Dear FRONTLINE,

Please tell T.R. Reid that the level of his objectivity, competence and overall professional journalistic skills makes Michael Moore's "Sicko" seem sooo sophomoric and inept.

Michael Moore FAILED his audience. T.R. Reid did the leg work, dragged his knuckles throught the details as best he could for the duration of a show he had and did an workman like job.

THANK YOU Frontline for putting out quality content. I don't feel like I'm being talked to like I'm some kind of ignorant simpleton as did Michael Moore.

John Favre
Denver, CO

Dear FRONTLINE,

Affordable and available health care and insurance is the most important issue for me, but I feel it is far down the list of priorities in the political campaigns. Hopefully a program like this will get more people thinking about the alternatives. The idea that change can occur - and must occur - needs to be embraced.

Two of my children were born in Japan in 1977 and 1981. My former-husband and I were on visitor visas - not even Japanese citizens - and we were given the same benefits and care that our Japanese friends received. Medical care was perhaps more basic and less consumer-informed than in the US, but it was thorough and comprehensive. Certainly there was no paperwork nightmare as can happen with insurance companies in the US.

Polly Whiteside
Lakewood, CO

Dear FRONTLINE,

Do police departments make a profit? Do fire departments make a profit? Why are there for-profit hospitals? Insurance companies are responsible to their shareholders, not to their customers (patients). This should be the first area addressed in changing our health care system. Uninsured and under insured people are awaiting to seek care far too long because they do not have or cannot pay. By the time these people come to the hospital they are in dire straights and it will cost much more to treat them now. The hospitals have to make up the cost somehow, so they raise their prices, which get passed on to the insurance companies. The insurance companies are not going to take the loss, so they are going to raise their premiums. So in the end people with health insurance in this country are paying for the people without it and industry is making a profit. It is appalling that the US has the highest % of GDP spent on health care but the lowest life expectancy and highest infant mortality than the other five countries. Why are we spending so much but getting so little in return? The focus should also be on prevention and education. But there is no money in prevention and education. Money is to be made in medicine, medication and treatment, and diagnostics. As one of prior comments strongly suggested, why is there no mention of nurses? There are about 500,000 physicians and over 2 million nurses in the US and not one mention of nurses in the program. Sad really. As a Professional Registered Nurse I see potential nurses could have to help this problem, but no one is asking and unfortunately, nurses are not talking. Does anyone outside of health care even know what nurses really do? More importantly, what nurses could really do if we were given more autonomy as health care providers. I am not trying to take away from physicians, but nurses could be agents for change in our health care system. I suggest our national nursing leadership step up to the plate and be the voice for nursing that you should be. I also suggest the national, state and local politicians find out what a huge untapped resource nurses are. Everyone deserves quality health care. I believe that the `free market' system we have now is socially unjust and the focus needs to change from profit for a few to access for all.

R N
Seattle, WA

Dear FRONTLINE,

The first question that Americans must ask themselves when discussing this issue is whether we want to live in a civilized society or a barbarous one. If we choose to live in a civilized society, we must begin the discussion with the premise that all Americans must have full coverage. I have been in medical clinic administration for 15 years. I could write a long book about the scores of patients (read: fellow Americans) that have been nickled & dimed and abandoned by what passes for the provision of healthcare in our country. Answer the first question and the answers to the other questions will become more apparent.

Diego Taylor
Del Rio, Texas

Dear FRONTLINE,

I enjoyed the show and think that there were some valid arguments but like Mr. Reid, I have lived in some of the same countries he has and my experience is somewhat less glowing.

I am currently in Japan and although the cost is very cheap, the options are limited. More troublesome, and something which has received a great deal of reports in the last couple of years is the number of hospitals which can refuse treatment. There have been highly publicized cases of pregnant women, in an ambulance, being refused by upwards of 30 hospitals resulting in the death of the woman and/or the baby. I also was involved in a life threatening medical emergency and was denied admittance to upwards of 10 hospitals. You are supposed to call an emergency room before you show up to see if they can accommodate you and if you just show up (which we did after being turned down by 6 hospitals over the phone) they will still turn you away. My own story was documented and published and I am not alone.

I have a friend who is Japanese, married to a physician in Japan and she flew to the United States and had her baby there. Her child had some complications and had to stay in a hospital in America for a week after birth. Even though she had to pay it all out of pocket she still preferred the care over what was available to her in Japan and she also knew that if she was unable to pay, and despite what the media would have you believe, she would not have to pay. Right or wrong you cannot be denied medical care in America for lack of funds.

