'Sicko': Heavily Doctored, By Kurt Loder

Is Michael Moore's prescription worse than the disease?

Michael Moore may see himself as working in the tradition of such crusading muckrakers of the last century as Lincoln Steffens, Ida Tarbell and Upton Sinclair -- writers whose dedication to exposing corruption and social injustices played a part in sparking much-needed reforms. In his new movie, "Sicko," Moore focuses on the U.S. health-care industry -- a juicy target -- and he casts a shocking light on some of the people it's failed.

There's a man who mangled two of his fingers with a power saw and learned that it would cost $12,000 to save one of them, but $60,000 to save the other. He had no health insurance and could only scrape together enough money to salvage the $12,000 finger.

There's a woman whose husband was prescribed new drugs to combat his cancer, but couldn't get their insurance company to pay for them because the drugs were experimental. Her husband died.

Then there's a woman who made an emergency trip to a hospital for treatment and subsequently learned her insurance company wouldn't pay for the ambulance that took her there -- because it hadn't been "pre-approved." And there's a middle-aged couple -- a man, who suffered three heart attacks, and his wife, who developed cancer -- who were bankrupted by the cost of co-payments and other expenses not covered by their insurance, and have now been forced to move into a cramped, dismal room in the home of a resentful son. There's also a 79-year-old man who has to continue working a menial job because Medicare won't cover the cost of all the medications he needs.

Moore does a real service in bringing these stories to light -- some of them are horrifying, and then infuriating. One giant health-maintenance organization, Kaiser Permanente, is so persuasively lambasted in the movie that, on the basis of what we're told, we want to burst into the company's executive suites and make a mass citizen's arrest. This is the sort of thing good muckrakers are supposed to do.

Unfortunately, Moore is also a con man of a very brazen sort, and never more so than in this film. His cherry-picked facts, manipulative interviews (with lingering close-ups of distraught people breaking down in tears) and blithe assertions (how does he know 18,000* people will die this year because they have no health insurance?) are so stacked that you can feel his whole argument sliding sideways as the picture unspools. The American health-care system is in urgent need of reform, no question. Some 47 million people are uninsured (although many are only temporarily so, being either in-between jobs or young enough not to feel a pressing need to buy health insurance). There are a number of proposals as to what might be done to correct this situation. Moore has no use for any of them, save one.

As a proud socialist, the director appears to feel that there are few problems in life that can't be solved by government regulation (that would be the same government that's already given us the U.S. Postal Service and the Department of Motor Vehicles). In the case of health care, though, Americans have never been keen on socialized medicine. In 1993, when one of Moore's heroes, Hillary Clinton (he actually blurts out the word "sexy!" in describing her in the movie), tried to create a government-controlled health care system, her failed attempt to do so helped deliver the U.S. Senate and House of Representatives into Republican control for the next dozen years. Moore still looks upon Clinton's plan as a grand idea, one that Americans, being not very bright, unwisely rejected. (He may be having second thoughts about Hillary herself, though: In the movie he heavily emphasizes the fact that, among politicians, she accepts the second-largest amount of political money from the health care industry.)

The problem with American health care, Moore argues, is that people are charged money to avail themselves of it. In other countries, like Canada, France and Britain, health systems are far superior -- and they're free. He takes us to these countries to see a few clean, efficient hospitals, where treatment is quick and caring; and to meet a few doctors, who are delighted with their government-regulated salaries; and to listen to patients express their beaming happiness with a socialized health system. It sounds great. As one patient in a British hospital run by the country's National Health Service says, "No one pays. It's all on the NHS. It's not America."

