Dear FRONTLINE,

In 2007 I tracked all of my family medical expenses on a spreadsheet. What I was surprised about was that the medical insurance company that I have for my family was able to dictate what they would pay for a medical procedure and effectively discounted 61% off the total charges invoiced by the medical establishments for the year. So in a way the medical field is already being dictated to what they can charge in this case. I agree that what the US needs to do is take the profit motive out of health care. I just hope that the Congress that we as Americans have elected can have the courage and stomach to fix this crisis that is effecting every community in the nation. Health care for retired city employees in my town is one of the causes for the ever present rise in my property taxes as well as a yearly increase in my health premiums.

Ron Peterson
Chelmsford, MA

Dear FRONTLINE,

I moved to the states from Taiwan 7 years ago. It took me quite some time to figure out how the medical system works in the states. When I was in Taiwan, getting health care was so convenient and highly efficient, and most of all, simple and affordable. We never have to make appointments to see a doctor (what's with making appointments with a doc, how do I predict when and where I'll be sick??).

In many aspects, United States is a more advanced society than Taiwan. If Taiwan can figure out a good health care system, U.S. can do it, too!

Nina F.
Phoenix, AZ

Dear FRONTLINE,

I am a second year medical student. I would have greatly appreciated some investigation into the hours worked by physicians in other countries. While I have not yet begun my clinical rotations on the wards, I often hear anecdotally that US physicians work like crazy despite ever decreasing government reimbursement. If we switched to a national system, would a doctor's school debt be forgiven? Would he have less on-call days or 2 a.m. emergencies? I feel that national health coverage should be a priority for our nation, but as a physician in training I fear I will be forced to accept lower payment, with no improvement in quality of life, or hope of escape from debt.

Kirksville, MO

Dear FRONTLINE,

What an outstanding program. I recommended it to several friends and members of my family.

What made my blood run cold was when I realized that we in the U.S. are essentially subsidizing lower-cost drugs in countries that have laws about price controls and bargaining power. Drug companies are barred from charging whatever the market will bear in Switzerland or Canada so they jack up the prices in the U.S., even though we as taxpayers have often funded a large portion of the research. Americans are even legally barred from buying cheaper drugs abroad, and Medicare Part D specifically forbade negotiation of lower prices. It's incredibly unfair. We do not have a free market system. We have a drug- and insurance company-driven system, and it must stop.

Kathryn K
New York, NY

Dear FRONTLINE,

Wonderful show. Should be required watching.

I was struck by a common theme that ran throughout the presentation. All of the doctors interviewed were primary care doctors. Universal Healthcare systems seem to place heavy emphasis on primary care, ie keep the population healthy to begin with. In the US and especially in NJ, there are not enough primary care physicians. I know they spend less but how to they allocate what they spend? In comparison to the US, I would like to know how much is spent on a) the elderly, b) chronic disease, c) primary care d) specialty care and e) administration.

Princeton , NJ

Dear FRONTLINE,

The very first thing I noticed in this program, and to me the most obvious thing of all, is that all the countries examined have set out to insure the health of their citizens just like their education. These countries have committed to their citizens, and a not-for-profit model is likely the only way to truly accomplish an efficient system.

What many Americans, likely including those involved with drug companies, fail to realise or express is that as collective bargaining unit, i.e. in a large health insurance or government health insurance situation, they have much more power than all these small health insurance providers scattered around the country. The reason Americans buy their prescriptions in Canada is that the Canadian government has committed itself to making necessary medical treatment and pharmaceutical products available to those who need it, not just those who can afford it. They negotiate with the drug companies to insure that their citizens can access the treatment they need.

The Canadian system isn't perfect, but it can be improved upon, both by Canadians and by other countries who adopt or have adopted similar health insurance programs.

Fundamentally, however, the way of thinking in American health care needs to be rebuilt from its very roots:

Profit is the wrong motivation in health care-

Health should be the motivation.

L Flett
Kingston, Ontario, Canada

Dear FRONTLINE,

I enjoyed your show and found it very provocative. I have the benefit of not only being a provider (physician), but also having the benefit of working under Dr. Paul Ellwood, who founded the HMO concept along with Alan Enthoven of Stanford.

