The Orbis

Issue date: 4/15/09 Section: Opinion

On April 7th, several student groups co-sponsored a showing of the Michael Moore documentary piece “Sicko” followed by a panel discussion on the deteriorating state of the American health care system. While the movie’s message about the dangers of our for-profit health care model tugged at the viewer’s heart strings, Moore spent very little time discussing how to implement systematic reform nor the practical implications of such reform on our economy and existing health infrastructure.

The 2007 documentary followed Moore on his journey through the heartland of America, meeting with downtrodden citizens who faced bankruptcy, escalating medical bills, and failing health despite owning an insurance plan. While there are nearly 50 million Americans without health care coverage, “Sicko” focused on those people who had insurance but were nonetheless denied coverage when a sudden or traumatic incident occurred. Listening to a wife tearfully tell the story of her husband’s death after their insurance company denied payment for his cancer medication, the viewers may feel a surge of populist anger at the insurance giants who pride themselves on high denial rates and “profit loss prevention.” In stark contrast to the high medical bills and insufficient care of the American patients in the film, Moore also invited the audience on a tour of Canada, the U.K., France, and even Cuba, making the argument that all of these countries offer free, fast and accessible care that the U.S. system can’t, or won’t, provide.

Moore highlights the most heartbreaking HMO stories of Americans and juxtaposes them with free hospital visits in the U.K., government paid vacation time in France, and prisoners receiving universal health care at Guantanamo Bay. However, in crafting his message, Moore fails to delve into hard analysis of the universal care system, as he never seriously addresses criticisms about the foreign systems, including supposedly long wait times or “rationing” of care. By handpicking the most heartbreaking stories about American patients, like an 80 year old who can’t afford to retire because of his medical bills, “Sicko” tells a story with maximum emotional impact in a way that leaves little room for open discussion about how to actually change the U.S. system.

It’s undeniable that U.S. health care is badly in need of reform. Despite spending more money on health care than any other country, the U.S. lags behind many of its Western counterparts in average life expectancy, infant mortality rates, and quality of life rankings. Yet, it’s impractical to call for a sudden shift towards the NHS in England or the mixed system in France, without taking into consideration what will happen to today’s health care industry workers, doctor compensation, and a method of paying for the system in a country that’s already experiencing economic distress.

Following the documentary showing, which was hosted by Vanderbilt Students for Nonviolence, American Red Cross, Are You M.A.D., Unite for Sight, and the American Medical Student Association, Professor Larry Churchill and Dr. Robert Miller of the Medical School led a short discussion about the state of our health care system, moderated by History Professor Arleen Tuchman. The questioners and panelists all agreed about the urgent need for reform, but much like the film, the necessary conversation to follow- how to actually achieve that reform- did not fully transpire.

Churchill explained that the film’s “portrayal of the health care system as a racket is a fair assessment. Fundamentally, the system’s not designed to deliver care. The heavy regulation that’s needed to achieve that end doesn’t exist.” On a similar note, Dr. Miller said, “We can’t afford to look toward any other standard than universal health care. If you can’t start there, you’re probably not in the right conversation.”

The panel’s suggestions for reform revolved around small steps toward progress and a caution against immediate, sweeping change. Incentivizing primary and preventative care, preventing insurance companies from denying coverage for pre-existing conditions, and offering federal insurance programs for the low-income uninsured could serve as a band aid for our current problems.

Throughout the film, the need to address the plight of patients in pain and in debt was stressed repeatedly, but several questions remain about how to deal with the current system in place. How do we confront the for-profit insurance companies that would oppose reform-minded legislation? Moreover, how do we change the priorities of politicians whose pockets are lined by these same insurance companies? Can a country as large and populous as the U.S. implement the same strategies that found success in a country of smaller scale like Cuba or the U.K.? Perhaps these issues are so daunting that it’s unreasonable to assume one movie could effectively tackle them.

Some of the criticism about the lack of constructive dialogue could be lodged against Moore’s directorial style and his persona in the U.S. political arena. Moore has crafted his identity as a polarizing figure that, for better or worse, has come to represent part of the American left. Even those who agree with his substantive points may feel his arguments are cheapened by the stunts he pulls or the closeups of crying faces that border on manipulation. Louder members of the conservative movement prop up Moore for strawman tactics in much the same way some leftist pundits frame Ann Coulter or Rush Limbaugh as the only faces of the right. As a result, most of the people who listen to Moore and take his documentary claims seriously are those who already agree with him, creating an echo chamber effect. Predictably, many of the 50 or so people who attended the screening laughed appreciably at the Bush jokes interspersed throughout the film, which start to ring hollow now that he is out of office.

Overall, “Sicko” could rightfully be considered a penetrating look at the failures of the U.S. health care system. However, it misses the opportunity to offer a detailed alternative and to sell its message to the entire country rather than just a segment that is already amenable to change

Health Care Systems: By the Numbers

Ranking of World’s Health Systems
(World Health Organization, 2000)
France- #1
United Kingdom- #18
Canada- #30
United States- #37
Cuba- #39

Average Life Expectancy
(CIA World Factbook, 2009)
Canada- 81.23 years
France- 80.98 years
United Kingdom-79.01 years
United States- 78.11 years
Cuba 77.45 years

Infant Mortality Rate
(per 1000 live births; UN study 2006)
France- 4.2
United Kingdom- 4.8
Canada- 4.8
Cuba- 5.1
United States- 6.3

Per Capita Health Care Spending
(in USD; World Bank, 2002)
United States- $4,271
France- $2,288
Canada- $1,939
United Kingdom- $1,67

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