In 1971, Edgar Kaiser, the son of the founder of Kaiser Permanente, one of the first big HMOs, went to see John Ehrlichman, a top aide to President Nixon, to lobby the Nixon White House to pass legislation that would expand the market for health maintenance organizations (HMOs). Ehrlichman reported this conversation to Nixon on February 17, 1971. The discussion, which was taped, went like this:
Ehrlichman: I had Edgar Kaiser come in…talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because the less care they give them, the more money they make.
President Nixon: Fine.
The next day, Nixon publicly announced he would be pushing legislation that would provide Americans "the finest health care in the world."
When tapes of the Nixon-Ehrlichman conversation and Nixon’s subsequent public statement are played halfway through Michael Moore’s new movie SiCKO, it is one of the film’s more revealing moments. By this point in the film, Moore has already demonstrated that health insurance companies and HMOs are parasitic villains that routinely deny necessary medical care to make more bucks–even when their money-grubbing leads to the death of patients. Looking for the original sin that led to the present mess, Moore zeroes in on this Nixonian moment, which encapsulates the film’s premise that the United States health care system is defined by a fundamental conflict: profit versus care, and–no surprise–profit beats care.
Moore makes this point magnificently in SiCKO, which is the best film in the Moore canon. I say this as one who had a mixed reaction to Fahrenheit 9/11. (See here.) This time around, Moore has crafted a tour de force that his enemies will have a tough time blasting (though they will still try). It’s not as tendentious as his earlier works. It posits no conspiracy theories. The film skillfully blends straight comedy, black humor, tragedy, and advocacy. You laugh, you cry–literally. And you get mad.
The film stitches together a string of health care horror stories. Moore opens the movie by looking at two cases involving Americans who don’t have health insurance. One fellow who sliced off the tips of two fingers is told at the hospital that he can attach the ring finger for $12,000 and the middle finger for $60,000. He can’t afford both. Ever the romantic, Moore reports, this man opts to save his ring finger.
But SiCKO is not about the uninsured. It’s about those who have insurance and who have been screwed. Moore began this project by advertising on the Web for tales of health care woe. Within a week, he had received 25,000 emails. That’s plenty of raw material. One enterprising father of a child who was going deaf and whose insurance company would only pay for one ear implant wrote his insurance firm and asked if its CEOs would like to appear in Moore’s film. The company–whaddayaknow–quickly authorized payment for the other implant.
From this flood of complaints, Moore drew compelling and heartbreaking stories. A woman is denied payment for a major procedure because she neglected to mention on her insurance application that she once had a yeast infection (which was, of course, unrelated to the procedure she needed). A mother loses her 18-month-old daughter because a hospital won’t treat her without authorization from her insurance company and her insurer insists she takes the child (during an emergency situation) to an in-network hospital. A woman who was in a car crash is denied payment for an ambulance trip because she did not receive pre-approval for that cost. A man is denied a bone-marrow transplant that could save his life and dies.
Moore interviews health care industry insiders who confirm the worst suspicions. A former employee at a health insurance sales centers cries as she talks about how she was trained to handle prospective clients who might be health risks. "I’m such a bitch on the phone," she says. Doctors who worked for health care companies tell how they were encouraged to deny claims to save their companies money. Medical reviewers for one health insurance company who rendered the most denials received bonuses. Footage from a video surveillance camera shows a Los Angeles hospital dumping an indigent patient on Skid Row. "Who are we?" Moore asks. "Is this what we have become: a nation that dumps its own citizens?"
Moore’s meta-message is, It doesn’t have to be this way. He visits Canada, England, and France and compares their health care delivery systems to America’s. He plays this for loads of yucks. In a British hospital, he goes looking for the place where a patient has to pay his or her bill. He cannot find such a check-out counter. Then–a-ha!–he finds a cashier. But–here comes the punch line–this is where the hospital hands out cash to patients who need a few pounds to cover the cost of their transportation home. Yes, in a British hospital you can leave with more money than you came in with.
What about those put-upon doctors who must work under the heavy yoke of Britain’s National Health Service? He interviews a young doctor who drives a new Audi and lives in a posh million-dollar flat. The British system, the doc says, is fine for doctors–unless you want to live in a $3 million flat and own three or four cars. As for drugs, every prescription in England costs the equivalent of ten bucks–no matter what drug or how much of it. An American who blew out his shoulder trying to walk across the famous intersection at Abbey Road on his hands tells Moore that he obtained great hospital care for no money.
