Showtime has been airing Michael’s Moore’s documentary “Sicko” about the U.S. healthcare crisis. You can watch it tonight and again on Sunday. It might be a good idea to tune in now that the debate over healthcare reform is heating up. I wrote a review of “Sicko” nearly two years ago around the time the movie was released (see below). I still stand by what I said.
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Michael Moore Right than Wrong on Healthcare
by Carl Mercurio (Originally published June 19, 2007)
It’s time for a fair, objective and constructive assessment of Michael Moore’s new movie “Sicko,” which debuts in theaters across the county on June 29. After all, that’s what the healthcare industry seems to want—a fair and objective assessment.
“A review of America’s healthcare system should be balanced, thoughtful and well-researched to pin down what works and what needs to be improved. You won’t get that from Michael Moore,” says Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America (Washington).
“I don’t think Michael Moore set out to make a balanced movie,” Karen Ignagni, president of America’s Health Insurance Plans (Washington) is quoted in one media report. She adds, “He set out to make a movie about government-run systems and imposing them on the United States as the solution to the healthcare crisis.”
O.K., so let’s be balanced, objective and thoughtful. Here’s what I took from the film after viewing it at a New York press screening this month.
Like all Michael Moore films, “Sicko” is emotional, thought-provoking, and politically charged. He portrays as villains America’s health insurance plans, drug companies, the government and to a lesser extent hospitals and physicians.
The heroes are good, hard-working Americans who have suffered terrible emotional, physical and financial hardships after being denied care by their health plan or because they lack health insurance all together. Despite being billed as a comedy, “Sicko” is not nearly as funny as Moore’s prior films. This time, the tragic subject matter overwhelms even Moore’s wry humor.
Nor is it Moore’s best film. That distinction belongs to “Bowling for Columbine.” But the fact that it’s not his best is not his fault. It’s only because the topic has already been covered so well and so extensively. We lack neither knowledge nor understanding of the fundamental flaws in our healthcare system. What we lack is the political will to do anything about it.
Moore Wants to End Profits in Healthcare
“Sicko” calls for an end to profit motives of any kind in healthcare and advocates universal coverage of three types: 1. Canada’s single-payer government insurance program. 2. The British and Cuban systems—true socialized medicine in which the government owns hospitals and employs physicians. 3. France’s multi-payer system, which relies on public and private funding.
All three systems offer healthcare that is free of charge at the point of care. All achieve superior overall results to the U.S. at a lower cost. Yes, regrettably, this is true—as any objective, balanced and thoughtful assessment of the data will attest.
Moore also implies that everything you could possibly want is provided free and in a timely fashion in these systems. That’s simply not true. Every system has shortcomings—some more significant than others.
But let’s be fair: in the main, these systems are equitable, humane and viable alternatives to a failing U.S. system. And whatever shortcomings critics may point to, these government-run systems provide one seeming guarantee that the U.S. system can’t claim, even for people with insurance coverage: they protect you from going bankrupt from healthcare bills. Isn’t that what insurance is supposed to be all about?
“Sicko” also offers high praise for the Clintons for taking on universal healthcare with their ultimately doomed initiative. The irony is that the Clinton proposal would have afforded HMOs a central role. Jonathan Cohn, in his book “Sick: The Untold Story of America’s Health Care Crisis and the People Who Pay the Price” (HarperCollins, 2007), notes that the Clintons didn’t have the resolve to advocate all-out single-payer healthcare back in the early 1990s So they tried—and failed—to push through a compromise that included private health plans.
The day may well come when the health insurance industry regrets working so hard to shout down the Clinton plan. Think how far the industry has already come—or been dragged by popular opinion—in advocating a universal healthcare compromise of its own. The industry’s formal statement on “Sicko” says, “Washington and the states should take immediate action to ensure that every American has healthcare coverage.” For the record, that’s an industry trade association calling for government intervention. It’s a far cry from “Harry and Louise.”
A Failure of Managed Care Leadership
“Sicko” also implies that preventive care services in countries with government-run systems are superior to the U.S.—again, suggesting that this is the fault of a system dominated by for-profit insurance companies. That’s not entirely fair. Data show that many preventive measures improve dramatically for people in managed care plans.
But what happens to the healthy has never been the rub against managed care. The problem is what happens when you have a serious medical problem.
Harvard University professor Robert Blendon once offered a provocative assessment of public attitudes toward managed care after the first HMO horror stories started to emerge. Blendon pointed out that the HMO backlash of the 1990s actually occurred as overall customer satisfaction with HMOs was pretty high. His conclusion: people are willing to endure obtrusive administrative barriers and other annoyances as long as they aren’t denied care when they are really sick.
His solution was a high-risk insurance pool that would ensure coverage to those with high-cost medical conditions. (The Clinton solution was to heavily regulate HMOs, restricting the ability of health plans to deny coverage and care). Maybe it would have worked; maybe not. The point is that this was a decade ago. All this time the managed care industry has known that denying care to its own sick members is among its most unconscionable—and untenable—behaviors. The industry has done nothing to address the issue.
Let’s be fair and objective—and painfully clear. The leadership of the managed care industry has failed on two fundamental industry issues. The first is a policy issue: the failure to offer a viable solution to the problem of the uninsured immediately following the demise of the Clinton healthcare proposal; instead, the industry waited more than a decade as the ranks of the uninsured swelled to more than 45 million. The second is a consumer issue: the failure to consistently provide plan members with the insurance protection they need—and the healthcare coverage they have paid for—when they are sick.
Both are moral issues as well, and Moore couches them as such. They are central to “Sicko” and in fact to every thoughtful, fair and balanced critique of the managed care industry.
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