If you have seen a Michael Moore film or two, you know what to expect. In that sense Moore’s latest film on the sad state of health care in America, Sicko is more of the same. If you hate Michael Moore, you will probably loathe the film. If you like him, you will probably be singing its praises. If like me you are neutral on the guy, you will find merits and detractions in this film, but overall find it a worthy investment of two hours of your time and about ten bucks.
Moore’s films do have a tendency to be harbingers. Some like Bowling for Columbine will push your buttons but, as the Virginia Tech massacre attests, are doomed as far as affecting real change. In Sicko, Moore makes the case for universal health insurance. It may be that with our health care system so dysfunctional that it will contribute toward changing the dynamics of the debate. However, even a rabid Michael Moore hater would have a hard time disputing his assertion, shared by most Americans: our health care system is broken.
If you have not seen a Michael Moore film, do not expect objectivity. Moore makes no pretense at objectivity. He picks subjects for which he has already made up his mind and then assembles the documentary footage to make his statement. He interjects a bit of humor, some self-deprecation and large doses of sarcasm. There are also heaping helpings of scorn at those he does not like. Since almost everyone hates the HMOs and PPOs, it is hard not to cheer Moore on. Little of what we learn in Sicko is actually news. Of course, the health care industry is about making money. Insurance companies would not be profitable if they did not keep an eye on their bottom line. Denying claims and cherry picking clients will always be in their interest. When the consequences are played out with real people, they can be personally disastrous.
Something needs to change. Moore’s solution is to create a nationalized health insurance like those used by most first world countries. He visits Canada, Great Britain, France and Cuba. In each country, he finds that the health care there is far better than what is available in the United States. He busts some myths, including the pervasive one that socialized health care in Canada is worse than in the United States. He does this by visiting clinics, pharmacies, emergency rooms and hospitals in these countries and talking with patients, doctors and nurses. We learn that the founder of Canada’s national health system is considered the country’s biggest hero. We learn that there would be mass riots if Great Britain even considered abolishing its system. In addition, we learn that the French live longer not only because of their excellent health care system (yes, doctors make house calls) but also because of their generous policies regarding maternity and disability leave. In France, working mothers can even get government supplied nannies for a modest cost. There are no complicated forms to fill out. In Great Britain, you need only give your name to get service. If you are poor, the hospital cashier will even give you money on your way out to reimburse you for your transportation expenses. There are never any hospital bills to fret over. Doctors are very well remunerated. Physicians in Great Britain also get bonuses depending on how well they improve the health of their patients. What an idea!
It all sounds great to me. Where do I go to sign up? What Moore omits is some context. In France, for example, the health care system is great, but the costs of its welfare state result in huge deficits. Their unemployment rate is roughly twice ours and their ranking among industrial countries is slipping. Moore surreptitiously takes a group of Americans who have fallen through the cracks of our health care system to Cuba. There they receive the free medical care they were denied in the United States. Drugs costing hundreds of dollars in the United States cost five cents in Cuba. Yes, they have high tech machines like MRIs in Cuba too. Nevertheless, Cuba is a dictatorship. Moore seems more entranced with the free health care than the poverty and the ruthless dictator that runs it, who will tolerate no dissent. It appears that the only place where free universal health insurance is available in the United States is at Guantanamo Bay. To get great free health care in this country, you may have to become a terrorist.
Meanwhile back in the United States, Moore gives us sad vignettes of people slipping through the gaping cracks in our health care system. They will invoke empathy from many of you. An older couple moves into a room in their daughter’s house. Due to their medical conditions, they can no longer afford the house they were living in. A 79-year old man cleans toilets to afford the co-pays for the drugs he needs to survive. A man stitches a gash on his own knee because he is uninsured. A HMO dumps indigent patients on Los Angeles’ skid row. An uninsured man has two fingers cuts off in an accident but can only afford to have one reattached.
Moore traces the rise of HMOs back to the Nixon Administration and shows how they grew in prominence. We learn more things we already know: profits for HMOs and PPOs like Aetna are going through the roof, in part by denying care to those who thought they were insured. We get to relive the fight for national health insurance early in the Clinton Administration. Moore traces the arguably unhealthy connections of health care contributions to political campaigns.
In Sicko, Moore’s primary contribution is to take us first hand into other first world countries and show us how they manage their nationalized health care systems. Much of the rest of the movie simply tells us things we already know, or should know if we have been paying attention. Our health care system is so bollixed up that it would be difficult not to show the advantages of nationalized health insurance. By documenting concrete examples from other countries, he shows a means by which it could also be done here. Moore’s solution though seems more revolutionary than evolutionary. He does not use the words “single payer” but his intent is clear enough: that if other countries can make universal health insurance work, we can too. He suggests that this can only be accomplished by the fed up voters, particularly the disenfranchised demanding that the government act.
As a documentary, Sicko is better than average. However, Moore has done better work. It is hard to escape its obvious conclusion. I see his essential message as this: we have taken the notion of rugged individualism to an unhealthy extreme in this country. While it has been a virtue, it cannot be used everywhere in the marketplace. Trying to make it work in the health care industry has proven to be folly. We need to understand that everyone benefits when health care is provided to all regardless of their ability to pay. By the end of his film, if you are not turned off by all the sarcasm, his conclusion should be hard to disagree with.