Michael Moore's Imperfect Diagnosis

The New Republic: "Sicko" Has Its Flaws, But Is Also A Compelling Indictment Of U.S. Health Care

(The New Republic) 
Moore wants to weave these tales into an indictment of the idea that for-profit companies can be counted upon to provide Americans with affordable medical care. But that's a complicated argument to make. Even an intellectually rigorous filmmaker would have to cut a few corners; Moore cuts many.

Sometimes, for example, there are good reasons to deny coverage of experimental treatments. In the 1990s, HMOs caught a lot of grief for denying bone-marrow transplants to breast cancer victims. Years later, studies showed the treatments — which are both expensive and painful — worked in only a tiny fraction of special cases. Would the bone-marrow transplant denied to Pierce have made a difference? It seems unlikely. Experts told me that the treatment never made it past the experimental phase because of ineffectiveness and harmful side-effects.

But, while not every HMO treatment denial bears second-guessing, many do: During the '90s, peer-reviewed studies showed that insurance companies were cutting costs in ways that routinely jeopardized patient care. Nor is there any doubt that insurers try desperately to avoid covering people with serious medical conditions: Following exposés by Lisa Girion in the Los Angeles Times, California officials investigated BlueCross for precisely the kind of practices Lee Einer describes, eventually fining the insurer $1 million because it was rescinding coverage without even asking policy-holders about supposed misrepresentations. Although Wellpoint, the parent company of Blue Cross, denied wrongdoing, it also promised to change its cancellation procedures.

Still, while it's easy to beat up on insurance companies that deny coverage — or drug companies that charge a lot of money, or employers that don't offer their workers benefits — the truth is that they're all acting rationally. They're businesses, after all, and businesses are designed to make profits — which, it turns out, isn't always in the best of interests of people who are sick. If you want a different outcome, you need to come up with a different system, one that starts by guaranteeing every single person health insurance and making sure that insurance includes generous benefits.

Moore spends the second half of his film concentrating on systems abroad that do precisely this. Over the years, opponents of universal health care have scared middle-class voters into thinking universal coverage means long lines and substandard care. Moore responds by reprising his familiar man-on-the-street role, taking his cameras for a lively jaunt through some of these countries.

He starts with Great Britain and Canada, focusing on what is undoubtedly their chief virtue: affordability. Inside a British hospital, Moore prowls the halls, looking for a place to pay bills. But, when he finally finds the cashier, he learns that this cashier is there not to take money but to give it away, in case people need money for transport home. (Apparently, that's covered under British national health insurance.)

Nobody in the United States seriously proposes recreating the British or Canadian systems here — in part because, as critics charge and Moore ignores, they really do have waiting lines. A closer model for the United States would be France, which doesn't have that problem and which — thankfully — also merits considerable screen time in Moore's movie. As Paul Dutton explains in a new book called "Differential Diagnoses," the French prize individual liberty, so they created an insurance system that, today, allows free choice of doctor and offers highly advanced medical care to those who need it. One of this system's most appealing features, which Moore showcases, is the availability of 24-hour house-call service via a company called SOS Médecins. (Moore travels along with one of the company's doctors as he rides around Paris one night, taking dispatch calls like a taxi driver and then administering at-home medical care to a young man with some kind of stomach problem.)

All of this does cost money, naturally, and Moore acknowledges what many assume is the French system's big drawback: its high taxes. But Moore also provides the same answer that any good policy wonk (including yours truly) would: They pay more in taxes but less in private insurance. In fact, the French system, like every other one in the rest of the developed world, costs less than ours overall.

The French like their system a lot — more than the citizens of any other country, including the United States, if you believe the opinion polls. The World Health Organization likes it a lot, too: It has ranked France's system tops in the world. But that isn't stopping critics from attacking it. In a pre-buttal of "Sicko" that appeared in the New York Post, the Cato Institute's Michael Tanner warned last week that Moore missed the real problem in France: its shortage of high-tech care.

