Wednesday, November 24, 2010

SICKO (2007): Michael Moore and National Health Care

Michael Moore’s take on National Health Care in Sicko, like just about any issue he takes on, is never completely wrong.  He just has a tendency to lay it on thick.  When he reports on statistics like infant mortality or life expectancy figures, I wish that he would give the actual statistics and a source from where the statistics are taken.  As it is, the numbers he does produce are suspect.  And when he becomes flip, it does nothing to make his argument seem any more convincing.  However, when he puts an actual human face upon a tragedy, he does not need to editorialize.  It’s these suffering human beings that he shows which generally give his films the most significance.
Moore begins his film, Sicko, by showing an elderly couple forced to move into their daughter’s spare storage room because medical costs have for all practical purposes bankrupted them.  He then goes on to show a variety of other individuals in a similar dilemma.  Moore travels to Canada, France, England and finally Cuba to show that this would never occur in those other countries.  For each nation he makes the claim that their citizens outlive those in America, and that their infant mortality rates are lower than those in the United States.*  Moore discusses the cases of a number of individuals who died or were otherwise injured because an insurance company denied their claims.  He also shows a variety of people from other countries with similar illnesses or symptoms that had received treatment for free.  When speaking to a number of displaced Americans in France, he learned that pregnant women even had their laundry taken care of at the expense of the government.  The implication that Moore makes is that the media and the American government distorted the conditions claimed to exist in these other countries, and that his filming indisputably proved that such problems actually do not exist.**  In the end, Moore takes a number of individuals including rescue personnel injured or sickened by conditions during 9-11 first to Guantanamo Bay and then eventually to Cuba where they received treatment that they could not receive in America.  All of the patients’ had their health dramatically improved due to the universal health coverage of the Cuban government.***  (Michael Moore asked Chė Guevara’s daughter to render her opinion on the differences between the Cuban and American healthcare systems.  He could just as well have put the question to Fidel Castro and garnered the identical answer.)
Moore claims to have received e-mails or letters from more than 25,000 Americans dissatisfied with our current health system.  Some of these Americans show up in Sicko, and most are burdened by financial hardship.  He also interviews a number of citizens from foreign countries who are remarkably well to do and thus satisfied with the systems for their respective country.****  It’s impossible to know from just watching the film if these individuals interviewed are a true sample of the population of any country.  Moore uses his camera selectively.  He undoubtedly had no intention of producing or directing an unbiased movie to begin with.  He used the film footage in the U.S. and on foreign soil that backed his argument, and he discarded whatever countered it.
Probably the strongest argument for National Health Care Moore never uses: the wealthier the nation, the more that is generally spent upon the health care system.  But separating out what money is spent on health providers by the governments of respective countries, and what money is spent due to the contributions of private donors requires further study.  Further study is something Moore is probably unwilling to do.  Moore is not the unbiased sociologist who withholds judgment until all of the facts are in.  He is slipshod with the truth and likes to point the finger at convenient targets.  It’s interesting that through the use of videotaped conversation showing Richard Nixon in a cabinet meeting, Moore somehow comes to the conclusion that the start of our current health system came to being through the initiative of Nixon, himself.  Nixon is a disgraced figure and favorite target of those on the left, but Nixon was not solely responsible for the setting up of our health system.  National Health coverage has been discussed and advocated on a serious level since as early as the 1930s and certain programs were implemented at that time.  Significant innovations were made to our healthcare system through legislation passed during the Kennedy and Johnson administrations.  And even accepting that Nixon was the architect of our current “infamous” system, there have been six Presidents since his time who have had the opportunity to modify, if not completely gut, the system that is in place.
The best portions of Sicko remind me of scenes from Roger & Me where we can see some very real devastation on the lives of people who the system did not take care of. The film coverage of those suffering under our current system is undoubtedly authentic.  In a “for profit” type of medical system, certain individuals without the resources to fight the system will be hurt when their health needs go counter to the financial needs of large insurance companies.  Impediments will be put in the way of such individuals through denial of claims for a variety of reasons including: (1) disclosed or undisclosed prior medical conditions which effectively cancels their coverage; (2) treatments that are considered too experimental to be covered; (3) the downgrading a dire diagnosis so that a condition is no longer considered life threatening – thus giving the insurance company an out to not provide money for the care; (4) coverage that was somehow dropped for individuals who were under the impression that they would be covered because of difficulties in understanding the policy, etc.  So long as the executives of these insurance companies do not have to look at the cases too closely, they can sleep well in their expensive homes.  Moore is perfectly correct in pointing out the amount of money the insurance and pharmaceutical companies are spending for lobbying costs (including contributions that have been made to the campaign of George W. Bush) to make sure that the present system is not modified.  And his argument is extremely effective when he shows the incomes that CEO’s of insurance companies and pharmacies make, and then juxtaposing that to the costs that the sick or injured person spends for drugs and medical care.
Sicko (a miserable name for a documentary as it negates the seriousness of the message being advanced) comes close to being non-partisan (Hillary Clinton is also criticized for accepting campaign donations from the insurance industry) and is certainly not the worst documentary ever made.  Moore is an excellent storyteller and, as in all of his films, he presents us with people we care for and he singles out the villains.  Perhaps because he has been so heavily criticized in the past for humiliating various individuals while having the camera stuck in their face, he refrains in Sicko from asking embarrassing questions to these very individuals that he wants to vilify.  He, instead, uses a couple of insiders to the medical profession to bring out various observations that the ordinary individual would not be privy to.  An insurance examiner and doctor, who both made a great deal of money by denying patient’ claims, were now conscience stricken because of the damage that they had done.  (Their testimony was much more damning than the many meaningless conversations Moore held with citizens of other countries whose familiarity with any healthcare system was limited.)  When Moore merely reports the facts without being overtly manipulative, his documentary style works.  It’s when he tries to do more (and it’s understandable why he is trying to do more because he does not deal in trivial subject matter) he simply cannot resist the temptation to skew the argument in his favor.  Sicko would have been better if Moore had first just presented the problem, and than sought out the solution to the problem – instead of already having his mind made up going in.  Today, there are even many conservatives who are convinced that the healthcare system is broken.  Think how much more convincing Moore’s argument would have been to them if he would have argued his case factually.*****  Moore needs to be more careful with the truth.
* Michael Moore knows, or should know, that the definition used in reporting infant mortality rates is different for each country.  Forty percent of infant deaths occurred within one day of birth, and many nations do not even include this in their reportage of infant mortality figures. The United States does include these infants in their statistics.  Other nations (including Belgium and France) do not report infant mortality if the infant is born lifeless in less than 26 weeks of gestation.  Again, the United States includes these in their figures.  In fact, the United States reporting on infant mortality may be the most stringent of any nation in the world. 
** Moore asks the question, why don’t Americans like the French?  He shows the French embracing and laughing outdoors in the public squares of Paris.  Moore, of course, does not indicate that French unemployment is three times higher than the United States, or that per capita income for the French nation is thirty percent less than it is in America.

