A number of reviewers have described "Sicko," Michael Moore’s new documentary film about health care in the United States, as funny. It isn’t.
Sure there is a chuckle or two to be had. You have to smile when Moore uses '50s-style anti-communist film clips to mock the fear-mongering American politicians engage in whenever the subject turns to "socialized" medicine, or when he is bellowing through a bullhorn while bobbing in a boat in Guantanamo Bay, Cuba, begging for the same level of health care for workers injured in Sept. 11 rescue efforts as we afford the evildoers locked up in maximum security at Gitmo.
But "Sicko," which opens nationwide Friday, is not funny. It is tragic. You should not come out of the movie theater smiling. You should leave angry. "Sicko" is right on target about the mess that is American health care.
Moore's critics would like you to believe "Sicko" is slicko. Those with vested interests in preserving the current status quo in health care have already activated their lobbyists, media flacks, think-tank mouthpieces and trade organizations to go after Moore and his movie. There are nearly $2 trillion worth of vested interests out there in insurance, managed care, hospitals, doctors, advertisers and salespeople looking to keep their share of the health care pot of gold.
But there's no disputing the key flaws in our system that "Sicko" makes abundantly clear: Nearly one in five Americans doesn't have health insurance. And even those with insurance often face incredible and sometimes lethal hurdles to adequate health care — from crushing out-of-pocket expenses and co-payments to snail-like bureaucracies unresponsive to the needs of their clients (usually by design in the hope that they simply go away).
As if that's not trouble enough, your doctor may be motivated to deny medical care as he climbs the corporate ladder. Your employer could go bankrupt and leave retirees high and dry. Insurance companies may deny your claim and drop coverage for pre-existing conditions.
And when insurance payments dry up, hospitals have literally tossed patients onto the street. "Sicko" tells these stories irrefutably and grimly.
Paying more for less
Worse, if that is possible, Americans pay more for this mess than anyone else in the world for health care — and we get less for our money. Despite our love of the free market, the rest of the industrialized world delivers care to more of its populations with much more economic efficiency than we do. The only parts of the U.S. health system that approximate the efficiencies of Canada, Germany, Singapore, Australia, France, the Netherlands and Sweden are Medicare and the Veterans Affairs hospital system. Moore goes so far as to visit Cuba to show that even those under Fidel’s dictatorial thumb have easier to access health care than many Americans.
Why do we put up with a broken, bloated, bureaucratic and increasingly barbaric health system? Because your politicians are in the thrall of the people who profit from it. And just enough of us have access to a fairly decent level of care that the misery of the uninsured, underinsured and tapped out does not move us to care.
And Moore doesn't get into this, but even if you have great health insurance, don’t get comfortable. You, too, could be getting the runaround or finding yourself on the outside looking in unless reform comes to American health care.
Will boomers bankrupt the system?
Baby boomers are getting older. And while it is chic to babble on about 50 being the new 40 and for 60-year-old women to grab the headlines by having babies, the fact remains that this group is entering into old age, a time of heavy reliance on health care.
A system that barely can get by dealing with chronic illnesses and the demand for long-term care will soon be tipped over by an entire cohort of geezers who, no matter how religiously they jog and or how much pomegranate juice they drink, will use health care to a degree never seen anywhere in the world at a price that, if nothing is done, will bankrupt the country.
The boomers are partly to blame. They built a health care system to suit their medical needs when they were middle-aged. We have some of the finest acute care hospitals in the world for treating heart attacks and transplanting organs. But we are not prepared to deal with long-term care, home care or hospice, a lack of health care personnel willing to work in these settings and the complete absence of insurance to pay for most of what you need when you are old, disabled or both.
Not only will the ranks of the elderly be exploding but we'll also soon see a rise in genetic testing. More and more of us will find out that we are at risk of various ailments. This means your insurance company and HMO will have even more tools to use to figure out how to chop the risky off their rolls.
Moore has it right in "Sicko." American health care is in serious need of rehaul and repair. Ignore the bleatings of those out to discredit Moore by saying he is too flip with his depiction of health care in Canada or France, who chafe at his cheekiness in noting that we guarantee imprisoned terrorists better health care than we do our own sick neighbors, or that he never says that many have to wait 18 months in England to get a hip replacement.
No one in Canada or France would even contemplate exchanging their systems for our health care mess. Prisoners do enjoy a more meaningful right to health care than many Americans. And while you may wait a long time for a new hip in England, a fair number of people in the U.S. will never get that hip replacement because they cannot pay for it.
If you think Moore is exaggerating the woes of the health care system and if you think — as his often bought and paid-for critics charge — that he is just a sloppy, overfed left-wing ideologue, then go down to your local hospital emergency room or nursing home and tell it to those waiting there for care and compassion. Except for luck and a few ticks of the clock, they might be you. If Moore’s call to action is not heeded, such a visit tells you all you need to know about what awaits you in terms of health care in America. Nothing funny at all about that.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.
