June 19, 2007
Out of Frame: Sicko
Michael Moore is a loudmouth. His films tend towards the brash, arrogant, and inelegant, usually leaving subtlety and nuance to smaller personalities. He has a flair for public spectacle and complete lack of shame that would make P.T. Barnum proud. But say what you like about Michael Moore, he's no dummy. He just plays one in the movies.
Sicko, Moore's examination of the state of America's health care, may be his smartest film. It follows on the heels of the polarizing Fahrenheit 9/11, which, objectively speaking, was probably his weakest: an angry polemic that preached exclusively to the choir, confirming everything the Left already believed, and solidifying the Right's hatred of him. Moore's passion and anger got in the way of making an effective film. Fahrenheit's weakness was that Moore's politics were the only thing on display. Sicko, in sharp contrast, makes the political personal. Moore's smartest move is to let his subjects make his points for him.
The film, which screened at a preview in D.C. last night, begins with a number of stories of misadventures in American health care that are extraordinary in their inhumanity. Extraordinary, but sadly not surprising. We're now used to them. Most center on HMOs tap-dancing around technicalities and bending the definition of "pre-existing condition" in order to deny care, usually with devastating consequences. Moore reins in his tendency towards sarcastic humor through much of this section, allowing the victims' sadness to carry the film. It's an uncharacteristically measured start.
The film picks up steam, and Moore hits his stride, as he gives a brief history lesson on the rise of the HMO system. Moore may be a loudmouth. He may be clever at editing a sequence in a slightly underhanded way to achieve his goal. But he knows when to shut up and just let things play out. In a revealing sequence from the Nixon tapes, the President is being briefed on Edgar Kaiser's health care model. His adviser states quite plainly that it's a for-profit model, and that what makes it so effective is that it seeks to make money by treating patients as little as possible. The very next day, Nixon makes a speech telling his fellow Americans about an amazing new idea in health care. It's simple and unadorned, one of the most memorable moments in the film, and says a great deal. It's a mark of maturity on Moore's part to leave his stamp off of the sequence.
As the film develops, Moore does some traveling. He talks to patients and providers in Canada, England and France, dispelling myths about long waits for care, substandard technology, and doctors underpaid on government payrolls. While his "Aw, shucks" Midwestern disbelief wears a little thin, it serves to make his point: what people in these countries believe to be basic human rights is absolutely foreign to us. When the only cashier's window in the entire hospital is devoted to giving patients money rather than taking it from them, or when doctors are offered financial incentives to care for their patients more effectively (rather than incentives based on how many claims they can plausibly deny) something just seems turned upside down in our heads. Does he pick and choose just the positives? Absolutely. But this is a position paper, not a newspaper article. As Orson Welles pointed out in F for Fake, truth is always measured by degrees in filmmaking, and always through the filmmaker's lens and cuts.
There are the usual political pot shots. But they are much fewer and farther between than usual, and directed at both sides of the aisle. He reserves special disappointment for Hillary Clinton as a former potential savior of American health care who now receives more money from the health lobby than nearly any other elected official. Moore is smart enough to realize that polarization distracts from his message, and so he lines up Conservative Party Canadians and no less than Margaret Thatcher to lend their support to the idea of government sponsored health care.
The filmmaker's tendency towards stunts is also scaled back. The much publicized transport of 9/11 workers to Cuba to receive treatment is the only real "stunt," and that sequence comes off as moving and is difficult to criticize when the workers have tears in their eyes because they're finally getting the care they've been consistently denied at home. There is none of Moore's usual grandstanding, the uncomfortable guerilla tactics at the doors of squirrely corporate executives to throw their transgressions in their faces.
Moore depoliticizes the issue by humanizing it. Again and again, Sicko shows doctors, patients, and public officials from other countries who cannot understand how anyone could deny someone the best care available simply because they can't pay for it. They wonder how those needing medical attention can be seen purely as a vehicle for profit. They laugh at the very idea. As we watch the sickening sight of an elderly woman being dropped off curbside at a shelter by a hospital (with a hospital official admitting this is routine practice), he asks who we are as a nation that this is acceptable to us. Wondering what makes those other countries different, he concludes that, "They live in a world of 'we', not 'me'." It's a brutal assessment to close what is really an emotionally brutal film. Brutal, but not hopeless. Moore has dropped the polemic in favor of a plea: for us to care about each other a little more. And he's couched that plea in the most effective film he's made.
