The Tragicomedy of American Healthcare: Michael Moore’s Sicko, & How We Do Things in the SF Bay Area
When Michael Moore—a filmmaker and former Eagle Scout, who went to seminary to become a priest—solicited health care stories from his e-mail list, he got a flood of responses. He reported in a PBS interview, “I put out a call for people to send me their health care horror stories. I got over 25,000. It was appalling to sit there for literally months and read what they had to go through.”
The massive health care industry is 15% of our gross national product. “I am tilting at a pretty big windmill here,” said Moore, “but we have to do something about this because it’s criminal that we let 47 million of our citizens go uncovered, uninsured, and we allow the profit motive to be involved in a hospital or doctor’s decision-making process.”
I was not spared Moore’s agony by my tiny interviewee group of four San Franciscans—two housed but at risk of homelessness and two unhoused—who shared their health care stories.
Says Moore, “There are nearly 50 million Americans with no health insurance. They pray every day they don’t get sick because 18,000 of them will die this year simply because they are uninsured.” Moore tells the story of Rick, a hopeless romantic, who decided to have his ring finger surgically re-attached. After slicing off two digits in a carpentry accident, one re-attachment was all Rick could afford.
“But, this film isn’t about [the uninsured],” continues Moore. He narrows his focus to “Those who are living The American Dream, the 250 million of you who have health insurance.”
My four uninsured subjects live in a lower circle of suffering, nowhere near those at the “Dream’s” loftier heights.
Through my four interviewees, I have reviewed Moore’s film Sicko from a somewhat broader perspective: My subjects’ stories expose the ways that the “broken” medical care system’s evil geniuses—insurance companies, providers and facilities, and the government’s social security disability program—conspire to screw both insured and uninsured, housed and homeless, 25- and 75-year-old Bay Area sick and wounded health care recipients.
Howard Vicini
Howard Vicini, 58, whose medical stressors have rendered him both insured and uninsured and put him at risk for homelessness, told me, “I straddle the fence with this story.”
Howard has suffered intractable pain for years. He spoke to me by cell phone on his way to a meeting. When, I kidded him about multi-tasking: walking, talking, and thinking, he replied, “I sometimes have trouble doing two things at once.”
In 1975, as a young culinary worker, Howard worked on the Alaskan Pipeline. A huge pile of negligently un-shelved frozen meat boxes toppled, pinning him on a freezer floor where he lay alone for 45 minutes, his back broken at lumbar vertebra L4-L5 and L5-S1. Though dazed by shock, like many responsible employees, he worked three more days, then collapsed.
He underwent two back surgeries in Anchorage. The strain from his lower back ruptured a neck disc.
In 1977, following his doctor’s death in a plane crash, he moved to San Francisco for medical care.
During Howard’s work hiatus on COBRA, his doctor left for a honeymoon forgetting to pre-authorize his patient’s sixth back surgery. Even though the doctor admitted culpability, Howard’s carrier wouldn’t relent and give him coverage.
He appealed to Social Security arguing, “I’ve proved my incentive working for 22 years paying into Disability since I was hurt.” They agreed and promised, “Give us 90 days. We’ll restore your Social Security Disability [allowing him Medicare for the surgery], then you can return to work.”
“Three-and-a-half years later in 1993, I was on my third appeal.” Forced to stop working, “I hit bottom really fast.” Four neurosurgeons said the delay made his spine inoperable.
Pain prevented his continuing a second career earning $50,000 to $75,000 yearly in graphic arts. By 1997, surgical co-pays depleted 22 years of savings. “I lost everything I worked for and went on General Assistance.”
From 1995 to 1996, he moved from a three-bedroom condo to a warehouse to sleeping on a friend’s living room couch.
His lawyer explained that, even in an age of the wonders of the x-ray, Social Security disallowed “invisible disabilities.” Although in extreme neck, back, and leg pain from progressive stiffness, fusion, and nerve scarring in upper and lower back, he used no visible assistive prosthetic appliances like crutches or a wheelchair—devices you can see.
This led to the ultimate indignity: A psychiatrist made the case that Social Security drove him crazy, thus rendering him mentally incompetent.
Disability payments provide a tiny income covering very low rent. Though still in constant pain, he must earn about $200 a month “to scrape by.” Need for knee surgery interferes with his doing this pick-up work.
“The most crushing thing is that, despite doing everything I was supposed to and more, I suffered for my surgeon’s error. This led to a nightmare of Biblical proportions. I don’t know if people realize how close they are to the same situation.
“Thanks to Michael Moore for spending his money to get this important issue out there.”
Howard supports passage of Senate Bill 840, the California Universal Healthcare Act, which will deliver insurance companies to the scrap heap and provide health care for all Californians, including dental, vision, and prescription drugs.
Mesha Irizarry
Mesha is an acutely ill diabetic patient, who had Kaiser Medical insurance from 1980 to 2002.
When Mesha warned a Kaiser nurse that giving a diabetic a glucose solution might cause her death, the woman said, “shut up,” and hooked her up anyway. Mesha lost consciousness and spent six days in intensive care. She did not file suit. Kaiser gave no response to her suggestion that Quality Care re-educate staff on diabetic patient procedures.
