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.