I enjoyed Mr. Hayes's assessment of Michael Moore's SiCKO, but I disagree with the part about Cuba. Yes, it is possible for rabid opponents of socialism (who liken it to Nazi Germany or Stalin's USSR) to use the Cuba scenes as fodder for their arguments. But I think Moore was trying to illustrate that even a communist dictatorship is capable of, and willing to, provide basic healthcare to its citizens. If Fidel Castro's regime can do this for Cubans, then why can't America provide national healthcare for its people? Taken in that light, I think the tragic irony demonstrated in the final thirty minutes or so of the film actually reinforces the overall message that there is no valid reason why the United States of America can't take the best aspects of other countries' health care systems and apply them at home.

Michael Kwiatkowski

Cleveland, OH

I only partly agree with your point about the inclusion of Cuba. After all, even the World Bank praises Cuba's health care program, as does virtually everyone who studies economic development issues. It's good that Moore does not shy away from the point: "Even a poor country can have a good health care program," is the message.

But I agree that, if Moore was going to include the Cuba scenes, he should have given it a lot more of this kind of context, maybe even had a World Banker talk about it.

Todd Tucker

Washington, DC

One of the lines in the movie that is not getting the attention I believe it deserves is from that old warhorse Anthony Wedgewood-Benn, who notes in regard to the cost of World War II that if we can spend that much money killing people, then we can just as well spend that much money making people feel better. (My entire review can be found on my blog.)

Jak King

Vancouver, BC

This has to do with the Ronald Reagan contribution to Sicko. Reagan was an FBI informant solicited by Hoover during WW2 while Reagan was on the front line selling bonds for the war. He, DeMille, Jack Warner, gave Hollywood names to Hoover contending them to be commies, but they just wanted to eliminate some competition. I think Charlton Heston was involved.

Ken Lusk

Clayton, GA

Sicko is Moore's most mature work.

The American health system is sick because American values have been perverted by grubby polticians, greedy corporations, voter apathy and electoral disenfranchisement. America finds billions of dollars for war, while the sick and the dying are dumped by hospitals on to the streets.

Living in Australia, where we have had universal healthcare for over thirty years, I was genuinely flabbergasted by the extent of the neglect and abuse. Where is the mainstream US media on this?

The issue is encapsulated in the early scene in Sicko, when a middle-aged couple arrive at the their daughter's home, after medical bills have left them destitute, to live in her storeroom. Moore lets the wholly shabby scene play out without intervention. The indifferent put-upon daughter coldly leads her parents to the storeroom, which is presented as is, full of junk and with zero effort to prepare it for her parent's arrival, while the other child from hell, the son, sits on his sister's sofa with legs folded and berates his parents by complaining of the burden they will place on him. Contrast the treatment of these hapless parents with the dignity with which they are welcomed by strangers in that "pariah" state, Cuba.

This is where I disagreee with part of The Nation's review of the film. The Cuba segment was risky and until Moore segued onto the streets of Havana, I was unsettled by the Guantánamo expedition, but the segue was seamless and propelled by its own logic.

It seems perverse to argue that a filmmaker should not popularize an issue in this way simply because of the risk that he will be labelled as a propagandist by the right.

Challenge the conservatives to show us that hospital patients are thrown from taxis onto the streets of Havana by the hospitals charged with their care.

Parts of this letter were previously published in a Reader Review by me on the New Yourk Times Select Web Site.

Tony D'Ambra

Sydney, Australia

I just got back from seeing Sicko and thought it was a terrific and very moving film. The film has many individuals telling their stories about what happened to them because they did not have health insurance, or did have it and nonetheless did not receive affordable or proper treatment.

In this country the right wing always attacks and blames the individual. If someone doesn't have insurance, it's their own fault. If they lose their job, they should get another one. If they're sick, they probably caused it themselves. And the most effective part of this movie is in showing person after person suffering from our current system, so that the perspective is that "we all" have a problem, not just this individual or that individual. Terrific film. Now let's tell our politicians that we want national universal healthcare now.

Nancy A. Butterfield

Camarillo, CA

Beyond SiCKO, there's Kucinich.

As a long-time Nation subscriber, I urge you to give Dennis Kucinich more coverage.

Kucinich represents most Americans' aspirations on all issues, but the press ignores him. I expect The Nation, at least, to give him some column inches.

As for health care, Kucinich cosponsors HR 676 with Conyers. It's time this was recognized. Kucinich has for years been a leader in pushing for universal, single-payer, publicly funded, privately delivered health care for all.

