Saturday, June 23, 2007

Sicko - B+


In theaters starting June 29th. Rated PG-13, 113 minutes.

Michael Moore is a talented filmmaker with a penchant for straw men and hyperbole. In Sicko he takes aim at the healthcare system in the United States, comparing and contrasting it with socialized medicine in Canada, England, France and Cuba. His basic premise is that the US should provide universal health care paid for by the government, and claims that we are the only Western democracy that does not do so. The film argues that the country should pull together and 'think in terms of we, not me' on this issue, and, presumably pay higher taxes and pay our doctors less and we'll have a perfect universal healthcare system. As with all of his films (Roger & Me, Bowling for Columbine, and Fahrenheit 9/11), there is some truth to parts of the picture that he shows, which makes for an entertaining yet skewed movie experience.

Like a magician, he takes leaps and hides things to accomplish his illusions. The primary foils in Sicko are US HMO's and the politicians that helped establish them (Nixon) and perpetuate the system (all of them). As you might imagine, there are myriad tragic anecdotal health care stories in the United States, a country of 300 million people. Surely there are similar tragic anecdotal stories in all of the countries he shows as shining lights of healthcare, but he doesn't worry with that inconvenient truth (rim shot). The stories Moore uses are compelling and moving. While I agree that HMO's are terrible and that a system that incentivizes denial letters over people's health is inherently flawed and needs to be changed, I don't agree that socialized health care is a perfect system (although it might work in the US in some form).

The juxtaposition of someone being denied a medically necessary procedure and free healthcare from attractive and smiling physicians and nurses obviously leads you to the conclusion that governmental health care is better than the US system, which leaves 45 million uninsured and several million afflicted with an HMO. The scenes in the other countries are funny/sad because of the excellent care that is being shown at no immediate cost to the recipient.

Another downfall of Moore's films is the tendency to overreach on his points, which ultimately hurts the overall impact of the film. He has two of these moments in Sicko. The first is a dinner party in France with Americans living there. They gush about the free health care, the 5 weeks of paid vacations, the state provided nannies (who even do your laundry), the 35 hour work week, and all of the other perks of living in France (never mind the banlieus and Islamic demographic trends). He goes on and on showing the greatness of this system without showing the real cost it has, either in taxes or in national productivity. The second overreach is his use of 3 people who went to ground zero on 9/11 to volunteer. They have been denied care from the $50 million fund set up for volunteers (Moore fails to explore why) and he takes them to Guantanamo Bay to get the same care (state of the art) that the prisoners there do. That stunt is actually funny and drives home his point. Where he goes askew is when he takes them to Cuba for world class healthcare and has them go to a firehouse as returning heroes. The fawning and sycophantic portrait of a communist country is a joke.

I will admit to having my viewpoint on this issue challenged. Moore says repeatedly that a society is judged by how it treats its less fortunate, and I agree. He also quotes De Toqueville in saying that America's greatest strength is its ability to correct its course. The most effective scenes are with Michael Benn, a former member of British Parliament, who speaks knowledgeably about democracy and healthcare and the confluence of the two.

This is definitely worth seeing, and I am really looking forward to Doctor's comments or separate review of this one.

Viewing Note: I had the odd experience of talking in person to President Bush and seeing this movie with a sold-out house of hard core liberals in the same week. The pitcher in the gay couple sitting in front of me was a 'yepper', who nodded vociferously and said 'yep' or purred an emotional 'wow' at every single possible point. The GWB potshots were met with cheers and it got long applause at the end.

3 comments:

Doctor said...

A complicated issue requires a long post. In Canada, lawyers have no power and there is no significant litigation threat. There is also a ridiculously long waiting list (at least 6 months) for a simple procedure. Many surgeries are postponed indefinitely. But it's free. Canadians have been trained to not expect much from their healthcare.

Most Americans expect perfection from their healtcare experience and nothing will ever change that. People will always want the right to sue doctors. Nearly every doctor I've talked to has been involved with lawyers at some point. And it's almost always for something where they didn't do anything wrong. Doctors are rarely sued for their mistakes.

People like Moore want it both ways - free healthcare for everyone and let trial lawyers sue the pants off of all the doctors and take 33% of the settlement. If you want a healthcare system like Canada, fine, take away the threat of lawsuit and most doctors I know will gladly give over a bulk of their salary. But in Canada, doctors make twice as much. Let's change the healthcare system and legal system at the same time. Losing side pays legal fees. How many frivolous lawsuits would that stop?

OK, now - obviously there are some major problems with the American healthcare system. Google is currently working on keeping people's medical history on line - this is an important step forward and will save time and stop unnecessary tests.

The one thing I remember from Warren Beatty's Bulworth is an interesting point that insurance companies take 30% off the top and it's estimated that the government would only take 10-15% off the top. Not sure I believe that, though - didn't the postage stamp just go up again?

Another interesting development occurred recently in Massachusetts where the government would force people to buy healthcare like they force us to buy car insurance. Great idea. We need more ideas. We really need to figure this out.

Most doctors don't like insurance companies telling them how to practice medicine. Insurance companies were initially designed for rare, life-threatening circumstances, not for every visit. (You don't take your car in for every door ding or oil change). But there wasn't enough money in it. If Moore is basically after the insurance companies, I can't really argue with that.

But if anyone thinks we should go to a nationalized healthcare system, we already have one - it's called the VA (Veteran's Administration). It's free, it has long lines, and usually has substandard care (including the recently maligned Walter Reed). If this is how we treat our hero veterans, how are we going to treat the average crack whore?

Lawyer said...

Moore bats away the Canadian 'waiting list' issue by anecdotally talking to 3 or 4 different people. He focuses on only the bad part of our system and only the good parts of their system.

Great points about American expectations and the legal impact. While lawyers have abused the American system and cause much of the problem, no litigation threat is also a scary proposition. I believe most lawyers that file malpractice suits are bloodsuckers, but I also think that some litigation threat is necessary in any industry to protect the public from bad or incompetent companies/doctors.

I also like the Mass. idea, which provides the 'worst case scenario' insurance for everyone, while leaving the proverbial door dings to each person to deal with.

Doctor said...

All of my Canadian information is from a physician friend from Canada who moved to the US to practice medicine. I have personal experience working in a VA. VA doctors don't live in fear of lawsuits, by the way. Other doctors order way too many tests (defensive medicine) so they can never gets asked on the stand, "Why didn't you do ____?"

I'm not sure how things work in Cuba, but I'm pretty sure Miami isn't 50% Cuban because Fidel gives great healthcare.