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  • BIOETHICS FORUM ESSAY

I’ll Tell You What’s Sicko

It’s a sultry July Saturday 40 years after the Summer of Love, and the liberals are again converging. In this incarnation, the Haight is replaced by Prospect Park, a bucolic enclave in Brooklyn’s ultra-liberal Park Slope. The long hair is grey or missing, and barking dogs running free during early morning off-leash hours substitute for guitar riffs. Knots of people loiter with lattes, and I overhear them sticking it to the man – this time, George Bush and the health insurance companies, brought to you courtesy of Michael Moore’s Sicko.

The slow burn I feel doesn’t come from inhaling the acrid smoke of an illicit plant substance, but from frustration with my fellow Americans, myself included. Martin Luther King said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” So where have we been? There are now 47 million uninsured Americans – fully 15 percent of us, and 9 million of them children. Far be it from me to defend either Bush or the insurance industry, but what they contributed to this moral catastrophe happened in full sight of the nation. The breakdown of the American health care system has been front page news on a more-than-once-a-week basis; editorials and columnists have bemoaned it; lawmakers at the state and federal levels have proposed bipartisan legislation; organizations such as the Robert Wood Johnson Foundation have sunk vast resources into bringing together coalitions that include groups that tend to be adversarial, such as the Better Business Bureau and the AFL-CIO. All that’s been missing is … us. What’s sicko is that it takes the massive Hollywood bankrolling of a muckraking journalist to get widespread attention on this issue that has been tightening around our national neck like a python for almost two decades.

In fairness, Moore gets this. At the beginning of the film, he says, “This isn’t a movie about the uninsured. This is a movie about the rest of you.” Moore clearly believes that America’s dysfunctional health care system exposes a deep national fault line: our lack of solidarity as a people, rooted in our Puritanical and sometimes fanatical belief in the power of the individual, who with good hard work (and, courtesy of Bush, maybe some tax breaks if he or she makes more than $200,000 a year) can solve his or her own problems, including health care. However, Moore can’t resist burying this point in sensational tales that provoke his hallmark outrage at the “big guy.”  And, as the Prospect Park conversations demonstrate, this gives people the comforting opportunity to point fingers at a fault that in truth lies not exclusively in the insurance company stars, but in ourselves. The result is that Sicko is an exercise in indignation likely to perpetuate the oversimplified world of us versus them, and so avert any meaningful change.

Nonetheless, Moore is hard to resist and Sicko is clever storytelling. The film opens with Adam sewing up his own cut with a needle and thread. That will get your attention, if you can look at it. Of course, regardless of the ills of the American health system, no one has to sew up their own wounds (and how’d he get that footage anyway?). The ER takes all comers – it’s just that the costs of treating in the ER chronic illness or illness that could have been prevented with the right basic medical care are a major driver of health care costs, and contribute to the health premiums that the uninsured can’t afford. But nothing says bad box office returns better than good economic analysis, so time for the next frame.

Rich’s anecdote is that after severing two fingers, he opts to have only one sewn back on due to the costs. As his wife says, “It’s not right that our choices are a car or a reattached finger.” Well, sure. No one should have to cost out finger replacement. But isn’t there something strange about opting for a car over a finger? Is the finger a fungible consumer item? If Rich values his finger so little, it’s hard to imagine he will want to pay higher taxes in the interest of the fingers of the uninsured.

In another anecdote that plays on the heart without engaging the head, a man with kidney cancer is denied coverage for an experimental bone marrow transplant, and dies three weeks later. However, unfounded desire does not justify expenditures, and BMT is not listed as either a proven or experimental treatment for advanced kidney cancer in the definitive Physicians Data Query from the National Institutes of Health. But Moore doesn’t dabble in medical details, nor recognize that demand for questionable, futile, or unnecessary diagnostic tests and treatment is another one of the health-care cost drivers that got us in the mess we’re in.

Then there are Larry and Donna, representing the underinsured. They are forced to move in with their adult children after Donna’s cancer and Larry’s heart disease bankrupt them. The kids don’t want them – they haven’t even cleaned the cluttered, tiny room where they are putting their parents in bunk beds. Donna, a former newspaper reporter, says that if someone had told her ten years ago that she would find herself in this position, she wouldn’t have believed it. Donna, that’s exactly the problem. Unless it hits our individual pocketbooks, far too few in America believe there is anything to worry about.

The shabby way their children treat Donna and Larry is in sharp contrast to Moore’s kumbaya portrayal of foreign solidarity. Indeed, Sicko is most compelling when it takes us on a world tour of nations with universal health care – and better health outcomes than ours. Bully for Moore to go to Canada and speak to a conservative golfer who dispenses with the old saw that Canadians have to wait years to get bypass surgery. Yes, there are waits in Canada for surgery – but only for elective surgery, not for emergency surgery. The trip to the U.K., where a hospital cashier doesn’t collect the bills (or the deed to your house), but doles out car fare to and from treatment, is an effective punch at the contorted financing of our system.

Moore even brings us to Gitmo, where we learn about the fabulous medical care the prisoners there receive. He goes there illegally on a boat from Miami, bringing along some ill 9/11 workers who have not secured treatment in the homeland. It’s a great sight gag – so clever, in fact, that we risk losing sight of the overarching rights issue of holding these individuals outside of the protections of the Geneva Convention. Their supposedly good health care doesn’t make up for that, of course.

But France is where Moore really falls in love – and who wouldn’t, with the wine and cigarettes and paradoxical good health. There is much to admire in the French system, where a national insurance fund that is both publicly and privately funded guarantees all citizens access while still maintaining patient choice of private physicians. But Moore goes beyond health insurance to wax poetic about the solidarity of the French in general. They give new mothers laundresses! They have good, free day care! They get lots of vacation time! But the Bordeaux might have let Moore forget that four summers ago, while families used up their long vacation time, 15,000 elderly people died, almost all unnecessarily, in a heat wave. In response to the tragedy, as USA Today reported, “[the] French Parliament released a harshly worded report blaming the deaths on a complex health system, widespread failure among agencies and health services to coordinate efforts, and chronically insufficient care for the elderly.” In terms of deaths, this huge public health and social failure dwarfs Katrina and isn’t far from the estimated number of deaths in the U.S. attributed to uninsurance annually.

Near the end of his film, Moore concludes, “We’re in the same boat. We sink or swim together. What’s our problem? We live in a world of we, not me.” Moore is correct that we as a nation must look to our values if we are to establish a just health care system that guarantees coverage for everyone. My favorite part in the movie was when Moore put on a PBS hat and interviewed Tony Benn, the left-leaning British Parliamentarian. Benn said that after World War II, the U.K. determined that if there’s money to kill people, then there’s money to save them. It seems such an obvious calculation. But for the U.S. to get there will require a careful parsing of our values that leads to nuanced discussion, dialogue, and compromise.  The recently passed bipartisan Massachusetts health care reform effort shows that this is possible. Unfortunately, as my Park Slope pals demonstrated, Sicko ultimately fails to serve this cause. It is predominantly an exercise in gleeful finger-pointing, not a much needed tool for seeking solutions.

Mary Crowley is director of communications and public affairs at The Hastings Center

Published on: July 20, 2007
Published in: Health Care Reform & Policy

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