"Experience should teach us to be most on our guard to protect liberty when the Government's purposes are beneficient....The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well-meaning but without understanding."
-Supreme Court Justice Louis Brandeis, in a dissenting opinion in Olmstead v. U.S., 277 US 438, 479 (1927)
The disparate forces that have come together to make, promote, and use Michael Moore's film Sicko share an old and bankrupt collectivist agenda. But all of a sudden in 2007, their blueprint is hotter than ever and is being hyped as the final solution to the widely reported problems with American medicine.
In recent years, the dual operating systems for running health care delivery in the U.S.-an incompatible mix of the traditional for-profit private sector and the increasingly influential, federally-funded and -dominated bureaucratic model-have developed strategies and techniques that might serve to pave the road towards total government-run "universal health care" in the near future.
Before going any further, it is useful to consider the thoughts of British privacy expert Simon Davies
, a Visiting Fellow at both the London School of Economics and the University of Essex. The British have lived under complete socialized medicine, the National Health Service (NHS), since 1949, and, lacking the protections of an American Constitution, are considerably ahead of the U.S. in terms of monitoring, databasing, spying on, and controlling their citizens. People like Davies therefore have their work cut out for them. (It is not the purpose of this article to discuss the widely reported failures and breakdown of the NHS.)
In 1995, Davies published a seminal essay, "Superhighway to Dystopia
," in which he essentially predicted what is happening in the United States now, more than a decade later. A technological imperative is helping to drive, and is providing the mechanisms that enable, increasingly intrusive public policies that favor maximum control of the population and the alarming loss of personal freedom. All of this, Davies wrote, is made possible by sophisticated mass monitoring and surveillance, the merging of private and government databases (finally achieving the "perfect and total identification of human subjects"), and citizen complacency as "technology has spawned an age of mass pacification." As Davies noted, "The Big Brother society imagined by the world in [the past] depended on coercion and fear. The society we are developing now is more like Huxley than Orwell. It is Brave New World. Instead of the repressive tyrants and their omnipresent, brutal, and intrusive technology, the public is being brought to heel by a lethal expectation of compliance."
There is no other area where the developments that Davies warned us about have a better chance of coalescing into the ultimate matrix of domination than in the brave new world of socialized medicine that many people like Moore are heralding. Two linchpins essential to the success of statist health care delivery are Electronic Medical Records (EMRs) and Evidence Based Medicine (EBM). (See Part I
of this article.) A major stated purpose of Electronic Medical Records is to amass enough data to enable bureaucrat "experts" chosen by the government to measure "evidence" of medical "outcomes," and to determine which therapies, drugs, tests, and other procedures are supposedly the most effective, both clinically and in terms of cost, according to the current scientific fashions. The final step is to publish standards of practice that every doctor and health care professional in the country will have to follow. These clinical directives from on high constitute the EBM or Evidence Based Medicine part of the "E"-quation. Also part of the plan is to monitor much more closely-and to modify and control-an individual's behavior (eating, drinking, exercising, smoking, and other "lifestyle factors," and even whether or not a person takes his medication exactly as prescribed) with improved health status as the promised outcome.
In this kind of techno-Utopian world, however, the problem is that there can be no such promises.
In the U.S., the Federal Government has an Office of the National Coordinator for Health Information Technology
(ONC) at the Department of Health and Human Services (HHS) that is overseeing and enthusiastically promoting the creation of the new public-private national electronic health data and medical records network. Between 2006 and 2008, the ONC's budget is doubling to $118 million
a year. The office has been a favorite of both Democrat and Republican members of Congress, and there was a big role for health information technology (HIT) in the Clinton Health Care Reform plan of 1993-'94. After that proposal failed (it didn't even make it to a vote in the Democrat-controlled Congress), many individual elements of HIT went forward incrementally. The recently appointed (by President Bush) permanent director of the HHS HIT office, Robert Kolodner, M.D., who served on the Clinton Health Care Reform Task Force, said
at a meeting on IT at the Institutes of Health on September 19, 1999: "Like it or not, when IT comes in, there will be a fundamental change in the whole process of care and who is delivering what care."
