SiCKO

Would Americans rather be valued consumers to be profited from or as members of a group who have the right to be taken care of and who share the responsibility of taking care of others?

SiCKO is a provocative documentary directed by the filmmaker Michael Moore on the U.S. healthcare system. Released in 2007, the film generates emotional rapport with its audience by depicting the experiences of Americans both insured and uninsured within the healthcare system as unjust and painful. Through these personal accounts, Moore brings to focus the larger failures of insurance companies. Attempting to dispel held the generally held conceptions of Americans of socialized healthcare, the film compares the healthcare systems of Canada, Britain, France, and Cuba with the U.S. healthcare system by presenting a collection of case studies and statistics. Concurrently, SiCKO traces back through the policies of past legislature to provide the political- historical context of why these US healthcare systems exists in its current form. In the final minutes of the film, Moore calls for Americans to learn from other countries and fight for socialized healthcare. In short, Michael Moore created this film to make the American public aware of what he sees as the failures of the healthcare system in the United States to spur citizens into action to fight for transforming the current capitalist model into a socialist one. (Moore 2017).

Relation to Politics of Health

SiCKO provides an important outlook into the ideologies of healthcare, the value of the bodies of individuals, and the role and political influence of institutions. The view in the United states values healthcare as a commodity, not a right. This is called the “market principle” and leads to the creation of healthcare systems driven by profit (Quadagno 2010: 130). Individuals’ bodies are valued for their belonging to the group of consumers of a commodity sold by certain institutions. In contrast, the view held in European countries values healthcare as a right. This is called the “principle of social solidarity” and leads to the creation of healthcare system intent on providing quality healthcare to all, basing contribution on income, and dividing cost among all group members (Quadagno 2010: 130). Individuals are valued for belonging to a group which takes care of its members through member controlled institutions. In short, this film captures major key points of discussion in the discourse of the politics of health.

National and International Historical Context

Moore lays out the historical background of the development of American healthcare into the current, capitalist system instead of a socialist one. In 1971 Richard Nixon addressed congress to promote the expansion of health maintenance organizations (HMOs). This would create a national health insurance partnership instead of nationalized health insurance to cut costs and keep the Federal government involvement out of matters in the private sector (Nixon 1971).  Later, the American Medical Association (AMA) did not support John F. Kennedy’s healthcare program proposal called Medicare. Thus, the AMA organized something called “Operation Coffee Cup” where people gathered in homes to drink coffee and listen to a recording titled, “Ronald Regan speaks out Against Socialized Medicine” (Skidmore 1989, 89). In the jacket of the recording, there were instructions on how to use to create the greatest effect on listener to make listeners feel like they needed to write to Congress “to combat socialized medicine” (Skidmore 1989, 89). After playing the recording, the AMA urged listeners to protest Medicare. When Hillary Clinton attempted in 1993 to reform the United States healthcare system through the Health Security Act, Republicans and groups such as the AMA and the Health Insurance Association of America spent millions of dollars lobbying to defeat the proposed plan for universal healthcare (Cymer, Pear, and Toner 1994). Finally, pharmaceutical companies showed impressive influence when President George W. Bush signed the Medicare Drug Improvement Modernization Act in 2003 (Oliver, Lee, and Lipton 2004). Authorizing Medicare to cover prescription drugs, the bill subsidized coverage for some but left gaps in coverage and thereby significantly increased expenses for others (Oliver, Lee, and Lipton 2004) As a result, although purported to help seniors with prescription drug coverage, the bill hurt many recipients of Medicare. The pharmaceutical companies lobbied and donated money to congressmen and the Bush administration to ensure the bill was passed. In short, throughout America’s past, institutions such as HMOS, the AMA, and pharmaceutical companies have worked hard to keep the American system a private, profit driven one, primarily benefiting the institutions themselves.

