—Mike Moore, narrating Sicko
A couple days ago I saw Sicko, and left with a glimmer of hope that the debate about our scandalous and brutal system of health care might move to another level. How? By looking beyond the limited "solutions" proposed in places like D.C. and here in Oregon, where an increased cigarette tax—blocked by legislative Republicans (1)—would've provided coverage for all uninsured children in the state.Meanwhile, the health-care crisis becomes more pronounced every year: only 60% of employees have health insurance through their jobs, compared to 69% in 2000 (2). And the coverage is less comprehensive as it grows more expensive. As Moore's interviewees appallingly reveal, insurance companies are relentless about applying policy exclusions to limit or deny coverage altogether.
The film also takes a close look at the myths about the purported failures of "socialized medicine" in places like Canada, Great Britain and France, then concludes with a foray into the Cuban health-care system. Moore's interviewees suggest that national health insurance in those countries is widely viewed as successful, and they look upon the U.S. system with horror. And those systems are not only less expensive: they produce better health outcomes, including such things as lower infant-mortality rates and longer life expectancies.
Moore argues that it's time to broaden the discussion to see what could be borrowed from these foreign models to create a system of universal care that's appropriate for the U.S. and our boundless (and often justified) suspicion of government programs. ("Appropriate for the U.S." would probably mean, of course, a "mixed" system of private and public payers rather than the simple "single payer" system that gets surprising support in polls.)
But Moore's film isn't about the uninsured, nor is it just about those who think they're adequately insured until the hospital and doctor bills start to fill their mailboxes. And it's not ultimately about alternative health-care systems in other countries, either. Its real focus is the same issue that's presented by the torture "debate:" "who are we," as Moore asks, and what do all these policy choices reveal about our national values? (3)
I've always defined politics as public morality, since policy choices always reflect personal and social values and, ultimately, moral decisions. Moore's films, including Fahrenheit 9/11, demonstrate how policy debates and decisions are distorted by a dysfunctional political process that is front-loaded in favor of narrow economic interests. And by a national media that is too lazy or ideologically conditioned to inform or redefine the debate.
The inevitable result, in health-care policy and everything else, comes at the expense of the democratic and utilitarian notion of the "greatest good for the greatest number."
Moore contrasts the contentious model of French politics, in which the "government fears the people," with the contemporary American model in which "people fear the government." If Americans make limited demands on their government and its corporate masters, Moore argues, then it's because of economic insecurity—the fear of losing their jobs and their health insurance, fear of being unable to pay the massive debts that they've incurred (often for health care). That gnawing anxiety has been amplified in the atmosphere of generalized fear that is one of the legacies of 9/11—a legacy that politicians from Bush to Cheney to Giuliani have been quick to exploit.
The result is a political climate in which the large majority of citizens seems demoralized, anxious, cynical and abstracted—and too jaded to even vote. This vacuum has reinforced the tendency of politicians of both parties to respond to those who finance their campaigns and, quite often, employ them after they leave office. In the absence of populist pressure from the disaffected majority, national and state governments are dominated by those who have a deep economic interest in the status quo (4). This dynamic results in policies that are patently absurd, producing the cruel, mechanistic and inhuman health-care system that Moore describes.
One other thing that shouldn't be overlooked in any review of Sicko, or any other Moore film: it's hilarious. Moore heaps well deserved, and unanswerable, ridicule on those who have created and perpetuated this absurdity. When I wasn't on the verge of tears or rage, I was often laughing uncontrollably.
Margaret Thatcher famously said: "There is no such thing as society: there are individual men and women, and there are families." In that kind of world, there can only be individual, rather than collective, solutions. Even in this great American bastion of individualism, though, Moore points out that we've found collective solutions to individual problems by creating police and fire departments, schools, libraries, social security, Medicare and a postal system.
Everyone faces the risk of illness and death, so why not find a common solution to the need for health care? If John has to pay for Mary's medical procedures now, whether through taxes or health-insurance premiums, then Mary and the rest of us will pay for his later. If you spread the risks and share the costs, everyone ultimately benefits. The private system now in place simply excludes too many people and costs too much (due in part to the constant administrative pressure to exclude people). And it produces bad outcomes far too often.
Illness may be an individual problem, but we have a common interest in seeing that we all get the best available treatments for it. And it's the only approach that's morally defensible.
Sicko is an important film, as most critics seem to realize. See it, then come back and add your comments.
(1) Oregon law, as a result of the conservative "tax revolt" that has decimated the state's public sector, requires a 3/5 majority to approve any additional taxes. The Democrats enjoy a majority in both house of the legislature, for the first time in years, but they lack the necessary 60% to pass any tax. So the conservative program of "starving the beast" of government has resulted in denying basic health care coverage to thousands of uninsured Oregon children. Legislative Republicans, yielding to pressure from the beer and wine lobby, refused to raise a tax on alcoholic beverages that hasn't been adjusted for 30 years. And the pathetic corporate minimum tax of $10, which is actually paid by thousands of Oregon corporations, also remains unchanged after decades. "Who are we," indeed?
(2) And their premiums increased by 9.2% in just one year (2005).
(3) This is a familiar subject on this blog (as seen here and here) And also here, where I wrote (not long before Mitt Romney proposed "doubling" the size of Guantanamo rather than closing it):
Unfortunately, and to our national shame, it's an exaggeration to say that there's a "debate" at all: there's little evidence of any controversy outside the Beltway, raising profound questions about the state of U.S. political culture these days. If I had to guess, I'd say that the general attitude on the subject may be summarized by a phrase from an altogether different controversy: "don't ask, don't tell." The Administration, it would seem, is tacitly authorized to take whatever action George Bush deems suitable to protect the country...(4) This analysis isn't new, of course, as Greens and the few remaining Naderites would hasten to add. The system of "legalized extortion and bribery," otherwise known as campaign finance, has been around for decades and has never been more entrenched than it is in 2007.
PHOTO: A demonstration in support of public services in Paris, 2005. The banner reads: "Privatizations: Stop! All together for public services."