The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

A European’s View of Sicko

Posted by Alan on July 2, 2007

I’m actually getting a bit bored of all the Sicko hullabaloo. To his credit, however, Michael Moore has created quite a conversation. Here’s an interesting take from Jurgen Reinhoudt, a research assistant at the conservative American Enterprise Institute. Mr. Reinhoudt is from the Netherlands and, besides researching single payer systems, he’s seen one first hand. The anecdotes he tells are frightening and he ably takes Mr. Moore to task for his one-sided, biased movie.


4 Responses to “A European’s View of Sicko”

  1. akatz said

    My apologies Mr. Reinhoudt. I was being a bit lazy. I couldn’t make the time to fact check your article nor was I interested in getting into a “he said, she said” argument with the other commentators. I wanted to get back to my message for that post which was that heavy reliance on anecdotes is a bad way to make public policy. So I did accept as possible that you might be distorting reality to make your point.

    The fact is, I’m in general agreement with your core assertions, I just wasn’t focusing on them in this post. There are clear flaws in government-run systems. And as we’ve seen in California and elsewhere, the flaws in the U.S. system are not limited to for-profit enterprises — non-profits engage in the same, and sometimes worse, activities. Your article sheds some important light on the health care reform debate, which is why I cited it in this blog.

    In the end, there’s usually a Rashoman aspect to most anecdotes. Instead of arguing back and forth about what really happened and why, I’m hoping we can focus on building a better way of handling health care in this country. The reality is there is no perfect system. The key is to focus on fixing what’s wrong with our current approach while preserving what works. You’ve made a valuable contribution to that debate.

  2. Jurgen Reinhoudt said

    Dear Mr. Katz,

    The use of anecdotes in the article was meant to rebut a central claim made by Michael Moore, namely, that government-run healthcare systems yield blissful results.

    In my article, never once do I state that the U.S. Healthcare system is perfect—that would be spin. Nor do I claim that government-run healthcare systems are cesspools of misery.

    Instead, I argue, to the best of my modest abilities, taking government-run healthcare systems in France, the UK, Canada, Cuba and the Netherlands as examples, that removing profit from healthcare and making healthcare a government-run program will not yield satisfactory answers to Americans seeking a better system.

    Your readers dislike the criticism and their responses seem to me to be stridently ideological; some seem outright angry.

    In one response, a reader claims that one of my examples is flawed, because “the woman mentioned was in fact seeking assistance from an out-of-hours privately run consultation line over a holiday weekend while her doctor’s office was closed.” But why was the doctor’s office closed? Why could she not speak to her physician? Why could she not get access for a pressing medical emergency? The reader immediately blames private companies—yet the main agent controlling British healthcare is the government. Similarly, many advocates of government-healthcare in the U.S. blame HMOs for many of the ills in our system and conclude that the private sector in general is to blame for problems in U.S. healthcare; but who created a system that relies so strongly on HMOs? To his credit, Moore shows the answer in his movie: the Federal Government.

    Many problems in healthcare, here and abroad, are government-created. Of course government is not the source of all ills in healthcare, or in society at large; far from it.

    But neither is a government-controlled healthcare system the solution to our healthcare problems, which your readers seem to believe.

    You don’t have to take my word regarding problems in the NHS. This is why I extensively refer to outside documentation in the article, which I trust you’ve read for documentation. Take this outside opinion:

    “despite all the extra billions spent by the Government, the NHS remains horribly overstretched. Too much money has gone on bureaucracy rather than recruitment of front-line staff and technicians. Hospital staff are overworked and exhausted. They do not have the time to carry out the necessary doublechecking to avoid errors. [.] The most recent survey of NHS standards shows that there are now almost one million incidents and lapses in hospital care annually. And according to the National Audit Office, there are around 2,000 avoidable deaths every year in the NHS, while another 5,000 patients die annually from infections acquired in hospital. This may be a conservative estimate. An official report last year said that up to 34,000 patients a year may die because of medical mistakes”

    writes Dr. Sarah Burnett, a consultant radiologist in private practice, in an article titled “Make no mistake, the NHS can kill.” (

    I do not argue that British healthcare is “bad”—only that it is not perfect, and in defending that assertion, I use not only statistics (such as official waiting list times in the UK, Canada, and peer-reviewed studies of deaths related to waiting lists in the Netherlands) but yes, also anecdotes.

    I take issue with your response to a reader’s post that I “may be distorting reality a bit to make his point” and that “If that’s the case [I’m] as guilty as Mr. Moore.”

    My article is based on facts, studies, statistics, and well-documented anecdotes. Its thesis is that government-run systems do not yield bliss. And that is a defensible thesis.

    Respectfully yours,

    Jurgen Reinhoudt

  3. akatz said

    Thanks for the feedback, Rb. It sounds like at least one of Mr. Reinhoudt’s examples distorts the truth. Another example of why public policy through anecdotes is so risky (the topic of an upcoming post). Like Mr. Moore, Mr. Reinhoudt may be distorting reality a bit to make his point. If that’s the case he’s as guilty as Mr. Moore.

    Personally, I believe public policy should be based on facts about the system, not anecdotes — as emotionally charged as those may be. For example, in Canada the provincial governments set annual global budgets for a hospital. If the hospital uses their budget up in November, they don’t schedule surgeries in December. That’s a documented reality of Canadian-style single payer system. That there are unacceptable waiting lists in Canada is also a by-product of their system, documented by the court decision ruling them improper.

    So, if Mr. Reinhoudt twisted or mistated facts, I apologize and urge readers to consider carefully any side’s use of anecdotes. Health care policy is complicated enough without propoganda and questionable information thrown into the mix.

  4. rb wootton said

    dear sir

    in your review of SiCKO you state:

    “The Mail on Sunday reported that “A woman died from multiple organ failure after consulting eight [NHS] doctors who failed to spot she was suffering from septicaemia… They diagnosed her with various conditions, including flu, food poisoning and colic… Her partner said the couple were forced to wait eight hours for a doctor to arrive on the Sunday before Miss Campbell died.”

    regarding your research and subsequent revision of same, it should be pointed out that the woman mentioned was in fact seeking assistance from an out-of-hours privately run consultation line over a holiday weekend while her doctor’s office was closed. they are not doctors or nurses, but are ‘consultants’ trained to literally stave people off during the hours and times when NHS surgeries and practices are closed for as long as possible, fobbing them off until their normal surgery (doctor’s office) reopens. she called that consultancy line numerous times over that 3-day weekend describing her symptoms, and they tragically never told her she sounded serious enough to go to hospital. they were reading from the script they were provided with, yet you make it sound like these misdiagnoses were going on over an extended period of time, and were conducted by any number of NHS doctors.

    this extraordinary incident which you use to deride the NHS is in fact a perfect example of what happens when PRIVATE HEALTHCARE COMPANIES are put in place of a social medical system. you chose a poor example, and restating the story leaving out crucial pieces of information does not strengthen your argument at all, in fact it makes Moore’s all the stronger. i live in the UK and while not a super-patriot by any means, your piece exaggerates and misstates a very isolated few incidents that do not even come close to the horrors of the private health care industry scenarios i encountered first hand myself when i lived in the states.

    your spin, exaggerations and revisionist history do not leave me at all impressed.

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