Michael Moore's Look at American Healthcare

With his 2009 film 'Capitalism: A Love Affair,' Michael Moore once again demonstrated a knack for locating and highlighting the plight of the nameless, faceless ordinary Americans who are virtually ignored by the mass media and most politicians, and who have few if any opportunities to tell their stories. He honed this skill in several previous films and it has become more or less formulaic. This review takes a look at Moore's previous film, 'Sicko' (2007), in which he examines the contentious issue of health care in America. Although nearly 50 million Americans have no health insurance and thousands will die every year because they are uninsured, ‘Sicko’ is also about the 250 million American citizens who do have health insurance, but for whom the system is tragically dysfunctional, and point often lost on the interminable election year debates about healthcare.

Most of the first part of the film focuses on numerous case studies of patients and their problems with the health care industry and insurance companies, and Moore has a unique ability in telling these stories to elicit both tears and laughter from the audience. The first case makes the immediate point of the film by showing a man who accidentally sawed off the tips of two fingers, but who was given the option to repair the middle finger for 60,000USD or the ring finger for 12,000USD. He next profiles a late middle aged couple who were driven to bankruptcy and had to sell their home because their insurance would not cover the costs of their medical treatments, giving them no choice but to move in with their children. Then there is the woman who was in a serious car accident and who was sent a bill by her insurance company for the ambulance ride to the hospital because she did not seek ‘pre-approval’ from the insurance company prior to the accident. Moore located these people and many others by soliciting their stories on his website, through which he received 25,000 replies in the first week alone. Among the respondents was the family of an infant girl who was losing her hearing and who was told by the insurance company that she could only receive a cochlear implant in one ear, since fixing both ears was considered ‘experimental treatment’ and therefore not covered by insurance. However, when the father wrote the insurance company and said he was ready to tell his story to Michael Moore for a new documentary film, the rejection was overturned.

Because of his reputation as an investigative film maker, Moore also began to receive insider information from people in the health care system who were frustrated by the industry for which they worked. One informant, who worked for a health maintenance organization, revealed hundreds of pre-conditions that would automatically exclude people from obtaining health insurance. True to style, Moore names the companies, executives and politicians responsible for the deplorable state of health care in the US. In one case, a patient was told by Blue Shield, one of the pre-eminent health care providers in the US, that she did not have a brain tumor but when she collapsed on vacation in Japan was told by Japanese physicians that an MRI showed she did indeed have a tumor, while Blue Shield had repeatedly refused her an MRI. The medical reviewer of another large health care company, Humana, flatly stated that in the industry the definition of a good medical director was someone who could save the company money, and the doctors with the highest number of treatment denials would actually receive a bonus from the company, while any payments for a claim are termed as a ‘medical loss’ by the industry. Some companies even employ a team of ‘hit men’ to scour health care applications and patient histories going back five years for any clerical errors, health conditions or other factors that could lead to a direct denial of service. Moore makes it clear that the American health system is governed by money, not by concern for the well-being of citizens, and that decisions regarding the provision of health care are done with an eye toward maximizing profits.

Moore found several medical practitioners with a conscience, such as Dr Linda Pino, former medical reviewer at Humana, who told her story to a 1996 Congressional hearing: ‘I am here primarily today to make a public confession. In Spring of 1987 as a physician I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this, because in fact what I did was I saved a company a half a million dollars for this. And furthermore, this particularly secured my reputation as a good medical director and insured my continued advancement in the health care field. I went from making a few hundred dollars a week as a medical reviewer to an escalating six figure income as a physician executive. In all my work I had one primary duty and that was to use my medical expertise for the financial benefit of the organization for which I worked. And I was told repeatedly that I was not denying care, I was simply denying payment. I know how managed care maims and kills patients, so I am here to tell you about the dirty work of managed care and I’m haunted by the thousands of pieces of paper upon which I’ve written that deadly word, denied.’ This prompts Moore, as a patriotic American, to ask, ‘How did we get to the point that doctors and health insurance companies are actually being responsible for the deaths of patients?’ This is followed by some historical review of how the present health maintenance system in the US was proposed during the early 1970s as a for-profit private enterprise by then US President Nixon. When that system was challenged by health care reforms during the Clinton administration, this led to charges of ‘creeping socialism’ by the conservative and business friendly opponents of reform, led by doctors of the American Medical Association, and the health care industry spent over 100 million US dollars to defeat the proposed health care reforms. Since then, as Moore shows in his survey of the American political scene, health care has been firmly in control of the insurance companies and drug companies, who make gratuitous payments to politicians.

Americans have been heavily indoctrinated by government and industry to view any form of socialized public services as the devil’s spawn, a step toward communism and total government control of American lives, and that socialized medical systems are deplorable and generally ineffective. But a quick look at most other industrialized capitalist states suggests that socialized medicine can be highly effective and even become the norm. France is first in the WHO ranking of world health systems (the USA ranked 37), so Moore decided to visit France, along with Canada and the UK, to explore their free universal health care systems. Contrary to the claims voiced loudly in the US corporate media, Moore finds that Canadians are satisfied with and proud of their free universal health care system, where citizens are fully covered for all manner of ailment, illness and injury, with no insurance needed. He finds similar situations in the UK and France. While those who live with free universal health care would not be surprised, Moore dwells on these cases mainly for the sake of Americans propagandized against free universal care by their own government. Moore did find one place on American soil that offered free health care: the Guantanamo Bay military base where the US detains ‘enemy combatants’ from its ‘war on terror,’ who according to the US government itself receive free health care. Moore ventured to take a boatload of US citizens, including some who were injured in the 911 rescue operations but refused treatment in the US, to try and get them free medical treatment at Guantanamo Bay. The tongue in cheek segment, in which Moore says to Guantanamo Bay guards, ‘these are 911 rescue workers, they just want some medical attention, the same kind that al Qaeda is getting,’ makes its ironic point well, although their boat is turned away and Moore was reportedly later investigated by the FBI for the stunt. They were able to visit Cuba, known around the world for having one of the best health care systems and for being most generous in providing doctors and medical equipment to Third World countries, where the US citizens were able to get treatment at Havana hospital and obtain the medicine they needed. One American woman wept when she found the same medicine she needs, for which she pays 150USD in the US, for a few pennies in Cuba.

Michael Moore has his devotees and detractors, and his work is difficult to encapsulate in a short review. What’s clear is that he provides a valuable comparative look at international health care that few are privy to. Several clips from ‘Sicko’ are available on viral media sites, and the trailer can be viewed on the official website. The special edition DVD has in addition to the main feature a number of extra features worth viewing in their own right, some of which provide further evidence of Moore’s conclusions and his responses to detractors.

[This review is by Yusef Progler and originally appeared in the Journal of Research in Medical Sciences, vol. 13, no. 5, 2008.]