Lost in the Movies: Sicko


(The above image is of a woman delivered by the hospital, via taxi, to a community rehab center after she could no longer pay for her stay. They essentially dumped her on the sidewalk where, addled and still clothed in her hospital gown, she wandered the streets until someone found her and brought her inside. She is one of many - others arrived still in pain or with IVs in their arms.)

Sicko is not an electric, polemical masterpiece like Fahrenheit 9/11; it feels longer than that film, is not as formally original, and drags in spots. However, it is a far more mature work, more subtle, more focused, and ultimately just as devastating. As "entertainment," I prefer Fahrenheit, but I have more respect for Moore's work in Sicko; flaws and all, he nails the HMOs to the wall and asks basic moral questions that can't be evaded. It helps that the subject he's dealing with is a no-brainer: why on earth does the richest, most powerful country in the world have such a shitty health care system? Why should the incentive of health care providers be to avoid treating people? Why, years after these problems became apparent, are we still unable to impose a solution? It may seem that these are "easy" questions, that there's no bravery in asking them. But the fact remains that we are currently stuck with an inhumane, indeed inhuman, situation and however obvious it may seem that it's wrong, the fact of its existence requires an outraged critique.

Moore shows wisdom right away by telling a few horror stories about the uninsured (one man was asked to choose between severed fingers because he couldn't have both reattached) and then informing us that, "this movie isn't about them." Instead it's about the majority of Americans who do have insurance, but whose providers find infinite ways of denying them the service they're paying for with catastrophic, and occasionally even fatal, results. Sicko has moments more harrowing and infuriating than anything in Roger & Me, Bowling for Columbine, or Fahrenheit 9/11. The targets of these outrage are as culpable as any of his early opponents, and more universally despised. However much conservatives may decry the horrors of "socialized medicine," few would want to defend the doctors and HMOs that refused a bone marrow transplant because it was "experimental" (effectively sentencing a man to death) or forced a woman to drive her sick daughter to another ER that was "in the system," killing the little girl as a result.

Yet what Moore doesn't do here is interesting. His usual impulse is to storm the citadels of power with his camera and poke it into the faces of those who have devastated average lives. I expected him to do as much following the bone-marrow transplant, but he holds back. And cathartic as it would be to see him make the insurance company sweat, it would be easy and, in a sense, miss the point. There are some minor villains in Sicko, but no large ones. We hear about how Nixon encouraged HMO-based care in 1971 in near-mercenary terms (thanks to scratchy White House tapes), laugh at Reagan's fearmongering warnings about the evils of creeping socialism, i.e. Medicare, and shake our heads as we watch the president and various congressmen, some in the pockets of lobbyists and others former and future lobbyists themselves, parade before the camera with dollar amounts imposed over their heads to indicate how much they've been paid off.

But when Moore gets health insurance employees before his camera, they are ashamed of their work, some of them weeping as they recall turning people down. In Sicko, the villain is societal and endemic. In Roger & Me, it made sense to hunt down Roger Smith and confront him personally. In Bowling for Columbine, it made less sense to ambush an Alzheimers-addled Charlton Heston, but theoretically at least it was the NRA Moore was going after. And though there were no climactic interviews in Fahrenheit, the obvious target was Bush, and the entire film was structured around him. But Sicko recognizes that the health care crisis is too entrenched, and you can't find one single face to put on it.

And there's a larger point too, one Moore doesn't exactly make, but which occurs to us gradually. We can fume at the insurance companies all we want for screwing the public but let's face it: that's what they're there for. They are businesses. The point of business is to make money. Like the scorpion stinging the frog halfway across the river, they'll do what's in their nature even if it kills them too. When we put our health-care system in the hands of groups whose sole purposes is profit, what the hell do we expect to happen? It makes no more sense to get angry at them (though of course this reaction is inevitable) than to get angry at a lion for eating its prey. What does make sense is to put a system in place that prevents exploitation and, ideally, circumvents the profit motive altogether.

This leads us on Moore's second thrust: having displayed the mendacity of American health care (or more accurately, American health insurance) for all to see, he tries to figure out what works. He globe-trots, first to the usual suspect in any Moore film, Canada, and then to Europe, where he visits the UK and France. I am not familiar with all the systems in these countries, but Moore's incredulously upbeat portrayals of their perfection invite skepticism. These are the passages which most closely hew to Moore's previous flawed approaches: he is generally not fond of nuance and so we get an essentially utopian view of alternative systems. But, on a fundamental level, he is correct: whatever the unseen drawbacks of these programs, they work better than the one in the U.S. - if in no other way (though he punctures a lot of hysterical myths), than to this basic degree: they provide for the health needs of their citizens.

