June 26, 2007
Sicko
About two-thirds of the way through "Sicko," Michael Moore takes us to France, where health care is free, doctors make housecalls, daycare is cheap, and vacations are long. A group of American ex-patriots, sitting around a cafe table, extol the wonders of their adopted, family-friendly environment. "Is there a reason the government wanted us to hate the French," Moore ponders. "It was enough to make me put away my Freedom Fries."
A few scenes later, we're back in the U.S. watching the largest hospital in Los Angeles dump an indigent, mentally confused patient on the doorstep of homeless shelter because she didn't have money or insurance. "Who are we," the filmmaker asks in his omniscient narrator's voice. "Is this what we've become? A country that dumps its citizens on the sidewalk because they can't pay their hospital bills?"
The national discussion provoked by the film will inevitably focus on the gross failures and inequities of the U.S. health insurance system, as it should. And like most people who know too much about that system, I could complain for hours about the inaccuracies, unfair comparisons, agit-prop stunts and questionable political judgments that went into the making of "Sicko." You'll read plenty such comments in the mainstream media when the reviewers get their hands on the film this weekend, and you may have a few of those thoughts yourself when you go see it.
But they pale by comparison to the larger point that Moore makes over and over again in this heartrending, brilliant and occasionally very funny film. Our patchwork private health insurance system is a tragedy for those whom it fails. But its failures are really just a metaphor for what a growing proportion of Americans recognize is wrong with this country.
Whether looking at Canada's privately-run, provincially paid for health care systems, or England's National Health Service, or France's social democracy, or Cuba's impoverished egalitarianism, Moore finds the universal thread that makes their social systems more successful than ours. "They live in a world of we, not me," he says near the end of the film. "We'll never fix anything until we get that one thing right."
The film is filled with heartrending stories of people who couldn't afford or were denied care, usually by profit-maximizing insurance companies. And that is ultimately what keeps us glued to the screen. Indeed, the real people whose stories Moore tells triumph over the questionable settings in which he put some of them (I'm thinking here of the highly publicized stunt of taking ill and injured 9/11 rescue workers who can't afford needed medical treatments on boats to Guantanamo Bay to demand health care as good as the detainees ostensibly get).
But is individual misfortune enough to sway a political debate that will be dominated by people with their own well-financed megaphones and a compliant media willing to spread their distortions? Already Moore is being attacked for promoting socialized medicine, even though neither Canada nor France directly employ most of their physicians.
But that's the point with Moore's work. As with most of his films, Moore has succeeded in putting himself at the center of a major political debate. So what if there are enough mistakes to give the insurance industry, the drug companies, and their spokespersons plenty of ammunition. It's controversial! It's fun! And it's made Moore a rich man.
A few weeks ago, I watched Bill Mahar interview Moore on HBO. Moore said his only goal was to get people asking why we're the only industrialized country in the world that doesn't have universal health insurance coverage. Mahar enthused that he thought the political reaction to the film would push the movement for universal coverage "over the edge."
Even though I wholeheartedly agree with the film's overarching message, it's going to take a lot more than agit-prop to push this movement over the top.
Posted by gooznews at June 26, 2007 10:59 PMFor a negative review that's precisely in the spirit you mentioned, see David Denby in the most recent New Yorker.
I thought he totally missed the points you made above. His big insight was that Moore ignored the fact that Canadians wait in lines (which is mostly BS anyway, I'm told).
Posted by: Jared Bernstein at June 28, 2007 10:04 AMCanadians wait in lines (which is mostly BS anyway, I'm told).
I'm not sure I agree with your BS comment. When you hear similar stories from different sources, you have to figure if there's smoke, there's probably fire. Nevertheless, waiting in line may not be as onerous as thought. Our private pay system leaves much to be desired in this are. Our own insurance/private pay system does not move us to the front of the line. When an ingrown toenail becomes so painful/infected that one gives in to the pain and calls a doctor to take care of the problem, only to learn that the soonest one can be seen is 2-1/2 weeks, how can that NOT be considered "waiting in line?"
Here in our "private pay" society, influence and "knowing someone" still seem to outweigh the importance of ability to pay. Even when one is insured. . . or willing to pay out of pocket . . . short of an emergency room visit, one may still find himself/herself "waiting in line."
Posted by: Melody at June 28, 2007 02:42 PMMelody is right. We do wait in line in the US. When was the last time you were in the ER and there was no one in the waiting room?
As someone who grew up in a country, Sweden, where medicine is provided by the state at little or no cost to the individual, I have few good things to say about health care in the US. (And I've lived here in the US for 2 years and change now, and have had my fair share of encounters with the health care system.)
I challenge anyone to name one thing that you cannot get in, say, Sweden, that is available to health care consumers in the US. World class doctors? Check. The latest (and supposedly greatest) medications? Check. Advanced medical equipment? Check. (As an aside, my Swedish great uncle worked for the company that introduced the first single-use artificial kidney. And yes, that was in Sweden.)
Some have asked why, if health care is so good in other countries, people travel to the US to receive treatment. I'll tell you why, because if you have $250,000 to spend you can get your own room, your own nurse, a few doctors, and, if you're lucky, HBO. In Sweden, you get treated the same as everyone else. Sure, the US health care system is great if you're rich, but the question is what's best for the society as a whole. And, in my mind at least, there can be little doubt about that, if you just scrape the surface a little bit.
Sorry for the rant.
Posted by: Anders at June 29, 2007 04:20 AMI agree with your overriding comments about this being a heartrending and brilliant film, but I think the tone of much of the rest of your piece is far too negative. There are a few gimmicks in Sicko, and of course some oversimplification; there are even a few outright errors. But the film is full of critically important truths -- not only about other systems that demonstrably far outperform ours at a fraction of the cost, but also about the cruelty of our own "system," and the way it places profit far ahead of health, or human beings. Perhaps most critically, the film suggests (implicitly, rather than explicitly) that this is a problem not limited to health care, but instead reflects far larger societal issues about fairness and social justice and concern for each other -- the "who we are" to which you make reference.
With all due respect to how much you know about this (a great deal, certainly), I personally (a Professor who's been teaching at a medical school and a school of public health for many years, and who knows a little bit about this as well) find your generalization about all the potential gripes of "people who know too much" fundamentally unfair, and basically misleading. This is not merely a film whose heart is in the right place; it is one whose head (its facts and arguments -- not agit-prop) are in the most fundamental ways highly accurate, as well as powerful. And like it or not, it has a lot more chance to move the debate forward than all the learned articles in Health Affairs.
Posted by: Jerome at June 29, 2007 02:48 PM