While for profit institutions have driven the development of the American health system, the drive of socialist politicians, the lessons learned from war, and the power of the people have lead to the creation of the socialized healthcare systems of Canada, Britain, France, and Cuba. In 1948, the National Health Service (NHS) was created in England. World War II changed the dynamic between people and the British government. As the government had almost total control of everything during the war, people were more open to the idea of government control of the healthcare system (National Archives). Additionally, as during the war the government provided healthcare for civilians, welfare of the people became one of the top priorities following the war. The Canadian socialist politician Tommy Douglas fought for universal healthcare after World War II. He reasoned that if Canada could find money to fund a war, the money could also be found to take care of the people (Lovick 2013). In France, according to one doctor, the universal healthcare system exists because people demand it. The government does what it can to please its citizens because it wants to avoid protests. Finally, in Cuba, the free, government controlled Cuban system most likely developed due to the communist ideals held by Cuba’s revolutionary leader, Fidel Castro. Castro created a dictatorship with control over all aspects of life (Britannica Academic 2017). He also expanded the social programs of the country making healthcare free for all members of society from every class (Britannica Academic 2017).

The American System: Healthcare as a Commodity

SiCKO clearly points out the flaws of the American healthcare system. First, health insurance is extremely difficult to obtain in the United States. When the film was made in 2007, insurance companies could deny people coverage because of their pre-existing conditions. Nearly 50 million Americans were uninsured. Implemented in 2014, the Affordable Care Act in 2014 attempts to address this issue. The ACA protects half of the American population who would otherwise be denied coverage because of pre-existing conditions (ASPE 2001). However, obtaining insurance does not ensure coverage because insurance companies actively avoid paying for treatment. The film depicts the cases of patients denied payment and coverage. In the case of Tarsha Harris, Blue Cross dropped payment for the coverage of an operation because she did not disclose on her insurance application that she had had a yeast infection. They claimed her yeast infection qualified as an undisclosed pre-existing condition which exempted them from paying for her current treatment. In another case, the health insurance company of Julie Pierce denied cancer treatment for her husband although his doctor urged the company to approve the treatment. Consequently, he died. These and other denials of treatment by United States health insurance companies can be explained by examining testimony from the whistleblower Dr. Lina Peeno. In 1996 during congressional testimony, Dr. Peeno brought to light the intent of insurance companies to place profit over life. As a medical director for the insurance company Humana, she testified that by denying coverage of an operation she had caused a man’s death. She did so because she was instructed to use her medical knowledge to save the company money (Rovner 2007). Dr. Peeno explained that doctors working for such institutions are incentivized to make such choices because those who make the most denials will be paid more and ensure career advancement. Additionally, providers may only pay for treatment at certain hospitals. In the case of Donelle Keys her insurance company, Kaizer Permanente, denied payment to treatment her unconscious 18-month-old daughter, Mychelle, at the hospital she was taken to by emergency medical personnel. As a result, the doctors refused to treat her daughter. By the time Mychelle was transported to a new hospital, she underwent cardiac arrest and died.  Some hospitals go even so far as to drop off patients who cannot afford to pay bills at homeless shelters (Serna and Winston 2014). Moore points out that those incarcerated, such as terrorists at Guantanamo Bay, receive state of the art, free healthcare while 9/11 volunteers struggle to pay for treatment.

Despite what Moore cites as the failure of the American healthcare system to provide affordable, accessible medical treatment for many of its citizens, supporters of the American system believe in its superiority to the European models of socialized healthcare. Mainstream media, politicians, and conservatives say that patients in socialized healthcare systems are unhappy with long wait times, restricted choice of doctors, and poor quality of treatment (Moore 2007). Additionally, they worry that the tax burden that would be placed on citizens by universal health care would hurt lower and middle class families (Moore 2017). Finally, doctors would be paid significantly less and would be unhappy working in such a system for the government (Goolsbee 2007). They purport all of these issues would prevent U.S. citizens from being content with a socialized healthcare system. Additionally, critics highlight that drugs are only cheaper in other countries because “they are free-riding off of the massive profits made in the American market” and that lowering the prices in the US would drive up prices in other markets (Goolsbee 2007). Another point of concern is that that malpractice is not the same in countries with socialized medicine. The legal tort system would have to change dramatically to allow a reduction in cost (Goolsbee 2007).

