And I Think I'm Going to be Sick!
Background
Sicko is Michael Moore’s 2007 documentary on aspects of the American health care system compared to that of a handful of other nations. It’s Moore’s fourth major documentary since he popularized the format with Roger & Me in 1989.Moore’s tendency in all his documentaries, including Sicko, is to make frequent appeals to emotion while using distorted statistical data to support what are often controversial claims. In my opinion, much of Moore’s work tends to lean toward the realm of propaganda. This does not make his films less entertaining, but for me it significantly diminishes the idea of the word documentary when they are described as such.
Overview
Sicko begins with a number of case studies involving individuals and families who claim they were negatively affected by some aspect of America’s health care system. For the most part, these case studies involve the denial of benefits by insurance companies or the high cost of certain types of treatment.As is his style, Moore tends to allow the stories to unfold through interviews with the people involved. It is an effective story-telling mechanism, and allows the viewer to identify with the emotional aspects of a particular story. With Sicko, Moore captured a wide variety of individual interviews on camera, but he seems to have been frequently denied interviews with high-level personnel at government or corporate offices.
The second portion of the film takes the viewer to Canada, England and France. We find, according to Moore, that the universal health care systems of those places are superior to America’s health care system. Here Moore attempts to debunk perceptions about universal health care as a drain on taxpayers, second-rate in terms of quality and as offering poor compensation for physicians and other health care professionals.
In the last section of Sicko, Moore takes a group of Americans to Cuba where they receive treatment care of Fidel Castro's regime. In this segment we find that Cuban authorities are happy to provide top-notch care to disgruntled Americans. In a sense I think Moore wanted shame Americans with the notion that Cuba has a ‘better’ health care system, despite America’s supposed economic advantages.
Overall, Sicko does open the door for dialogue considering the possibilities of universal health care in the United States. The universal health care systems in Canada, England, France, and even Cuba, are certainly admirable in what they attempt to accomplish. Moore does a nice job of contrasting some of the worst things about America's health care system with some of the best things about those particular universal systems. There are, however, a few variables that I feel have been left out of Moore’s equation.
American health care Facts
For one thing, and I’m not sure that many people are aware of this, but the American government does spend a large sum on health care, the highest per-capita and as a percent of the GDP in the world.[1] In fact, government outlays for Medicare and Medicaid are over 22 percent of the total income tax outlays.[2] About fifty percent of all medical bills in the United States are paid out by the federal government.These figures do not include what individual state governments contribute to health care, nor do they include what the federal government pays in health care for federal workers, including veterans and military personnel. It also does not include the amount the federal government invests into health care research, or other government agencies that deal with health care such as the Centers for Disease Control, the Occupational Safety and Health Organization and so on. Furthermore, it does not include the aid packages the US sends to other countries to improve their sanitation, agriculture and health care infrastructure.
In Sicko Moore questions how Americans can spend more per capita and as a percentage of GDP than any other Western society and still have a worse health care system. Apparently Sicko is an attempt to show the viewer what Moore means by 'worse'. While his attempt is full of panache, I'd argue that Moore doesn't actually establish that America's health care system is 'worse' than any other.
In 2007, incidentally the same year Sicko was released, the United States Congress received the results of a study they commissioned regarding the differences in health care investments between the United States and 26 other industrialized countries. The report is probably a worthwhile read for anyone interested in the health care debate. It found, contrary to what Moore might have you believe, the most substantial reason per capita medical costs in the United States are higher than other study countries. Americans tend to receive more intense and more technologically advanced care than citizens from all of the comparison countries in the study. Additionally, Americans are far more likely to undergo surgical procedures than the citizens of those countries.[3]
Mortality and Statistics
In Sicko, Moore mentions that Canada, England, France and Cuba (infant mortality only) all have higher life expectancies than Americans. On the surface it appears that universal health care may be the cause of some of this higher life expectancy. But then Englanders only live .7 more years than Americans and the French (metropolitan statistic only) and Canadians about 2.5 years. [4]
The point I want to make in relation to these statistics, is mortality is a very real phenomenon that universal health care will not prevent. The fact is, to be an American, Western European, or Japanese now, in the aggregate sense, is to have better access to health care than any previous generation in any civilization ever to exist. China has universal health care, and they are 82 on the list, a full 53 spots below the non-universal-health care United States. Perhaps the reason citizens of Japan, England and France have a higher life expectancy, on average than Americans is, contrary to what Moore indicates, because they, on average live healthier lives. Universal health care may in fact have absolutely nothing to do with living, on average, an extra eight months in Great Britain.
