America's sick healthcare system

"Critical Condition" turns a more sympathetic eye toward Kaiser Permanente, the nation's largest managed care organization. Smith shows how Kaiser willingly took on the money-losing work of serving people with HIV/AIDS in the 1980s despite fierce financial competition, and decided to start screening patients over 50 for colorectal cancer several years ago even though no major medical group had called for it.

Yet in order to get a sigmoidoscopy at Kaiser, you have to have a personal doctor who'll notice how old you are and order it for you. Vivian Hannawaite, 68, of Fremont, Calif., didn't have one, and by the time she got her sigmoidoscopy, not only did she have cancer but it had already metastasized to her lymph nodes, greatly reducing her chances of survival.

Compelling as such stories are, "Critical Condition" really hits its stride when it visits the presidential candidates' home states of Texas and Tennessee. I can just imagine Al and George calculating how they might use this material for their next political ads. But they might want to wait. Patients in both of their states get screwed. The only difference is how.

In Texas, Jody Beal, an oil worker from Abilene, suffers a heart attack just as he's between healthcare plans. His story isn't unique: nearly 25 percent of all Texans are uninsured, Smith says, one of the highest proportions in the nation. Diagnosed with congestive heart failure, Beal racks up $125,000 in hospital bills. "If I coulda made it to age 65, I would have had some insurance," he says. "But I didn't make it."

To pay the bills, his wife Sandi goes back to work selling funeral plans door-to-door. A TV crew follows her and one of the program's most heartbreaking moments comes when she makes her pitch to one family, only to find that everyone already has a plot. For a moment, her face falls, though it's hard to imagine how selling a plot can possibly help her dig out of debt.

Cut to Tennessee. Smith profiles TennCare, Tennesee's innovative program that provides insurance to the state's working poor. He finds a kid with sickle cell anemia, a woman pulled back from death after a head-on collision with a truck, a heart patient who could never get private insurance, all of whom literally owe their lives to TennCare.

There's only one problem -- nobody wants to pay for it. TennCare lost $20 million last year, according to Smith, and the Legislature is "in an uproar" over how to save it. Participating hospitals complain about low reimbursement rates and are fleeing the program, even though many feel it is among the best in the country. "Money doesn't solve everything," a Tennessee legislator tells Smith, who seems taken aback by her fuzzy logic. Isn't money precisely the problem? Of course it is, but the state won't spend it. Thus TennCare seems destined to fail.

"Critical Condition" is a journalistic gem, so painstaking and intelligent that it seems churlish to criticize it. But it ends on an odd note, with Smith telling viewers that "the quality of your healthcare depends as much on you as your own doctor. That means you need to become informed. Ask the right questions. Be your own best advocate. Your life may hang in the balance."

Very true, but as "Critical Condition" shows, asking the right questions isn't going to help if you're uninsured and have a heart attack, or of you need a sigmoidoscopy and your health plan forgets to give you one.

Yet "Critical Condition" goes well beyond the piecemeal approach to healthcare reform that we've seen in this year's presidential campaign. With just weeks to go until the election, Gore and Bush are still haggling over prescription drug coverage for seniors. But making sure Aunt Vivian gets her Vioxx is not healthcare reform. Fixing Medicaid could be, but even that doesn't help folks like Jody Beal, who "aren't poor enough, sick enough or old enough" to get government help, as Smith puts it.

Much as I hate to quote George Bush the Elder, it does come down to the vision thing. Ironically, Al Gore had a front row seat the last time somebody had one about healthcare, and that was in 1994, when Clinton challenged Congress to pass legislation guaranteeing insurance to all Americans, regardless of income.

Now that is reinventing government. But what we got during last week's presidential debate was this: "I'd like to see, eventually, in this country, some form of universal healthcare," said Al Gore, responding to George Bush's offhanded putdown of Clinton's healthcare plan. "But I'm not for a government-run system. In fact, I'm for shrinking the size of government." And on Gore went with another rendition of how he'd shrink Washington.

Bush's vision is hardly better: As he's fond of saying, he's a man with a heart, a very big heart, a heart that he wears on his sleeve. But just try to pry the wallet out of his pants. If elected, Bush said during last week's debate, he would give families earning $30,000 a year a rebate of $2,000 to buy health insurance; although he called it "a huge down payment," the meager amount must have made hopelessly indebted and uninsurable people like Jody Beal want to reach for their unlicensed handguns.

To solve America's healthcare crisis, we'll need reinventions, and more than a few politicians are going to have to open their wallets. If you have any doubt about that -- and who could? -- "Critical Condition" is just the medicine you need.

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