Sicko, Michael Moore’s follow-up to Fahrenheit 911, is a polemic against the American system of health care and health insurance, finding many examples to back up its basic argument that the system militates not only against those who cannot afford health insurance but against many of those who can. It begins with stories such as that of Adam, who had an accident and had to stitch his own wound up because he has no insurance. 50 million Americans don’t possess any health insurance, thus disenfranchising them from the vast majority of medical care. However, the focus of the film is as much on those who discover that their health insurance doesn’t adequately cover the care they require for a variety of reasons, most of them the results of insurance company skulduggery.
The evidential anecdotes that Moore has come up with are often horrifying and heartbreaking. He posted a note on the internet to discover if he could find horror stories about insurance companies. An elderly couple are forced to move from their home and into a spare room at their daughter’s house because their insurance doesn’t cover the cost of their cancer medication. A choice has to be made between owning one’s own house and staying alive. Another young woman was in a car crash but received a bill for the ambulance ride to hospital because the “ride was not pre-approved”. When she was supposed to get the ride approved is a moot point; perhaps when she was lying on the floor. The evidence simply piles up and up. A nine-month old young girl is informed that she can have a cochlear implant in only one ear because, according to Moore, “it is experimental for her to hear in both ears.”
Former employees for the insurance companies line up to testify to the practises in which they engaged, denying insurance to people with a dizzying range of pre-existing conditions ranging from CJD to Anemia. Meanwhile, those who do get insurance are denied treatment for the most spurious of reasons – pre-existing, not life-threatening (i.e. a brain tumour), experimental. It appears that the doctors employed by the companies to make these decisions are given bonuses based on the number of treatments that they refuse. Even if treatment is allowed, the companies have often managed to send in a hit-man to get their money back by finding a slip-up on the application. One hit-man, Lee, describes it as akin to prosecuting a murder case; the scrutiny and the pressure to find something amiss is comparably intense. Some states allow the companies to claim money back based on past symptoms which were not treated but which could reasonably have been considered to be treatable. “The crack is not unintentional… somebody made that crack and swept you towards it. The intent is to maximise profits.”
The film develops from a tightly argued expose of insurance company malpractice into a broader and less convincing examination of the American obsession about the dangers of “socialised” medicine. The continual inability to provide a proper level of state health care often seems baffling to those of us brought up in the sometimes frustrating but still reassuring National Health Service. Every attempt to bring in state health care, such as Hillary Clinton’s in the 1990s, has been blocked; according to Moore, this is because the legislature has been bought by the health insurers and the drug companies. Even a recent attempt to bring in help for pensioners with their prescriptions has meant that 2/3 of elderly people end up paying more. Universal health care, ever since the 1940s, has been associated with the extreme left-wing; that remarkable political philosopher Ronald Reagan was wheeled out in the 1960s to testify against this kind of creeping Communism. The American healthcare industry has constantly criticised universal healthcare as being characterised by high taxes, a lack of autonomy for doctors and long waiting lists.
In response to these allegations, Moore cites the health services of Canada, France and the United Kingdom. This has led to considerable controversy, alleging that Moore ignores the drawbacks of these systems in order to further his basic point. It may give British viewers pause for thought to see the NHS praised to the skies, especially those who are on a lengthy waiting list for an operation. But it occurs to me that the fact remains that anyone who is in an accident or has a serious illness can get care, regardless of their financial situation or whether or not they have insurance. That strikes me as a pretty glorious thing – the fact that we do nothing but complain about it is perhaps as much a sign of how complacent we are rather than of any basic flaws in the system. It doesn’t help his case, incidentally, that his main interviewee on the subject is Tony Benn at his most unbearably smug, nor that Moore keeps doing a bit of pantomime to express his astonishment that no money is changing hands. Nor, come to think of it, does he mention MRSA. But his general argument that “socialised” medicine can work seems to me to be a strong one and, generally, his examples manage to strengthen his basic case – that universal health care is, at the very least, a practical system which can work without necessarily leading to socialism.
The biggest problem with the film is the usual one with Moore. His relentlessly one-sided attack is bracing and entertaining but seems designed specifically to preach to the converted. I agreed with virtually every word of the film but then I generally agree with Moore’s views. Anyone looking for a real debate will be disappointed – Moore seems terrified of counter-examples; for instance, there’s no mention of the real drawback of the Canadian systems which is the lack of modern equipment in more remote areas meaning that, for a lot of Canadians, treatment involves a long journey and costs of accommodation for the families of sick children. Those who disagree with Moore will be infuriated by the tone of the film – mocking, jocular, relentlessly self-reflexive – and many of those on the fence will be alienated by the highly subjective approach. Great documentary filmmakers allow everyone on every side of an issue to talk – the greatest of all, such as Marcel Ophuls, will allow them to talk so much that they manage to condemn themselves without any input from the interviewer. As for Moore’s big stunts – in this case, taking a load of ill people to Guantanamo Bay where free healthcare was given to inmates – they don’t really work because they say more about Moore’s passion for self-aggrandisement than the issue at hand. Moore is a fine entertainer, who makes very diverting films. But I don’t think he’s a great documentarian because his view of the world is so simplistic. What he needs to add is complexity.
Optimum’s DVD of Sicko is a pleasing package. The film is presented at its correct aspect ratio of 1.85:1 and has been anamorphically enhanced. It was shot on HD Video and also includes a large amount of archive film from a variety of sources. As such, the visual effect is slightly inconsistent but the new material generally looks very strong and some of the older footage is acceptable and sometimes more than that. The colours throughout are excellent. The detail throughout is perhaps not as strong as it could be but that’s the main drawback. The soundtrack, presented in either Dolby 5.1 or Dolby 2.0, is highly functional. The Stereo mix is actually little different to the 5.1 track since this isn’t the kind of film where surround audio is likely to make much of an impact. Dialogue and music are eminently clear throughout on both audio tracks.
The extra features consist of further material on the issues raised by the film. There are a number of featurettes which focus on issues such as the impact of Sicko in Washington, the need to raise money to fight diseases, the health system of Norway, the French social security set-up, religious freedom in Cuba (a somewhat spurious interpolation), the LA premiere of the film and a heartbreaking look at a Texas town where 60% of the people live in poverty. Most of these are interesting but it’s easy to see why they weren’t included in the main body of the film since points are mainly being repeated. We also get forty minutes of extra interviews, including more time with Tony Benn who seems to want to become a national treasure in the mould of Alan Bennett. Finally, the theatrical trailer is included along with a music video.
Sadly, no subtitles are included for either the film or the extra features. Given the message of the film, one would have thought that Optimum could have had some consideration for hard-of-hearing viewers.