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“Sick Around America” Needs a New ‘Script

Last week, PBS aired Frontline’s new documentary “Sick Around America,” which was written, directed and produced by Jon Palfreman.

Sick Around AmericaIn case you missed it, you can watch it online here.

The hour-long segment does a great job of outlining the major problems with our healthcare system, but could have been much stronger in proposing and analyzing potential solutions.

And we felt that, in attempting to present a “fair and balanced” view, the show bent over backwards to include footage with Karen Ignagni, president and CEO of America’s Health Insurance Plans (AHIP), and other representatives of the insurance industry, at the expense of consumer advocates.  There was not a single interview on a national, single-payer proposal, for example.

(As an aside, Ms. Ignagni admitted in the video that she has severe asthma, and would most likely not be able to purchase individual insurance on the private market due to her “pre-existing” condition. How ironic.)

So let’s review: what are the major problems that we were shown? 

We do have high quality health care services available in this country. 

The problem is accessing them.  

Employer-sponsored coverage:

  • Folks with comprehensive employer-sponsored health insurance are incredibly lucky, as such plans typically cover most major medical expenses, as well as doctor visits and prescription drug costs.
  • The number of people with such coverage is declining. 
    • As the cost of private insurance continues to rise, employers are dropping coverage for workers or are raising employee contributions for premiums and co-pays.  This makes it harder for workers to afford such insurance, and some opt out of purchasing coverage even when it is available through their place of employment.
    • As the recession continues, folks are losing their jobs and employer-sponsored benefits.  While the recently unemployed are technically able to continue their employer-sponsored benefits through COBRA, the premiums are too high and unaffordable for most.  You can read about this issue here.   

The private market:

  • Those folks who are not offered coverage through their place of employment (or who have recently lost their jobs) have the option of obtaining coverage on the individual private market.
  • As we’ve shown before, it is very difficult to find an affordable, comprehensive plan in this market.  Why?
  • First, for-profit insurers go out of their way to deny coverage to those with a pre-existing condition.  This is a practice known as medical underwriting.   
  • Second, the coverage offered on the individual market is pretty poor.  Even if a person is able to buy a policy, he or she might not actually be saved from high medical bills in the case of an emergency. 
  • This is because many of the plans offered on the private market are “bare-bones” plans that may have reasonable monthly premiums, but don’t really offer any real benefits. 
    • They have high deductibles before coverage kicks-in, which means that folks still must pay for routine doctor visits and preventative care services on their own. 
    • And these plans have limits on the total compensation a person may receive for a catastrophic emergency or illness.   

  The uninsured and the social safety net:

  • So what happens when a person cannot obtain insurance through their place of employment, or on the individual private market?  
  • Fortunately, there are some public social safety net programs, like Medicaid, Medicare and SCHIP to help these folks get coverage.
    • But access to such programs is limited- by a person’s age and income- and many middle-income, middle-age folks fall through the cracks.
    • Click here for more details about the uninsured in America.
  • People without insurance have two options: to pray that they don’t become sick, or to face daunting medical bills for care when they do fall ill.

In short: Our healthcare crisis can no longer be thought of as just a policy issue to be dealt with in Washington, D.C. The crisis extends to all areas of our lives, and Americans are now trying to make long-term decisions that include how they will have access to health care.

  • Young people with big dreams are delaying their plans to take jobs that will provide coverage.
  • Spouses are staying in unhappy marriages because, as Georgetown University Research Professor Karen Pollitz puts it, they simply cannot afford to “divorce their insurance.”

At some point, this becomes a big (and costly) drag on our entire society.

While reminding us that Congress now has a critical window of opportunity to move on healthcare legislation, the video offers little discussion of the reforms that are on the table.

And some argue that the film contains factually incorrect information about the for-profit insurance industry and the role that it must play in healthcare reform.

  • There is no mention of President Obama’s plan to have a public insurance option that would compete with private providers, and how effective such a plan might be in bringing down health insurance costs.
  • The segment does not discuss a single-payer plan that would cover all Americans much in the same way that Medicare now covers those aged 65 and older.
  • At one point, Ms. Ignagni says that all Americans should be required to buy health insurance because folks in other countries are also required to do, and that is the only way to make insurance more affordable.
    • This is simply not true.  People in other countries are not required to buy insurance from for-profit insurers. 
    • They do purchase insurance, but they purchase coverage from highly regulated, not-for-profit insurance agencies (Germany), or the government pays for their coverage (Canada).

And unfortunately, “Sick Around America” did not include any of the valuable findings from “Sick Around the World,” which aired last year and examined the health systems from five developed countries: the U.K., Japan, Germany, Switzerland, and Taiwan.

PBS has set up an online talk section for folks to post their comments about the video. We encourage our readers to take a moment and let Frontline know if you have any concerns.

Our recommendation:  join the national conversation. The public should demand a follow-up segment that clearly compares the costs and political feasibility of current and future reform legislation.

More on the connection between this Frontline feature and changes in healthcare journalism tomorrow.

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