Michael Moore is as conspiratorial as ever. The online leaking of Sicko, his new documentary on the American health care system, was an "inside job," he said. It was an attempt at "ruining the opening weekend's box office" by those with a "vested interest" in seeing the film fail. And that's not all. Government officials, the Fahrenheit 9/11 and Bowling for Columbine director told reporters, are so anxious about his paean to Cuba's health care system that he stashed the master reel in Canada, lest the Bush administration try to seize it.
But the administration needn't worry about Sicko. As with much of his previous work, Moore's latest film is, by turns, touching, naïve and maddeningly mendacious, a clumsy piece of agitprop that will likely have little lasting effect on the health care debate. Moore is right that the American system is sick—on this, there is bipartisan and public consensus. The United States has the highest per capita health care spending in the world, with comparatively disappointing results. But his radical prescriptions, which include a call for a British-style, single-payer system, will likely have little resonance with viewers. Indeed, according to a recent ABC News/Kaiser Family Health study, insured Americans are overwhelmingly (89 percent) satisfied with their own care, while broadly concerned about rising costs of prescription drugs and critical of the care others receive.
Sicko starts off rather well, with an effective montage of health care and bureaucratic nightmares, from insurers slithering out of active policies and denying coverage retroactively (with conditions as insignificant as a previously undisclosed yeast infection used as justification) to the rejection of new applicants for reasons both bizarre and abstruse (like the 6'2", 135 pound applicant turned down for being "too thin"). But as is often the case, Moore quickly overreaches, implying that such horror stories are de rigueur, a uniquely American problem that could only be solved with further government intervention.
Sicko presents us with the case of Doug Noe, whose young daughter Annette was born with an acute hearing disability. When a doctor suggested a pair of cochlear ear implants, Noe's insurance provider, Cigna HealthCare, approved the procedure for only the left ear, arguing that a two ear operation was "experimental." But when Noe alerted Moore to Cigna's intransigence, the company quickly reversed its decision, fearing bad publicity.
Score one for Citizen Moore.
Such heartless penny-pinching, Moore argues, is uniquely American, the logical endpoint of a system that puts profit before people, as the saying goes. But fear not. For according to Sicko, there exists an alternative, modestly utopian alternative. In Europe—specifically France, England and Scandinavia (Moore filmed in Norway, but didn't include it in the film, he told audience members at the Washington, DC premiere, because it was so generous he feared American audience members would think it was pure fiction)—every health care issue is handled by a squadron of munificent bureaucrats.
But, the viewer is left wondering, who will pay for all this generosity? Don't governments too suffer from cash shortfalls and ballooning budget deficits; situations that require corners to be cut, beds to be freed up, the cheapest route taken? What of Moore's implication that, once turned over to the government, things become "free?"
Take the case of four-year-old Elias Dillner. In 2004, Dillner's parents were told by doctors that their son too would benefit from cochlear implants. After being fitted with the first implant, Dillner's insurance provider said the second operation could not be "prioritized." The family would have to wait. "We will do anything," Elias's mother told reporters, "even if it means that we have to take out a loan for the operation." Without insurance, the second procedure would likely cost $40,000.
But Dillner's truculent insurance provider was not Aetna or Kaiser, but the notoriously generous Swedish welfare state, where health care is "free." And because there is no private clinic in Sweden that could perform the operation, Elias will sit in a queue, hoping, in lieu of privatization, for prioritization. Swedish legislator Robert Uitto said that the Dillner case was unfortunate, but "People shouldn't, on principle, be allowed to purchase care in the public system."
Sicko also introduces us to Diane, whose brain tumor operation was initially denied by Horizon BlueCross because it didn't consider her condition "life threatening." She eventually received treatment, but "not without battling the insurance companies," Moore says.
Jack Szmyt found himself in a similar situation. After waiting two months for his initial diagnosis—he too had a brain tumor—Szmyt was told that it would be another month until doctors could start the necessary treatment. Rather than wait in a queue, he borrowed $30,000 from a friend, and flew to a private clinic in Germany. Had he not sought private treatment abroad, his German doctor said, he would likely have died. When contacted by the media, his insurer, again the Swedish government, said it didn't consider the assigned waiting period "unreasonable."
Such examples suggest that Moore's depiction of European-style medicine as an easy panacea for America's problems is rather more complicated than presented. Massive queues and cash shortages have plagued all of the systems profiled—and celebrated—in Sicko. In the case of Cuba, whose system Moore also praises, this includes shortage of basic medical materials and medicine. And the credulous audience member is none the wiser.
One of the systems Sicko suggests as a template for a remodeled American health care is the United Kingdom's National Health Service (NHS). The "first way [the British] decided to pull together after the [Second World War]," Moore says, "was to provide free medical care for everyone."
Viewers are taken to London's Hammersmith Hospital, held up as a shining example of socialized care, where doctors are well-paid and patients well looked after. Moore ambles through the corridors interviewing patients that acclaim the NHS's 'free care,' and express horror at the barbarism of the American system. Indeed, the facility's "cashier" exists to give money to patients—for travel reimbursements—rather than taking it from them. But as is often the case with Moore's films, the reality is more complex.
In 2005, London's Evening Standard reported that Hammersmith Hospital would slash hundreds of jobs; the hospital, the most debt-ridden in Britain, was hemorrhaging money and desperately needed to cut costs. And while the hospital was "downsizing", Hammersmith's CEO—yes, even the NHS has an executive class—collected a year-end bonus of close to $20,000. Small beer by American standards, but enough to provoke tabloid headlines in Britain.
Much like the American hospitals Moore excoriates, Hammersmith Hospital, the Evening Standard reported, faced pressure from administrators to limit the number of patients treated in order to cut spending. In a country where the government promises to winnow down queues to 18 weeks, this isn't an anomalous problem. A recent BBC documentary accused the NHS of using dangerously high doses of radiation on patients "to save time and money."
After the critical reaction to his previous films, Moore opts for elision over outright falsehood. So when he marvels that a doctor working in the NHS owns an Audi and "million dollar home," it is hardly in his interest to point out, as The Independent did in January, that "soaring salary levels of doctors are worsening the NHS cash crisis." And while bitterly lamenting the U.S. system of "wage slavery"—American students, Moore says, are saddled with debt and, thus, "won't cause [employers] any trouble"—he ignores a recent report from the British Medical Association suggesting that, by their fifth year of medical school, British students "have accumulated an average debt of" $39,000.
It is these sections, where Moore uncritically praises institutions with which many locals have ever-declining levels of faith (only 4% of Britons surveyed think the system "has enough money and the money is spent well"), that will likely alienate his non-ideological foreign fans. It is one thing to nod one's head in agreement with the Bush-bashing Fahrenheit 9/11—likely a mere reinforcement of previously held views for most Europeans—but it is quite another for a Briton to watch Moore tell viewers that English pharmacies don't sell milk and laundry detergent, when there is a Boots—the British version of CVS—just around the corner.
Sicko concludes with Moore speaking in soothing, dulcet tones over mawkish orchestral music. The sotto voce lesson is Rodney King-ish, admonishing Cubans and Americans to just get along, and for the rest of us to take care of our fellow man while, presumably, campaigning for Dennis Kucinich. So after two hours of limp jokes that would make Bruce Vilanch wince and a continent-spanning exploration of socialized medicine, Moore's specific policy prescriptions are impossible to find. Without them, he ends up urging viewers to just let the government run the damn thing.
But as P.J. O'Rourke once commented, if Mike thinks health care is expensive now, just wait until it's free.
Michael C. Moynihan is an associate editor of reason.
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