The use of EMRs and EBM is much further advanced in the UK, which has had socialized medicine for 59 years. An indication of how the already intrusive nanny state there is continuing to expand based on what EMRs and EBM make possible came on June 27, 2007 with the publication of an article in the London Telegraph, "GPs to screen every patient for heart risk
." According to the story, "Millions of people could be prescribed cholesterol-reducing statins [drugs] under guidelines published today by the Government's drug-rationing watchdog. GPs will be told to draw up a 'systematic strategy' to identify which patients on their books are most at risk of developing heart disease. These patients will then be called to their local clinic or health centre for blood tests to measure their cholesterol levels. . . People who are found to have a 20 per cent or greater chance of developing cardiovascular disease over the next decade will be prescribed statins to try to reduce their cholesterol. However, GPs will also be encouraged to help patients to change their lifestyle, whether it is giving up smoking and alcohol or exercising more." Statins, a category of drugs that inhibit an enzyme the body uses to produce cholesterol, are not without side effects and risks
. One wonders what degree of choice in the matter, if any, people in the UK who are identified as candidates for the statins will have (to refuse the drugs, opt for another therapy, and so on).
The bottom line here is that the days when the practice of medicine was a highly individualized science and art of healing, with the doctor-patient relationship paramount, sacrosanct, and protected, are gone or going fast. From now on, especially if universal health care becomes the norm, there will be fewer unique treatments actually available to the patient, and instead more rigorous enforcement of the "approved" ones (à la the British model described above). If the doctor wants to get paid (or to stay out of jail), he will have to kowtow to the new official government cookbook of allowed and approved medical practices, and avoid the verboten ones. To ensure compliance, the government will be looking over the physician's shoulder as he electronically documents and communicates to the central databases everything he knows about and has done for his patients, down to the minutest details.
But Where Is the Evidence?
All of the jargon, including things like "evidence based medicine," can sound impressive, especially to a lay public that's been dumbed down and conditioned to accept scientism as the modern religion. So it may come as a shock to learn that the actual evidence for evidence based medicine is really quite thin or even nonexistent.
Like much about the complex field of modern medicine, the data pointing to EBM's lack of efficacy is buried in the pages of difficult to decipher professional scientific journals, mind numbing think tank policy papers, obscure government reports, and the experiences of other countries that have experimented with EMRs and EBM. An excellent, easy to understand overview is provided by Bernadine Healy, M.D., former director of the National Institutes of Health and currently the Health Editor
for U.S.News & World Report (USNWR). Last September 11, in her USNWR column
, Healy wrote "Evidence-based medicine has the ring of scientific authority. But it's not as self-evident as it sounds. . . Touted as a way to improve patient care and restrain unnecessary treatment, EBM sees itself as a major shift away from traditional medicine that emphasizes the expertise of the medical profession. That includes knowledge of the underlying nature of disease, mechanisms of therapy, basic and clinical research, and physician experience. The autonomy and authority of the doctor, and the subsequent variability in care, are the problems that EBM wants to cure." And most important, "EBM carries its own ideological and political agenda separate from its clinical purpose."
In other words, it's made to order for a political provocateur with an ideologically-driven agenda like Michael Moore.
In 2006, the peer reviewed scientific publication International Journal of Evidence-Based Healthcare
published a seven-page "Scholarly Article" titled "Deconstructing the evidence-based discourse in health sciences: truth, power and fascism
." The four authors are academicians (Ph.D.s and R.N.s) at the University of Ottawa and Ryerson University in Toronto. The first two sentences of the article provide a summary: "The objective of this paper is to demonstrate that the evidence-based movement in the health sciences is outrageously exclusionary and dangerously normative with regards to scientific knowledge. As such, we assert that the evidence-based movement in health sciences constitutes a good example of microfascism at play in the contemporary scientific arena." The authors take pains to defend their controversial use of the word "fascism," and Healy, in her USNWR column
, seems to agree with them: "Though harsh," she says of the lead author, "he makes a point: By anointing only a small sliver of research as best evidence and discarding or devaluing physician judgment and more than 90 percent of the medical literature, patients are forced into a one-size-fits-all straitjacket. Ironically, this comes at a time when both human genomics and informed patients are demanding more tailored and personal prescriptions for care."
