Thursday, July 30, 2009

Sicko (Dog Eat Dog/Weinstein Co./Lionsgate, 2007)

by Mark Gabrish Conlan • Copyright © 2009 by Mark Gabrish Conlan • All rights reserved

Michael Moore’s Sicko, two years after its release, turns out to be unexpectedly timely in the middle of the debate in Washington, D.C. over health care “reform” — though I use the term in quotes because the entire deliberation at the federal level has been committed to the idea that, whatever happens, the current structure of the U.S.’s private, for-profit health insurance industry as the bulwark of health coverage must be kept intact. I would argue — and I’m sure, on the basis of his film, that Moore would agree with me — that universal coverage and a private insurance industry are mutually incompatible: you can have one or the other, but not both. The reason is very simple: it’s the enormous profits the health insurance companies are making (mostly for their shareholders but also for their CEO’s and other top executives) that are sucking resources out of the system that otherwise could be used to extend coverage to the currently uninsured. The resources to cover everybody exist nowhere else — which is why the Congressional Budget Office (CBO) recently estimated that the so-called “reform” being pushed by the Obama administration and the Democrats in Congress would cost a whopping $1 trillion more than the current system.

Sicko the movie is typical Michael Moore — a good amount of grandstanding and a liberal dose of wit (sometimes clever, sometimes heavy-handed) to make a serious point: that everywhere else in the advanced industrialized world, government guarantees its citizens access to health care as a right and it is simply accepted as a matter of practicality and realism that the health care system will be funded primarily by taxes — and will make its services available to anyone, regardless of coverage, employment status, pre-existing conditions or ability to pay. It’s a movie that went absolutely nowhere, though, in terms of affecting the debate over health care — on the July 10, 2009 episode of Bill Moyers’ Journal, Wendell Potter, former public relations director for Cigna, boasted of his and the industry’s efforts that “blunted” the potential political impact of Sicko:

“WENDELL POTTER: I thought that he hit the nail on the head with his movie. But the industry, from the moment that the industry learned that Michael Moore was taking on the health care industry, it was really concerned.

“BILL MOYERS: What were they afraid of?

“WENDELL POTTER: They were afraid that people would believe Michael Moore.

“BILL MOYERS: We obtained a copy of the game plan that was adopted by the industry’s trade association, AHIP. And it spells out the industry strategies in gold letters. It says, ‘Highlight horror stories of government-run systems.’ What was that about?

“WENDELL POTTER: The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you’re heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern.

“BILL MOYERS: And there was a political strategy. ‘Position Sicko as a threat to Democrats’ larger agenda.’ What does that mean?

“WENDELL POTTER: That means that part of the effort to discredit this film was to use lobbyists and their own staff to go onto Capitol Hill and say, ‘Look, you don’t want to believe this movie. You don’t want to talk about it. You don’t want to endorse it. And if you do, we can make things tough for you.’


“WENDELL POTTER: By running ads, commercials in your home district when you’re running for re-election, not contributing to your campaigns again, or contributing to your competitor.

“BILL MOYERS: This is fascinating. You know, ‘Build awareness among centrist Democratic policy organizations … including the Democratic Leadership Council.’ … Then it says, ‘Message to Democratic insiders. Embracing Moore is one-way ticket back to minority party status.’


“BILL MOYERS: Now, that’s exactly what they did, didn’t they? They … radicalized Moore, so that his message was discredited because the messenger was seen to be radical.

“WENDELL POTTER: Absolutely.”

