Why ‘Sicko’ hits a nerve

The Los Angeles premiere of “Sicko” at the Samuel Goldwyn Theater was over, the audience on their feet and the “stars” -- a.k.a. underserved, suffering patients and whistle-blowing insurance company employees -- had taken their bows.

Michael Moore, wearing a suit-minus-tie and sans his signature cap, was looking at them with a paternal glow.

Then came the lone question, shouted from the audience.

“What do we do?”

For Moore, it’s a no-brainer. He wants the insurance industry out of the picture. He rattled off two bills, a kind of “Medicare for All” plan (SB 840) proposed by state Sen. Sheila Kuehl (D-Santa Monica) and a similar national bill in Congress sponsored by House Judiciary Committee Chairman John Conyers Jr. (D-Mich). Both bills propose a system modeled on Medicare, funded by tax dollars, with guaranteed benefits extended to Americans of all ages.

One of two people invited by the Los Angeles Times to view the premiere and offer their insights and expertise said she agreed with Moore. Dr. Karen Lamp, medical director of the Venice Family Clinic, which provides free care to 23,000 uninsured and underinsured people each year, says she believes in universal coverage.

“I was ashamed at watching the experiences these people had,” Lamp said as we brushed past actors Larry David and John Cusack to nab a table on the theater’s patio. The crowd inside clustered around Moore.

But for someone on the front lines of trying to catch those who fall through the cracks, the dramatic examples on the screen were not revelations. “I actually didn’t think the stories were all that extreme,” Lamp says.

Jeffrey Wasserman, the other invited viewer, was more circumspect.

“There’s not just one way to do this,” he said, passing up the sushi offered by a waiter. A senior policy researcher for the Santa Monica think tank Rand Corp., Wasserman is working on a project comparing just about every healthcare plan proposed by states, congressional leaders and presidential candidates.

Because the goal of the Rand project is to put forth objective measures of all proposals, he keeps his opinions to himself.

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Complex problems

As Moore’s movie points out, the problems associated with America’s system are economic, social and cultural. They go beyond the boundaries of the provision of medical care. We see a case of patient dumping, shown through the lens of surveillance video snippets from Union Rescue Mission in Los Angeles, in which a disoriented woman in a hospital gown is dropped off in a cab to wander aimlessly. No healthcare reform plan will solve America’s homeless problem, Wasserman says: “People have nowhere to go, they have no social support.”

We see uninsured Rick, who sawed off the tops of two fingers and can afford to have only one tip reattached. He chooses the less costly ring finger. Then Moore presents a contrast: a Canadian man who has had a worse saw accident, losing all five fingers, but has had all of his fingers reattached, at no charge.

There are Donna and Larry Smith, insured but left bankrupt by the co-pays and deductibles they were charged after his three heart attacks and her cancer. They lose their home and must move into their daughter’s basement storage room.

And there is Frank, at 79, still mopping bathroom floors and unloading crates for an hourly wage and health insurance benefits because Medicare’s drug benefit doesn’t cover all the medications his wife needs.

“If there are golden years, I can’t find them,” Frank says in the movie.

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Drug expenses

It was after 11 when the showing ended, and the crowd was drifting away, heading down Wilshire Boulevard. Lamp comments that she knows plenty of people like Frank, who, despite the new Medicare drug plan, can’t afford prescriptions. “That’s been a nightmare for us,” she says.

The Medicare drug plan has a coverage gap in the middle, called the “doughnut hole,” ceasing payment when medication costs reach $2,400. Federal payments don’t begin again until costs have reached $5,451 , but by then, Lamp says, many of her patients have given up.

Long delays in care is another tale familiar to Lamp: “Until our patients find the clinic, they’ve often gone a long time without care,” she says. She describes a woman who came into the Venice clinic with a huge breast tumor that could have been found earlier if she had had preventive screenings.

In “Sicko,” some people simply cannot get health insurance. One young man who is 6 foot 1 and weighs 135 pounds is denied coverage because he is too thin. A woman who is 5 foot 1 and 178 pounds is turned down because she is too fat.

The film, Lamp and Wasserman agreed, is a conversation starter.

“Moore presented a powerful and emotion-packed series of stories that illustrate just how broken our healthcare system is,” Wasserman says. “He has a unique talent for being able to tell stories through the eyes of people.”

Lamp, like Moore, endorses the single-payer system as a way out of the mess. Wasserman keeps mum on what he thinks. The Rand project -- results will be released next year -- will analyze a range of possible solutions including single-payer systems and one in effect in Massachusetts.

That state plan weaves together private and public agencies to cover nearly everyone. It requires employers to provide health insurance or face a fine, and that money helps finance insurance coverage for people who can’t afford it.

The Rand project also will examine consumer-directed plans that require more responsibility and higher co-payments from patients. The theory is that those measures will encourage people to make wiser, less costly health decisions.

In line with that, Rand will put an objective mix of measures of cost, access and quality on a grid so the reader can interpret the economics and trade-offs of each proposed solution.

The next phase of the discussion is up to the American public, and its collective answers to that question shouted from the audience: What do we do?

Of course some of America’s health problems -- obesity, smoking-related disease, poor diet -- are matters that individuals could take in hand for themselves. When Moore left the stage, he may have been giving a nod to the need for such personal responsibility. “Now, come and join me for a walk,” he said, “to the salad bar.”

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susan.brink@latimes.com