That last statement is even truer than you'd know from watching "Sicko." In the case of Canada -- which Moore, like many other political activists, holds up as a utopian ideal of benevolent health-care regulation -- a very different picture is conveyed by a short 2005 documentary called "Dead Meat," by Stuart Browning and Blaine Greenberg. These two filmmakers talked to a number of Canadians of a kind that Moore's movie would have you believe don't exist:

A 52-year-old woman in Calgary recalls being in severe need of joint-replacement surgery after the cartilage in her knee wore out. She was put on a wait list and wound up waiting 16 months for the surgery. Her pain was so excruciating, she says, that she was prescribed large doses of Oxycontin, and soon became addicted. After finally getting her operation, she was put on another wait list -- this time for drug rehab.

A man tells about his mother waiting two years for life-saving cancer surgery -- and then twice having her surgical appointments canceled. She was still waiting when she died.

A man in critical need of neck surgery plays a voicemail message from a doctor he'd contacted: "As of today," she says, "it's a two-year wait-list to see me for an initial consultation." Later, when the man and his wife both needed hip-replacement surgery and grew exasperated after spending two years on a waiting list, they finally mortgaged their home and flew to Belgium to have the operations done there, with no more waiting.

Rick Baker, the owner of a Toronto company called Timely Medical Alternatives, specializes in transporting Canadians who don't want to wait for medical care to Buffalo, New York, two hours away, where they won't have to. Baker's business is apparently thriving.

And Dr. Brian Day, now the president of the Canadian Medical Association, muses about the bizarre distortions created by a law that prohibits Canadians from paying for even urgently-needed medical treatments, or from obtaining private health insurance. "It's legal to buy health insurance for your pets," Day says, "but illegal to buy health insurance for yourself." (Even more pointedly, Day was quoted in the Wall Street Journal this week as saying, "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.")

Actually, this aspect of the Canadian health-care system is changing. In 2005, the Canadian Supreme Court ruled in favor of a man who had filed suit in Quebec over being kept on an interminable waiting list for treatment. In striking down the government health care monopoly in that province, Chief Justice Beverley McLachlin said, "Access to a waiting list is not access to health care." Now a similar suit has been filed in Ontario.

What's the problem with government health systems? Moore's movie doesn't ask that question, although it does unintentionally provide an answer. When governments attempt to regulate the balance between a limited supply of health care and an unlimited demand for it they're inevitably forced to ration treatment. This is certainly the situation in Britain. Writing in the Chicago Tribune this week, Helen Evans, a 20-year veteran of the country's National Health Service and now the director of a London-based group called Nurses for Reform, said that nearly 1 million Britons are currently on waiting lists for medical care -- and another 200,000 are waiting to get on waiting lists. Evans also says the NHS cancels about 100,000 operations each year because of shortages of various sorts. Last March, the BBC reported on the results of a Healthcare Commission poll of 128,000 NHS workers: two thirds of them said they "would not be happy" to be patients in their own hospitals. James Christopher, the film critic of the Times of London, thinks he knows why. After marveling at Moore's rosy view of the British health care system in "Sicko," Christopher wrote, "What he hasn't done is lie in a corridor all night at the Royal Free [Hospital] watching his severed toe disintegrate in a plastic cup of melted ice. I have." Last month, the Associated Press reported that Gordon Brown -- just installed this week as Britain's new prime minister -- had promised to inaugurate "sweeping domestic reforms" to, among other things, "improve health care."

Moore's most ardent enthusiasm is reserved for the French health care system, which he portrays as the crowning glory of a Gallic lifestyle far superior to our own. The French! They work only 35 hours a week, by law. They get at least five weeks' vacation every year. Their health care is free, and they can take an unlimited number of sick days. It is here that Moore shoots himself in the foot. He introduces us to a young man who's reached the end of three months of paid sick leave and is asked by his doctor if he's finally ready to return to work. No, not yet, he says. So the doctor gives him another three months of paid leave -- and the young man immediately decamps for the South of France, where we see him lounging on the sunny Riviera, chatting up babes and generally enjoying what would be for most people a very expensive vacation. Moore apparently expects us to witness this dumbfounding spectacle and ask why we can't have such a great health care system, too. I think a more common response would be, how can any country afford such economic insanity?