As I tell my friends and family in America, if it sounds too good to be true, it is. And having experienced medical care in other countries I still think that America has the best coverage.

Shibuya-ku, Tokyo, Japan

Dear FRONTLINE,

As many of the other respondents aptly noted, Mr. Reid ignored many other areas of relative inefficiency in our system. I wonder how much money is spent on advertising not by pharmaceutical companies, but by hospitals and other providers, and how much more care for the poor could be provided, or providers/nurses better paid, if these funds were put to better use. The media, of course, ignores this because they are the beneficiaries of all the advertising dollars. I wonder what the advertising/PR budgets are like in these other countries?

I would also be skeptical about our government's ability to get the results it desires with legislation. The HIPPA bill (Kennedy/Kassebaum) was supposed to allow one to transfer insurance coverage from one job to another, and maintain it during times of unemployment. It seems to have done none of and this while imposing unfunded mandates upon healthcare providers at all levels, and in my view as a physcian, severe inefficiencies. Obviously, the approach in Taiwan goes in exactly the opposite direction. Besides learning from other countries, we must also realize that our own legislation often does not produce the expected results.

Manalapan, New Jersey

Dear FRONTLINE,

Thank you for a much-needed survey of how other countries make health care available to all.

But you do a disservice when several times during the show you wondered whether "Americans" would accept such a large government role in the health business, repeating the commonly-held view that Americans are suspicious of government. I think this supposed aversion to government involvement is a myth spread in large part by the private health industry. And unfortunately, you repeat it.

I think if we could scrap our system and adopt any one of the health systems the show describes, Americans would be elated...unless the media keeps harping on the supposed perils of government involvement.

Avi Bortnick
New York, NY

Dear FRONTLINE,

Finally someone looked at what other coutnries are doing to see what we can learn from them. Very good coverage from all sides: government, patient, insurance company, physician, etc. I hope that our three political candidates have seen this. If not, you should send them a copy. Or run for office so you can help them fix our US Healthcare issues. No one should go without care, especially the elderly and our children.

DeAnna Coleman
Nashua, NH

Dear FRONTLINE,

Another excellent Frontline. One statistic that struck me was that 30% of Swiss pharmaceutical profits are from American consumers. My guess is that this statistic is similar around the world. Why don't Americans realize that by avoiding negotiations with drug companies, we are effectively paying for other countries pharmaceuticals?

After some digging around, I found that this is exactly the point made in the Uwe Reinhardt interview, which apparently didn't make it in the show. In a global marketplace where other countries are imposing price ceilings, it makes no sense for America to unilaterally "leave it to the market." We should instead be using market principles to implement policies which benefit Americans - namely, to stop paying for Switzerland's drugs.

Palo Alto, CA

Dear FRONTLINE,

I enjoyed the program. It supplies a lot of information about other countries' health care systems that is difficult to access and interpret.

I hope you can produce a sequel that will help guide us through the process of deciding what we want, and implementing it. The political problems are three: 1) There are powerful interests who will oppose change for financial reasons, 2) Most Americans are insured to some extent, and are afraid of losing something they value, and 3) Most uninsured are not ill, and are too busy and too unempowered to participate in the debate.

Frank Turner
Eugene, OR

Dear FRONTLINE,

This show was an excellent commentary on the current health care crisis that exists in the U.S. By the end of the program, I would have gladly accepted any one of the health care systems in the several countries visited with my deepest gratitude. Having been without regular health care or health insurance for many years, I am now eligible for an employer based health insurance plan but find that I am too poor to afford either the deductible or the co-payments, but not poor enough to qualify for the State funded managed care program. I agree with the consensus that health care is a basic human need and that everyone should have the right to good health care. Access to the health care system should be equal for all regardless of income level or ability to pay.

At the age of fifty-eight years, I would welcome our Government's involvement in mandating that change take place in the Health Care Industry and in helping to restructure and direct that change. Any of the health care systems implemented by those countries examined in this program would be an enormous improvement. The sooner the better.

Katherine Reidy
Tulsa, Oklahoma

Dear FRONTLINE,

Dear FRONTLINE,I noticed that the family physician in Germany, who makes a fraction of the income compared to family physicians in the US, did not have to pay for medical school. I am a medical student who will graduate with nearly $130,000 in student loans, most of which are accruing interest at 6.5%. If the US works to reform the healthcare system in a way that reduces income for doctors, it is important to also address the cost of medical education. As a future doctor, I don't mind the idea of being paid less if it means that we have improved our healthcare system. However, the amount of debt that medical students acquire and must repay is daunting!