Also weighing in on these issues is the Citizens' Council on Health Care
(CCHC), which released a report
in December 2004 "How Technocrats are Taking Over the Practice of Medicine: A Wake-up "Call to the American People." A CCHC news release
about the report describes it as "shin[ing] a bright light of openness on the terms 'evidence-based medicine' and 'best practices,' including the purposes of proponents and the concerns of critics." According to Twila Brase, CCHC founder and the report's author, "Evidence-based medicine is an attack on the patient-doctor relationship. EBM is not individualized care. It is group-think medicine. . . Control over medical decisions is being shifted from doctors to data crunchers; from professionals at the bedside to bureaucrats in big offices. . . The public should not be fooled by the nifty-sounding names. Evidence-based medicine is managed care masquerading as science."
It should be noted that most of the proponents of government-run universal health care (ranging from requiring that all U.S. residents buy government-approved medical insurance to single payer) highlight both EMRs and EBM in their prescriptions for reform. That includes the leading Democrat candidates for president in 2008, and even many Republicans (President George W. Bush
is also a major proponent of EMRs, as is former Health and Human Services Secretary and 2008 Republican candidate for President Tommy Thompson
). Sen. Hillary Rodham Clinton (D-NY) cites the necessity of both EMRs and EBM in her "7 Point Plan for Health Care Refom
." On June 25, 2007, health care and public health policy writer Matthew Holt noted
"both Sens. Hillary Rodham Clinton and Barack Obama's [D-IL] health plans both place a lot of stress on expanding the use [of] electronic medical records. Obama's plan suggest [sic] a federal program of $10 billion a year to help physicians get these records. Both Senators and even the trade association of American private insurers support the creation of a federal agency that will perform a role somewhat similar to that of the [one] played in the UK by the NICE
" (National Institute for Health and Clinical Excellence). NICE, by the way, is responsible
for the new NHS policy to screen everyone in the UK for heart disease and to mandate drug treatment for those deemed to be "at risk."
Thanks mostly to politicians who use these terms as self-serving buzz words, concepts like universal health care, electronic medical records, evidence based medicine, and their accoutrements may have attained a certain mystique or cachet. But when you consider their actual lack of evidence, their reinforcement of a one-size-fits-all cookbook therapy approach, and the ominous and unprecedented threats to Americans' personal privacy and freedom represented by things like EMRs, they appear more like a Faustian bargain than ideas whose time has come.
Cuba Si! Yanqui No!
The rhapsodizing by Michael Moore and many others of life in communist Cuba suggests a deeper, darker, and much sicker belief system and motivation beyond simply reforming American health care or making it "more affordable." Sicko, with its brazen, uncritical, and positive view of socialism in action beyond socialized medicine, is the new Exhibit A helping to prove the case that these agendas are seriously skewed.
Another indication of an interlocking nexus of insidious agendas at play among universal health care proponents-even among supposedly objective mainstream journalists-was on display in a particularly obsequious news media report about Moore, Sicko, and Cuba that aired twice on CNN's Situation Room With Wolf Blitzer on June 28. The purported objective was for CNN's Havana correspondent to compare how Moore's Sicko portrays Cuban health care with the reality on the ground in the impoverished island nation. CNN anchor Wolf Blitzer, according to the network's transcript
, introduced the segment by trying to play God and interpret Moore's motivation: "He feels he's helping diagnose a sick society" (meaning the United States, of course). Things went downhill fast from there.
Addressing Blitzer on camera from Havana, CNN correspondent Morgan Neill said: "Wolf, in Moore's new movie, Cuba is painted as a sort of health care paradise compared to the United States. We took a look at just how that picture holds up." Next up were clips from Sicko, which included Reggie Cervantes, an American Ground Zero rescue worker who complained of not being able to get help for her 9/11-related respiratory problems and who Moore took to Cuba. Cervantes: "It's the same kind of care we got here. The difference is, there is no bill." On camera again, CNN correspondent Neill intoned: "Is that really how it works? Just about. Actually, foreigners, or at least those of us not involved in making movies, usually do have to pay for our care. And it's worth pointing out, there are separate hospitals, like this one [in the background] for non Cubans. Nevertheless, Moore's central point is valid. For Cubans, health care is universal and it is free." Aside from the fact, that is, that foreigners usually are required to pay something and there are several significantly different tiers of care, depending on one's status, influence, wealth, and other factors.
CNN then showed a woman identified as "Gail Reed, an American journalist who lives here, [and who] co-produced a documentary [¡SALUD! or "Health"] on Cuba's health system." On camera, Reed said: "They [the Cubans] concentrate on prevention. They concentrate on bringing services closer to people's homes so that the big-ticket items don't really take up, don't sponge up all that small budget they have."
