Answering my own questions since 2001

Sicko is Moore at His Best and Worst

With Michael Moore’s permission, I downloaded and watched a leaked copy of Sicko, his documentary about the tragically compromised American health care system. You can do the same, if you’re thus inclined.

Moore is a master polemicist, and Sicko seems to be a distillation of techniques he toyed with in his earlier work. The film is essentially a series of anecdotes, and Moore spends the bulk of his time telling stories about the superiority of health care systems in Canada, UK, France and Cuba.

One thing I remember from theatre school is that 70% of directing is casting. Moore is exceptional at this, populating his film with the accessible, friendly, articulate people who can best support his thesis. Whether it’s a Ground Zero volunteer with untreated respiratory problems or a charming, wealthy English doctor, they play their supporting roles perfectly.

Combine his casting with a natural gift for cinematic storytelling, and you’ve got the makings of a great movie.

I was frustrated by the dearth of supporting facts and evidence, a departure from earlier films. Despite there being plenty of statistics to support his case, Moore rarely cited them. He relied more exclusively on his case studies. For example, the best he offered on Canada was that we have cheap drugs and a longer life expectancy (which may or may not be the result of better health care).

That makes for a more emotionally compelling film, but not necessarily an intellectually gratifying one.

There were also egregious sins of omission. For example, Cuba may have exceptionally-trained medical professionals, but they regularly struggle to obtain the equipment and medicine they need to care for their patients. That sort of thing is to be expected, though, in rhetorical work like this.

Maybe the facts were less necessary because his thesis–that the US health care system is deeply broken, and pales in comparison to other Western nations–was much less assailable. Of course, having enjoyed 30-odd years of Canadian medicine, I may just be biased.

In any case, every American ought to take a look at this film. Every Canadian too, so that we don’t take what we’ve got for granted.

UPDATE: I just browsed around and looked at some criticism of the film. Critics seem to be working way too hard to debunk Moore’s claims about Cuba. That’s an unfortunate red herring, and distracts from the core debate about American health care. Even if Moore’s critics are 100% correct and can emphatically prove that America’s system is superior to Cuba’s, isn’t that a dreadfully hollow victory?

18 Responses to “Sicko is Moore at His Best and Worst”

  1. Jeff

    I expected Sicko to be less compelling than Moore’s previous 2 films, but it was just the opposite.

    It’s really awful how people who pay for health care (in the U.S.) are routinely denied services. It’s basically a cash grab for the insurance companies.

    Moore’s bit about France was pure gold on so many levels.

  2. double-plus-ungood

    Even if Moore’s critics are 100% correct and can emphatically prove that America’s system is superior to Cuba’s, isn’t that a dreadfully hollow victory?

    Absolutely, considering that the the GDP of Cuba is $3,900 per person compared with the USA’s $43,444.

  3. Ryan Cousineau

    Of course, nobody wants to say it so much, but even as bad as the health care system in the US is (for a substantial minority of its citizens, it should be said, as opposed to the well-covered ones), no country’s medical care system (at least the parts where the US differs substantially from the rest of the world) makes much of a difference.

    What separates the developed world life expectancies from undeveloped-world life expectancies is mostly stuff like child immunization, clean drinking water, and effective treatments for diarrhea (ORT, which is pathetically cheap and incredibly effective).

    What separates Cuba (and other nations, mostly in the “developing” category) from the US is probably the availability of enough, but not too much food (and not a lot of meat). Thus the average Cuban is on a calorie-restricted but not starvation diet.

    The average American or Canadian or European? Not so much.

    Meanwhile, the health care spending makes people healthier in relatively marginal ways: the rare young cancer patient (LIVESTRONG, Derek) benefits if we can extend their life by 30+ years, but they are rare. We can give you knee surgery and hip replacements, but those don’t make you live longer, they just make you able to play golf at age 60.

    Unfortunately, all these marginal treatments are really pricey. As has been noted in the field, the last six months of a patient’s life are often the most expensive, medically speaking. This is because, well, we can’t always be sure they’re going to die, but without medical intervention we’re pretty sure they will.

    Then they do, and all we have to show for our dramatic medical intervention is a lot of public health expenses.

    This is NOT my argument against having a big complicated single-payer medical system. I like having extensive access to the best medical system money can buy.

    But any serious examination of modern health care systems needs to be clear-eyed about what they can and cannot do for the money.

  4. darren

    Ryan: Interesting points, Ryan. Got any supporting articles that assert the relative minor role that healthcare plays in a nation’s health?

