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Moore's 'Sicko' Lands Blows on U.S. Health Care

Director Michael Moore has found critical and popular success with documentaries that blend comedy and pathos to attack powerful interest groups. But those films are nearly always challenged as misleading. His latest work, Sicko, is an indictment of the U.S. health care system, highlighting insurance horror stories and profiling countries with universal health care.

Melissa Block sizes up Sicko — as entertainment and expose — with film critic Bob Mondello and science correspondent Joanne Silberner, who covers the health industry for NPR.

Melissa Block: Michael Moore does what he does quite well, which is to mix tragedy and comedy, back to back.

BOB MONDELLO: At the very beginning, he starts out with a whole bunch of horror stories; they're absolutely grim, and you look at people who are deprived of care because they can't afford it. And he does a lot of clever things to make the reasons for this funny. For instance, he uses the Star Wars theme, and he shows all of the various reasons you can be denied coverage by your insurance company, rolling away on the screen — it's thousands of them. Then Moore starts suggesting that there are other places where health care works better, for instance, Canada, Britain and France, and even — this is the shocking one — Cuba. As he shows other systems, I think it is a very persuasively put-together picture of the health care problem, and it's also very, very funny.

I wonder if there is a moment in this movie that you thought worked especially well?

MONDELLO: The sequence when he goes to Britain. He talks to the people at the National Health Service hospital about the cost of the care they're getting. And you can see that as soon as he mentions money, their brows furrow, and they can't get their head around the questions. They have almost literally never thought about money and medicine in the same breath. I think that is so telling, because I know when I go to a doctor or to a hospital, it is almost the first thing I'm thinking of — "Oh my God, how much is this going to cost?"

Let's talk about some of the medical cases Michael Moore describes in this film. At the very beginning, there is one about an American man who loses the ends of two of his fingers in an accident with an electric saw. He did not have insurance. The man must choose between having his middle finger reattached for $60,000, or his ring finger for $12,000. The man chooses his ring finger. How can a man be put into the position of making that choice?

JOANNE SILBERNER: [In the U.S.,] the hospital doesn't have to give him care unless it's lifesaving care, and his life wasn't threatened by the loss of two digits. So the hospital was within its rights to say, "We can reattach your two digits, but it's going to cost you." The irony is that if he had insurance, the insurance company would have paid far less than $12,000 or $60,000. The insurers can negotiate rates with hospitals that individuals can't.

There are also a number of times in the movie where we hear from people who either work or used to work inside the health care system, either turning down applicants for insurance, denying claims...

SILBERNER: He had an insurance company employee who started crying when she described what she had to do in terms of talking with people who called in.

Moore contrasts the U.S. system with the systems in France, Britain and Cuba, where care is free. He claims there's no waiting, and you can choose your own doctor. And in France, he says, there are doctors who make house calls in the middle of the night. How accurate are those claims?

SILBERNER: I think some of the things that those countries are willing to pay for are things that we Americans would not be willing to pay for. There was also the remarkable revelation that in France, when you're a new mother, a government employee will come to your house and maybe even do your laundry and make you soup. That's not going to go over well in this country.

What about the notion that long lines for health care in other countries are a myth?

SILBERNER: Moore didn't really look at the other side of that. What happens in each of these countries is that they get near to crisis situations, where there are lines — this has happened in Canada, too. And then the government, under pressure, puts more money into the system, and the lines go away. But then they come back. It's a cyclical thing; those lines come and go.

One thing did bother me with presenting Cuba as a paragon of health care, while showing the 9/11 workers who couldn't get care in this country: Moore didn't point out that, on that famous chart where the U.S. comes out 37th in health care, Cuba comes out 39th. So I'm not sure that was the best comparison for him to make.

MONDELLO: On the other hand, that is not necessarily something we should be terribly proud of — being 37th in a chart where France is No. 1.

One of the things he does that's very clever is to try to destroy the myth that socialized medicine is so terrifying. When you see what is probably the most impressive hospital I've ever seen, in Cuba, and it looks like a gigantic Hyatt hotel, it's simply not what you were picturing. We were joking when we came out of the film that it was probably the only MRI machine in all of Cuba, and it may very well have been. But the fact of the matter is that it was there and it was able to help a patient. The rooms there did not look decrepit and old, which is kind of what I expected.

SILBERNER: I think there's an issue of expectations. What do the Cubans expect? What do the French expect? What do the British expect? We expect to be able to get drugs like a recently approved drug for cancer that adds 13 days to life at a cost of $4,000 a month. I don't think people would expect that in France or Germany or Cuba. Thirteen days of added life with some side effects for $4,000 a month? We want it, and they don't. When we stop wanting things like that, I think we can move ahead.

In this movie, Moore advocates eliminating insurance companies entirely and going to a single-payer, government-funded system. This is not what any of the mainstream candidates this year are talking about.

SILBERNER: No, they're talking about various packages that would make insurance more affordable, give a little more government assistance, and in some cases, create a bit more regulation. They are talking about incremental changes, and this comes from the experience of '93 and '94, when attempts to change the system got nothing changed.

MONDELLO: We've had a lot of pictures recently about Iraq, and we had An Inconvenient Truth last year about climate change. These movies are not going to change policy. But it certainly does change the debate. If you think about the way the administration talked about climate change prior to An Inconvenient Truth, and the way it's talking about it now, I think it's clear that there was a major shift. I'm not sure if the movie is responsible for that, but certainly it changed the way the media dealt with it. It was a very persuasive case. And I think this will be a very persuasive case for a lot of people, too.

This transcript has been edited for length and clarity and may include portions of the conversation not broadcast on NPR.

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