Sicko is full of grim horror stories (though the film as it exists didn’t confirm my fear that it would be too gross to watch), including the uninsured patient who sliced off the tips of two of his fingers with a table saw and was told by the hospital that he could have a choice: they could reattach his middle finger for $60,000 or his ring finger for just $12,000. There’s also the incredibly moving testimony of Dr. Linda Peeno, speaking before a congressional committee in 1996 virtually in tears as she told about her routine denials of health insurance claims, including one that actually resulted in someone’s death — and for which service she was handsomely rewarded by her insurance company, as part of a system that routinely gives bonuses to doctors in charge of review panels based on how many claims they deny: the more denials you issue, the more money you get:

“My name is Linda Peeno. I am here primarily today to make a public confession: In the Spring of 1987, as a physician, I denied a man a necessary operation that would of 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 for the more, this particular act secured my reputation as a good medical director, and it 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 for the organization which I worked. And I was told repeatedly that I was not denying care, I was simply denying payment. I know how managed care pains 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 in which I have written that deadly word, ‘denied.’”

Sicko is basically a morality play, alternating dire stories from the U.S. health care system — individuals denied medical coverage (including a middle-aged couple forced to move into their daughter’s basement and share house-room with her computer because he had three heart attacks and lost his coverage, and she got cancer), individuals turned down flat by insurers who didn’t want their business at all because the companies feared they would cost far more than they’d bring in in premiums (there’s a receding crawl, accompanied by the Star Wars main theme, showing all the “pre-existing conditions” insurers routinely turn down potential customers based on), coverage conveniently pulled because the insurer’s detectives (one of the detectives, who’s since left the business because he, like Linda Peeno, actually had an attack of conscience, is one of Moore’s most fascinating interviews) uncovered a “pre-existing condition” (like the woman who was denied a claim for a $72,000 operation because years before she had had a yeast infection and sought medical care for it, and she hadn’t disclosed that on her application — indeed, the detective Moore interviewed said that in some states you can be denied coverage even for a health problem you didn’t seek treatment for based on a “prudent-person” doctrine that a normal person in that situation would have sought care) and in some cases the deaths of several patients (including an 18-month-old girl and the African-American husband of a white woman who actually worked at the hospital where she was trying to get her husband treated for bone-marrow cancer, who in the middle of a hostile hearing suddenly said, “Is it because he’s Black and I’m white?,” and stormed out of the room) — with happy tales of how wonderfully single-payer health care works in the rest of the civilized world.

Moore visits Canada (where he encounters an American woman who claims to be the common-law wife of a Canadian just so she can access the single-payer health care system — I’d known about people in the northern U.S. crossing the border into Canada to buy prescription drugs more cheaply but I’d never before heard of Americans going to Canada and using subterfuges to get actual health care), Britain, France and Cuba — the last the most controversial part of his movie; at the time the Chicago Tribune reported that Moore was actually under investigation by the U.S. Department of Homeland Security for having filmed in Cuba and they were threatening to seize his film, so he had to sneak it out of the country to show it at the Cannes Film Festival — in which he gathered together a group of Americans that had been denied care, including some people who’d volunteered their services as rescue workers at Ground Zero after the 9/11 attacks, and sought to get them onto the U.S. naval base at Guantánamo Bay after Republican Senators boasted during Congressional hearings that the detainees there didn’t have it so bad because the base had state-of-the-art hospital facilities in which the detainees got state-of-the-art care.

Not surprisingly, Moore wasn’t able to get his people to Guantánamo, but he was able to land them on Cuban soil (there’s a grimly funny credit to the effect that Department of Homeland Security regulations prohibit him from showing just how) and to get them treated in the Cuban health care system. He also shot an interview with Alecia Guevara, a Cuban pediatrician and daughter of Che Guevara (who’ll, you recall, originally trained as a doctor and whose first role in the Cuban revolution was as a medic treating revolutionary fighters in the field, before he rose to become a participant and a commander in actual combat), who says, “Cuba is a little island in the Caribbean with little to no resources. We can do a lot to improve the people’s health. This does not happen in the United States. Why are we able and you are not?” Wendell Potter made a similar point in his interview on Bill Moyers’ Journal (a fascinating tale that’s basically Cinderella in reverse: he got off his company-issued private plane, where he was served dinner on gold-rimmed plates with gold-plated utensils to eat it with, and attended a health fair in Tennessee and saw the uninsured literally flocking to get tests and treatments in crudely set-up stations in open-air booths, and that was his “aha!” moment during which he realized how the industry that paid him so well had screwed up America’s health-care system), when he said that the movie contained “a great truth,” which was:

“That we shouldn’t fear government involvement in our health care system. That there is an appropriate role for government, and it’s been proven in the countries that were in that movie.