Ditto Canada. Ditto France. Doing his I-can’t-believe-it act, Moore grills Americans and locals in each country who relate stories of receiving quality care for no payments. A Canadian doctor, with a straight face, says that he has "never told anyone we couldn’t put a finger back on" because of a patient’s inability to pay. In the land of surrender-monkeys, Moore discovers that government-paid doctors–Sacre bleu!–make house calls, and new parents are visited by federally-paid daycare providers. And get this: a fellow who completes chemo in France gets three months of paid leave to recuperate (on a beach in the south of France, no less). No wonder, the United States ranks 37th in the world when it comes to the health of its citizens, just edging out Slovenia.
Moore whacks the U.S. political system for catering to the needs of the insurance industry not the citizenry, pointing out that the health care lobby pumps millions of dollars into the campaigns of lawmakers. He notes that Senator Hillary Clinton, once the scourge of the health care industry, has become a top recipient of contributions from health care firms. (Movie mogul Harvey Weinstein, executive producer of the film and a friend of Hillary Clinton, pressed Moore to cut that part of the film. Moore turned him down. In a recent interview, Weinstein conceded he had asked Moore to delete this portion.)
In the film’s climax, Moore gets on a boat in Miami with three 9/11 rescue workers who have been unable to obtain the necessary treatment for ailments apparently caused by their exposure to debris at Ground Zero. His mission: bring them and other health care industry victims to the Guatanamo detention facility in Cuba, where (according to the Bush administration and Republican congressional leaders) the detainees typically receive fine medical treatment. Gitmo, Moore cracks, is "the only place on American soil with free universal health care."
Moore’s small flotilla approaches the camp. He takes out a bullhorn and shouts, I have three 9/11 rescue workers who need medical attention. He adds, They just want the kind of treatment al Qaeda is getting. No one in the guard tower responds. A siren goes off. Maybe we better leave, he says. Moore takes the rescue workers and the others to the Havana Hospital where they receive–as do all Cubans there–free quality treatment.
Sure, it’s a stunt–but a telling one. One of the rescue workers is living on a monthly disability payment of $1000. Her inhaler costs $120, and she needs at least two a month. She breaks down and cries when she learns she can purchase the same drug in Cuba for five cents. Were she a suspected terrorist in Gitmo, she would get the device for free.
Moore’s right. The health care system in the United States is a bad deal for many Americans. (Don’t get me started about Oxford, which routinely denies almost every claim I submit for my family.) He glosses over some of the problems overseas (the French social welfare system is under much pressure), but he debunks the hyperbolic scare-’em criticisms hurled at the Canadian and British systems by free-marketeers who defend the U.S. system. As for the charge that a universal health care system would be "socialized medicine," Moore rightfully counters that in the United States there’s socialism when it comes to the public well-being; there are public schools, public fire departments, and public libraries. What about public health?
In the film, Canadians, Brits and French laugh at Americans for their cockamamie health care system. Explaining their own systems, they all say that it’s a matter of communal security: we take care of each other. In other words, leave no citizen behind. Moore does not explicitly call for a particular set of reforms. But he clearly wants a taxpayer-funded system that cuts out the insurance companies and provides universal care to all.
Health care policy can be mind-numbingly complicated. Try to sort out the differences between Senator Barack Obama’s health care plan and Senator John Edwards’ proposal. And remember the wire chart the GOP cooked up for Hillary Clinton’s proposed reform? But Moore, to his credit, cuts through the surface-level details and gets to the essentials. Why not health care for all? Why allow corporate profit-mongers to decide whether an 18-month-old girl lives or dies? Why is the population of the United States, as wealthy as this nation is, not as healthy as the population of Britain, France, Canada, and 33 other countries? Why settle for a sick system?
Advocates of universal health care (note I say care, not coverage) are hoping SiCKO leads to political change. The California Nurses Association, which supports a single-payer system, is organizing across the country in conjunction with the movie’s appearance. It’s hard to see a film moving a nation–and, in particular, the politicians who pocket all those health care industry dollars. But Moore has produced a work that maximizes his talents as social critic, humorist, filmmaker, journalist, and advocate. SiCKO is brilliantly funny and sad. It’s a dead-on diagnosis. Don’t get sick before seeing this film.
JUST OUT IN PAPERBACK: HUBRIS: THE INSIDE STORY OF SPIN, SCANDAL, AND THE SELLING OF THE IRAQ WAR by Michael Isikoff and David Corn. The paperback edition of this New York Times bestseller contains a new afterword on George W. Bush’s so-called surge in Iraq and the Scooter Libby trial. The Washington Post said of Hubris: "Indispensable….This [book] pulls together with unusually shocking clarity the multiple failures of process and statecraft." The New York Times called it, "The most comprehensive account of the White House’s political machinations…fascinating reading." Tom Brokaw praised it as "a bold and provocative book." Hendrik Hertzberg, senior editor of The New Yorker notes, "The selling of Bush’s Iraq debacle is one of the most important–and appalling–stories of the last half-century, and Michael Isikoff and David Corn have reported the hell out of it." For highlights from Hubris, click here.