do feel like America can't move forward until it solves the healthcare dilemma. I did the no-insurance thing my first year out of college and was terrified that something would go wrong. This year the insurance offered to partners through the school's plan was so prohibitively expensive (and crappy, to boot) that I found short-term major medical insurance to get me through ski season at $75/month, and am now without again until I can get on Ben's plan in July. I distinctly remember the feeling of relief that I had when I started my job back in 2002 and signed all the health care papers.

Last week I was talking to a friend's girlfriend, from Canada, who ended up needing emergency surgery while she was visiting him here. She was so confused by the focus on insurance--she said while she was doped up on morphine they kept asking her "ok, we need to run test X, but what about your insurance??" Meanwhile her company was a little bummed that she was in NH instead of Canada (since they have to pay, whereas if she'd been in Toronto the government would have covered it), but everything ended up being covered. I told her how expensive even simple meds like the Pill are here compared to in Canada and she was shocked. Sigh.

Pages