Sicko' and the dermatologist

September 1, 2007

I have recently seen the newly released Michael Moore movie, Sicko, and it left me with profound sadness and some outrage about how our country cares for the medical needs of its citizens. We physicians have all seen the deterioration of medical care over the past 10-15 years, particularly for middle class working people, many of whom are forced to go without health insurance, while gambling that they do not develop a serious and expensive illness which could ruin them medically and financially.

I recently saw the Michael Moore movie "Sicko," and it left me with profound sadness and some outrage about how our country cares for the medical needs of its citizens.

We physicians have all seen the deterioration of medical care over the past 10 to 15 years, particularly for middle-class working people, many of whom are forced to go without health insurance, while gambling that they do not develop a serious and expensive illness that could ruin them medically and financially.

One of the main themes of "Sicko" is that insurance carriers have an inherent conflict of interest when it comes to dealing with their clients.

A dollar paid out for a medical claim for an insured person is one less dollar of profit for the corporation. It pays to withhold coverage. This is a very poor premise for a healthcare system.

Many carriers have established criteria for coverage of various illnesses. We are familiar with the arcane and completely arbitrary rules governing what will and will not be covered. However, it is really all simple: Try to avoid spending money on healthcare of the insured. These "guidelines" are often cloaked in scientific or regulatory clouds, which give them some appearance of legitimacy.

Pair of pet peeves

My two least-favorite ploys of the insurance carriers go like this:

Call to action

What can dermatologists do individually and collectively about this terrible state of affairs? Here are some suggestions.

The American Academy of Dermatology (AAD) has significant influence in Washington, based on a long track record of patient advocacy. This clout could be brought to bear in the halls of Congress and elsewhere to educate the elected officials and others about the national scandal that is unfolding with regard to quality healthcare in this country, and about the fact that physicians would like to be a part of the solution. Perhaps this could take the form of impartial panels that could establish national guidelines for medical care.

I know that many would regard this as an intrusion on the prerogatives of an individual to practice the way he or she wishes. However, those prerogatives are now long gone, as the insurance carriers have taken over as the final arbiter. I would rather not have an institution with a financial incentive dictating to me how I should be practicing medicine.