  5. darren

    Actually, the real research comes from this guy. There’s a lengthy, in-depth debate on this blog post which kind of makes my head spin. It does contain, however, many arguments for and against your thesis.

  6. Ryan Cousineau

    Yes, but only the ones that agree with me are right :).

    To clear up much of the fogginess in that debate, here’s the most incisive comment.

    What the famous RAND study measures is the marginal value of the extra health care the lucky people got, as opposed to the health care that people, even people poor enough to be uninsured, seek out on their own dollar.

    This means I should probably mitigate my statement up there in comment 3: the cheap things that functional health care systems do (prescribe antibiotics, set broken bones) work really well. But they’re so cheap that even the poorest Americans, one way or another, have access to them.

    This is possibly a counterintuitive result, but not an inconceivable one. There are a few ways hospitals can make you sicker rather than healthier, so with marginally health-improving treatments, the iatrogenic risks of getting treated may swamp the putative benefits. And as that link suggests, maybe we need to be a bit more aggressive about making doctors WASH THEIR HANDS!

    The important thing is to not accept blindly that health care does what you think it does in the way you think it does. Lifestyle considerations, on average, trump the effects of marginal improvements in health care spending or consumption.

    Now if you’ll pardon me, I have to eat an apple danish and ride my bike for an hour.

  7. Ellen Liversidge

    I was pleased to read your comment that “we (Canadians) shouldn’t take what we have for granted.” Not only are your drugs negotiated by the government (and therefore cheaper), you have, as do the Western European countires, a stronger drug safety system. Dissimilarly, in the U.S. Big Pharma has run like a steamroller over Congress – paying for campaigns; two lobbiests for every Congressman, and a broken drug safety system at the FDA. This results in over 100,000 deaths of innocent people by prescription drugs per year in this country. One of them was my son, killed by the Eli Lilly drug Zyprexa.

    So don’t take for granted either that you have a government-managed drug safety system that saves lives, not just dollars. The corruption here in this area is rampant and the companies take no note of it. In fact, they are in the process of weakening/killing the first drug safety bill Congress has tried to pass in years. It is a David vs. Goliath fight.

  8. Chip

    Hi Darren,

    I enjoyed reading the comments about Sicko. After seeing the film I looked for more evidence, pro and con, for the film’s points and counter arguments to get a better overall view. After all this I’m convinced that universal health care is possible if governments are willing to shift their priorities. One article noted that France’s health care system was 2.7 billion in the red — that’s chump change for the U.S. government compared to what we spend in Iraq and boondoggle/earmark pork barrel projects in America. I know that based on population alone, any US health care system would far exceed the cost of France’s, but we could still afford to pay for it. FDR used the Public Works system to jump start the American economy during the depression, Eisenhower’s highway project also helped spur the US economy. America reaped huge benefits from putting a man on the moon, so we could also reap even more benefits by implementing the best, most advanced health care system in the world. Unlike insurance companies who avoid “experimental” proceedures, the US should do all it can to develop and harness the latest technological innovations. To the those who oppose anything that smacks of socialized medicine on ideological grounds we could simply say it’s a top secret weapon program. :)

  9. Manuel

    - Chip, the U.S. already has the most advanced health care system in the world. Also, FDR did not succeed in jump-starting the economy with public works programs. The economy was horrid throughout his first three terms in office, and didn’t turn the corner until something called World War II.

    – The anecdotes Moore presents throughout Sicko are carefully hand-picked. It would be easy (as On the Fence Films proved) to find anecdotes showing that other health systems are worse than the U.S.’s. What is little discussed is the fact that poor, uninsured people in America can receive free health care through the Medicare and Medicaid systems. The key word is “poor.” If you’re middle class or above, and make the choice to forgo health insurance, then yes, you’re going to lose your house and other assets if you have a major medical problem. And yes, if you have an HMO you might not always have access to the latest, greatest experimental medical treatments. But the answer is not to turn over our entire health system to the federal government. Does anybody honestly want our medical system to be run entirely by the same people who run the DMV and the Postal Service? Improvements can be made at the margins. There are several interesting experiments underway in states such as Massachusetts. A single-payer system may work (though not nearly as well as Moore would have you believe) in a smaller, more homogenous country such as France. But in the U.S. it would be a disaster.