Sicko opens nationwide on June 29.
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If our health care system is so bad then why are so many people from other countries coming here for treatment?
I just wanted to say it before any GOP apparatchiks could because it seems to be the only defense they have of the existing system, even though it's a point based on no studies or facts.
i'm no expert on the matter, but are they perhaps coming here simply because those you refer to are wealthy enough to afford it? just because the best hand surgeon or best neurosurgeon is in the united states doesn't mean the entire system here is better than the system(s) elsewhere.
Another point in F for Fake is that quote from Picasso: Art is a lie that helps us see the truth. It's a highly recommended essay film that was way ahead of its time.
I'm no fan of Moore's agit prop, but I'm definitely seeing this. There's no such thing as a purely objective documentary; the act of editing forces you to cherrypick your facts in order to fit the narrative you want to tell. You're not going to see substandard European service or waiting in lines any more than you'll see Europeans paying higher taxes for that level of service, because that's not the story Moore is telling. The question is, what's the healthcare industrial complex's response?
I'm thinking it will be similar to the corporate media's response to Oliver Stone's questions raised in JFK: a bunch of doctored "facts" and character assasination that prove the military/healthcare industrial complex knows what's best.
I think it's the quality of treatment they come here for, not for our system of health insurance. Sort of like the NRA types leaving out the part about (paraphrasing)"against a tyrranical government" when quoting the 2nd ammendment.
There was a 60 Minutes piece last fall about westerners flocking to southeast asia and India for quick, inexpensive procedures in luxury settings. Not to mention americans who travel to Cuba for free cancer treatment.
If our health care system is so bad then why are so many people from other countries coming here for treatment?
Conversely, why are so many Americans leaving the country to have elective surgery done overseas? These are American-educated Indian/Asian doctors operating in hospitals that meet or exceed U.S. standards, offering weeks of recuperating therapy where their U.S. counterparts boot you out after a day. And what does medical tourism mean to those who can't afford air fare?
People that come here from other countries (in terms of what I think you are saying) are not the ones who are suffering from Managed Care issues in the US.. they are coming here, writing a check, or using thier credit card etc. etc., getting great care and going back to where they came from.
I can see both sides of the Michael Moore love/hate view, but I for one, can't wait to see what this newest film really have to say. I think all people in this country have a "I know someone who was sick and..." story that inevitably involves a fundraiser because the insurance didn't cover what they needed.
I saw it too and I really liked it. Some of it was frustrating because I know how badly our health care system sucks but I found it hard not to be moved by this movie. He asks hard questions and we owe it to ourselves and future generations to try to answer them.
Health care treatment in America is not sub-par. Health care access/availability is. And there ARE long waits for some kinds of elective procedures in countries with government-managed health care! That's not a myth!
As with all the other issues of today (Iraq, immigration, etc), you don't get a do-over. You can't simply raze the current system and implement a new one any more than you can etch-a-sketch those other two issues and start over. It'd be more interesting to hear some pragmatic suggestions for fixing the problem than an overwrought explanation of the problem.
Treatment is subpar, too. It's commonly believed by foreign exchange students that they shouldn't go to the doctor in the U.S. -- they'll be treated poorly and misdiagnosed and cultural differences will not be respected.
But I take issue with his description of HMO's, although not always a good thing. Treating the symptom, maintaining health, are breakthroughs in modern medicine. It needs to happen both ways of course. But health maintenance and preventive care are really revolutionary.
My great uncle worked for Kaiser Steel. And was a big advocate of his healthcare plan -- the rest of the family thought HMOs were a communist plot to nationalize our healthcare but changing the way we thought about medicine.
I guess that just shows that our views of these things change overtime.
Funny, I thought treating the CAUSE of the symptom was more important. You know, so the symptoms actually stop happening altogether?
And preventative care is definitely revolutionary. Too bad it's pretty clear that's not what HMOs are in business for.
Listen to the cliche criticism of Michael Moore..Farenheit 9/11 was actually a GOOD movie, well done. His critics are all advocates of the status quo pro political apathy set. Check out "Society of the Spectacle" by Guy Debord.."What appears in the 'spectacle' is good because it appears." In other words anyone who questions the general "appearance" of things or the "official story" is villified and pilloried.