To stage this point in the most dramatic way possible, Moore boards a group of ill 9/11 workers (whose bills go unpaid since they were volunteers at Ground Zero) and takes them to Guantanamo Bay, where accused terrorists are offered better medical care than them. Since they are not allowed into the facility, Moore "decides" to take them off U.S. soil and into the surrounding area: that of our old buddy, Cuba. The stunt is slightly disingenuous, in that it's silly for Moore to pretend he didn't expect to end up in Cuba, but it is so transparent that it's effective. In an impoverished country, Moore finds Americans the health care they can't get in their homeland, even after incurring their wounds in the service of their nation.

It wouldn't be a Moore film without a dramatic, provocative stunt of this sort and if it makes its point effectively, it also invites criticism. Moore treats the Cuban scenes as if there's no Potemkin Village quality to them, even though he's operating in a dictatorship where citizens can be forced to put in a show of solidarity. And it rubs salt in the wounds of his detractors - look, Castroland treats its citizens well! - in a way that is probably unnecessary, given that he offers so much for them to agree with in the rest of Sicko. But Moore is who he is, and that's bound to create problems in his attempted outreach. This is also evident in Moore's rush to embrace government intervention, not just in medicine, but in matters as trivial as laundry, lending fuel to the fire for those who sense creeping socialism in a desire for free health care.

The film is strongest when it exposes and tackles the problem, and becomes a bit wobblier in proposing solutions, given Moore's propensity for utopian admiration of non-American societies, and his tendency to simplify. But he makes a convincing argument that we don't need to take another country's system whole-hog: why not grab bits and pieces, seeing what works and moving towards a better society instead of standing, paralyzed, in fear of something hypothetically worse than the already terrible situation at hand? And it seems to me that Sicko's ultimate aim is not to offer some grand solution, but to get the ball rolling.

The movie has been credited for igniting a more in-depth health care debate in the 2008 election and I'm not sure if that's the case, but the issue has certainly come to the fore this year. It's worth discussing for a moment how the various candidates align with Moore's own vision of a troubled society. Neither McCain nor Obama offer a government-only solution, nor do they technically provide universal health care, though Obama promises universal access. But given what we see here in this movie, the stubbornly profit-focused insurance companies, the inability of the system to think in terms of the patient's needs first, how do the candidates engage with the problem?

McCain's solution is to make it more difficult for small businesses to cover their employees, provide a mere $5000 for families and $2500 for individuals to buy their own policies, and drop restrictions on state-bound companies, which means that providers can relocate to a state with little regulation. If this is supposed to be a proper response to the demonstrated greed and self-interest of health insurers, than Joe Lieberman is Michael Moore's favorite Democrat (and by the way, he's not! Really, he's not! I think we all know he's not!). Obama offers all Americans access to the coverage provided to congressmen, mandates that children receive coverage, and promises tighter regulations so that insurance companies can't exclude people with pre-existing conditions.

I would like to hear, among other matters, what sort of fines will be incurred by families who don't cover children, what the cut-off is for businesses required to provide coverage (how small is small?) and above what income level this would apply, and also how the insurance plan offered to congressmen (which if I'm not mistaken, is more privatized than Medicare) would be enforced with the average citizen; I'm sure the providers don't challenge powerful politicians on matters of payment and coverage, but would they show the same restraint with, say, Joe the Plumber? I will say that Obama's plan seems more sensible, and more cognizant of the fact that the private sector is not interested in the public good as an end in itself, nor it would seem, in the case of health care, at all.

In this climate of pending change, Moore's presence in the cultural and political wars of our society seems to be fading, his role becoming less clear. As an agitator, he's at his best when shut out of the room, banging on the walls. But in these situations he also has a tendency to shout, to ossify, the vilify those who disagree and contribute to a polarized air. He does have the ability, demonstrated more in Bowling than in Fahrenheit, to ask questions without immediately knowing the answer, and it is this ability which he takes a step further in Sicko. His role is to expose, not to condemn - often the exposure will serve as its own condemnation, in which case his cutesy musical found-footage montages and camera-hogging presence become superfluous (both are cut to a minimum here).

When Moore shows up again at the end of the movie, it's in a surprisingly genial and somehow optimistic gesture. We see him from behind, lumbering up the steps of the Capitol with a basket of laundry in his hands, a winking reference to the French government-does-your-laundry program that is highlighted earlier. It's a surprisingly gentle conclusion to a Michael Moore movie, which to me suggests a desire for closure, relief, and the hesitating ability to trust again. Throughout Sicko, Moore makes the most of being an ignorant American, astonished at all the things these people's countries provide for them. I found his centrist posturing in Fahrenheit to be fundamentally dishonest but here it's such a transparent shtick that it's hard to take offense (obviously, Moore doesn't really think there's some secret way French citizens pay their bills at the hospital). And there seems to be something genuine in Moore's desire to be seen as an average American; it was always there, but sometimes got lost in the left-wing outrage he proffered. Now he seems to be taking a step back from the vehemence of his outsider posturing.

