July 5, 2007 -- The latest Michael Moore (“Bowling for Columbine” and “Fahrenheit 9/11”) documentary is one of his best, a scathing, unblinking look at what is wrong with health care in the United States. This is not a documentary filled with talking heads speaking in generalities, although there are some of those. This is a collection of stories of real people with real, sometimes deadly problems. This is not a carefully-researched analysis of what is wrong with health care in the U.S. It is simply a collection of stories about people living here, and in other countries, and how the various health care systems affect them, for better or worse. As usual with Michael Moore films, it is not objective and it plays fast and loose with the facts at times. It nonetheless hits its bloated medical care target dead center. It is entertaining and thought-provoking. It is a real eye-opener. What gives this film its real power is not what is on the screen at all, however. What gives it power are the real memories of people in the audience. Anyone who has been around long enough and knows enough people will have known someone suffering some of the same kinds of medical care problems that are suffered by people in this film.
In the movie Moore said he asked for medical horror stories on his web site and got 25,000 responses in a short time. When the health care industry learned that Moore was making a film about industry problems, it went into panic mode. The mere mention of Moore's name in a letter to one insurance company caused it to reverse its previous decision and provide two operations for a young child going deaf, one operation for each ear, instead of just one. This is shown in the film (Moore doesn't mind tooting his own horn). Moore also sent a $12,000 check to one of his biggest critics, who runs the website moorewatch.com so he could afford to pay health care expenses. Moore says in the film he sent the check anonymously, but if you casually mention the check to several million movie viewers it quickly ceases to be anonymous.
Moore is a master of street theater, ambush interviews, and clever publicity stunts. His movies may not always be convincing, but they are usually informative, thought-provoking, controversial, provocative and entertaining. His movies are not objective. They always push a particular point of view. In this movie he is pushing several ideas: 1. Health care in this country is too expensive and too few people have full access to it. 2. The American health care system is designed to maximize profits from the sick, not to maintain a good level of health (in fact, those two goals are probably incompatible) for everyone. 3. The system has led us to a point where we look out for ourselves and not for others. 4. Other countries have successfully created systems in which the middle class and the wealthy are willing to help provide care for the poor, not to just care about themselves alone. 5. In other health care systems, doctors are free to give the best patient care and don't have to ration care based on how wealthy the patient is, or how much care his insurance will pay for.
This story is told through a series of interviews with people who have lost their insurance coverage, whose insurance claims have been denied, or who have gone bankrupt paying for medical care, despite their insurance coverage, and many other problems. One woman, mourning the death of her husband, blamed a company which refused to pay for a bone marrow transplant that might have cured his cancer. The company called the commonly-used treatment “experimental.” The movie does touch on some people who were injured when they didn't have insurance, but most of the cases are about people who had medical insurance and had problems getting the proper care anyway. Interviews are also conducted with people who used to work for insurance companies. In one Congressional hearing, a doctor told how insurance companies award bonuses to doctors reviewing insurance claims who successfully deny the most requests for coverage.
Perhaps the most heartbreaking stories are those of heroic volunteers who worked hundreds of hours at Ground Zero in New York after the 9/11 attacks. Despite political promises that these volunteers would be compensated for their medical expenses arising from breathing the toxic air at the site (which the government originally said was safe), some have seen their claims for medical care denied. Moore rounds up several of these people and takes them to Guantanamo Bay where the U.S. provides free medical care for alleged terrorists being held there. If the government can provide free care for terrorists, Moore asks, why not provide free care for 9/11 rescue volunteers? Moore shouts his demand from a boat to a distant Guantanamo guard tower. It is Moore at his confrontational street theater best. Moore continues on down the coast of Cuba, where he finds treatment for the 9/11 rescuers. One of them buys an inhaler of medicine that costs her $200 in the United States. The same inhaler in Cuba costs 50 cents. Cuban doctors perform a battery of tests with modern electronic diagnostic equipment, including something that looks like an MRI or CT scanner. Perhaps the most emotional moment in the movie comes when the volunteer firefighters are honored by a crew of Cuban firefighters.
