Monday, August 10, 2009
In Michael Moore's movie "Sicko," a widow named Julie Pierce tells a tearful story: Her husband died of kidney cancer after their health-insurance company denied payment for a bone-marrow transplant that might have saved his life. Ms. Pierce's rage is palpable as she repeats the word her insurers used in response to her husband's request. "They denied it," she sneers. "Said it was 'experimental.'"
Viewers of the documentary are meant to understand that "experimental" is health-insurance code for "expensive," and that Ms. Pierce's husband was left to die for the sake of profit. According to Mr. Moore's movie, "Any payment for a claim is referred to as a medical loss," and when a claim is denied, "it's a savings to the company."
But Mr. Moore is so busy following the money that he doesn't take the time to follow the science. Treating cancer patients with bone-marrow transplants has a dubious history.
Twenty years ago, many oncologists believed that bone-marrow transplants, along with high doses of chemotherapy, might offer a cure for breast cancer. Insurance companies refused to pay, calling the treatment experimental and unproven. Breast-cancer sufferers went to court: In one case, a jury awarded $77 million to the family of a woman who was denied payment for the treatment. Wives and mothers told heart-rending stories in newspapers and on TV. Politicians quickly moved to guarantee the treatment to all breast-cancer patients. Ten state legislatures mandated that every insurance policy cover bone-marrow transplantation for breast-cancer patients. Amid the media circus and political self-congratulation, the question of whether bone-marrow transplants are medically effective faded into the background.
The sad truth is that the treatment isn't effective. When researchers released the results of their clinical trials to the American Society of Clinical Oncology in 1999, they showed that the treatment offered no benefit. Worse, it often killed women faster than their cancer, and caused them unnecessary pain. At a time when their health was at its greatest risk, more than 30,000 women were exposed to an invasive, harmful and ultimately useless treatment that the National Institutes of Health no longer recommends. But only one state legislature has repealed its law requiring insurance companies to pay for the treatment. Some doctors believe bone-marrow transplants might help kidney cancer patients, and the NIH is conducting clinical trials to find out. Until the treatment has been shown to do more good than harm, insurers are reluctant to pay for it.
Mr. Moore claims that because private insurance companies are driven by profit, they will always deny care to deserving patients. For this reason, he argues, profit-making health-insurance companies should be abolished, our health- care dollars turned over to the government, and the U.S. should institute a health-care system like the ones in Canada, Britain or France. But does Mr. Moore think, even for a second, that any of the government systems he touts in his movie would have provided a bone-marrow transplant to Ms. Pierce's husband? Fat chance.
When government is in charge of health care, the result is not that everyone gets access to experimental treatments, but that people get less of the care that is absolutely necessary. At any given time, just under a million Canadians are on waiting lists to receive care, and one in eight British patients must wait more than a year for hospital treatment. Canadian Karen Jepp, who gave birth to quadruplets last month, had to fly to Montana for the delivery: neonatal units in her own country had no room.
Rationing in Britain is so severe that one hospital recently tried saving money by not changing bed-sheets between patients. Instead of washing sheets, the staff was encouraged to just turn them over, British papers report. The wait for an appointment with a dentist is so long that people are using pliers to pull out their own rotting teeth.
Patients in countries with government-run health care can't get timely access to many basic medical treatments, never mind experimental treatments. That's why, if you suffer from cancer, you're better off in the U.S., which is home to the newest treatments and where patients have access to the best diagnostic equipment. People diagnosed with cancer in America have a better chance of living a full life than people in countries with socialized systems. Among women diagnosed with breast cancer, only one-quarter die in the U.S., compared to one-third in France and nearly half in the United Kingdom.
Mr. Moore thinks that profit is the enemy and government is the answer. The opposite is true. Profit is what has created the amazing scientific innovations that the U.S. offers to the world. If government takes over, innovation slows, health care is rationed, and spending is controlled by politicians more influenced by the sob story of the moment than by medical science.
this prompts a response:
My name is Julie Pierce. My husband was Tracy Pierce. I am featured in Michael Moore's documentary 'SiCKO.' In the movie, I share my deceased husband's story — his unsuccessful battle with our insurance company to receive what could have been life-saving treatments for kidney cancer.
I just read your Wall Street Journal article written on Sept. 13, 2007, titled "Sick Sob Stories." You begin by talking about Tracy's role in 'SiCKO,' and claim the bone marrow transplant denied by our insurer would not have saved him. You also accuse me of "sneering" over our situation.
In your 'reporting' of this story, you did not contact me, and you did not contact my husband's doctors. I cannot believe that a publication like the Wall Street Journal would print such an accusation without talking to anyone involved — especially in such a personal matter, which resulted in the death of my 37-year-old husband and the father of my child.
If you had contacted me, I would have told you that bone marrow transplants became a last option, only after our insurer denied many other treatments again and again and again.
