On the Fourth of July (of all days), my wife, Karen, and I went to see the Michael Moore film SiCKO. As the movie progressed, I couldn't help but wonder what my friends in aesthetic medicine would make of it. After all, quite a few of you have told me that you strongly prefer to run a strictly cash practice and want nothing at all to do with health insurance companies.

To be sure, the film had nothing to say about elective medicine—it concentrated on the plight of Americans who don't have—and more to the point, who do have—health insurance, and contrasted our system with the universal coverage that prevails in other Western countries. I doubt that even Moore would advocate that all citizens are entitled to government-paid, tax-supported facelifts and tummy tucks.

But, of course, there are cases—many of them—in which aesthetic surgery and other procedures are medically indicated. Otoplasty for teenagers with "Dumbo ears," abdominoplasty for bariatric surgery patients, and breast reduction for both males and females are only a few. Should society address the psychological and physical needs of these patients, just as Moore says it should for "conventional" conditions such as heart disease or cancer?

SiCKO and other sources have indicated that France has one of the best nationalized health care systems in the world. Friends of mine who live in France also strongly praise that country's system, but they add that its major weakness is that too many patients overuse the system and this may potentially lead to some restrictions in access to care. I asked them whether the French system would cover these types of aesthetic procedures, and they replied that they likely wouldn't be covered completely, if at all—but that they would cost much less in France than the United States, with no drop in the quality of care.

One can certainly imagine the difficulties of incorporating aesthetic treatments into nationalized health care—especially procedures that are performed for psychological reasons. It would be awfully tough to come up with widely accepted standards to determine which patients are eligible and which are not.

So once again I'm asking for your reactions. Do you favor a national health care system, and if so, should it cover medically indicated aesthetic procedures? Florida plastic surgeon Eugene J. Strasser, MD, JD, FACS, responded to last month's message in this month's "In Review" article—let's hear from you this time.

Michael J. Block