There’s so much wrong with Michael Moore’s Sicko that it’s embarrassing, especially for a health care pundit, to reveal the emotional punch it gives you. You know that your head is being bowled over by your heart, and you also know that it’s very, very cleverly done. But that doesn’t make the message any less powerful.
In the end it’s emotional half-truths that seem to move us so perhaps Sicko will have the desired effect — getting this nation’s politicians off the dime on universal coverage. Of course, the contrast Moore’s setting up is not to the rational debate that you may get from me here at Spot-on, or in the pages of Health Affairs. The contrast that Sicko sets for itself is with decades of right-wing propaganda.
That propaganda shown in the movie includes not-yet President Ronald Reagan making speeches for General Electric Corp., likening universal health care to creeping totalitarianism. And it contains a brief clip of an anti-Medicare speech given to an empty Madison Square Garden in 1962 by the head of the American Medical Association. Of course the Reagan Administration continued the huge growth of Medicare, and the AMA benefited incredibly from that growth. That disingenuosness aside, the same echoes can be hear today in sound-bites littering the movie from Fox and CNN’s talking heads.
An even more ridiculous example of this type of thinking were the Fox News commentators who this week blamed the terrorist attacks by doctors in the U.K. on the British National Health Service and the ease by which it’s infiltrated by foreigners. Of course, roughly one quarter of American residents (trainee physicians) are foreigners too.
In other words, propaganda is nothing new in health care. And of course propaganda is more useful for maintaining the status quo than creating a new one. And that’s maybe why Moore decided that it was easier to take just one part of health care – the insurance industry, and more particularly 1990s-style HMOs – and vilify them.
Sitting in the theater I was amazed at how unevenly he did it, too. Moore mixed stories from 20 years ago with recent abuses, and he conflated problems with hospital dumping with what were probably medically rational decisions to not pay for futile procedures. He also gave a relatively easy ride to the profiteers in the insurance industry who have destroyed community rating in the last twenty years and instead tries to make us believe that the HMO act concocted by (evil Republican, Watergate) Nixon was the start of the problem.
But back in Nixon’s day, HMOs were pushed by a bunch of pinko-Left coasters who – like Moore – were regarded as communist agitators by the forces of organized medicine. A colleague of mine once noted that HMOs went from being communist conspiracies in the 1970s to capitalist plots in the 1990s as the HMO moniker got taken up by for-profit insurers who never embraced the “health maintenance” concept.
In the past 10 years, HMOs, and with them most of the more dramatic denials of care that Moore portrays as recent events, have more or less disappeared. They’ve been replaced by traditional insurers who use aggressive and often poorly understood underwriting techniques to deny insurance to people who need it or, even worse, take it away from people who think they’ve got it. Moore did get that somewhat right when he showed the example of Blue Cross of California retroactively canceling insurance policies for no good reason – and that was just last year, with a state investigation still ongoing.
Sicko also carries the assumption that all medical care is good for you. We know that’s not the case. In fact the data is pretty damn clear that too much care is bad for you. And that’s probably the case for one or two of the examples in the movie; particularly the one of the cancer patient denied a bone marrow transplant. The most famous lawsuit ever against an HMO was over the mid-1990s denial of a autologous bone marrow transplant for a patient with close to end-stage breast cancer. HealthNet refused to pay for the treatment, calling it experimental. And it was. The patient’s brother was a lawyer and he sued and won an $89 million award. While HealthNet at the time handled itself very badly, ten years later the facts are in. That surgery doesn’t work for breast cancer and it causes more pain for the patient and a lot more cost for the rest of us. But that’s a difficult story to tell.
What’s an easier story to tell is that we are all in this together. Now, like the radical individualists at the Cato Institute, some Americans – and a higher proportion of the low percentage of Americans who actually vote – do not think that we’re all in this together. But in general there’s theoretical broad agreement that we should do something about the health insurance mess, and that underlies the real question when it comes to the debate about health care.
It’s something on which Moore correctly focuses: How do you put everyone in the pool? How do you make sure that the act of being sick doesn’t condemn poor people to bankruptcy – the fate of the first family who come up as an example in Sicko? How do you stop condemning sick people to being unable to afford to get care at all, which is what happened to the 9/11 rescue workers Moore took to Cuba?
Moore at least has a vision of getting everyone in that pool and making sure that neither the least of us, nor those who got hurt in their finest hour, get left out. Which is a hell of a lot more than can be said for most of those attacking him and defending the status quo.