Thomas Walkom
The Star
Jun 09, 2007
Among the glitterati, Michael Moore used to be a hero. Now he is a bum. When Roger and Me, his film on General Motors head Roger Smith and the deindustrialization of America, came out in 1989, he was lauded by reviewers as a breath of fresh air, a 21st-century gonzo journalist. When it was later revealed that the dramatic core of that film, Smith’s refusal to be interviewed by Moore, was untrue, the filmmaker was denounced as dishonest.
Now comes Sicko, Moore’s latest film and a scathing indictment of U.S. health care. The critics are determined not to be taken in again. When the flick showed last month at the Cannes Film Festival, Canadian reviewers blasted Moore for whitewashing this country’s medicare system. At a pre-release showing for reporters this week, there was more muttering about his “manipulative” techniques.
The critics should relax. It’s true that Sicko may not make it in a peer-reviewed academic journal. Caustic and blatantly opinionated, it makes no pretense at even-handedness. It does not delve into what is good about the American health system, of which there is plenty. Its description of universal health care systems, such as Canada’s, is cursory. It is not comprehensive.
It is, rather, a film designed to agitate its audience and make a political point, what in the old days — before propaganda got a bad name — might have been called agitprop.
And it is also fundamentally accurate.
Audiences in Canada, Britain, France and Cuba — the countries Moore visited on his health odyssey — might be bemused by portions of Sicko. In Moore’s Paris, everyone is well-dressed and attractive. In Britain, everyone is polite. In the relatively short Canadian portion, the narrator looks in on a Windsor hospital emergency room and finds no one waiting longer than 45 minutes. To any Canadian who has ever been forced to go to emergency, this would seem unbelievable.
But Moore is not making a film for Canadians or the Brits or the French. He doesn’t delve into Canada’s debate over two-tier medicine. He ignores British controversies about public-private partnerships in health and pays absolutely no attention to French complaints that upfront user charges subvert that country’s medicare system. He doesn’t care about any of this. Nor should he.
Moore is making a film for Americans. And what he is telling his compatriots is very simple and very true: that America’s refusal to embrace some kind of universal health care system makes absolutely no sense.
This is not a novel point. Nor, outside of the U.S., is it even remotely controversial. In Canada, no one except for a few diehards in the right-of-centre Fraser Institute lionizes the U.S. system. Dr. Brian Day, the incoming head of the Canadian Medical Association is a vigorous critic of Canadian medicare. But he touts French or German medicare, not the U.S. model. Ditto Preston Manning, the former Reform party head. He says he wants a two-tier system that would keep the existing universal system.
The reason is simple. Universal public medicare works — which is why every industrial country outside of the U.S. employs some form of it. For those who choose to read the scholarly literature, the evidence is overwhelming. Americans spend more per capita on health than any other nation in the world and get worse results. This is not just Michael Moore talking; it is the Organization of Economic Co-operation and Development. When Moore says Canadians live on average three years longer than Americans, he is correct. When he says infant mortality rates are lower in this country than the U.S. he is right there too.
It’s not just Canada. United Nations figures show that a baby born in Havana has more chance of surviving than one born in New York City. The British live longer than Americans as do the French and Japanese. Is it simply coincidence that all of these countries, save the U.S., have some form of universal public care system?
Nor is there any doubt as to the culprits. Again, the evidence (from the New England Journal of Medicine among others) is overwhelming. Americans waste billions on so-called administration costs attributable to private health insurance companies. As Sicko accurately points out, some of these costs are incurred by insurers doing everything they can to avoid paying benefits to sick policyholders. Moore finds this weird and he is right. Paul Krugman, the Princeton University economist who now writes for The New York Times, makes the same point. But Michael Moore is more entertaining.
So why don’t Americans wise up? Moore looks to vested interests in the U.S., primarily doctors, insurance companies and drug firms. Discount that as paranoia if you wish. But it is all documented in the contemporary press accounts of the bitter debates over Bill Clinton’s failed attempt to bring in universal health care.
Moore also fingers the bizarre strain of anti-communism that still runs through U.S. popular culture. If you think he is kidding, you should read some of the email I get from Americans when I write — in a far more restrained way than Michael Moore — about medicare. A good many Americans do think that medicare (or, as they call it socialized medicine) is a plot against freedom. As Moore says, this view is amplified by the media.
In 2000, a Yale political scientist named Ted Marmor published an article in the academic journal HealthCare Papers that made exactly this point.
Looking at media coverage of flu epidemics in Canada and the U.S., Marmor found that identical events (overcrowded waiting rooms, patients dying on the way to hospital) received entirely different interpretations in the media. If a woman in Los Angeles died from the flu, the blame was placed on the virus. If a similar flu death occurred in Montreal, Canadian medicare took the heat.
Is Sicko worth seeing? I leave it to my colleagues who are more knowledgeable about film to say something intelligent about this. But personally, I get a kick out of Moore. At times, he uses all the Hollywood tricks to wind the audience into his story. At other times, he’s more Brechtian: During the French segment of Sicko, it’s as if he’s saying: “I know this is a cartoon, but look at me doing this cartoon!” As a piece of entertainment, it works.
But I suspect Moore is trying to do more than entertain. He’s trying to whack his fellow Americans on the head and say to them: Hey! Wake up. Why do we run our health system in such an insane way? No one else does.
And in that, he is absolutely right. Good luck to him.