Health care in America is great - for those who can afford it. I work in rehab, though, and my patients are routinely denied further treatment sessions, routinely denied adaptive equipment that could make their lives safer, easier, and more independent, and routinely denied therapeutic equipment that could aid in their recovery - all by their American insurance companies. My facility has the know-how to give fabulous care - but we are very frequently limited by the resources available to our patients.
Health care here is already rationed - it's just rationed by how rich you are.
all of my canadien friends say the 'long line' thing is BS.
Actually Chris, that's not a cliched criticism of Fahrenheit. I agreed with both the objectives and viewpoints of that film, I just felt Moore stated them poorly. I applaud him for questioning the "official story". I think he'd have done more good by doing so in a way that would not further alienate anyone even slightly inclined to dislike him.
I just watched the film last night and highly recommend it. It is very frustrating to see how good the healthcare is in other countries.
I can vouch for how good NHS is in the UK; I studied abroad there and had to see a doctor for the flu once. Visit was free, meds were free, no insurance necessary.
PS You can watch Sicko right now via streaming video here: www.videostored.com
(I somehow don't think Michael Moore will mind ;)
I think it's kind of funny that no one seemed to notice that "repeat it til you think it's true" was making a joke in the first comment.
Jerry - I don't know about your Canadian friends, but in the UK under the NHS waiting lists are simply a reality. Most people take this to mean you have to wait to see your doctor. In fact, there are plenty of GPs and family practitioners in the NHS - it's the higher end, more expensive treatments and procedures that are in short supply and are rationed by means of waiting lists.
One of the greatest strengths of the US health system is the Medicare program. Clearly it's a mounting problem in terms of budget, but the fact is that Medicare is an "entitlement" program. That is to say, if you qualify for treatment you get it. This is in contrast to "discretionary" programs where there is a set budget and providers are prohibited from spending more that their budget. The NHS is, in essence, a discretionary program. Westminster/Whitehall sets the budget/forecasts etc and health systems have to stay within that budget.
As a result, seniors (or pensioners) are ROUTINELY denied treatment in the UK that qualified US seniors would certainly recieve. Of course, in the US we routinely deny care - of any sort - to the uninsured. We have different ways of rationing care, but to suggest that rationing is a myth is just misinformed.
You're not going to see substandard European service or waiting in lines any more than you'll see Europeans paying higher taxes for that level of service, because that's not the story Moore is telling.
I saw the movie last night, and you're right: Moore doesn't show that stuff. Partly this is because he's making a case; partly it's because stories about inferior care and long lines in single-payer systems are scaremongering.
The fact is that Americans pay much more for their healthcare than any other country, yet still have some of the poorest health outcomes in the developed world. Do you have to wait in line at the NHS for procedures? Sure -- for procedures that aren't particularly urgent, you might. Would you get less healthcare, in terms of absolute dollars? Probably. But it'll do you a lot more good to get frequent cheap preventive checkups than you would get out of an extra day on the ventilator while you're in the ICU at the end of your life.
The NHS isn't all that great, but it's worlds better than our system. I strongly recommend that anyone interested go read Ezra Klein's "Health of Nations" article at www.prospect.org/cs/articles?articleId=12683. It examines Germany, the UK, France and our own VA hospital system. I'll happily admit that pretty much all that I know about this subject comes from there, but it's enough to know that the waiting-in-line and inferior-care objections are canards.
Is it true that Roger from Roger and Me never was dodging Moore, and agreed early on to meet with him? Did I hear that somewhere?
Reid:
Yes, then-General Motors chairman Roger Smith actually meet with Michael Moore, but that part of the film was CUT from the final version.
A new film made by Michael Moore supporters, Debbie Melnyk and Rick Caine, called "Manufacturing Dissent" relates that information and a bunch of other stuff on how Moore twists the truth for his own agenda.
I don't care to hear anyone preach... but this film sounds like it shows some a number of unseen truths. I had a big seizure 3 weeks ago (first one, went to ER) and I've been seeing the bills roll in. Thankfully my company has somewhat avg benefits, so instead of the rough $1700ish total I owe, it would have been over 8 grand... WOW.
