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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.

By ROSE ANN DEMORO, CNA/NNOCC Executive Director
LA Daily News
June 6, 2007

MICHAEL Moore’s riveting new film provides a valuable lesson that we can solve the health care crisis without dumping more resources into a too-often heartless, private, insurance-based system.

Lack of insurance is not the trouble in America. The insurance industry itself is the problem.

A Zogby/UPI poll in February found that 42 percent of Americans said their insurer had refused to pay a medical bill. A USA Today/ABC poll in March found one in four Americans had trouble paying for medical care in 2006, although two-thirds of those were insured.

“Sicko” puts human faces on those numbers. Like Donna and Larry Smith, who had to sell their home and move into a cramped room in their daughter’s house when their medical bills became unpayable. Or Laura, the young woman sent a huge bill for her post-accident ambulance trip because it wasn’t “pre-approved.”

Neither story is an aberration. Moore unearths 1971 White House tapes in which President Nixon and John Ehrlichman discussed the pending bill to promote managed care. Ehrlichman reassures Nixon that “all the incentives are toward less medical care … because the less care they give ’em, the more money they make.”

Three decades later, Moore shows the inevitable evolution of this scheme, partly through two industry whistle-blowers who agonize over their role in denying care. “You’re not slipping through the cracks. They made the crack and are sweeping you toward it,” one says.

In an intimate final screening in New York that the California Nurses Association was invited to attend with the real-life stars of “Sicko,” Moore made clear his view on whether the bandages and sealing wax that some politicians and presidential candidates favor can fix this callous system. “We have to eliminate the private insurance companies. They have to go,” Moore said.

Such sentiments may not be widely popular on Capitol Hill. After all, “Sicko” notes, the insurance industry’s “biggest accomplishment might be buying our U.S. Congress.” But beyond Washington, it gets a different reception.

A New York Times/CBS poll this year found that 64 percent said the government should guarantee coverage for all, and 55 percent identified it as the top domestic priority for Congress and the president.

Can it really be done? Moore shows us four ways how – Canada, Britain, France and even Cuba. He could have added every other industrialized country where care “doesn’t depend on your premiums; it depends on your needs.”

Amid the four other countries Moore visited, the U.S. is last or next to last in one health care indicator after another, such as life expectancy, adult mortality and infant-mortality rates, to name three, according to World Health Organization statistics. Only when it comes to per-capita spending are we number one.

Where does the money go? From one-fourth to one-third is siphoned off the top for paperwork and profits for the private insurers, compared with less than 5 percent for Canada or our own Medicare, a publicly run program.

Forcing everyone to buy insurance, as Gov. Arnold Schwarzenegger proposes, or providing tax credits or shifting more government money to the HMOs won’t solve the crisis; it will just reward the insurers for their system of preventing care and make them wealthier.

Put that money back into delivery of care. Set up a system in which everyone is covered, for life, with quality medical care, comprehensive benefits and cost controls.

Sound impossible? Most of those featured in “Sicko” would not have been helped at all by the majority of the limited reforms proposed in Congress or by most of the presidential candidates to date. But we can accomplish that here in California with Sheila Kuehl’s Senate Bill 840 or nationally with House Rule 676 in Congress, both of which would guarantee comprehensive health care for all without relying on the insurance industry.

“Sicko” profiles three Sept. 11, 2001, rescue heroes who have since struggled to obtain needed care. Moore tries to bring them to one place where the U.S. does guarantee universal care: the military base at Guantanamo.

Only when they’re turned away do they go next door to Cuba. “They just wanted some medical attention, the same kind (our government) provides to al-Qaida,” Moore says. For the rescue heroes or the rest of us, is that too much to expect?

Rose Ann DeMoro is executive director of the California Nurses Association.

By David Lazarus
San Francisco Chronicle
Friday, June 8, 2007

Passage of SB840 — a bill that would guarantee health coverage for all Californians — by the state Senate this week is a significant victory for all those who believe health care is a right, not a privilege. But that may still be wishful thinking.

It’s unclear how SB840, authored by state Sen. Sheila Kuehl, D-Santa Monica, will fare in the Assembly. And even if it’s passed by the full Legislature, as was the case last year, it almost certainly would face a veto by Gov. Arnold Schwarzenegger, as was the case last year.