This was news to me. I spent a lot of time researching France when I wrote my book, and I never heard anything about shortages of high-tech care. I asked Victor Rodwin of New York University, this country's leading expert on the French health care system, if he had ever heard of such shortages. He hadn't, either.

In the interest of fairness, I decided I would ask Tanner himself: What was his evidence? He said the French government was starting to tighten access to specialists. Well, sure — but it's still a far cry from what managed care has done in this country for years. He also said that France has fewer MRIs and CT scanners than the United States, which is very true and very irrelevant. Most experts think we have far more than we need here. If there were real shortages in France, there would be long queues to use them, and there's no evidence of this, either.

Tanner's op-ed was a good reminder of the proper context for considering "Sicko" — the fact that opponents of universal health care have been spewing half-truths and outright falsehoods for decades. If anything, the proponents of universal health care have probably been too honest, getting so caught up in nuance and policy accuracy that they undermine the very real moral power of their own argument. As another great health care debate begins, it's worth remembering that the fundamental challenge isn't technical. We have plenty of good ideas for achieving universal coverage. The challenge is political. Our side needs some passion and, yes, perhaps a little simplicity, too. That's what Moore has supplied. No wonder the health care industry is spooked.

[redhoffer]

Lost in this debate about Michael Moore is that the average Cuban (income-wise) can more easily access quality healthcare than the average American. It is really no contest. I was aware of that before this film came out. Same thing with Canada, an average Canuck can get quality healthcare more reliably and easier than an average American.

Does that mean I should move to Cuba if that bothers me? No, as a patriotic American it means I should expect our leaders to fix that, and be willing to sacrifice to help make the change. The status quo should bother any caring American.

If you are an American who doesn't care about that, maybe because you don't have a personal issue accessing quality healthcare, than I say you have the problem. It shouldn't be a dem or repub issue, it is just common sense.

Many conservative columnists will just attack the messenger here (Moore), but the message is unchanged, the healthcare delivery system in the USA is terribly and obviously flawed and unless you are cashing in on the current system you should want to change it.

[xzavierbrown]

I dont think Moore's miguided movie would be of any assistance in helping our healthcare system. But of course, Moore really do not care about gun control or terrorism or the wellbeing of this country. it is pretty obvious, JUST LIKE BONO AND GOLDOF, that they hide under the guise of philantrophy and "caring" to sell thier wares and make MORE MONEY..

where have this world gone??in terms of improvement every since these misguided bleeding heart liberals had taken charge??where are we in africa??any better??
where is bono and goldof and moore financially since they had taken over??any better??

[codexkills]

Has the healthcare system been rigged? Why do we feel that the free market and government safety net cannot work? Maybe the number of doctors has been limited, and the tasks that nurses can do have been limited. That would cause the price for healthcare to go up. Maybe the capital requirements required under law for health insurance companies are way too high. That would limit the number of health insurance companies and cause the price for insurance to go way up. Maybe there's hidden price fixing for insurance. Maybe the drug prices are way too high for a reason. The free market seems to be acceptable for food and housing when backed by a government welfare safety net, but healthcare is somehow so freaking special that the free market supposedly doesn't work. I saw a doctor one time for 5 minutes, and she charged $400. Somehow, competition in the market has been unfairly limited to the point where doctors can charge whatever they want. I don't see why anything would be different if the government paid versus if I paid. The problem is the price.

[voteronpaul1]

We can't afford national healthcare now. To pay for anything, this country needs to stop this war. Just stop blowing up children across the world for no reason. Because it gets a little expensive. Second, stop the illegal immigrant bills. Let's get the budget out of the red so we can pay for something.
Then, ask if the same people who handled the Katrina FEMA disaster should handle healthcare. I'd rather take care of my own healthcare or at least have my state take care of this. If I don't like the way my state's doing it, I could move to another state. It's harder to just move out of the country.

[l8c6]

We the people of the United States of America in order to form a more perfect union...from there are words referring to the posterity of this union. Does this sound like callous rugged individualism the likes of every man, woman and child for their individual special interests?