Mesha’s other pre-existing medical conditions, which make difficult her ability to obtain insurance, slide away into the blackness like the Sicko list, backed in Moore’s movie by Star Wars music:
- skin cancer
- insulin-dependent diabetes mellitus
- osteoporosis
- acute vertebral neck arthritis
- spinal compression fractures with height loss
- hypothyroidism
- high cholesterol
- acutely painful diabetic peripheral neuropathy in hands, legs, and chest
- carpal tunnel syndrome
- malaria contracted in West Africa in 1969
- stomach ulcers
- malarial liver damage, possible hepatitis
- severed sural nerve in both ankles to stop diabetic neuropathic foot pain which prevented her from walking (Mesha cannot feel her feet and is prone to falls, burns, or injuries)
- painful varicose veins in legs around knees
- post-traumatic stress disorder
Her son, Idriss Stelly’s, SFPD shooting death on June 15, 2001, at San Francisco’s Metreon theater, made her unable to work. In a year of unemployment following this trauma, she lost all benefits. Post-traumatic stress disorder caused two suicide attempts on March 15, 2002 and March 15, 2005. “The suicide trigger was the shooting death of Richard Timms, who was black and disabled like my son.”
Nevertheless, she won a wrongful death suit against the SFPD establishing the Idriss Stelly Foundation to help police brutality victims. The Foundation supplies direct services and financial support to clients.
She experiences terrifying flashbacks seeing spinning bullets and hearing shots in her head. She lost consciousness in the Metreon elevator when she visualized bullets flying at her from the circular metallic pattern on the elevator walls.
In 2002 and 2006, Social Security denied Mesha Permanent Disability, knowing she was incapacitated by panic attacks, and chronically ill. After a physical and psychiatric examination, they wrote, “there was nothing that could not be fixed” and she was deemed fit for full time employment.
“When I applied for Social Security in 2002, I had Kaiser insurance.”
She escaped in humiliated tears from two Social Security Disability intake visits after the worker’s disdainful treatment—nonverbal hard looks, “that screamed, ‘Lady, we know you are scamming, and it’s not going to work.’”
“It’s all tied in,” says Mesha. After subjecting you to a “horrible intake,” you are sent to Market Street Medical Center, an Indigent Care facility, to sit for hours, waiting to be given physicals and psychiatric evaluations by Social Security-appointed doctors. These medical professionals avoid eye contact with you, testing, and sending you on your way.
“I was never acknowledged by my name.
“I told the doctor, ‘I am here today because the police killed my only child.’ He did not blink or bother to say, ‘I’m sorry for your loss.’
“You are cattle, a number.
“I am not biased; nor do I hate that system. I worked eight years, 40 hours a week, at San Francisco General doing medical rounds every morning. From 1986 to 1995, I was a full-time contract Shanti bilingual counselor, therapist, and French/Spanish interpreter, visiting AIDS patients in jail, on the psychiatric facility, in intensive care, in Emergency, the AIDS ward, and all the HIV wards. I counseled their families. From 1995 to 1997, Mesha was Shanti program director.
In June 2007, because of her diabetes pre-disposition, Kaiser-Permanente denied Mesha full monthly coverage of $365 for hospitalizations, medications, and ambulance, all of which she frequently requires.
With the rest of Mesha’s money, she purchased a private insurance policy from U.S. Health, at charges of $239 a month for diabetic supplies and 30% of medical bills. Two thirds of it must still be paid by Mesha.
Six years after the award of the $250,000 settlement for her son’s wrongful death-by-cop, the $50,000 from the recent sale of her house is her only remaining asset.
When medically uninsured, Mesha went for care at San Francisco General Hospital, she thought her indigent status would absolve her from payment. However, her bill was assessed at $14,000. The City Tax Collector’s threats to seize her assets could slice her savings by half, and threaten to end her housing.
Michelle Malone
This attractive, 53-year-old black-haired young woman sat waiting in a Tenderloin drop-in center to sign up for a bed for the night.
“Last week I had a really bad toothache.” Without major work on her teeth, she fears job-hunting will be fruitless. At San Francisco General, the urgent care doctor doled out ten pain pills and wrote a referral to the oral surgery clinic, “which was a painful four or five days later.” She waited from 8:30 a.m. to lunch. After dental students probed her teeth and took x-rays, they sent her to the billing office. The clerk announced, “We’ll need $1,700 before we start any work.”
“What?” cried Michelle, “You know I am homeless and have no money. Why have you wasted my day here knowing you couldn’t help me!
“I found out later they get paid by Medi-Cal for the examination and x-rays.”
I asked her what was happening with her teeth.
“Nothing.”
Michael Moore points out the industry disparity between the white upper and middle class and the poor and people of color who, “always get slapped down first.”
“We rarely talk about how dentistry isn’t covered. Yet so many things begin because people have bad teeth.” You don’t become a very well person if you are forced to eat mushy foods and can’t chew healthy fibrous fruits and vegetables.
Chucky
This 26-year-old homeless red-head was well-traveled—a conservative Army brat who, “likes to use the proper channels. I’m not a big fan of Michael Moore.”
Unhoused a third of his two years in San Francisco, he job-hops to earn more money.
At St. Francis Hospital, Chucky witnessed a event of “hospital dumping,” an atrocity Michael Moore films in Sicko.
This homeless Viet Nam vet co-worker got falling-down drunk, urinating and defecating on himself. At St. Francis they incinerated his clothes.
“He told us, ‘They’re going to make me walk out in a wrap-around hospital gown. Your ass hangs out. It’s gross!’”
Chucky and a friend, armed with a video camera and threatening a law suit, talked to the hospital administrator. Shortly thereafter, the homeless vet left the hospital dressed in clothes delivered by a security guard. Despite his respect for the chain of command, Chucky observed, “In San Francisco, you gotta scream to be heard.”
This article is dedicated to Ellen and Terry.
Carol