  10. Gail

    When I returned from a trip to Cuba over Christmas/New Year’s, I went to the World Health Organization’s website to compare health indicators for Canada, the USA, and Cuba. I found the numbers quite interesting:

    http://gailatlarge.com/blog/2007/01/01/3009

    My experience with the U.S. healthcare system was mostly in 2005, when I was taking care of my husband who was dying of cancer. It was shocking what he had to put up with from the insurance companies. He was perfectly healthy until the age of 38 when he was diagnosed, and became very disillusioned with the system during his treatment. We also had myriad problems with his physician, who was licensed to perform aviation medicals by the FAA. I would’ve sued that doctor for negligence if I’d remained in the U.S.

    When I hear Canadians complain about the wait times for non-emergency procedures, I remind them that things could be SO MUCH WORSE.

  11. Manuel

    I had cancer 10 years ago and had no health insurance. I went to a county hospital and while the conditions were hardly luxurious, they healed me. I never had to wait more than a few days for an MRI or CT scan. This is not what I hear about Canada and other places with a single-payer system. And it did not cost me a single penny.

    I don’t expect everyone to accept my own experience as representative. But for every anecdotal case that the U.S. system fails someone, there are success stories. The same is true of other countries, I’d wager. But when it comes to Cuba, I always chuckle when I recall that when Castro was ill recently, a doctor was flown in from Spain. Try to imagine a U.S. president doing the same thing.

  12. Harriet

    Of course there is plenty of supporting evidence Moore could have used as for his film, and I’m sure he knows exactly where it is….if the film had been directed at an academic or well educated audience. As always, Moore intendes to inform those who have little patience and less ability to deal with statistical evidence. They are the same people Fox entertains with the run away bride and Paris Hilton stories.

    Unless we have film makers who can speak to this group of people, nothing will change. Thank God for film makers like Moore.

  13. Gail

    Manuel, I would never go as far as to say that the U.S. health care system allowed my husband to die after less than five months of treatment any more than you can claim that the same system saved you.

    You did yourself a huge favour by not having to deal with an insurance company in the first place, because the industry seems to have the whole country — doctors included — by the balls.

    Ever try to reach an insurance company after 5 o’clock on a Friday or over the weekend because a prescription was flagged and denied in the pharmacy’s database? Good luck. My husband was prescribed Percoset, Vicodin, Oxycodone, Hydrocodone, anti-nausea medication, et cetera by his oncologist and radiologist but we found out the hard way that the insurance company’s pill limit — regardless of dosage — was only 90 PER MONTH! We had to wait a whole weekend without medication to get the doctor’s letter to the insurance company to try and lift the limit, and the letter was valid ONLY ONCE. We never got the same insurance agent on the phone twice, so my husband who could barely speak had to explain everything over and over. Where is the file??

    The indignities and frustrations served to us by the insurance company (and it’s a major one) continued, even to the limits imposed on palliative care coverage.

    I’m not saying our case is representative, either, but when someone is fighting to live AND battling with an insurance company at the same time you have to wonder why it has to be this way.

  14. Jeffery Simpson

    If I were born in America I would either be dead or my parents would be hundreds of thousands of dollars in debt. They were young and just starting their own company when I was born with a congenital heart defect that would have killed me before I turned ten had it not been operated on.

    I have spent over a year at the University of Alberta’s hospital and figure that the very specialized treatment that I got would have cost millions of dollars, and most of it would have been considered experimental and so likely would have been had to get approved by an American HMO.

    Financially my parents, and their parents who would have had to chip in or watch a grandson die, would have been crippled. They’re well off and fairly wealthy now but they would have been in incredible debt because I would have cost hundreds of thousands to care for.

    People can throw facts and figures around a lot, but that won’t change my faith and belief in the single payer system. My parents have since paid way more in taxes than keeping me alive cost the government, money they would not have been able to afford to spend if burdened with debt at a young age. Their business was allowed to grow and they in turn employed more people who paid taxes, and thus helped pay for my surgeries.

    Moore may or may not get facts wrong once and awhile, and Canada’s system isn’t perfect, but I’ve never had to wait for surgery and I’ve had quite a few. I’ve never had to wait more than half an hour in ER (an amount of time that’s not unheard of even in the US) and I’ve been there a few times as well. I’ve never had a doctor say, “Well in the US they have this equipment but we can’t afford it.” and trust me I’ve had a lot of very expensive equipment used on me. I’ve been cared for by world famous doctors from around the world, some from American hospitals who chose to come to Canada.

    I liked Sicko. I hope it helps America make the move to single payer health care, because I know a lot of people suffer without it.

    And I apologize for being so maudlin.

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