American SiCKO

In his latest film, SiCKO, Michael Moore, the acclaimed film maker examines the ailing US health care industry. Rather than examining the challenges of the nearly 1 in 5 Americans who are uninsured, Moore focuses instead on the 250 million Americans who have health insurance coverage. Even those with insurance are not guaranteed health care as evidenced by the cases of several “ordinary Americans” whose lives have been dramatically and often tragically affected by the bureaucratic red tape of the insurance industry. Moore profiles a cross-section of tactics utilized by the for-profit insurance industry including denial of coverage due to pre-existing conditions and failure to secure pre-authorization for emergency services.

Moore squarely places the blame for the broken state of American health care at the feet of the US government; attributing its causes to two factors: profit and fear. First and perhaps more simply, health care goods and services have historically been treated as a commodity within the US. Under market forces, those who can afford to pay receive care, while those who can’t, simply don’t. As health care costs and the incidence of chronic diseases have risen, the number of individuals able to afford and/or qualify for health insurance coverage has begun to shrink. Secondly, and more to the point Moore makes later on in the film regarding values is the question of fear. Moore opines that American health care consumers are afraid of losing choice over their health care providers and long waiting times for procedures. He also suggests that American physicians are fearful of losing the quality of life guaranteed by their coveted six figure incomes. Finally, Moose censures the US government for its use of “red scare” tactics to convince the public that a government operated health system represents a slippery slope into a broader socialist state where the core American value of individual liberty is degraded in favor of the collective. By use of anecdotes Moore picks these arguments apart one by one. He travels to Canada, the United Kingdom, and France gathering tales of satisfied patients, well-paid doctors and even conservative politicians who advocate for government administered health care. While Moore’s comparative analysis offers a mere surface level examination of these systems the fact that each of them offers free universal health care serves as a striking contrast to the pay to play system operating in the richest country in the world. Coupled with the fact that the US health system ranks 37^th globally yet spends the most money per capita on health care the viewer is left with the feeling that even for those that can afford it, the American consumer is not getting what she pays for.

Unlike his previous films Moore manages to restrain himself from partisan showboating until the final chapter of the film during which he takes several 9/11 rescue workers to receive health care at the naval base at Guantanamo Bay, Cuba. Deterred only slightly by the land mines surrounding the base, Moore leads his crew away from GITMO to mainland Cuba where many health outcomes are better than in the United States. This slap in the face to US policy drives home Moore’s main message. If Cuba, a developing country can provide free comprehensive quality health care to its citizens, why can’t the US?

As Moore cogently points out many public services in the US are operated as social programs. The police force, the fire department, the public library system and the postal service are all administered by government. Americans widely enjoy these benefits and perhaps most importantly do not expect these services to turn a profit.

Rather than adopting a human rights based approach to health, Moore deals with the US health care crisis as a moral dilemma, one that he suggests can only be changed by a shift in values. In addition to learning valuable lessons from the health systems of other States, the US might also take a lesson from countries who have adopted the values enshrined in international human rights documents on economic, social and cultural rights such as the right to health. After all, the legal documents underpinning the international human right to health consist precisely of the values that Moore advocates for, namely universal (accessible), available, affordable, quality health care goods and services.

The fact that the US has not ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) which includes the right to health, nor the fact that a US constitutional amendment on the right to health does not exist does not preclude Americans from demanding health care as a public good. After all, the American public expects and demands that primary education is universal and free despite the fact that there is no US constitutional right to education. Rather than a frightening descent into socialism such demands should be seen as the greatest exercise of power within a democracy.

As Moore notes, societies are often judged by how they treat their most vulnerable. In truth socialized medicine already exists on American soil in the form of Medicare for the elderly and disabled, Medicaid for the indigent poor, the Office of Veterans Affairs for former military personnel and the Indian Health Service for Native American populations. In a modern democratic society perhaps the measure by which we judge ourselves should raised so that the United States can join every other industrialized nation in accounting for the health of all of its citizens through the provision of universally free and available health care.

SiCKO will be released in US theatres on June 29. No release date has been set for the UK yet. See http://www.michaelmoore.com/sicko for more information regarding the film.

-Dabney Evans