“You know, we have more people who are uninsured in this country than the entire population of Canada. And that if you include the people who are underinsured, more people than in the United Kingdom. We have huge numbers of people who are also just a lay-off away from joining the ranks of the uninsured, or being purged by their insurance company, and winding up there.

“And another thing is that the advocates of reform or the opponents of reform are those who are saying that we need to be careful about what we do here, because we don’t want the government to take away your choice of a health plan. It’s more likely that your employer and your insurer is going to switch you from a plan that you’re in now to one that you don’t want. You might be in the plan you like now.

“But chances are, pretty soon, you’re going to be enrolled in one of these high deductible plans in which you’re going to find that much more of the cost is being shifted to you than you ever imagined.”

The real message of Sicko — and it’s a quite depressing one — is just how far apart we are from the rest of the industrialized world in terms of basic values, and in particular how we see ourselves and our relationship with the state. The countries that have been able to pull off successful single-payer systems — in the movie, Britain and France along with Canada (a former colony of both of them) and Cuba (a country whose revolutionary government overthrew capitalism 50 years ago) — all have something of a feudal heritage, and while the official justification of feudalism as a mutually beneficial relationship in which the serfs received protection and security from the landowner in return for a share of their produce was honored in practice far more in the breach than in the observance, nonetheless it built into those countries’ social DNA a sense of a mutual obligation between government and the citizenry.

The United States, by contrast, was never a feudal society — it was capitalist from the get-go (the only serious competitor to capitalism as an economic system in the U.S. was the slave-based landed aristocracy of the South, and that conflict was settled by the Civil War) — and has had a very different conception of the role of government, basically one in which government is seen as inherently suppressive of individual rights and therefore must be kept in check as much as possible. One of the grimmest parts of Sicko is the montage showing how the private health industry (not only the insurance companies but also the American Medical Association and the various trade associations including the hospital industry and especially the pharmaceutical companies) has killed attempts to establish government-based health care programs again and again with exactly the same rhetoric each time: it’ll take away your freedom to choose your own doctor, you’ll be forced into a government-run system where government bureaucrats will get in between you and your doctor and decide what care you can or can’t receive — and aside from a couple of slip-ups at the height of Lyndon Johnson’s “Great Society” in the 1960’s, where he was able to slip through Medicare and Medicaid (Mad magazine bitterly summed up the AMA’s opposition to Medicare when they joked, “Medicare robs older people of their freedom to choose the doctor they cannot afford to go to”), the health business has managed to kill every initiative to set up anything even remotely resembling the kind of health-care guarantees every other developed country gives its citizens.

The fact that they’ve been the same arguments every time — and they’re being trotted out again (with some interesting new wrinkles: before I saw the movie I’d heard a bit of Mark Levin’s talk show in which he quoted an article purporting to debunk all the claims that are made that other countries have better health outcomes and do more preventive care; he said that infant mortality rates are deceptive because they fail to take into account genetic differences between countries — to which one can only wonder exactly where he thinks most of the current U.S. population came from? All those despicable European countries that actually have universal single-payer health care! — and that if you factored out auto accidents and gunshot deaths, the U.S. life expectancy would exceed those in Europe … which seemed to me a place a Right-winger like Levin would ordinarily not want to go, since it suggests that we have too many cars and too many guns!) — is less depressing than the fact that they work every time.