I would have shown you a letter from our doctors at the Blood and Marrow Transplant Program at the University of Kansas Hospital, in which they argued strongly for the bone marrow transplant, citing "strong evidence" supporting the past success of that treatment — they wrote that it could "give him a chance to achieve complete remission." In fact, they called the bone marrow transplant "his only chance of survival."
Instead of calling me up and doing real reporting, all you can do is throw around studies from 1999 about the supposed inefficiency of bone marrow transplants for breast cancer patients — even though Tracy didn't have breasts. He had kidney cancer! I understand that you want to try to prove that private insurance in this country really isn't that bad. And I can see that you won't let the facts get in the way.
You go on to claim that Tracy wouldn't have received his transplant in a country with socialized medicine, either. Where is the evidence? Not only are more bone marrow transplants performed every year in Canada, but they invented the technology! So much for your ridiculous claim that "profit is what has created the amazing scientific innovations that the U.S. offers to the world. If government takes over, innovation slows, health care is rationed."
You are simply carrying water for the for-profit insurance industry that killed my husband. And then you have the nerve to accuse me of "sneering" about it. My husband has only been dead since January 18th, 2006. It is still fresh to me and my family, and comments like this are inhumane.
I have since tried to contact you via email, but you have not responded. I don't expect an answer. People like you just write with an agenda, without coming to the source or getting any facts, because your main goal is to try to discredit Michael Moore and universal health care. I understand it's a game — you did it without thinking about how you would hurt a family who have suffered — and are still suffering — such a tragic loss.
My family is not a "Sick Sob Story." We are a normal, American family that has had a significant member die from a horrible cancer that ravaged his body due to repeated denials from a health insurance company. We will never know for sure what would have worked because Tracy was never given a fighting chance. Over 18,000 Americans die each year because they don't have health insurance. I suppose theirs are "sob stories," too.
I don't want a hit-piece. I want answers. Why does our wonderful profit-driven system of medicine kill 18,000 Americans each year? Why do we pay far more for our health system than any other country, but have some of the lowest life expectancies and highest infant mortality rates in the Western world? Would you discredit the work of your late colleague Peter Jennings who, while suffering with lung cancer, did an excellent report titled "Breakdown: America's Health Insurance Crisis"?
I hope you have answers, but I am not optimistic. I pray that you will never have to go through what we went through — if you did, you wouldn't be so quick to cheerlead the system we were victimized by.
I read your reply to my WSJ Op-Ed. Let me respond to you, first, by saying that there is never any justice in the death of a 37-year old husband and father. I am sorry for your loss.
You accuse me of playing a "game" when I write about health care. This is untrue. I take this debate very seriously, because I believe that Americans suffering from illness should have access to the most advanced procedures, drugs, and treatments that medical technology can provide. I shudder to think of what would be lost if government takes control of healthcare.
Consider bone marrow transplantation. You write that Canadians "invented the technology," but I don’t think this is the case. I count bone marrow transplantation among the countless American medical innovations. The first successful bone marrow transplantation was performed in New York by Dr. E. Donnall Thomas. He went on to win a Nobel Prize for his work.
The data I’ve found also contradicts your assertion that there are more bone marrow transplants performed in Canada versus the US. Please tell me where you got that information. The Center for International Blood and Marrow Transplant Research reports that an estimated 16,700 patients received bone marrow transplantations in the US last year, vs. only 1520 patients who underwent the procedure in Canada. Per capita, there were 16% more transplants performed in the U.S.
As to whether the experimental procedure denied to your husband would have been available in Canada, my researchers contacted more than a dozen Canadian governmental organizations, medical societies, and research facilities. Some were firm in saying that it’s unlikely that any of these procedures are available in Canada, citing the "underwhelm[ing]" results of past clinical trials. Dr. Irwin Walker, McMaster University professor and former president of the Canadian Blood and Marrow Transplant Group, did say that his center might consider performing this procedure: "If our centre wanted to transplant [in] one or two cases of kidney cancer there wouldn't be an objection, but if we did a lot then it would have financial impact."
When government is in control, any experimental drug or cutting-edge treatment option will bring with it a "financial impact" on the pool of government funds, and be less likely to be made available. The Center for International Blood and Marrow Transplant Research tracks the activity of most transplant centers across the US and Canada. In America, their registry shows 106 Americans that received bone marrow transplants for kidney and urinary tract cancers between 2002 and 2006. In Canada, their registry shows only 4 such procedures over the same period.
Healthcare in America is a mess, but there’s a lot that’s great about it too. It’s easy to take for granted how rapidly medical technology has progressed over the last half-century, and all the lives that are saved every day which would have been lost only decades ago. If we introduce more choice and competition, American healthcare will become cheaper, more efficient, and more available to everyone.
You object to my use of the word "sneer," but I did not "accuse" you of "sneering over" your situation. I use the word to convey the anger I saw you express at insurance companies in Sicko.
I know that when you fight for government healthcare, you believe that what you are doing is right. While we agree that there is a lot that’s wrong with our healthcare system, we have different ideas about how to fix it.