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Culture: Sicko
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Tuesday, 10 July 2007 Written by Henry Midgley
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Michael Moore has never avoided the most humiliating points for the United States- amongst those in his latest film "Sicko" perhaps the most shocking is that rescue workers on September 11th 2001 have been refused treatment in the United States.

His latest film, Sicko, is about the Health Insurance Industry in the United States. Mr Moore's film is as many of his other films a very passionate and emotional film- a diatribe against the health system in the United States and how it betrays ordinary Americans according to his beliefs. Mr Moore's film is well made and polemically it betrays some interesting biases amongst Mr Moore's potential audience- particularly his American audience. I have to declare an interest here- I beleive that health care in the rich nations of the earth should be available to all, free of charge and paid for out of general taxation- whether you do that by the British or the French system- I question whether a country without that truly can say it cares for its poor.


The Failure of the Market


The problem that Mr Moore's film diagnoses very accurately is that market failure leads to real problems. For example all the incentives run for the companies to move people quickly through the system- beds are costs. All the incentives run for the companies diagnosing you as diseased beyond the terms of your contract- Moore's stories may be singularities but he is actually right- it doesn't make any sense logically for a health care company to spend more than they have to upon you- these things as President Nixon agreed in the 1970s setting up the system were not developed to cure Patients, but to make money.

Making money isn't bad and to a large extent as Adam Smith argued it produces good externalities- but in some circumstances and health care and education are significant ones the market fails- and the market fails because the moral imperative to provide is not recognised. Watching Michael Moore's film I was shocked to find that my ex girlfriend would not have been insured in the United States because she suffered from diabetes and therefore would be ruled out from insurance. But coming to think of it, she would have been an expense for a medical insurer- a horrific expense given that she regularly has to have medical check ups and furthermore lives in balance upon the amount of insulin she injects as opposed to the amount of carbohydrate she consumes. In the UK her treatment is entirely free- in the United States she would have to pay for it and would be unable thus to do what she does at the moment- iuse her degree from Oxford university to teach kids English.

There are various shocking stories in the Moore documentary- the two that really got to me because it reflects again another personal experience of my own- was that a woman had to pay for the fact that she was knocked unconscious by a car and an ambulance picked her up, of course whilst unconscious she didn't have time to ring her insurer who refused her funding for her ambulance trip. Another incident saw a mother take a child to the hospital and be refused entry because the hospital wasn't run by the same company- Kaiser- as she got her insurance from. Having had recent experience of the British A and E department of St George's Hospital in London, I can state categorically that both of those cases could have applied to my family when my father became ill suddenly- that neither did and that he received wonderful care from caring and kind doctors and nurses for whom no expense was too much and no step too far is testament in my view to the quality of the National Health Service and further strengthens Moore's general point.

Point of view


Moore does all this from a pose of fake naivete- we know he knows more than he lets on- that when he asks questions of UK hospital staff and wonders round the hospital searching for where the place to pay is and is surprised when the cashier he finally finds is the man who pays those too poor to pay their own way home their travel expenses. Moore stands up or seeks to appear to stand up for the normal Middle Class American- what is so odd about the film looking at it from a European point of view is how absent the working class are from Moore's sight. He does record the poorest strugglers- but its on the Middle Class he concentrates- the poise to me echoes the central point about American politics which is the invisibility of the lowest classes of the population.

Sicko is a much better film than Moore's last effort Farhenheit 911. Its much more focused- and the story flows better. But furthermore Moore doesn't concentrate his fire as much on conspiracy theories at the top- he makes clear the connections between Capitol Hill and the Insurance lobby but doesn't overplay them- unlike the way that for him Iraq became all about oil in the last film, a rather interesting fantasy to say the least. Rather this is a more honest exploration of a problem- if this represents a new direction in his film making then its one to be applauded.

Illustrations


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On September 11th they went to help
and now have to pay for their own health care
Moore's film is illustrated with examples from nations that do provide the model of free care- from France, Canada, the Uk and even whisper it Cuba. Moore's film is furnished with hard cases- though they exemplify the whole principle that he wants to explore that health companies operate as classic corporations. Story after story after story bombards your senses and Mr Moore lets them mostly speak for themselves- he uses the contrast between the way that even Al-Quaeda terrorists are treated and the way that Americans are treated in America. Furthermore in France and Canada and the UK people with analogous diseases to those partially or not treated in the US are shown treated and cured. He balances the fact that in all those countries the infant mortality rates are lower, life expectancies are higher and the people generally suffer from less acute rates of major disease.

Moore's film is obviously partial- things in France, the Uk and Canada aren't perfect- the NHS in this country is always being complained about and tinkered with and sometimes things do get better sometimes they don't. Interviewing Tony Benn and allowing him to talk about the idea of socialist nirvana is a bit too much- Benn is a wonderful visionary but his vision isn't neccessarily perfect. Dentistry in the UK functions much more like the US system than like a European one. He doesn't deal with the argument that the system in the US promotes innovation particularly in drug development. And there are all sorts of economic problems in France not to mention an ugly dictatorship in Cuba- which Moore glosses over- but this film is a polemic to make one point that the United States the richest nation in the world cannot and will not treat many of its own people without them mortgaging or losing their houses- will not treat them without them compromising between cost and need. Now that is barbaric.

That's not to say that Moore's film is without flaws- most of them relate to Moore himself- he intrudes too much occasionally and is too lacrimous. There are unpleasant touches- his charity to a runner of an anti-Moore website was admirable but using it as a debating point feels like taking advantage of his wealth. The central point though is correct- societies should be judged by how they treat their sick and the idea of not treating sick people because they don't have enough money makes me glad to live in the UK with the (however flawed and imperfect) NHS.

Just one last irony- it has come to something when Moore might be prosecuted for taking those September 11th volunteers over to Cuba so that they receive proper medical treatment that they can't receive in the United States- it may a wonderful publicity stunt- but it does make the point that the documentary as a whole makes, the American health system is a disaster- to paraphrase Neil Kinnock's words, if you live in America I warn you not to be sick, I warn you not to be poor or to be meek, to be feeble or old because if you do you'll be deserted.