On Friday's Anderson Cooper 360, CNN medical correspondent Dr. Sanjay Gupta examined the accuracy of the claims presented in Michael Moore's film Sicko. Gupta found that while there are complaints about America's health care system, "you won't find medical utopia elsewhere." Although Gupta did not show much skepticism in reporting that life expectancies in Cuba are about equal to those in America despite being outspent by American 26 to 1 in health care, the CNN correspondent did report that in countries with tax-funded universal health care, that "even higher taxes don't give all the coverage everyone wants."
Gupta discussed the waiting lines that exist in some industrialized nations, and found that "Americans have shorter wait times than everyone but Germans when seeking non-emergency elective procedures," although he also found that "only Canada was worse than the United States when it comes to waiting for a doctor's appointment for a medical problem." After informing viewers of the higher taxes paid in other countries, he also relayed that "even higher taxes don't give all the coverage everyone wants" as health analyst Paul Keckley informed viewers that "15 to 20 percent of the population will purchase services outside the system run by the government." (Transcript follows)
Regarding Cuba, Gupta cited statistics which claim that while America spends substantially more per person on health care each year than Cuba, that America does not have a "far better outcome," contending that life expectancy is about equal in both countries. Gupta: "The United States spends $6,096 a year per person, versus $229 a year in Cuba. And astronomically more money doesn't mean far better outcomes. In fact, Americans live just a little bit longer than Cubans, on average."
After Gupta's report, host Anderson Cooper interviewed Karen Ignagni of America's Health Insurance Plans to hear criticism of Moore's film from the insurance industry point-of-view. During the interview, Cooper was inquisitive about the importance of profit-making for insurance companies, as three out of four questions he asked dealt with profits.
Cooper: "You know, let's be honest. Insurance companies are for-profit businesses, and the way they maximize profits is by minimizing payments. Isn't that correct?"
And later, Cooper continued: "Insurance companies have people whose job is to retroactively look at big claims that have been paid out for any evidence that there might be some preexisting condition so they can, you know, deny the claim. Again, the bottom line is profit for these companies."
And his final question: "There are all these commercials from insurers about how, you know, they want to help people, and clearly, I'm sure there are good people who do want to help people. But again, the bottom line is profit and maximizing profit."
Below is a complete transcript of Gupta's report followed by Cooper's interview with Ignagni from the Friday June 29 Anderson Cooper 360 on CNN:
MICHAEL MOORE, from the June 29 Larry King Live: We have a tragedy taking place every year now -- 18,000 people a year, these are the, these are the actual official statistics, 18,000 people a year die in this country for no other reason other than the fact that they don't have a health insurance card. That's six 9/11s every single year.
ANDERSON COOPER: That was Michael Moore earlier on Larry King Live. His new movie, Sicko, opened nationwide today, and as you may have already heard, it is a scathing indictment of the U.S. health care system, starring American citizens and their medical horror stories. Moore, of course, is known for his controversial style of filmmaking. Some have questioned the facts in his films. So tonight, we thought we'd ask CNN chief medical correspondent Dr. Sanjay Gupta to do a fact check.
UNIDENTIFIED MALE, clip from Sicko: That's not on, right?
MOORE, clip from Sicko: No.
UNIDENTIFIED MALE, clip from Sicko: Okay.
Dr. SANJAY GUPTA: Sicko throws some hard punches at the United States health care system, and it seems just about everyone has something to say.
UNIDENTIFIED FEMALE: He's played fast and loose with the facts.
MARK MEANEY, National Institute for Patients Rights: Michael Moore was spot on.
MOORE: The facts, I think, support what I believe.
GUPTA: And Moore presents a lot of facts throughout the movie. But do they all check out? "Keeping Them Honest," we did some digging, and we started with the biggy. The United States slipped to number 37 in the world's health care systems. It's true. Thirty-seven is the ranking, according to the World Health Organization's latest data on 191 countries. It's based on general health level, patient satisfaction, access and how it's paid for. France tops the list. Italy and Spain make it into the top 10. The United Kingdom is 18.
MOORE, from Sicko, in a boat: Hello?
GUPTA: Moore brings a group of patients, including 9/11 workers, to Cuba and marvels at their free treatment and quality of care. But hold on. That WHO list puts Cuba's health care system even lower than the United States, coming in at number 39. Moore asserts that the American health care system spends $7,000 per person on health, whereas Cuba spends $25 per person. Not true, but not too far off. The United States spends $6,096 a year per person, versus $229 a year in Cuba. And astronomically more money doesn't mean far better outcomes. In fact, Americans live just a little bit longer than Cubans, on average.
So Americans do pay more, but the United States also ranks highest in patient satisfaction. And Americans have shorter wait times than everyone but Germans when seeking non-emergency elective procedures like hip replacement, cataract surgery or knee repair. That's not something you'll see in Sicko, as Americans tell their tales of lack of coverage and suffocating red tape. It's true that the United States is the only country in the western world without free universal access to health care. But you won't find medical utopia elsewhere.
The film is filled with content Canadians and Brits sitting in waiting rooms, confident care will come. But in Canada, you can be waiting for a long time. A survey of six industrialized nations found that only Canada was worse than the United States when it came to waiting for a doctor's appointment for a medical problem.
PAUL KECKLEY, Deloitte Health Care Analyst: That's the reality of those systems. There are quotas. There are planned wait times. The concept that care is free in France and Canada and Cuba, and it's not. Those citizens pay for health services out of taxes. And as a proportion of their household income, it's a significant number.