Reid-
Moore attended a shareholder's meeting where he asked Smith a number of questions. It was taped, but not by Moore, and the incident in question occurred before he began filming the movie.
DCist Ian..
What are you saying?.. If he'd have presented it better the "Moore-Haters" would have been won over? The "Moore Hatin'" machine is a deliberate vested interest. It's going to be deployed as a given. Farneheit 9/11 was not a documentary. It was a screed but it was thought provoking and threatening to people who DON'T want you to ask questions about the bin Ladens, the profit motive of war makers, and so on. It comes down to how we see the arts in a militaristic country like ours. Notice how conspicuously a-political many "working" actors are today. Notice how a-political network tv shows are compared to Norman Lear's day. Public opinion is valuable and vested interests are willing to pay millions to shape it. General Electric would love to propagate the attitude of "leave the political stuff to us, you guys just go shopping." Artist's like Moore want to shake you up and make you think, not think for you.
Calm down, Chris. We're ideologically on the same side, yet you're going on the offensive. What purpose does that serve?
I know Moore's never going to sway the people that hate him. There are an awful lot of people in the middle, though, who are turned off by overt partisanship from either side. You reach those people by more subtle means. Sicko succeeded in that where Fahrenheit failed. In my opinion. That's all I'm saying.
I resent the "calm down" remark. I am hardly "out of control" by your inference.It's hard to argue the "Fahrenheit" failed. It's only one of the most successful movies of it's type in history. Had it been more subdued it wouldn't have been HIS movie, ie: his oerve and statement.
The differences in the health care systems between countries is rooted in the same fundamental differences between the role of government and the role of the individual. The fact of the matter is that health care costs money. Everyone wants the "best care available", but by definition not everyone can have or needs the best care in every instance. So how do you draw a line? The ideal system would not incentivise advanced treatment or optional procedures that are not really necessary, but only the individual is in a position to be the final judge of what is needed and what is not, and so the financial burden should be on the individual. The government should only be involved to the extent that they help the individual citizen be in a position to receive and manage care the way they see fit. And yes, it should not be a surprise that sometimes health care providers need to make financially-based decisions about care. There are applying a finite set of resources to ever-expanding expectations about what health care should provide. Should emergency victims be treated regardless of insurance? Absolutely. But why should we expect the healthcare system or our government to take care of and plan for our every possible need? That is my responsibility, and to put the blame anywhere else is a shameful shirking of your own responbiility to yourself and your family.
As much as I sound like a cheerleader for Michael Moore I am the first to acknowledge the problems with government managed health care. American culture is characterized by significant obesity, drug abuse, alcohol abuse, smoking, sexual liberality, extreme sport risk taking and various other lifestyle disregard for their own health.
I'll side with Chris on this. MM wouldn't win over any more people by using mushier tactics. He's polemic, but not so unhinged as the opposition. Why fight fire with a smaller fire? To claim the moral high ground (he has it anyway) and be drowned out in the noise just plays into the "progressives are pussies" meme. Not to be confused with the "progressives are shrill American haters" meme. They've really got us boxed in, don't they?
And these are folks who brought us "freedom fries". Where is the appreciation of reality over image?
Hell, I value facts over image so much that to me "Farenheit 911" runs second to "The Whole Truth About the War in Iraq". Crappy last-minute production values, but spot on analysis.
I have never seen a Michael Moore film but I enjoyed Sicko. The ride to Cuba actually shocked me, I wasn't expecting it. The scene with the Cuban firefighters was moving.
Americans won't accept a free or universial health care system because individuals in our society always want to be "better" than the next person. Ideological/political differences have nothing to do with it.
Universal health care is pretty abstract to me though. I mean does that mean if I break my leg I get it reset for free? I mean EVERYTHING for free. I
don't understand it, I will admit. Free heart surgery?
Not necessarily, but in some countries. Everyone makes it up and defines it as they go along.
It's probably safe to say it means a certain standard of care with no out of pocket expense to the individual. Broken leg? Probably. Heart surgery? Probably depends on precisely which procedure. Silicon implants? I doubt it. Viagra? Sure, 'till more women get a say in such things.