So I say this: Let the people decide. If our lawmakers can’t or won’t recognize the urgent need for universal coverage, then it’s time to repackage SB840 as a ballot initiative and put it to a vote by those most directly impacted by our obscenely dysfunctional health care system — us.

For her part, Kuehl told me that she still wants to try her luck in the Legislature before taking SB840 straight to voters.

“Ballot initiatives should be brought only when the tipping point is reached,” she said. “I think a lot more education has to be done so that people understand why this bill is the gold standard for health care.”

Well, school’s about to start. On June 29, Michael Moore’s new documentary, “Sicko,” hits theaters. It’s said to offer a devastating depiction of the roughly 47 million Americans who lack health insurance and to make a powerful case for universal coverage.

Moore will screen “Sicko” in Sacramento on Tuesday and participate in a legislative briefing at the Capitol. He’s also scheduled to join Kuehl at an afternoon rally that organizers hope will draw more than 1,000 supporters of universal coverage.

“This movie is going to have a big impact on the movement,” Kuehl said. “It will be a major indictment of the insurance industry and what they’re doing to us.”

After SB840 passed 23-15 in the state Senate on Wednesday afternoon, Moore issued the following statement:

“The health care industry has a death grip on our society because the insurance companies put profits before patients, which is why we as a country spend considerably more on health care than other developed countries and get back far less.

“In recognizing that for-profit insurance is incompatible with a caring, a moral and a high-quality health care system that provides coverage for all, Sen. Kuehl is leading the fight to break the industry’s death grip.”

The timing has never been more auspicious for health care reform in both California and the nation. The issue is consistently polling at or near the top of voters’ concerns, and politicians have been busy cobbling together a variety of plans for how things could be different.

But most of those plans envision expanding our current system to cover most (but not necessarily all) of the uninsured. They don’t address the nagging problem of ever-increasing health care costs, nor do they remedy the extraordinary fact that an estimated one-third of all health care spending is squandered on bureaucratic overhead.

SB840 would tackle these issues only on a statewide basis. But this would be a start, and it would demonstrate for the rest of the country that universal coverage is both politically and economically feasible.

“It’s the only sensible approach,” said Rose Ann DeMoro, executive director of the 75,000-member California Nurses Association. “It takes away the power of the insurance companies and essentially creates an expanded Medicare system.”

SB840 would establish what’s called a single-payer insurance system for all Californians. In other words, tax dollars would create a pool of publicly administered funds that would be applied to covering medical treatment for state residents.

This would replace the existing employer-based system and private insurers’ premiums, deductibles and co-pays.

A 2005 study by the Lewin Group, a health care consulting firm, found that a government-run system as envisioned by Kuehl’s legislation would cover the almost 7 million Californians now without insurance while saving about $8 billion.

Rival plans put forward by Schwarzenegger and Democratic leaders in Sacramento would seek to extend coverage to the uninsured by having employers contribute varying amounts to a state pool.

The insurance industry, meanwhile, is also championing reform — but only to the extent that reform means enlarging its customer base, not introducing a single-payer system. Insurers and their allies are already blitzing the airwaves with ads touting favored proposals.

So would a ballot initiative work? It wouldn’t be easy.

“Insurers would spend hundreds of millions of dollars to defeat it,” observed Jerry Flanagan, health care policy director at the Foundation for Taxpayer and Consumer Rights, a Southern California consumer advocacy group.

“They’d attempt to focus people on tax increases and drown out that this would be far less than what people now pay in premiums and deductibles,” he said.

A Field Poll found in January that 81 percent of voters believe that government should be responsible for ensuring “that all Californians have access to affordable health care insurance.”

At the same time, though, more voters (42 percent) would choose to receive coverage from an employer than from the government (22 percent), the poll found.

Flanagan interprets these numbers to indicate that California voters don’t yet understand the nuts and bolts of a single-payer system, or the savings that would be achieved under a government-run insurance program.

The onus would be on reform advocates to educate voters about the facts amid what would undoubtedly be an all-out campaign by insurers to maintain the status quo.

I think people are smart enough to tell right from wrong, and to know what’s in their best interest.

If state lawmakers are unclear on the concept, let us have a say about California’s health care future. It’s our money, after all. And our lives.

David Lazarus’ column appears Wednesdays, Fridays and Sundays. He also can be heard Saturdays, 4 to 7 p.m., on KGO Radio. Send tips or feedback to dlazarus@sfchronicle.com.