Universal Health Care Problems
It is difficult to deny that Moore’s view of universal health care in Sicko is attractive. The people using the system, the doctors and the politicians interviewed by Moore were all portrayed as pleased with, if not staunch advocates of, their respective health care systems. In my mind, Moore’s portrayal of universal health care is downright utopian. Then I found some other opinions.
Some cursory research on each of the universal health care systems examined in Sicko immediately revealed a plethora of data that seemed to contradict Moore’s claims. I can’t possibly get into all of the details here, and the information is out there for anyone interested, but here are a few examples from the other side of the debate.
The 2005 documentary on the Canadian health care system, Dead Meat, interviews a number of people who were put on waiting lists, in many cases for years, for treatment. In typical Moore fashion, the creators of Dead Meat also interviewed the families of people who lost loved ones who were put on waiting lists for treatment. It also shows Canadians who finally get the care they need outside of Canada. One of the places they go is the United States. In Canada it is illegal to purchase health care insurance, but it is possible to put a second mortgage on the family home to pay for necessary treatment in the United States or elsewhere.
Cuba, as a premier provider of medical care for tourists, likely accepts some of those Canadians who are seeking expedited treatment for health problems. The problem in Cuba, is the high quality care afforded to foreigners doesn’t seem to reach the majority of Cubans. In fact, the high quality Cuban medical care seems to be reserved for paying tourists or high-ranking Cuban military personnel.[5] Incidentally, when Fidel Castro was ill, he had a private physician from Spain fly in to provide his care.
And then there are Great Britain and France, two of the strongest economies in Europe. Both of these countries have been debating health care reform for years. The problems they are having are the same problems we have in the United States. How to provide quality care in an environment of rising costs and diminishing resources. While Great Britain has many of the same problems as Canada, Moore was more than a little disingenuous in describing France's system as universal and government-funded. In fact, the French system works by using a co-pay system which is often covered by one of the private insurance plans carried by 93 percent of the French.[6]
The problem with many of the American case studies Moore presents to us in Sicko then, is the fact that most of them were about people who had been denied experimental treatment or drugs by their insurance carriers. Remember, Sicko's American case studies were about people who had health insurance coverage. After viewing some the literature on the subject, there is absolutely no reason to believe that any of Moore's case studies would have received their desired 'experimental' treatment or drugs under any of the universal health-care systems mentioned by Moore. In fact, the evidence seems to support that people who desire the most technologically advanced medical treatment will find it in America over any other country in the world.
American Health Care Problems
These points, however, do not address problems associated with the for-profit health care and insurance industries in the United States. There is a relevant debate regarding the rising cost of health care in the United States and the impact that this is going to have on all aspects of American life. If the current system can be improved, then it makes sense to discuss the issues in an attempt to find solutions to the problems that we are currently facing. While there are likely a variety of solutions to those problems, I'm not convinced that waiting for the supposed panacea of universal health care, which may ultimately never arrive, is our best option.Final Thoughts
This analysis of Sicko, and the message implied therein, really only scratches the surface of the complicated universal health care debate. All in all, I appreciate Moore’s work in Sicko for bringing the debate closer to the mainstream, but ultimately find it difficult to respect Moore’s methods or message due to the sheer weight of the information that is left out or glossed over in favor of appeals to emotion. Additionally, I felt that Sicko in many ways was a debate about needs versus wants more than a realistic discussions of the issues.While I’m honestly not very well versed in Medicaid and Medicare, I wonder if these programs do not provide adequately for the uninsured in the United States (which is perhaps why Moore did not address the uninsured in Sicko). When it comes to mortality, no health care system, no number of experimental treatments, and no amount of money spent will be good enough for some people. I don’t know what to say about that, except that I feel it is not related to the debate surrounding universal health care.
Ultimately, people in the United States who are not happy with their health insurance policies have access to better health care than the majority of people alive on Earth today, and likely have accesss to magnitudes better health care than that afforded to any previous generation of any civilization ever to exist. Universal health care paradigms may not be an improvement on this state of affairs in the United States, and I’m not convinced that Sicko addresses this aspect of the debate at all. As always, it is worthwhile to question the assumptions.
[1] World Health Organization; http://www.who.int/whosis/database/core/core_select_process.cfm?countries=all&indicators=nha
[2] Center on Budget and Policy Priorities; http://www.cbpp.org/4-14-08tax.htm
[3] CRS Report for Congress; U.S. Health Care Spending: Comparison with Other OECD Countries; Sept. 17, 2007
[4] US Census International Database; http://www.census.gov/cgi-bin/ipc/agggen
[5] The Cuban American National Foundation; http://www.canf.org/Issues/medicalapartheid.htm
[6] Healthcare Economist; http://healthcare-economist.com/2008/04/14/health-care-around-the-world-france/