While there are many important issues within this debate, the profound issue that has the greatest impact, and I don't believe was fully explored, was how our system treats end of life. In many systems, specifically Japan, people simply don't have the options that they face in the U.S. I don't think that most of the interventions are justifiable, but the advocacy groups simply make it too difficult to say no in the U.S. In many countries, elder patients simply die or are told their is nothing that can be done. Also, in the socialized nations, clealy price controls work but they also have the impact of producing non-sustainable systems (governement artificially supports the systems instead of raising taxes...eventually this will need to play out with tough choices.)

In addition, there is a conflict for employers to cover health costs, as they are strictly interested in the short-term benefits/gains of health savings, as opposed to the long-term interest of healthy living. In other words, with shorter employment periods, most companies believe that your lung cancer will impact you after you leave their company so no real incentive to prevent smoking.

Arthur Puff
Minneapolis, Minnesota

Dear FRONTLINE,

Great to control monetary costs, but at what other costs? Here, a friend was seen by docs,tests done and chemo started in one week. Saved her life. Who gets to decide treatment? Will we baby boomers be too old to be worth treating? Our government isn't supposed to take care of us. It is supposed to protect our freedom to take care of ourselves.

Rochester, NY

Dear FRONTLINE,

I am a viewer from Taiwan, Thanks for the program.
Some viewers are asking about the tax and insurance fee rate in Taiwan. I want to share some information to people who are interested.
The GDP of Taiwan is 15000USD. I am making 57000NT (around 1900 USD) per month, slightly above the average. My income tax rate is 13%. I have to pay 691NTD (23USD, 1.2% of my monthly salary) for my National Health Insurance Coverage per month. You have to pay for the co pay for every visit to the hospital. The co-pay goes up when you make more visits. We believe that health care should be a basic human right for everyone. I am not only satisfied but also proud of our National Health System.

Regarding to the privacy issue, you can add password to the NHI E-card. However, almost no body here does that. But, there are indeed some privacy concerns. HIV positive patient's record will be read and noticed by his dentist.
I still remember when I was studying in the US. There was one month period we were not covered by any insurance. I have a Chinese friend who gets injured. He was in panic and cried when he finds out that three visits to the local hospital costs him 2000USD (if I remember it correctly). Luckily, the Mass Health system bailed him out from the cost.
America has been the country of aspiration and admiration for people in Taiwan and still is. Hope that the health care issue could be faced properly in this election.

Ying Lei Chang
Taipei, Taiwan

Dear FRONTLINE,

I find it amusing that so many talk about tort reform. Do they mean to say that if a doctor killed a loved with their negligence that nobody should be held accountable. This is another example of the brainwashing by the insurance companies. The only way the heath care disaster in this country can be fixed is by removing the profit motive. This will never happen because Americans are greedy and put making money above all else.

Akron, OH

Dear FRONTLINE,

I enjoyed this show and think it is very informative, but I feel there is a large side to the story of health care that is not given enough emphasis, and that is the impact of diet on health.

A population of healthy people would naturally cost less to take care of than the perpetually sick who frequent traditional, expensive remedies for conditions which are entirely diet and lifestyle related.

Most people do not understand that many of the leading causes of death in America are entirely preventable and reversible with a healthy diet. The costs of treating heart disease, diabetes, Multiple Sclerosis, and cancers with traditional western medicine and treatments is tremendous. The results of these treatments are depressing -- heart disease is the leading cause of death in our country despite the multitude of pills, tests, and surgical procedures that profit doctors, pharmaceutical companies, and health care management companies. Traditional treatments and medicine for cancer, heart disease, and MS can cause horrible side effects, yet to increase your chances of preventing, halting, or reversing these diseases calls for following a simple, healthy diet which sadly too few know about.

The conditions and diseases I mentioned can be prevented and many can be reversed with a healthy low-fat whole plant foods diet such as that promoted by many leading vegan doctors and vegetarian societies. While many people will no doubt think that last sentence is an outlandish claim, I would urge them to look into the medical science themselves, and refer them to such books as The China Study by T. Colin Campbell, Dr. McDougall's books, the many books that are now available on reversing heart disease and Type II diabetes, and also Dr. Roy Swank's life long work helping MS patients halt and prevent the debilitating results of their disease by following a low-fat nearly vegan diet.

I don't think it is very likely, but if the traditional medical industries would take an honest look at what works and what doesn't regarding these diseases which affect so many thousands of Americans, they could easily bring about a healthy population who would not need their services as much, providing more room for money to go where it's really needed - comprehensive health care coverage for all.