Although there was a brief mention of a Cuban American filmmaker who is critical of Moore and a sound bite thirteen words long from a video he presumably posted on YouTube, correspondent Neill's conclusion was: "Cuba's health care achievements are impressive. According to the World Health Organization, life expectancy on the island is 77.1 years compared to 77.3 in the U.S. And infant mortality rates are actually lower in Cuba. All of that, while spending roughly nine percent what the U.S. spends on each citizen per year."
Anyone could have gotten that level of insight (a.k.a. misinformation/propaganda) simply by listening to Moore.
I was curious about Gail Reed, the Havana-based "American journalist" who co-produced ¡SALUD!
and who obviously impressed CNN. Not surprisingly, Ms. Reed and her colleagues on ¡SALUD!
are on the far left end of the political spectrum. Her co-producer is Peter Bourne, M.D.
, a close associate of former President Jimmy Carter during the 1970s who ultimately served as Carter's White House health advisor. And Reed, who CNN identified as a "journalist," is actually the international director of something called the Medical Education Cooperation with Cuba (MEDICC
Like SiCKO, ¡SALUD! is hardly an objective film. It's described as "exploring Cuba's contribution to global health" and it's being shown around the United States at benefits for left wing organizations
The international attention on Sicko is reportedly rubbing off on ¡SALUD!
and it seems to be helping Cuba gain attention and credibility for its health care, as well. On June 15, Cuban Health Minister Dr. José Ramón Balaguer, according to an article written by Reed
at the MEDICC Web site, answered a "marathon" round of questions from people in 60 countries during a two-hour Internet session. Reed wrote that "organizers said most of the questions were sympathetic to Cuba's programs." Balaguer had special praise for Moore and Sicko: "Such a film by a noted person like Moore undoubtedly brings the world a better sense of our humanistic principles."
The review of ¡SALUD! in The Militant sheds some additional light on the ideology, motivations, and agenda of people like Reed, Moore, and their associates and followers: "The reason Cuba was able to implement a universal health care system, providing medical care to all and sending internationalist medical brigades all over the world, is because Cuba made a socialist revolution. . .
"It is impossible for any country to emulate Cuba's sterling example in the world in health care without making a socialist revolution and forging the kind of leadership that puts the interests of humanity above everything. As the Argentine-born leader of the Cuban Revolution Ernesto Che Guevara
[himself an M.D., by the way] put it, to be a revolutionary doctor you must first make a revolution."
Meanwhile, after Cuba (and France), Michael Moore is reportedly planning another foreign trip. According to a news release by the Iranian Students News Agency (ISNA) datelined Tehran July 2 (complete with an unusually flattering photograph of Moore, minus his trademark baseball cap), “Writer, producer and director, Michael Moore is to come to Iran for the screening of his new production SICKO in the first international documentary film festival held here. This festival will be held from the 15th to the 19th of October in Tehran.”
was among the publications that reported earlier this week that Michael Moore would be going to Iran in the fall to screen Sicko
there. The headline on the brief USA Today
story on July 2 was "Moore will show off latest film at Tehran film festival." (On July 5, a Google cache version of the original USA Today
page, which has since been changed, is here
.) The source was a July 2 USA Today has subsequently described
as "a somewhat independent and generally respected source of news and information from Iran."
On July 3, USA Today
followed up with a "correction" to their story, and more information
at their blog "On Deadline," based on a statement posted at Moore's Web
site by Meghan O'Hara, Producer, 'SiCKO' on July 2 at 10:30 pm denying that a trip by Moore to Iran is in fact planned - and blaming the "right wing" for spreading the "rumor" about Moore making the trip.
In fact, the original source, as USA Today notes, was the ISNA. In light of Moore's affection for Cuba, the report about him traveling to Iran to screen his film certainly seemed plausible. Citing the ISNA, and aware that it had been confirmed in USA Today and elsewhere, I reported the news in Part II of my article which was submitted to American Thinker early on on July 3 and went online on the evening of July 4 (PDT).
Peter Barry Chowka, a former advisor to the NIH, is a widely published investigative journalist and medical-political analyst who specializes in reporting on the politics of health care and innovative therapies. His Web site is http://chowka.com/.