*** Obviously, in repressive nations like China, Cuba, and the late Soviet Union, not all of the facts are being reported accurately, and independent investigation can only go so far in negating the reportage distortions.  The former Soviet Union, for example, reported that there were twenty-four times more the number of centenarians living in their country than in the United States.  So what about this reported figure?  The per capita income for individuals in Cuba is little more than $1,500 per year (that’s a figure that I don’t think was made up by the Cuban propagandists).  With such an income disparity, I highly doubt the Cuban figures touted by Moore showing that Cubans greatly outlive Americans to be accurate. 
**** To prove that the French are not overburdened with taxes, he asks an upper middle-class couple about their major expenses.  They mention the mortgage, the furniture, even the vegetables in the refrigerator.  They make no reference to taxes!  The obvious implication (based on this one solitary couple) is that the French are not concerned about their tax rates.  Moore never mentions how much the French actually pay, so we are left to guess at the figure.  The average French citizen pays anywhere from forty to sixty percent of his gross pay for their national income tax.  In the United States, we pay twenty-five to thirty-five percent to the federal government on average, and another five to ten percent to the state government.  There is also in France a 19.6 percent Value Added Tax (a complicated alternative to a national sales tax) in existence.  In the United States, we pay a four to six percent sales tax.  The French tax rates are not the highest in the world, but on average they probably pay twenty percent more in taxes than we do in America.
***** Michael Moore is getting sensitive.  When criticized for his selective fact finding by both the local and national media, his response has been to blame the media for not getting it right on the Iraqi War.  He may be correct on the war, but that does not mean that his statistics on National Health Care are any more valid.  He has now won two Oscars and has previously been invited to attend the Republican and Democratic National Conventions.  He’s no longer putting his house in hock to pay for the making of his movies.  Therefore, he can afford a statistician to make sense of the numbers that are being reported to him and are being used in his movies.
July 17, 2007
© Robert S. Miller 2007

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