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Sicko II

Things Can Be Different

by ROBERT WEISSMAN

There are no talking head experts in Michael Moore’s masterful new film, SiCKO.

The first part of SiCKO features regular people detailing the horrors of the U.S. healthcare system, based on their own experience.

But more is needed than just a searing indictment of the present system. How to convey the idea that there is an alternative to the U.S. status quo?

Moore’s answer is to go to places that do have national health plans, and ask regular people there to talk about their experiences.

Moore follows a young American woman as she crosses north over the U.S.-Canada border and seeks to obtain healthcare under the guise of being married to a Canadian. (About which Moore says, "We’re Americans. We go into other countries when we need to. It’s tricky, but it’s allowed.)

This opens the door for an encounter with the Canadian single-payer health insurance system, where treatment is free for everyone and people can choose any doctor they like. Moore interviews everyday Canadians who express bewilderment at the U.S. system of charging sick people for care, and who indicate deep satisfaction with their system.

One man recounts enduring a serious injury on vacation in Florida, and needing to come back to Canada to get care, where treatment was free. "Why should other Canadians pay for your problem?" Moore asks of the man, who identifies himself as a Conservative Party member. "Because we’d do it for them," comes the reply.

This becomes in many ways the crucial message of SiCKO.

From Canada, Moore travels to the United Kingdom, which has a national health plan, where doctors and healthcare workers are employed by the National Health Service. Patients in a hospital laugh out loud at Moore when he asks them where they pay. When he finally finds a cashier’s office, it turns out that the cashier actually makes rather than takes payments — travel reimbursements for low-income persons.

Moore interviews a handsome young doctor, who explains that although he is on the government payroll, he is doing quite well, thank you. He shows off his fancy car and million-dollar home. And he reports that doctors are paid more if they can demonstrate good results — for example, convincing patients not to smoke.

Next is France, where Alexi, a French-born 35-year-old who had lived in the United States from the age of 18, explained that he moved back to France when diagnosed with a tumor. He received free treatment, and then three months of fully paid time off to recover.

Seeking "the real story," Moore dines with a group of Americans living in France. They explain not only that they get free healthcare, but that they benefit from mandatory extended vacation time, lengthy paid parental leave, and government-provided nannies for new parents (two times, four hours a week for a family subsequently visited).

U.S. health insurance industry front groups and corporate-backed libertarian think tanks are attacking SiCKO for an overly positive portrayal of overseas health plans. There is a small amount of truth to this. SiCKO does not discuss the shortcomings in these health systems, and they are not trivial. No system is perfect. And there are worsening problems especially in the Canadian and UK health systems, thanks to chronic underfunding and efforts to chip away at the integrity of the system by exactly the same forces that then point to their shortcomings.

Nonetheless, by any serious measure, these systems do far better than the United States. They provide universal coverage, with no fees. These countries’ health indicators are better, evidenced by everything from infant mortality rates to length of life (even though the United States is richer). They are also far more cost effective. More on these policy matters in my next column.

SiCKO ends by going to Cuba. Moore first takes 9/11 rescue workers who are suffering serious ailments but have not been able to get coverage, and some others in need of care, to Guantanamo (where the military has bragged that prisoners are receiving top-notch care). Rejected there, they venture into the Cuban health system.

What appears to have begun as a gimmick turns out to be incredibly moving, as the 9/11 rescue workers and the others are emotionally overcome as they find themselves in a system that doesn’t ask about their ability to pay, or tailor care based on their insurance coverage. The Cuban doctors and health workers are generous, courteous and respectful, and they treat the patients for the ailments presented, full stop. They brush aside proffers of thanks — their job is to treat the sick, after all.

The point of the visit to Cuba is not to celebrate the accomplishments of the Cuban healthcare system — which are extraordinary (Cuba has roughly the same health indicators as the United States, which is not only far richer, but adjusted for currency differences, spends 23 times more per person on healthcare than Cuba, according to the UN) — but to say, "Hey, if this poor country can provide healthcare to all, why can’t the rich power to the North."

From the care provided in Havana and in a touching scene at a Havana fire station, an even more profound lesson emerges: the power of a cultural commitment to care for one another. All of us for all of us, with as big an "us" as possible.

SiCKO is not an anti-American film, though much of the right-wing chatter says otherwise.

People in the United States do routinely pitch in for one another on a voluntary basis, Moore emphasizes. The problem is that the U.S. corporate health insurance system, the corporate-dominated economy more generally, and the ideology that undergirds both, seeks to defeat the essential insurance function of sharing risk — of everyone helping to take care of everyone else.

Moore offers this challenge, or plea: "If there is a better way to treat the sick simply by being good to each other why can’t we do that?"

People in the other countries visited in the film "live in a world of we, not me," says Moore.

To varying degrees, they have created solidarity societies, and they are happier, and healthier, for it.