Till death do us part or dump them like Newt did his wife when her cancer became his inconvenience.

Meanwhile from the right wing neo con fascist gullet comes forth the mantra
me,me,me,me,me,me,me,me...

[l8c6]

mommajomma, Uh, well be proud that there are americans who still believe in the founding priniciples that objected to the white house being named the "president's palace".

Rejoice in some hopefulness in the fact there are people who are successful fighting for the human cause instead of the cause of multinational corporatists who have a vision of oppression instead of a vision of progression for the human condition. Um, that's a little of what comes to mind.

[mommajomma-2009]

He's all yours, Democracks.... what are you going to do with him????

[rushlimpdrug]

"SICKO"
An appropriate title for an appropriate "man"Posted by processor2

Someone call 911 for this poor soul - seems he is having a seizure.
Wait! First make sure he has insurance and "Republican" tattooed on his a$$.

[drinuk]

The CBS headline to this story is very misleading. Moore may be slightly imperfect, he may not have gotten to the core of the current health scam but it is a further nail in the coffin of the scam we all suffer from. If I have a criticism it is that he should have applied a more forensic investigation.

During the last ten years over 1 Billion dollars have been spent by Big Pharma lobbying the American Government. Last year alone Eli Lilly spent 3.7 million lobbying politicians. Any sane and sensible taxpayer should be asking the following questions, 1, are they exerting unlawful infuence 2, are their products so bad they have to pay to get them approved and 3, Just who recieved this money. The latter I believe is the most important. With such enormous sums of money floating around in Washington how can we the public be assured we are getting the best available drugs and that health is being best served.

Moore was right to make his film but he should have gone much deeper.

[lestb35]

The answer to every problem is not a national top heavy. entitlement program.The self employed have always had to deal with the health care issue and they've come up with ways to get themselves and their families covered. People who have always depended on their employers to cover them are just clueing in that they have to pay attention and coverage matters.

[lestb35]

cozzicon, I've offered up many ideas for health care reform first and foremost getting it outof the benefit dept and into the hands of the consumer giving us more choice. The private practice Dr.s should have a big input along with public health officials. These are the experts and if you talk to Drs. they have a LOT of opinions on reform. I have come across more and more Dr. who are building their private practice on cash sales and not taking insurance at all.

[drinuk]

So Glaxo were concerned about Moore, Well! they would'nt be if they had nothing to hide and the interest of the company was simply to cure the sick. Like all other Big Pharma companies the patient comes LAST!

[neoconrcrazy]

Moore is a great American - God bless him!

Courage to speak the truth - and in these days, it's rare.

Keep it coming dude -

[hungry1968]

An appropriate title for an appropriate "man"
Posted by processor2 at 07:43 AM : Jun 23, 2007

Are you trying to say that you think the American health care system is perfect, and therefore Michael Moore is an idiot for wasting his time?

[grumpas]

"Fahrenheit 9/11," Moore's attack on the Bush administration and the Iraq war, may be wildly popular among Bush-haters and the most financially successful documentary ever.

I doubt that statement very seriously. We have a country full of dumb people who are easily fooled and aren't any brighter than one like Bush! Look at Processor 2 he can't even work his computer right! It takes a lot of effort to hit the 'publish' button once and wait!

[processor2]

"SICKO"

An appropriate title for an appropriate "man"

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[processor2]

"SICKO"

An appropriate title for an appropriate "man"

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[processor2]

"SICKO"

An appropriate title for an appropriate "man"

...

[processor2]

"SICKO"

An appropriate title for an appropriate "man"

...

[gkc99]

You can tell a lot about a person from the enemies he has. The Bushit / Darth administration is pursuing Moore with a phony, trumped up complaint about his trip to Cuba. Strange, how all the Republican businessmen can travel all they want to Communist China, but injured NYC firefighters can't travel to Cuba because Bushit says so.

As a person who got laid off by outsourcing to India, and was without health insurance, I think Moore's on the right track, no matter how much bribe money the AMA and the orthopedic surgeons contribute to the neofascists.