I didn't see Michael Moore's film Sicko, but I found some of the reactions to it rather interesting, particularly Dr. Hyman's response on his blog www.ultrametabolism.com/blog/ and Jon Herring's article "Don't Take Health Advice From a "Sicko" on Early To Rise.

Herring concurs with Dr. Hyman's statement that "If we improve a broken system just by reorganizing how it is paid for, we still have a broken system." This may be so, but it also true that if one improves a broken system just by optimizing medical care, one still has a broken system because that medical care has to be paid for, and getting seriously ill now can bankrupt you.

There are clearly two separate issues here, namely how to optimize medical care and how to pay for that care.

Unfortunately, there are limits to what optimizing medical care can do to reduce costs. Most chronic illnesses are considered lifestyle diseases. Your doctor can't quit smoking for you, get you off the couch, make you eat right, or manage your stress for you. When the inevitable problems arise, bills will have to be paid regardless of the state of the medical system.

There is something amusing about the Americans belief that the market - capitalism, free enterprise, call it what you want - is the solution to all problems. How can private companies provide coverage at a profit for patients whose lives may depend on the best and most expensive medical treatment available? You already know the answer - it's the system you've got now, with some people uninsured and others losing coverage or being bankrupted by co-payments.

The bottom line is that other industrialized countries achieve better health for less, and they all have a publicly funded system of medical care.