The European and Cuban Systems: Healthcare as a Right

The film explores socialized medicine by examining the healthcare systems of Canada, Britain, France, and Cuba. When presenting personal accounts of the healthcare system of Canada, SiCKO depicts an American who crossed the border and fakes a relationship with a Canadian to receive coverage, Canadian relatives who were unwilling to travel in the US without traveler’s health insurance, and a Canadian golfer who flew from Florida to Canada because treatment in the US would have cost him thousands of dollars while treatment in Canada cost him nothing. In an interview, a Canadian theorized that Canadians are willing to pay for the treatment of other people through socialized healthcare because other Canadians would do it for them. Strikingly, the national healthcare system was described as too important to be a partisan issue to be attacked. A Canadian doctor interviewed reports being proud to work in a system where they are free to focus on problem of the patient instead of worrying about how the patient will pay for treatment. Facts such as Canadians having a lifespan 3 years longer than the US lifespan and wait times in hospitals not being as long as purported in American media further drove home the point that the Canadian system has benefits. (Moore 2007)

The National Health Service(NHS) in the United Kingdom(UK) also provides free healthcare. SiCKO provides an example of an American visiting England who received healthcare when he dislocated his shoulder. Pregnant women are not charged for the time they stay in the hospital. Additionally, medications cost less. Standard charge for drugs in the UK is about 10 US dollars (NHS Choices 2016). Those under sixteen and above 65 do not pay for medication at all. The British doctor interviewed was happy to be working in a NHS practice as a government paid doctor. He reported doctors are paid by what they do for patients. An example of this would be if the number of patients who stop smoking in his practice drops, he receives a bonus. Far from destitute, this doctor lives in a million-dollar home and drove an Audie. He reported that doctors live a comfortable life but if a doctor wanted to be excessively rich then a capitalist system was the way to go. (Moore 2007)

The citizens of France are also very well taken care of by their healthcare system. In France, when Carina’s daughter Zoey had high fever, she took her to the hospital and stayed for three days for free. A Frenchman who underwent chemo treatment obtained three months of paid time off from his employer with a doctor’s note after finishing treatment to recuperate from his fight with cancer. Frenchman Dr. Jacques Miller reported that the system functions because people pay according to their means and receive according to their needs. A group interview of Americans living in Paris attested to their appreciation of the socialized healthcare system in France and state that reporting pre-existing actually conditions helps patients receive treatment they need and does not lead to rejection or punishment in the healthcare system. (Moore 2007)

In Cuba, the healthcare is also universal and free. Medicine costs a fraction of what it does in the U.S, and the money spent on healthcare per person is far below that spent per person in the U.S States (Campion and Morrissey 2013). While there is little consumer choice, the high emphasis in preventative medicine has led to infant mortality rates falling below the US level and life expectancy rising to the same age as in the United States (Campion and Morrissey 2013). Additionally, Cuban doctors work locally, visiting their patients at home at least once a year States (Campion and Morrissey 2013). Although poorly paid in comparison to U.S. wages and unlikely to become wealthy, doctors receive free education and are highly respected in their communities States (Campion and Morrissey 2013).

In short, patients and doctors of socialized healthcare systems are happy, well taken care of, and well off. Life expectancy, birth survival rate, and life expectancy in all of these countries matches or exceeds that of the U.S. The focus is not on profiting private companies and denying treatment options. The systems are universal, free, invest in preventative care, and promote recovery after illness. Moreover, drugs cost much less than in the United states. Pharmaceutical companies do not wield as much power over political leaders. Perhaps the potential costs of waiting a little longer for an appointment, more taxes, and letting the government choose doctors are outweighed by the benefits.

 

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