Part I: The Human Tragedy
When word got out that Michael Moore was working on a movie with the working title SiCKO, about the U.S. healthcare industry, the industry went bananas.
Memos started shooting around, warning insurance and drug company executives and representatives to keep looking over their shoulders, to make sure they avoided being ambushed by Moore and a camera crew. Indeed, they had something to fear, for they have a great deal of needless misery and suffering to answer for.
But it turns out that Moore didn’t need them after all.
Instead, he’s made a movie driven by heart-breaking story after heart-breaking story. SiCKO presents a devastating indictment of the US healthcare system by letting victimized patients speak for themselves.
When Moore announced on his web page that he was doing a movie about outrages in the US healthcare system and was looking for examples, he was flooded with 25,000 responses.
He profiles Dawnelle, whose 18-month-old daughter Michelle died because her health plan, Kaiser, insisted Michelle not be treated at the hospital to which an ambulance had taken her, but instead be transferred to a Kaiser hospital. Fifteen minutes after arriving at the next hospital, Michelle died, probably from a bacterial infection that could have been treated with antibiotics.
Julie, who works at a hospital, explains how her insurance plan refused to authorize a bone marrow transplant recommended for her cancer-riven husband. He died quickly.
Larry and Donna, a late-middle-age couple, find that co-payments and deductibles for treatment after Donna has cancer add up to such a burden that they have to sell their house and move into a small room in their adult daughter’s house. The day they move into their daughter’s house, her husband leaves to work as a contractor in Iraq.
Moore’s camera captures the pain, chaos and forced indignity imposed upon every day people who do their best to deal with an impossible situation.
Moore’s web page announcement also attracted responses from hundreds of employees in the health insurance industry, explaining how their jobs forced them to do things of which they were ashamed.
Lee, a former industry employee whose job was to find ways to deny or rescind coverage for healthcare, explains how hard insurers work to deny care, searching for any pretense. About denials of care and coverage, he says, “It is not unintentional. It is not a mistake. It is not somebody slipping through the cracks. Somebody made that crack, and swept you to it.”
Becky, another industry employee, says through tears that she’s a “bitch” on the phone with clients because she doesn’t want to know anything about their families or personal situations — that knowledge makes the inevitable denial of care too hard to stomach.
And Dr. Linda Peeno, a former medical reviewer for Humana, testifies before a Congressional committee in 1996 that her denial of needed treatment to a patient led to the patient’s death. “I am here,” she told the committee, “primarily today to make a public confession. In the spring of 1987 as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this. Because, in fact, what I did was I saved a company a half a million dollars with this.”
With some exceptions, SiCKO’s victims aren’t people without insurance. As Moore narrates, the movie is instead about the travails of the 250 million people in the United States with insurance.
There are some in the movie without insurance, however. A hospital places a destitute and disoriented woman in a taxicab, which drives away and literally dumps her on the street, near a shelter.
Rich, who has no insurance, has an accident in which he saws off the tips of two fingers. He is told sewing the ring fingertip back on will cost $12,000. The middle finger will cost $60,000. “Being a hopeless romantic,” Moore narrates, Rich chooses the ring finger.
The publicity for SiCKO says the movie sticks to Michael Moore’s “tried-and-true one-man approach” and “promises to be every bit asindicting as Moore’s previous films.”
This is actually somewhat misleading. The approach is a little different. There’s humor, but there aren’t many gimmicks in SiCKO. There’s no effort by Moore to confront industry executives. Moore himself has a much smaller role than in previous films.
It is also a bit deceptive — as an understatement — to say SiCKO is as indicting as Moore’s previous films. No matter how big a fan you may have been of Moore’s earlier movies, you’ll find that SiCKO cuts deeper and is more powerful and profound. SiCKO is, by far, his best movie.
This is, simply, a masterful work. It is deeply respectful of and compassionate towards the victims. It seethes with outrage, but its fury is conveyed by all of the horrifying stories it presents. The narrative is, by and large, understated. It overflows with raw emotion, but manages to explain clearly the systemic imperatives that lead the richest nation in the history of the world to fail so miserably at delivering healthcare to all.
SiCKO, Part II: Things Can Be Different
Could things be different in the United States?
Yes.
The second half of SiCKO looks at other countries’ healthcare systems, and finds that national, single-payer insurance delivers far better care.
There are no talking head experts in SiCKO.
The first part of SiCKO features regular people detailing the horrors of the US healthcare system, based on their own experience.
But more is needed than just a searing indictment of the present system. How to convey the idea that there is an alternative to the US status quo?