Of course, you'll always be free to spend your own money to get the precise level of care you want. That's important to remember. So is the basic fact that there will be a basic minimum level of care that is guaranteed.
To DC1974:
I am a perfect example of what you speak of about foreign exchange students:
As of right now I bare two "scars" from this wonderful health system in the US:
A) A missing tooth: Back in 1985 while attending high school as a FES in Decatur Illinois I got a bad tooth. I went to a dentist to have it fixed. The dentist broken the tool (the metal poker thinggie they use for killing the nerve) in the tooth, but because I was a foreign exchange student, he left it and closed up KNOWING that by the time it got infected I would be already out of the country (hence, no lawsuit) and it would be someone else's problem.
A year later I was in Georgia I got a very weird infection in one of my gums. It did not appear as a tooth issue, so the schools HR sent me to their "recommended" doctors, who basically looked at my teeth, and rather than sending me to a dentist, charge me $100 inestad, gave me a shot on antibiotics and send me home. Of course, not only that didn't do squat, but then I ended up having to go to a dentists anyway.
So I go to a dentist, he examines me, tells me he can't figure out why the prior dentist simply did not remove the broken poker and proceeded to removed the whole tooth. The piece of metal left was stikcing out from the root of my tooth a good bit, looked like a skewred tooth. I kept the tooth as a souvenir. The dentist could not believe I have been walking around with this in my mouth.
A year later I am in Spain and I happen to show the tooth to my brother in law, who is a dentist, just as a joke, a sort of visual exhibit to my tale. He looks at it, looks at me and asks very quietly:
" Why did the second dentist pulled out your tooth?... He could just taken out the metal piece and finish off what the first dentist failed to do?..Makes no sense"
Back in college. I pay the dentist that took my tooth out a visist and I asked him why did he pulled the tooth out instead of fixing it.
His answer: "Well, you are in college, you probably have no money, so I thought that was the only option."
He never asked if I could afford it. He simply assumed I was poor. Last time I attended a dentist in the U.S.. That was 1987.
2) Broken nose after falling downstairs in the dorm while moving a table.
Went to the doctor. I was aksed if I had insurance, which I didn't, but I told them I would pay. They demanded payment BEFORE treatment. I wrote them a check, They asked for cash. Bank was closed, nose needed to be set right away. So I needed to find $2500 in cash to pay for having my nose reset.
I bought a plane ticket to MAdrid for 980 dollars instead, went to a hospital right after getting off the plane, waited one day for my appointment, then had the nose reset for $375 dollars. Spent the week in Madrid partying and having a good time, costed me $2100 dollars less.
I get a kick when I hear Americans talk about "immigrants" coming here for "health coverage"..They NEVER talked about the MAJORITY of the immigranst who go home to get medical treatment because it is either too expensive here OR simply no good enough.
Allrighty then.
I have not seen this movie yet, and although it was directed by M. Moore I believe that the message behind this has no relevance as to who and what Michael Moore is, does or believes. I understand that the movie's role is to expose an unjust and profit-driven healthcare service.
Access to good health care at a low or no cost is a basic human right. If a government expects you to go to war and die, expects you to give money from your salary to fund government and corporate initiatives then it should have the decency to provide its population with access to education, health care, affordable housing, a fair wage, so and so on.
Sounds utopian huh?
Michael Moore is not an "issue", a messed up world with skewed priorities is the issue.
Jerry, your friends may not have long lines, but the Canadian Journalists at Canne thought he way off the market in his portrayal of their system.
"Reid-
Moore attended a shareholder's meeting where he asked Smith a number of questions. It was taped, but not by Moore, and the incident in question occurred before he began filming the movie."
Doesn't that make his entire film a shame? He meet with Roger Smith! And it doesn't matter if Moore didn't film it. The guy uses tons of film that he didn't personally create. Like everyone else, Moore twists facts and situations to fit his story. When watching anything ... Moore, Fox News, CNN, ABC, NBC, etc. just remember that and you'll be fine.
It only might make the film a sham if the point of the film was the lack of an interview. And it wasn't the point, it was just a narrative device to carry through the film.
And 5 minutes of questions asked in a group setting at a shareholder's meeting hardly counts as an interview of any depth or substance. That's what Moore was seeking with Smith, and that's what he was denied.
You're grasping at straws here.