Please let us see more information about this most progressive of Democratic candidates (the only Progressive, aside from Mike Gravel) or else explain to us all the universal boycott of news about Dennis and his positions on issues that concern all Americans.

There must be a reason why Democracy Now! reported that "Congressmember Dennis Kucinich drew some of the loudest applause of the night when he called for an end to the Iraq war" at Tavis Smiley's presidential forum.

Please let us hear more of the views of this most reasonable candidate.

Lenore McGee Luscher

Watsonville, CA

Germany: Universal Coverage, but not single payer!

I wish everyone would stop assuming that universal healthcare is equal to single payer healthcare. It is not!

In Germany, there is a two-and-a-half tier system of healthcare delivery. There is first the distinction between private health insurance and non-private health insurance. Private health insurance is basically the same as here in the US. The insurer is free to charge what he wishes and the purchaser can choose his coverage as he likes. The caveat is that in order to purchase private health insurance, you must have a certain minimum yearly income, the level of which is set by the government. When I was there a few years ago, the minimum was approximately €80,000 per year. If you earn more than that--you may purchase private insurance, if you earn less than that, you may not. Private health insurance in Germany is better than non-private in almost every way: front-of-the-line treatment by doctors, private hospital rooms, better coverage, etc. The downside is once you move into private insurance, you have to stick with it forever--even if your health deteriorates or you get old--either of which will send your premiums skyrocketing of course. As a privately insured individual, you may return to the non-private insurance system only if you are broke.

Most Germans don't earn enough to purchase private insurance, so they are in what I call the "non-private" system. I don't call it public insurance, because it isn't. Non-private insurers in Germany operate like credit unions in the US. They are medical co-operatives that pool health-related risk. There are many hundreds of these organizations. Any given individual will qualify for several of these medical co-operatives based on their profession, home address, religious affilation, etc., in much the same way that people qualify to join various credit unions here. You pick an insurance provider from among the co-operatives for which you qualify. You can choose based on coverage, rates (which may vary within certain boundaries), perceived "goodness" (usually related to how much they pay doctors--and therefore how much doctors like people covered by that co-operative), etc. Premiums in these medical co-operatives are based on a percentage of your salary, and deducted like payroll taxes--but they are not taxes: the money goes to your provider, not to the government. The higher your salary, the higher percentage you pay as your insurance premium--up until the above mentioned private health insurance minimum. When you earn more than that, the percentage of salary charged as a premium stays constant. This is to encourage people to stay in the non-private system even though they could afford private insurance.

With non-private insuracce your medical experience will not be as nice as with private insurance--all the basics are covered well, but you will share a hospital room, and you will not be bumped to the front of the line, or have access to special appointment times. I was in this system and I found it entirely satisfactory. It didn't bother me that someone with private insurance could come to the doctor's office at 8 when appointments for the rest of us began at 9. But then again, I'm not a bitter jealous person.

Medical services for non-privately insured people are basically "free" at the point of service, but there is a co-pay of €10 to discourage frivolous doctor visits encouraged by completely "free" healthcare.

German healthcare provides universal coverage by making membership in the local government's medical cooperative available to people who don't have jobs, income, etc. Their premiums are paid by the government as a social welfare benefit.

Oh, and paying cash for medical services is entirely legal. I did it myself before I entered the German health insurance system.

By introducing a measure of market economics to their healthcare system, Germany provides universal care without the typical waiting lists and rationing that are a common feature of all socialist economic systems. In fact, German newspapers often run articles on the horrors of medical care in the British NHS--the awful stories that Michael Moore doesn't want to talk about, but that are all too common in Britain, but almost completely unknown in Germany.

In short, Universal Coverage: YES! Single Payer: NO!

William Simms

Atlanta, GA

I have not seen the movie Sicko, and I doubt that it will be shown anywhere in Wyoming. This is an "ultra-conservative Republican " state. But with the "healthcare industry," even if you have "health insurance" the moment you start using it the insurance companies raise your premiums. With the high cost of medical care from diseases that hit you at "random" like: MS, Parkinsons, Altzheimers, and some forms of cancer. And some forms of cancer are "self-inflicted," like smoking. The conservatives point out the "life style" choices: diet, smoking, etc.

Thomas O'Brien

Casper, WY

What concerns me the most about the healthcare industry is the affordability of high-costing medications and worrying whether and when my drug benefit plan would be maxed out. Seems like one can get their medications for sometime in the US, but after a while or short while, they have to be sought from Canada and other countries.

Nick Rosen

Great Falls, VA