There's something wrong when the idea of health reform generates more attention from Hollywood than from our politicians in Tallahassee or Washington, D.C. But with this summer's release of Michael Moore's Sicko, that's certainly the case.
I watched the two-hour movie not just as a health-care consumer, but also as someone who has spent the past two decades writing for major newspapers and magazines about the many problems of the U.S. health-care system and the scant attempts at a major overhaul. It's been a rewarding career, but also quite depressing.
Nearly 15 years have passed since President Bill Clinton and Hillary Rodham Clinton made the last real effort to give all Americans health coverage by attempting to enact a new national health-care policy. Since then, by almost every measure, our health-care system has only worsened.
I remember attending a health-reform discussion and listening to Hillary Clinton in Harrisburg, Pa., days after she was named to head the reform effort. There was so much excitement from policymakers, and the public was clamoring for change. But then Clinton made some tactical errors — including drafting the policy largely in secret — that gave the industry the opening it needed to attack the plan. It all came crashing down a few months later when the insurance industry and other special interest groups used attack ads to belittle the plan.
If Sicko accomplishes anything, it's that more people are talking about fixing our health-care system that leaves 46 million Americans without health coverage. It is the number one cause of personal bankruptcy and forces those with insurance to often work through a bureaucratic maze to get the care they need. But due largely to Moore, health care is finally back on the agenda as the 2008 presidential campaign heats up.
Perception Versus Reality
It amazes me, as it no doubt amazes Moore, that we still have politicians who talk about the U.S. having the best health care in the world. By most criteria, we don't. Our life expectancy is several years shorter than that of Japan and several Scandinavian countries. We spend twice as much money per capita on health care, but still leave 46 million Americans without coverage. Then there's the quality question. We rank 37th in infant mortality. Medical mistakes are considered the fifth leading cause of death in the United States.
That's not to say we don't have great health-care institutions, great doctors and nurses, and a wide-range of other services. We do. But that's little comfort for people who lack access to the Mayo Clinic or Sloan Kettering or a physician to test them for diabetes or asthma.
The state of health care in America has a lot to do with the health system put in place by industry and government. But it also has much to do with Americans' behaviors. As a nation we still have poor diets (Moore included), don't get regular exercise (Moore included), and don't handle stress well. We still drive too recklessly, either with cell phones or alcohol. No matter how good of a health system we dream about, it wouldn't do much good if we continue our unhealthy behaviors.
Everyone has a story to tell about how the health-care system has failed them or their family at one time. Moore's movie is basically a compilation of victims' stories that he weaves together in a poignant fashion alongside statistics showing how unhealthy Americans are compared to the French, British, and other countries with universal health care.
There's the man lost two fingers to a table saw, but because he lacked coverage, could only afford to pay for the reattachment of one. There's the woman whose insurer wouldn't pay for her ambulance service following a car accident because it hadn't been preapproved. There's a deaf child whose insurer would only cover a cochlear implant in one ear instead of both. There's the 73-year-old man still mopping the floor at a grocery store, unable to quit because he needs the prescription drug coverage.
Moore puts the insurance companies on trial. He visits with former insurance company henchmen who say they are still haunted by their past work. A man whose job was to spy on claimants in hope of discovering something to nullify their claims says he hoped he didn't cause anyone's death. A woman tearfully recalls being driven to depression from denying insurance claims to people whom she knew deserved the money and would be ruined without it. Another talks of bonuses issued for those who denied the most claims.
Observations, Not Answers
Sicko doesn't get into the specifics of solutions for America's health-care mess. What it does is sound the alarm that America has a health system that too often rewards insurance company giants while tying the hand of doctors and leaving the sick feeling even more ill.
Some critics fault Moore for not letting insurers tell their side of the story in the movie. But Moore was not making a news piece for public television; he was making a movie. Americans hear plenty from their insurers. Those who have coverage are inundated with information from their insurers and they have a captive audience anytime you seek health care. Of course, insurers and pharmaceutical companies also use their considerable mass-marketing skills to tell their side as well. You can't watch television without being inundated with ads for new drugs and offers of coverage.
Much of Moore's movie is a tour through other countries' health systems. Moore takes a group of 9/11 volunteer recovery workers, all of whom have serious health problems, to Cuba via boat. He notes that U.S. prisoners being held at Guantanamo Bay from Afghanistan and other places have free medical and dental care, so he takes these recovery workers there and requests the same level of care — and is rejected.
Instead, Cuban doctors treat the workers. Prescription drugs are virtually free, and medical care is easily accessible. And the doctors are gentle and reassuring and appear to be very skilled.
Moore also follows a Detroit woman into Canada, where she gets drugs at half the cost of that in the U.S. He also amazingly finds a man who lost two fingers to an accident in Canada and had both reattached at no direct cost. By contrast, he recites the number of medical conditions that American health-insurance companies won't spring for. It provides one of the more painful belly laughs in the movie, when Moore rolls a seemingly infinite litany of exclusionary health-insurance clauses into outer space, to the tune of the Star Wars theme.
One of the transcending moments in Sicko is when the grand old man of the left wing of Britain's Labour Party, Tony Benn, says, "If we have the money to kill people, we've got the money to help people." At a time when the U.S. is pouring billions in the war in Iraq while cutting the Children's Health Insurance Program and Medicaid, Benn's comment is especially startling.
So too are the comments from French and English doctors who couldn't grasp an American system so driven by money. "I don't deal with money at all," said one doctor.
While Sicko only highlights the best of the health systems in Cuba, France, England, and Canada, I think most people in the movie audience realized that those countries don't have perfect systems, either. But Moore does show America has much to learn from other countries and the U.S. needs to stop calling itself "the best" when it comes to health care.
My main criticism of Sicko is also one of its advantages. Moore keeps everything so simple that even a 7th grader can understand the failings of the U.S. health system compared to those single-payer systems abroad. I also fear some people will think there is a "simple" solution to providing good health care. But, alas, there is no simple answer to our health system, just as there are no easy answers to getting individuals to live healthier. It's just a lot more complicated than telling yourself to eat right and exercise.
Some of my more conservative friends think the film was just too outlandish, particularly for all the horror stories he told. Moore collected hundreds of these anecdotes on his web site when he put out a query in 2005. They are the same type of anecdotes I have told in stories for 18 years. While policymakers have always questioned the wisdom of making new laws based on anecdotal stories, change only comes about when problems get to that deeply personal level. On the big screen, Moore brings these people to life and, in doing so, viewers can imagine themselves in the same devastating situation of not being able to get quality care when they need it. They watch these stories and ask themselves, "Will my family be next?"
For example, a week before Sicko premiered, the Los Angeles Times reported on a woman who lay bleeding on the emergency room floor of a troubled inner-city hospital and died after 911 dispatchers refused to contact paramedics or an ambulance to take her to another facility. The story of Edith Isabel Rodriguez, 43, who died of a perforated bowel on May 9 at Martin Luther King Jr.-Harbor Hospital, grabbed headlines for a few days around the country.
Movies have the power to move people, as witnessed by the impact of Al Gore's An Inconvenient Truth, which has spurred the debate over global warming. Now major automobile companies are making hybrid cars and engineers are looking to create new technologies that use alternative fuels as part of a movement to break the country's dependence on foreign oil. One can only hope Sicko has the same staying power with the public consciousness when it comes to health-care reform.
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