Moore travels to Canada, France and England, all of which have universal health care, subsidized by the state for little up-front cost to the patient. In France, there are tales of five weeks of annual paid vacation, a week off for weddings, liberal time off for child bearing, free nanny services, low-cost day care, 35-hour work weeks, and a variety of benefits most Americans can only dream about. One young American woman in her 20s living in France said she felt guilty enjoying these benefits when her parents had worked their whole lives for fewer benefits than she had already received merely by living in France. One young man who had cancer said he was given several months off after he was cured, at full pay, in order to fully recover. Moore is seen riding around with a doctor who makes house calls, something almost unheard of in the U.S.
Are these other health care systems as great as Moore says they are? Not really. Moore says, “Anyone can go to the hospital, can go to a doctor and never have to worry about paying a bill.” There are out-of-pocket expenses to the patient, even in England. What is true, however, is that American patients pay almost twice as much out-of-pocket expenses than patients in most other countries. Of the industrialized countries in the Organization for Economic Cooperation and Development (OCED), Americans had to pay significantly higher out-of-pocket expenses for health care, according to a New York Times News Service article By Kevin Lamb: “Americans spent US$5 out of pocket for every US$3 spent in OCED's median country in 2004. In 2005, 34 percent of sicker US adults spent at least $1,000 out of pocket, more than twice the percentage anywhere else in the six-country study (by the Commonwealth Fund of US, Canada, the UK, Australia, New Zealand and Germany). The U.S. consistently ranks last in the six-country annual study in the areas of access, equity, efficiency, safe care and in maintaining “long, healthy and productive lives.”
Is health care in America really 37th best in the world, as Moore says? It is according to one study quoted in the film. A more realistic ranking would put America higher, but still well behind Canada, the UK, Australia, France, New Zealand and Germany. The infant mortality rate in America, for instance is shockingly high, even if you eliminate minority births. Only about 40 percent of Americans are satisfied with their medical care, compared to over 70 percent in some other countries. Is the health care in Cuba as good as it is shown to be in the film? No, but it is pretty good for a very poor country. There are widespread shortages of basic medical supplies and equipment in Cuba. Moore singles out Kaiser Permanente, a large HMO in several attacks for patient dumping and denial of care. I personally know one seriously burned man covered by Kaiser Permanente. After spending a month in intensive care, racking up about $600,000 in medical bills, Kaiser Permanente paid for everything, including rehabilitation and nursing care. The man's out of pocket expenses were very low, and none of his burn care was handled at a Kaiser facility. On the other hand, elective surgery is another matter. The same guy has had to wait over six months for cataract surgery.
Opponents of this film have also gone overboard in their attacks, arguing the U.S. health care system is better than it is and arguing other systems are worse than they are. They also say that Moore is advocating the adoption of the either the Canadian, English or French health care systems in his movie. He is not. Moore quite specifically advocates the U.S. adopt the best features of successful health care systems in other countries and make this new hybrid system its own. Moore's opponents also smear all other systems as “socialized medicine,” (sort of like calling all immigration proposals you don't like “amnesty”) when this is not the case in most other countries (it is in England and Cuba, but those are exceptions to the rule). Germany provides better overall care than the U.S. using a similar multi-payer medical system.
This movie is not meant as a blueprint for a new health care system. It is more like a call to arms. The argument is that if the American people demand a universal health care system, they will get it, but they have to hold the politicans' feet to the fire and they have to elect people who will get the job done. The movie shows how the medical industry and drug companies dominate politicians, elections and the government with millions of dollars and thousands of lobbyists. That is a force that is difficult to overcome, even if there was effective campaign finance reform. Moore makes the argument in the film that the democratic and egalitarian principles on which this country was founded demand a more equitable medical care system. He argues that medical care should be a right, not a privilege for those who can afford it.
Moore argues that the current system works in favor of employers because many employees can't quit or switch jobs without losing their health insurance. One could also make the argument that when you depend on your employer for your health care, when you get a poor education and when you are relatively poor, it makes you more apt to be compliant and apathetic. This is exactly what the ruling classes want. The current system also makes it easier to recruit soldiers for war, since the military does supply health care. Opponents of universal coverage, whether they admit it or not, are arguing from a standpoint of social Darwinism -- the survival of the fittest. This film makes its stand and argues its points with great power and emotional force. This is the best documentary of the year so far. This is Michael Moore at his one-sided, bombastic, pot-stirring best. It rates a B+.
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