Having failed to rid the world of the George Bush administration with Farenheit 9/11, Michael Moore uses the American president to open his broadside against the American health care system. But, bipartisan in his criticisms, director Moore notes that, after failing to overhaul that system in 1994, now-Senator Hillary Clinton has become nearly the largest benefactor of the industry’s campaign contributions. Her 2008 presidential quest finds her avowing none of her former grand ambitions. Moore also runs through a brief, entertaining history of the HMO and of earlier attempts at reform.
But most of the documentary’s first half is devoted to visits and interviews with a number of Americans whose care was affected by financial considerations. Cannily, he doesn’t focus on the “almost 50 million” uninsured, but on people who thought they were covered until they found themselves at war with their insurance companies. Former insurance company employees recall working hard to find ways to deny coverage of patients who became expensively ill, such as by finding minor omissions on their applications. A mother talks about a dead child denied a life-saving operation by the refusal of her insurance company to pay for it. The point being, even if you’re insured, the American health care system is your problem too.
The next part of the film finds Moore visiting Canada, Britain, France, and Cuba to examine their systems of providing care. Although there are differences, the uniform thread is that in none of these systems is cost a factor in the way individual patients are treated. The Cuban excursion, which got Moore in some trouble with the U.S. government, follows an attempt to get some 9/11 rescue workers treated at the American facilities in Guatanamo Bay. Terrorists get free quality health care, we are told, so why not these heroes? Undoubtedly, Moore knows that many of the people at Guatanamo Bay are not terrorists, and he knows equally that his people will be turned away, just as he knows what a British hospital employee will say when asked how much the patients are going to have to pay for their care. This is Moore at his coyest and most tedious, but except for this Guantanamo segment, this sort of stunt-making, ever present elsewhere in his oeuvre, is absent. Still, it’s useful to find out that a poor country like Cuba has an infant-mortality rate below that of the United States. (This is according to a United Nations report, as documented on Moore’s web site along with other facts stated in the movie.)
But Moore’s big sloppy wet kiss is reserved for the French. In this land of lengthy paid vacation and maternity leave, not only is the health care free, but so is someone to help with the housework during the difficult first few months. This is startling whether you think it’s a great idea, as Moore clearly does, or an unwelcome and quite literal extension of the nanny state. Moore also visits the well-appointed home of one doctor and asks about his income. He does something similar in Britain, where the doctors make less because they are government employees. (The distinction between socialized insurance, which is widespread, and socialized medicine, which Britain and relatively few other countries have, is worth noting, but you could fail to notice it in Sicko.) The point is, don’t worry, national health care won’t turn doctors into minimum-wage workers.
Yet the scene also may inadvertently make the point that it will cost something to do this. This will be the easiest shot for critics to take—reform will cost money. Herein lies what I think is the biggest flaw in Sicko, if indeed the goal is to persuade. There’s actually an economic argument as well as a compassionate one to be made on behalf of national health care. There’s a large group of Americans like me who already agree with Moore, a somewhat smaller group who opposes national health care on libertarian or conservative principles, and a group in the middle who kind of agree that everyone deserves the same health care but worry about practicality and cost. The visits to the faraway lands should convince them of the viability of a government-run system, but Sicko only hints at the way equity can be achieved while reducing the amount spent overall on health care. The hints come when we see the amount of resources insurance companies put into accepting and rejecting new policies and in finding loopholes that will allow them not to cover people who already have policies. These efforts save the companies money but in the aggregate add to the costs of care without making us healthier. The lack of uniformity in plans and the array of paperwork they require create burdens that doctors, hospitals, and patients must suffer also, which is one reason why in the United States the non-treatment costs for private entities are several times that of Medicare. A single-payer system (one in which government is the sole insurer) also means that the government has a greater ability to negotiate costs with drug companies and other providers. The U.S. spends much more, absolutely and per capita, than any other country on health care, by far, and in return has a population that by most measures (such as lifespan) is less healthy than most other wealthy countries. This is the point that should be hammered home.
Of course, such a system would mean just a little bit less money for some doctors, a smaller insurance industry, perhaps decreased revenue for advertisers, etc. Perhaps dwelling on cost issues would mean acknowledging that all systems have trade-offs. Moore has defended his one-sided portrayal of national health care as counterbalancing what’s already out there about its supposed detriments. A fair point, I think, but in taking this approach he is unable to effectively argue against some of the critics. For example, the most frequent objection to the Canadian system is that there are waits for some procedures. The web site acknowledges this, but the film merely shows one not-busy waiting room with no waits to counteract the point. By not granting that there are waits (but for procedures, not office visits), Moore can’t make the counterpoint that this isn’t an implicit feature of government-run systems, or even that Canadians nonetheless have a much higher support for their system than Americans do for theirs, even though they see its flaws. He can’t point out that by simply choosing to spend a little more (but still much less per capita than Americans do) Canadians would be able to eliminate the waits.
I don’t want to overemphasize the criticisms. Merely showing the alternatives is a public service, as is the inside look at HMOs. While making perfect sense for their shareholders, it’s hard to argue that the private bureaucracy dedicated to discovering pre-existing conditions is, from the consumer’s perspective, money well spent. The thread running through nearly all of Moore’s work is that people have some responsibility for each other, and that’s really the premise of Sicko, too. It’s not as funny as Roger & Me, or as fun and freewheeling as Bowling for Columbine, but it’s more level-headed than Farenheit 9/11 and is, Moore or less, a revealing look at a subject Americans currently rate near the top of their concerns.
IMDB link
reviewed 8/13/07
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