Moore’s answer is to go to places that do have national health plans, and ask regular people there to talk about their experiences.
Moore follows a young American woman as she crosses north over the US-Canada border and seeks to obtain healthcare under the guise of being married to a Canadian. (About which Moore says, “We’re Americans. We go into other countries when we need to. It’s tricky, but it’s allowed.)
This opens the door for an encounter with the Canadian single-payer health insurance system, where treatment is free for everyone and people can choose any doctor they like. Moore interviews everyday Canadians who express bewilderment at the US system of charging sick people for care, and who indicate deep satisfaction with their system.
One man recounts enduring a serious injury on vacation in Florida, and needing to come back to Canada to get care, where treatment was free. “Why should other Canadians pay for your problem?” Moore asks of the man, who identifies himself as a Conservative Party member. “Because we’d do it for them,” comes the reply.
This becomes in many ways the crucial message of SiCKO.
From Canada, Moore travels to the United Kingdom, which has a national health plan, where doctors and healthcare workers are employed by the National Health Service. Patients in a hospital laugh out loud at Moore when he asks them where they pay. When he finally finds a cashier’s office, it turns out that the cashier actually makes rather than takes payments — travel reimbursements for low-income persons.
Moore interviews a handsome young doctor, who explains that although he is on the government payroll, he is doing quite well, thank you. He shows off his fancy car and million-dollar home. And he reports that doctors are paid more if they can demonstrate good results — for example, convincing patients not to smoke.
Next is France, where Alexi, a French-born 35-year-old who had lived in the United States from the age of 18, explained that he moved back to France when diagnosed with a tumor. He received free treatment, and then three months of fully paid time off to recover.
Seeking “the real story,” Moore dines with a group of Americans living in France. They explain not only that they get free healthcare, but that they benefit from mandatory extended vacation time, lengthy paid parental leave, and government-provided nannies for new parents (two times, four hours a week for a family subsequently visited).
US health insurance industry front groups and corporate-backed libertarian think tanks are attacking SiCKO for an overly positive portrayal of overseas health plans. There is a small amount of truth to this. SiCKO does not discuss the shortcomings in these health systems, and they are not trivial. No system is perfect. And there are worsening problems especially in the Canadian and UK health systems, thanks to chronic underfunding and efforts to chip away at the integrity of the system by exactly the same forces that then point to their shortcomings.
Nonetheless, by any serious measure, these systems do far better than the United States. They provide universal coverage, with no fees. These countries’ health indicators are better, evidenced by everything from infant mortality rates to length of life (even though the United States is richer). They are also far more cost effective. More on these policy matters in my next column.
SiCKO ends by going to Cuba. Moore first takes 9/11 rescue workers who are suffering serious ailments but have not been able to get coverage, and some others in need of care, to Guantanamo (where the military has bragged that prisoners are receiving top-notch care). Rejected there, they venture into the Cuban health system.
What appears to have begun as a gimmick turns out to be incredibly moving, as the 9/11 rescue workers and the others are emotionally overcome as they find themselves in a system that doesn’t ask about their ability to pay, or tailor care based on their insurance coverage. The Cuban doctors and health workers are generous, courteous and respectful, and they treat the patients for the ailments presented, full stop. They brush aside proffers of thanks –their job is to treat the sick, after all.
The point of the visit to Cuba is not to celebrate the accomplishments of the Cuban healthcare system — which are extraordinary (Cuba has roughly the same health indicators as the United States, which is not only far richer, but adjusted for currency differences, spends 23 times more per person on healthcare than Cuba, according to the UN) — but to say, “Hey, if this poor country can provide healthcare to all, why can’t the rich power to the North?”
From the care provided in Havana and in a touching scene at a Havana fire station, an even more profound lesson emerges: the power of a cultural commitment to care for one another. All of us for all of us, with as big an “us” as possible.
SiCKO is not an anti-American film, though much of the right-wing chatter says otherwise.
People in the United States do routinely pitch in for one another on a voluntary basis, Moore emphasizes. The problem is that the US corporate health insurance system, the corporate-dominated economy more generally, and the ideology that undergirds both, seeks to defeat the essential insurance function of sharing risk — of everyone helping to take care of everyone else.
Moore offers this challenge, or plea: “If there is a better way to treat the sick — simply by being good to each other — why can’t we do that?”
People in the other countries visited in the film “live in a world of we, not me,” says Moore.
To varying degrees, they have created solidarity societies, and they are happier, and healthier, for it.
Sneak previews for SiCKO are being shown around the United States on June 23. The movie opens nationally on June 29. Be ready to be driven to tears and rage.