Sicko

Presenting symptoms: queasiness, fever, hyperventilation, and mood swings.

Diagnosis: You’ve just seen Michael Moore’s latest film, “Sicko.” As the tagline says, “This might hurt a little.”

Moore’s record-breaking documentaries have taken on guns (Bowling for Columbine), the war in Iraq (Fahrenheit 9/11), and General Motors (Roger & Me). This time, he takes on the American health care system, comparing it to nationalized medicine in Canada, England, France, and Cuba.

Moore begins with three devastating cases. A middle-class couple were wiped out by health care costs and have to move into their daughter’s basement storage room, their lives reduced to what can fit into three dresser drawers, their pride and dignity reduced to nothing. A man who sliced off two fingers in an accident is forced to choose reattaching the ring finger for $12,000 vs. the middle finger for $60,000. Another man has to sew up his own wound. This takes just a few minutes. And then Moore tells us that this movie is not about these people, who are uninsured and thus fit into a “them” category for most people who buy tickets to movies. This movie is about “us” — the 250 million Americans who are insured, and the way the health care and insurance industries undermine our physical, financial, and political health.

Moore invited people to share their horror stories and we hear from a woman who was not able to get access to care for a brain tumor, a 79-year-old man who can never retire because he has to work at Pathmark to be able to afford his medications, an emergency ambulance ride that was not covered because it was not pre-approved, a woman who was kicked out of her coverage for not disclosing a pre-existing condition — a minor (and cured) yeast infection, a deaf child who could only get approval for a cochlear implant in one ear, and two people, one a baby, who died because they did not receive treatment.

But the real horror stories come from people within the industry, the insurance executives who explain that the payment of a claim was called “a loss,” that they were told that when they declined a claim they were not denying treatment, just denying funding, the claims adjuster who is first told that the minimum is a ten percent denial rate, then told it has to be higher, and paid a bonus based on how many claims are denied.

If our health care system is diagnosed as pathological, what is the cure? Moore visits facilities in Canada, England, and France. He speaks to Americans who have experienced medical treatment under both systems, including a young single mother who pretends to be Canadian so she can have her child treated across the border.

He traces back the origins of the problem to a moment recorded on Richard Nixon’s White House tapes, as he approves support for legislation creating a private system of Health Maintenance Organizations because “the incentives run the right way” — the less care they give, the more money they make. He shows us politicians lining up for a photo op for the signing of the prescription drug legislation, and gives each of them a dangling box showing the campaign contributions made by the industry. He sympathetically recounts Hillary Clinton’s disastrous attempt to try to create a universal health care system in the US only to see it demolished by a $100 million attack from the industry. He is less sympathetic when he ties her more recent “moderation” of her views to her own lavish campaign contributions. The health care industry employs four lobbyists for every representative on Capitol Hill. Senator Clinton receives its second-largest contributions. After the prescription drug legislation was passed, benefiting — according to Moore — the prescription drug companies more than the patients, 44 congressional aides and one Congressman went to work for the industry.

Moore shows us the shameful way we have denied treatment to the people we called heroes, the rescue workers at Ground Zero after 9/11. Yes, it is a stunt when Moore takes them to Guantanamo Bay to see if they can get the same top-notch medical care the US provides for the prisoners there, the people suspected or proven to have supported the terrorist attacks. And it is a stunt when he sets off in three little boats, like the Nina, the Pinta, and the Santa Maria, to take them to Cuba, where they receive kindness and medication from the local health professionals. Like the stunt he pulled when he took a bunch of tobacco-related cancer survivors to sing Christmas carols at cigarette companies, it is horrifying and mesmerizing — and guaranteed to raise your temperature, which is the point.

The movie makes three significant contributions. First, though it does not emphasize this point, the film makes it clear that the primary benefit of the other systems is that the incentives promote prevention. A British doctor explains that he gets a bonus based on how many patients he gets to quit smoking, for example. The perverse incentives of our system promote neglect until the problem becomes dire or catastrophic.

The second theme, as in Moore’s previous movies, is the corrupting role that money plays in politics and policy. Moore does not say this, but the cost of campaigns in the United States is vastly in excess of the other countries he visits. Thus, politicians need to raise millions of dollars and thus they are vulnerable to pressure from the people who write checks.

Third and most important is the way this film shifts the burden of proof. Americans take it for granted that everything is better here than anywhere else in the world. But the movie’s statisitics about infant mortality and life span place us far down the list. Moore does not pretend to give both sides of the story. Our infant mortality rate is in part a reflection of our bringing more high-risk pregnancies to term. But Moore lays down the intellectual and moral gauntlet and dares the insurance companies and politicians to respond. The audiences who see this film will be waiting to hear what they have to say.

Parents should know that this movie has themes that may be disturbing, including injuries, illness, and death, including a baby. There is a brief graphic shot of a wound and brief strong language. The focus of the film is on unjust and unkind treatment of people who are sick and poor or middle-class, and one (white) character says she believes her husband would have received better treatment if he had been white. As with all of his movies, Michael Moore makes very provocative statements, often in a humorous way, but some audiences may find them offensive.

Families who see this movie should talk about their good and bad experiences with the health care system. They may want to talk with their health care professionals about their own experiences and what they think we can do better. What are the advantages and disadvantages of the US system? The nationalized health system? Who is in the best position to advocate for improvements? Who is in the best position to obstruct them? Moore is the first to admit that he is not a journalist but an advocate. As with any advocacy, viewers should challenge its assertions and omissions by examining the responses from other perspectives. The most important contribution of movies like this is that they inspire people to find out more and research the facts and the issues to justify their beliefs and positions.

Families who enjoy this movie will enjoy Moore’s other films, including Roger & Me, Bowling for Columbine, and Fahrenheit 9/11. The John Grisham film The Rainmaker is the story of a lawsuit over the kind of insurance company policies portrayed in this film. Families should look at Michael Moore’s website and at the anti-Moore site Moorewatch, especially its response to Moore’s $12,000 check and the rebuttal film Fahrenhype 9/11. And they should view the films from The Moving Picture Institute, which uses Moore-style tactics and techniques for a conservative take on issues like environmentalism vs. economic development and freedom of speech on college campuses.