GUPTA: It's true that the French pay higher taxes, and so does nearly every country ahead of the United States on that list. But even higher taxes don't give all the coverage everyone wants.
KECKLEY: Fifteen to 20 percent of the population will purchase services outside the system of care run by the government.
GUPTA: So there's no perfect system anywhere. But no matter how much Moore fudged the facts, and he did fudge some facts, there's one everyone agrees on. The system here should be far better.
COOPER: Far better indeed. It's numbers like these, released just days ago by the Centers for Disease Control, that are fueling calls for change. Nearly 44 million Americans, almost 15 percent of us, did not have health insurance in 2006. The percentage varied widely by state, from nearly 8 percent in Michigan, Michael Moore's home state, to nearly 24 percent in Texas, President Bush's home state.
Moore's solution, as you just heard, is to give all Americans free universal coverage. He paints insurance companies as the villains. As you might imagine, they see it far differently. Joining me now is Karen Ignagni, president of America's Health Insurance Plans. Karen, thanks very much for being with us.
KAREN IGNAGNI, America's Health Insurance Plans: My pleasure.
COOPER: I want to play a clip from the film Sicko. Let's take a look.
MOORE: Laura Burnham was in a 45-mile-an-hour head-on collision that knocked her out cold. Paramedics got her out of the car and into an ambulance for a trip to the hospital.
LAURA BURNHAM: I get a bill from my insurance company telling me that the ambulance ride was not going to be paid for because it wasn't pre-approved. I don't know exactly when I was supposed to pre-approve it, you know? Like after I gained consciousness in the car, before I got in the ambulance, or I should have grabbed my cell phone off of the street and called while I was in the ambulance. I mean, it was just crazy.
COOPER: You represent insurance companies. How do you explain a situation like that?
IGNAGNI: I think, Anderson, there are only two possible explanations. One, straightforwardly, it was a mistake. Two, this was an auto accident. I've been in an auto accident, and I know my health insurer was the second payer, not the first. So in this case, maybe the health insurer actually was saying that it was the auto insurer's responsibility. But I think the point of this movie is that Michael Moore is right, and I watched the interview on Larry King, that it's time for our nation to confront the fact that we have 46 million people without health insurance. He's right about that. He's not right about the prescription, but he's right about what the need to move forward is.
COOPER: Let's listen to some of what he said to Larry earlier tonight.
MOORE, from the June 29 Larry King Live: The insurance company is the one deciding whether or not the doctor can perform a procedure or a treatment on a patient. I mean, just think about that. You go to see a doctor, the doctor says, I think you need this particular operation. But the doctor just can't order the operation or send you to a specialist. He has to call someone sitting in a cubicle, maybe 1,000 miles away, who can then give permission. And as you see in my film, the doctors who work at the insurance companies, they get bonuses for denying the most number of claims.
COOPER: Over the past 10 years, Karen, health care premiums have grown at four times the rate of wages and inflation, and insurance company profits have nearly tripled. You know, let's be honest. Insurance companies are for-profit businesses, and the way they maximize profits is by minimizing payments. Isn't that correct?
IGNAGNI: I saw that clip, and, in fact, there's another side to this story, which the point has been made by Larry King and others, that Mr. Moore never endeavored to see the other side of the story. First, Anderson, these are tragic cases. Anyone with, any human would say that. But now I think it's important, if we're going to be moving toward a solution, to find out is this a situation where there was a mistake? Is it a situation where the health plan, in fact, was interpreting the contract the employer purchased? Which is the case in the case that you just asked me about. Or is it an experimental process or procedure that employers simply don't cover? It's important to get the answers to those questions because it will guide how we proceed with health care reform.
COOPER: But, you know, just about everybody listening to this who's dealt with insurance companies on medical issues is not going to really buy that, you know, these mistakes happen or, I mean, we have seen plenty of cases. There's people interviewed in this film. We've seen testimony on Capitol Hill. There have been peer-reviewed journals. You know, I mean, insurance companies have people whose job is to retroactively look at big claims that have been paid out for any evidence that there might be some preexisting condition so they can, you know, deny the claim. Again, the bottom line is profit for these companies.
IGNAGNI: The case you're talking about is more than 15 years old, number one. We made some very different decisions 15 years ago than we make today. Our industry led the fight for independent external review because we wanted to give people a sense of peace of mind that, in fact, they could have another, a second opinion if they didn't agree with the decision. That's a very important difference.
COOPER: But it is, I mean, just so we're clear, you know, there are all these commercials from insurers about how, you know, they want to help people, and clearly, I'm sure there are good people who do want to help people. But again, the bottom line is profit and maximizing profit.
IGNAGNI: In every doctor's office, in every hospital, in every health plan, yes, it's true, in all of those situations. No margin, no mission. If you're not in the black, then you can't do your job. The individuals that we cover, 250 million of them, expect to have their health care coverage. We saw eight to 10 stories featured in the film, and, in fact, there was no attempt to get the other side of the story. And I know for a fact, because many of these cases are eight to 10 to 15 years old, there is another side of the story. In many of these cases featured in the film, it was simply a case where the health plan was interpreting, was this coverage purchased by the employer? Now, we can have a debate about whether employers purchase enough coverage. We can definitely talk about that. And what society's obligation ought to be. But that's a very different discussion. So if we're going to figure out where we go with the health insurance crisis in this country, the 46 million people who don't have coverage, we have to answer those questions very straightforwardly.
COOPER: We like to get all sides and let people represent themselves. Karen Ignagni, appreciate you representing your side.