Brigitte Smith
Madison, WI

Dear FRONTLINE,

Three major forces were covered in the multinational study and in the Frontline story: physicians, health care systems and settings/hospitals and payment/access mechanisms.

However, once again, the enormous service and profession that was entirely ignored, overlooked and taken for granted is that of professional nursing. The almost three million registered (professional) nurses in the US provide about 95% of all reimbursed health care services, given the 24 hour 7 day a week nature of much of nursing care.

However, nursing is afforded zero reportage in traditional media. Nurse experts are not consulted on any health care stories. Nursing research is rarely cited in health care stories, and nurses languish in unacceptable practice settings by virtue of their status as employees instead of as autonomous professionals.

Nursing is charged via social contract and statute to serve as a patient safety advocate, and it is the presence of nurses educated at a baccalaureate level or above which significantly impact patient morbidity and mortality rates.

No discussion of health policy or health care systems should ever exclude professional nursing, the scope of practice of nurses and the critical relationship professional nursing has with the health of individuals, families, communities and societies.

Failure to include nursing in health care discussions leaves the public uninformed about issues which have direct affects on their health. For example, the nursing shortage affects all health care services across all settings and patient populations.

The dearth of nursing faculty is a direct result of horrid work conditions and abominably low salaries - not even on a par with the most novice two year technical graduate in a first clinical position.

Clinical nurses do not have the opportunity to interact routinely with nursing researchers and educators. There is no formal educational requirement for nurses past licensure other than state by state diluted continuing education modules. And there is no mechanism for standardized curriculum development and implementation for novice nurses to have guided and mentored clinical practice. Orientation and training to employer policies and procedures is not standardized and serves the employer to the detriment of the nurses' clinical education and practice development.

Add to that the fact the nursing service leaders are no such thing. They are nurses selected and hired by patient care employers. These nurses exhibit corporate loyalty over loyalty to the nursing profession, their nurse colleagues and to patients. Indeed, the nursing managers and executives broke away from the national professional organization - the American Nurses Association - and formed the American Organization of Nurse Executives as a subsidiary of the American Hospital Association, which has direct and competing interests with nurses.

Until nurses have full autonomy to practice as professionals with publicly acknowledged legitimacy and authority over their own practice, patients suffer - preventable errors, preventable harm and preventable deaths. Nurses traditionally travelled to where patients are: tenements, rural areas, reservations, ghettos, and other areas where all other helping professionals loathed to tread. But in the unregulated free market, when nurses attempt to practice in areas which are not under-served or unserved, suddenly the physicians come out swinging accusing nurses of threatening the health of patients - and no one questions that assumption, which is spurious and is not based on any legitimate evidence.

Back to this story, though. In the links and references, there is not a single nursing related resource.

May I suggest a few?

The American Nurses Association http://nursingworld.org/The Online Journal of Issues in Nursing - hosted by the ANA at http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN.aspxThe National Institute for Nursing Research http://www.ninr.nih.gov/The American Association of Colleges of Nursing http://www.aacn.nche.edu/

Newton, MA

Dear FRONTLINE,

I think the most important question asked during the program is whether Health Care is a universal right. I venture to guess the majority of Americans would answer yes to that question.

The only reason we don't have Universal Health Care is because we are suckered into debating minutiae that inevitably distracts from the over-riding goal of Universal Health Care.

I propose we exert our democratic powers and demand a National Referendum much like Switzerland has done. If we make it crystal clear to our politicians that the majority of Americans want Universal Health Care, I'll bet you they will find a way to make it work.

Damien Vu
Los Angeles, California

Dear FRONTLINE,

Overall, I think this was an excellent program, showing what we might be able to learn from other countries, what they have done well, and what they have not done well. One comment I found troubling, that I think a rational health care system should not endorse, is the notion of alternative medicine such as homeopathy being included in a national health care system. I don't think the program was endorsing this, but it did seem to leave open the idea that homeopathy is a legitimate form of medical care, when in fact the scientific basis for homeopathy has long been disproven, no scientific study has ever found a legitimate method by which it could work, and no study has ever proven that it does in fact produce results beyond what can be accounted for with the placebo effect. I think that whatever health care system we have in this country, we should not be paying for health care charlatans whose methods have no scientific basis.

Arthur Nielsen
Seattle, WA