At Cannes, he offered this statement, quoted in Salon, "You know, I begin to hope that as I enter the discourse with this film, I might get some kind of a break. As far as the accuracy of my movies goes, I think the record speaks for itself." At the end of the movie, it's revealed that the author of a vitriolic anti-Michael Moore site nearly had to shut down his enterprise while his wife became sick and they couldn't pay for her treatment. Moore sent him an anonymous check for $12,000 and includes this anecdote in the film. Yes, there's a self-aggrandizing element to this but it hardly eclipses the humanity of the gesture, and Moore himself has acknowledged struggling with the inclusion of this material for that very reason. Ultimately, he decided it was the sentiment he wanted to highlight.

Michael Moore would hardly seem the type to cry, "Can't we all just get along?" but ultimately, Sicko does just that (without qualifying its desire for strong and effective change). Is Moore posturing himself for the Obama years (knock on wood, I know, don't measure the drapes...), is he genuinely alarmed by the quite personal vitriol directed towards him post-Fahrenheit, has he mellowed with age? All of the above? It will be interesting to see where he goes from here.


Admin said...

Fair review. In Australia we have had universal health care for 35 years and it works.

Admin said...

PS: By "fair" I mean't balanced. An excellent essay.

Joel Bocko said...

Tony, glad you appreciated it.

Re Australian health-care, what do you see as the drawbacks of the system, i.e. what should we look to avoid as we (hopefully) move towards more unviersal care? Or do you feel that, all things considered, it's about as good as it possibly could be?

Tony D'Ambra said...

Like all social goods there is never enough money, but overall in the current framework, most people are happy.

The system is fair, but for non-critical hospital procedures in some regions, there are waiting lists, and this is not so much a systemic issue, but due to insufficient long-term funding of public hospitals. In Australia, funding of hospitals is a join Federal-State task, and politics always is a factor, and from 1996 to last year under a conservative federal govt, the mantra of budget surpluses was fanatically adhered to along with income tax cuts, with vital spending on health, education, and infrastructure largely neglected.

The system here operates as a safety-net, where a doctor can choose to bulk bill and the patients pay nothing for a visit, otherwise the patient must pay a gap to the doctor. All public hospital beds are free.

The system is funded by a levy of 2.5% on taxable incomes, but those on low-incomes are exempt or get a tax rebate.

There is a private system of medical insurance ,where you can cover private hospital stays and private beds in public hospitals. But the high costs of private insurance premiums are subsidised by govt to the tune of over A$5 billion annually.

Most medication is subsidised by the govt, and there is a safety net threshold, after which additional scrips are free.

The bottom line is anyone, irrespective of income can be admitted to a public hospital bed and receive free care including all medication - even if they have private cover. The one caveat is that a public patient has no choice of doctor, while a private patient can choose his doctor. All medicines in hospital are free for public patients. Those on full social security get free medicines.

The system works for practically everyone, and a politician tinkers with it only at his electoral peril. There is no way the scenes recorded in Sicko of patients being turned away or dumped by hospitals can happen here.

This is NOT socialised medicine. Only hospital registrars and salaried doctors are employees. All other doctors and specialists, even when consulting in hospitals, are paid on a fee-for-service basis.

Health is a public good and should be delivered as one.

Joel Bocko said...

Wow, a detailed analysis - thanks!

I have a couple questions: 1) why is the doctor decided by the government, and 2) why does the government subsidize private coverage?

"a conservative federal govt, the mantra of budget surpluses was fanatically adhered to"

Well, look on the bright side: in our country we get neither surpluses nor universal health care! to quote the Wall Street Journal, we really are "lucky duckies"...(though they were referring to those fortunate souls who make so little money that they don't pay federal income tax...and then they have the gall to accuse the OTHER side of class warfare!)

Tony D'Ambra said...

> 1) why is the doctor decided by the government?

Not by the govt. As a public patient in a public hospital, you are allocated the registrar, and she will chose the consults. As a privata patieny, you may choose the consult. Outside hospitals, you are free to visit the doctor/specialist of your choice.

> 2) why does the government subsidize private coverage?

Good question. Firstly, the two tier system is to encourage those who can afford it to take out private cover, essentially to allow public resources to be focused on those who can't afford private cover. Secondly, the private funds - mutual funds and not for-profit - couldn't survive. There also tax penalties for those with incomes over $100,000 who don't take out private cover.

> in our country we get neither surpluses nor universal health care!


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