As it turns out, France can't. In 2004, French Health Minister Philippe Douste-Blazy told a government commission, "Our health system has gone mad. Profound reforms are urgent." Agence France-Presse recently reported that the French health-care system is running a deficit of $2.7 billion. And in the French presidential election in May, voters in surprising numbers rejected the Socialist candidate, Ségolène Royal, who had promised actually to raise some health benefits, and elected instead the center-right politician Nicolas Sarkozy, who, according to Agence France-Presse again, "plans to move fast to overhaul the economy, with the deficit-ridden health care system a primary target." Possibly Sarkozy should first consult with Michael Moore. After all, the tax-stoked French health care system may be expensive, but at least it's "free."

Having driven his bring-on-government-health care argument into a ditch outside of Paris, Moore next pilots it right off a cliff and into the Caribbean on the final stop on his tour: Cuba. Here it must also be said that the director performs a valuable service. He rounds up a group of 9/11 rescue workers -- firefighters and selfless volunteers -- who risked their lives and ruined their health in the aftermath of the New York terrorist attacks. These people -- there's no other way of putting it -- have been screwed, mainly by the politicians who were at such photo-op pains to praise them at the time. (This makes Moore's faith in government medical compassion seem all the more inexplicable.) These people's lives have been devastated -- wracked by chronic illnesses, some can no longer hold down jobs and none can afford to buy the various expensive medicines they need. Moore does them an admirable service by bringing their plight before a large audience.

However, there's never a moment when we doubt that he's also using these people as props in his film, and as talking points in his agenda. Renting some boats, he leads them all off to Cuba. Upon arrival they stop briefly outside the American military enclave on Guantanamo Bay so that Moore can have himself filmed begging, through a bullhorn, for some of the free, top-notch medical care that's currently being lavished on the detainees there. Having no luck, he then moves on to Cuba proper.

Fidel Castro's island dictatorship, now in its 40th year of being listed as a human-rights violator by Amnesty International, is here depicted as a balmy paradise not unlike the Iraq of Saddam Hussein that Moore showed us in his earlier film, "Fahrenheit 9/11." He and his charges make their way -- their pre-arranged way, if it need be said -- to a state-of-the-art hospital where they receive a picturesquely warm welcome. In a voiceover, Moore, shown beaming at his little band of visitors, says he told the Cuban doctors to "give them the same care they'd give Cuban citizens." Then he adds, dramatically: "And they did."

If Moore really believes this, he may be a greater fool than even his most feverish detractors claim him to be. Nevertheless, medical care is provided to the visiting Americans, and it is indeed excellent. Cuba is in fact the site of some world-class medical facilities (surprising in a country that, as Ricardo Alonso-Zaldivar noted in the Los Angeles Times last month, "imprisoned a doctor in the late 1990s for speaking out against government failure to respond to an epidemic of a mosquito-borne virus"). What Moore doesn't mention is the flourishing Cuban industry of "health tourism" -- a system in which foreigners (including self-admitted multimillionaire film directors and, of course, government bigwigs) who are willing to pay cash for anything from brain-surgery to dental work can purchase a level of treatment that's unavailable to the majority of Cubans with no hard currency at their disposal. The Cuban American National Foundation (admittedly a group with no love for the Castro regime) calls this "medical apartheid." And in a 2004 article in Canada's National Post, writer Isabel Vincent quoted a dissident Cuban neurosurgeon, Doctor Hilda Molina, as saying, "Cubans should be treated the same as foreigners. Cubans have less rights in their own country than foreigners who visit here."

As the Caribbean sun sank down on Moore's breathtakingly meretricious movie, I couldn't help recalling that when Fidel Castro became gravely ill last year, he didn't put himself in the hands of a Cuban surgeon. No. Instead, he had a specialist flown in -- from Spain.

* The figure cited in the original posting of this review -- 18 million -- was radically incorrect.

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