Americans simply buy the idea that having a government bureaucrat between you and your doctor is the epitome of social evil, while having a private bureaucrat between you and your doctor is just part of the price you pay for “freedom.” It really has to do with a difference in philosophy between this country and the rest of the world, the extent to which the ideal of “rugged individualism” is encoded into our social DNA and that except under particularly stressful conditions Americans instinctively reject collectivist solutions to our social problems and embrace individualistic ones instead. Moore has a fascinating interview with Tony Benn (formerly Sir Anthony Wedgwood-Benn, retired British politician who gave up his hereditary title and abbreviated his name to accord with his strongly Leftist “Old Labour” politics) in which, right after a montage of how much debt Americans live under, Benn says, “Keeping people hopeless and pessimistic — see I think there are two ways in which people are controlled — first of all frighten people and secondly demoralize them. An educated, healthy and confident nation is harder to govern.”

The implication is that Americans are fearful and hopeless and that they’re deliberately kept that way by their government and corporations so they won’t revolt the way people routinely do in countries like France, where governments who try to cut back on the society’s public benefits or employers who try to cut wages and perks are routinely met by tens of thousands of demonstrators in the streets. (One of the most fascinating aspects of Sicko was that Moore depicted the European welfare state in a positive fashion; when the U.S. media deign to mention it at all, it’s usually in a context of condemning European governments and employers for “spoiling” their people with 35-hour workweeks, six-month maternity leaves, five-week vacations and the rest of it — and thereby their economies are falling behind ours since we’re energizing ourselves by working multiple jobs, never taking time off and having the discipline of the market unimpeded by any dangerously socialist ideas about the government taking care of us. The fact that the U.S. economy isn’t appreciably stronger than the European ones by objective measures doesn’t enter into it any more than the fact that other countries’ health care systems keep their people alive longer and healthier.) One of Moore’s interviews with a Canadian explains just what a gulf there is between our perceptions of government’s proper role in society and theirs:

“Michael Moore: I’m wondering why you expect your fellow Canadians, who don’t have your problem, why should they, through their tax dollars, have to pay for a problem you have.

“Canadian: Because we would do the same for them. It’s just the way it’s always been, and so we hope it’ll always be.

“Michael Moore: Right. But if you just had to pay for your problem, and don’t pay for everybody else’s problem, just take care of yourself.

“Canadian: Well, there are lots of people who aren’t in a position to be able to do that. And somebody has to look out for them.”

Moore himself movingly articulates the communitarian perspective in his peroration at the end — just after he mentions that in what he wanted us to read as noble but which came off to me as an offensively patronizing act of noblesse oblige that he anonymously donated $12,000 to the proprietor of the nation’s leading anti-Michael Moore Web site after that person had said he might have to take it down because he could no longer afford both the maintenance of his site and the health insurance his wife needed — in which he says:

“It was hard for me to acknowledge that in the end, we truly are all in the same boat. And that now matter what are differences, we sink or swim together. That’s how it seems to be everywhere else. They take care of each other, no matter what their disagreements. You know, when we see a good idea from another country, we grab it. If they build a better car, we drive it. If they make a better wine, we drink it. So if they’ve come up with a better way to treat the sick, to teach their kids, to take care of their babies, to simply be good to each other, then what’s our problem? Why can’t we do that? They live in a world of ‘we’, not ‘me’. We’ll never fix anything until we get that one basic thing right. And powerful forces hope that we never do. And that we remain the only country in the western world without free, universal health care. You know, if we ever did remove the chokehold of medical bills, college loans, daycare, and everything else that makes us afraid to step out of line, well, watch out. ‘Cause it will be a new day in America.”

Don’t hold your breath, though: as Cathleen Decker noted in a fascinating article on the California budget crisis in the July 26 Los Angeles Times, despite their reputation as living in one of the most “liberal” states in the country, Californians have decisively rejected the idea that government has much of anything positive to offer in terms of solving social problems. Her article contrasted the major expansion of California government under Pat Brown’s governorship (1959-1967) to the anti-government attitude of Californians today: “In Brown’s California, there was a broad consensus that government was a competent force for good. Now, among Californians of all political ideologies, there is the opposite: a repudiation of government and, even more, of any confidence in the governor and the Legislature to act competently. On that matter, at least, California as a whole has shifted to the Right.”