Not to mention following a low-fat healthy vegan diet costs a lot less than paying for a heart bypass surgery.

Carolyn Avery
San Francisco, CA

Dear FRONTLINE,

Excellent program and very timely in light of the current Congressional Bill HR 676 (US National Health Insurance) that has been proposed with 70 co-sponsors so far! As a small business owner, I support a national insurance program so that we are not tied to our jobs because of fear of losing insurance, but instead can start our own businesses if we wish - isn't that part of the American Dream? I must correct the few naysayers who argue against learning from these other countries because they don't think that health care should not be free. NOTHING IS FREE. We all pay taxes already - if we had a better FINANCING system (like single payer), we would just have better care with the same money by eliminating the bureaucratic waste of private insurance companies (average 20% overhead compared to govt -run Medicare with 3%). Don't we want our taxes to go to good causes such as health care for all? Don't we want to live in a society where we take care of our most vulnerable as well as ourselves (especially when it does not cost more than what we are already paying!)?

Bella Dinh-Zarr
Washington, DC

Dear FRONTLINE,

Personal responsbility evangelists are ready to explain away the glaring flaws in our system, discount the role of government in our society but while personal accountability may be an issue, it is only an anecdotal explanation for a small fraction of our problems.

Our neglect of the un- and under insured is a profound statement about the value we place on human life, welfare and dignity. Our arrogance as a nation will be our downfall. We can learn from others and must appear foolish to those who have it figured out. Would I forego the latest and greatest pill so that many fellow human beings could get basic medical care without having to decide to pay the bill or feed themselves, ABSOLUTELY!

The free-market that so many cling to is the cause that Insurance companies are in the business to pay as FEW claims as possible. This is no different than the home, life or auto insurance industries. It's practice defies it's very purpose on a daily basis.

Wake up America, demand more, demand better!

moorhead, mn

Dear FRONTLINE,

Your story was excellent, but you omitted one important part of the solution - the role of individuals in keeping themselves well or participating in a chronic disease management program if you aren't well.We need educational incentives, but more importantly, financial incentives for people to take responsibility. If everyone is required to pay into the system, then healthy lifestyles and active participation in your health care can result in lowered premiums (or taxes) and the entire health care system will be less costly.

Steve Hurd
Grand Junction, Colorado

Dear FRONTLINE,

This was a disappointing Frontline episode, to be honest. A few crucial points were missed entirely, which any counterpoint would have addressed.

First, innovation in medicine happens primarily in the US because it is economically rewarded here. The fact that Germany admits to "negotiating" lower prices on drugs means only that the US health care payer is paying for the Germans as well. Innovation in health care will disappear if we move to socialized medicine. In our lifetimes, the largest price will likely be paid in speed of advancement in cancer care.

Second, exposure to lawsuits and other liabilities are a primary driver of healthcare costs in the United States, and are far more substantial than administrative costs. Tort reform will do more to lower costs than importing MRI machines from Japan.

Third, the implication of the program is that the US represents some kind of free market system, while productive and efficient socialized systems are showcased across the world. Let's keep in mind that a substantial portion of healthcare spending is done through Medicare and Medicaid: the US government. This is a not a free market. "Fixed" prices admired in the program (and experienced by many here as well) result only in shortages in services or quality, or both. There is no free lunch, unless we want to continue to borrow from China for our health care costs and then burden our children with paying for it, plus interest.

Fourth, bankruptcy is a recurring theme in this Frontline episode. Yet, bankruptcy represents a method to pass the true costs of unpaid care back to the system. How is this different from coerced taxation and lowered standards of living for everybody?

Fifth, what is the moral calculus for valuing the life of a 70 year old less than that of one who is 65? Hasn't the 70 year old "paid in" longer in the first place? Does Frontline endorse this calculation by Germany, Japan, and elsewhere as part of the rationing of services through statistical calculations of one's value? Is a 40 year old female breast cancer patient worth more than a heart bypass for a 45 year old male? Should bureaucrats decide this?

Finally, some would disagree that longevity statistics or cost are definitive measures of success. Why not ban smoking and alcohol, which would lengthen life expectancy in the US? Should we ban motorcycles? Doritos? Bungee jumping? Free societies mean a freedom to live life according to one's own priorities. Not everyone wants to live to 120, a bias that must be removed from any analysis of outcomes.

When is the rebuttal going to be aired to this version of Sicko for the elites?

Boston, MA