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A disconsolate couple are moving into their daughter's house in Denver. In their 50s, bankrupt through healthcare costs, they've had to leave their own home. They're being given a box-room, so cramped they'll need to erect bunks. Their truculent son from across town complains at the disruption their arrival will cause. The couple are upset at being a burden, ordinary Americans suffering hardship.
This is the best form of 'reality' film-making: its purpose not voyeurism but bearing witness. Late in its British run, Michael Moore's documentary Sicko managed to fill a London cinema for an early evening performance, drawing applause at the end, using scenes like these to condemn the callousness of market-driven healthcare.
Moore tells us that18,000 people die in America each year without any health insurance, but his focus is on the vast majority who are insured, his aim clearly to highlight not the worst excesses of the US system but its failure as a whole.
This is his least funny and least prankish film yet, and he himself scarcely appears, though it's no less entertaining for that. It's also his most far-reaching and radical work asking basic questions as to why the US won't provide decent health for its people, and whether there could be a better way of running things altogether.
Moore received 25,000 contributions following his call for healthcare stories to make this film. We meet 79-year-old Frank, who has to keep on working as a supermarket cleaner to qualify for free medical care under his scheme ("If there are golden years, I can't find 'em"). And car-crash victim Laura, who failed to book ('pre-appeal') her ambulance ride to hospital, which meant the ride was payable. And a deaf child, who was given one ear implant but refused the other on grounds that the treatment was "experimental".
Distressed healthcare workers also contacted Moore. Becky, who works in a health insurance company call-centre turning down requests for insurance cover, cries as she describes her distress at having to 'decline' needy people: "That's why I'm such a bitch on the phone." Hundreds of conditions like angina, diabetes, autism, cerebral palsy are simply uncoverable.
Another insurance worker, Lee, says his searches for slip-ups in patients' insurance applications, or for signs that their illness was a pre-existing condition, were conducted "like a murder hunt."
Dr Linda Pino, a former medical reviewer screener for major health insurance company Humana, tells a public hearing: "I denied a man a necessary operation that would've saved his life," and confesses that she gained financially as a result. The company awards bonuses to doctors with the highest rates of denial, insisting on a minimum rate of 10%.
From ground level, we switch to politics, tracing the current policy back to Nixon in 1971, and moving onto Hillary Clinton's universal healthcare campaign under her husband's presidency, which became the subject of Republican scare-mongering. What we in Britain take for granted, rightwingers warned would be a "bureaucratic socialistic takeover", and that it would "put government into your hospital!" Reagan went a step further. Begin with universal healthcare, he warned, and one day Americans would wake with socialism!
Clinton's plan was defeated by extensive lobbying from the healthcare companies, with Hillary herself a recipient of corporate largesse. Moore puts it less delicately, talking of the insurance and drugs companies buying Congressmen; comical footage has cartoon-style price tags pinned to eminent politicians. Bush's 2003healthcare bill allowed drug companies to raise prices, with the insurance companies as the middle-men. Many of the bought politicians and aides, having boosted the companies' profits by passing the new law, left Congress to become their executives.
Moore makes a series of comparisons with other countries, following first a 22-year-old single mother just across the border from Detroit to Canada, where she has to fake common-law marriage to a Canadian in order to receive free treatment for cervical cancer. She had been deemed 'too young' to have the disease and is thus refused treatment on her insurance.
Canadians can't comprehend paying for healthcare. Canadian relatives of Moore¹s don¹t even dare cross the US border without full insurance, frightened of a huge bill should an accident befall them.
The founder of Canada's universal healthcare, Tommy Douglas, is now considered to be the most important person in the country's history.
In England, Moore is astonished that prescription charges, against which many here railed bitterly, are only $10, no matter how big the prescription, and that only working adults have to pay.
At a typical National Health hospital, he learns that British maternity cover is 6 months' fully paid leave for women, and a further 6 months' unpaid. Patients leaving Accident and Emergency are asked how much their treatment cost. "There's bound to be a bill," he says. "You get to just go home?" Moore's amusing, wide-eyed shock in turn shocks a British audience, which takes its free treatment for granted. It's the American assumptions about payment that sound outlandish to us, not our system.
And healthcare is better in Britain; it is not "bottom of the rung" care, as one American had been told before having her three kids on the NHS. Major diseases are lower in Britain than in the US. The US has the worst infant mortality rate in the developed western world.
But what of the socialistic, bureaucratic control over doctors' lives, and their low pay? A typical British doctor Moore visits earns £85,000 a year, owns a $1 million house, and runs an Audi. Addressing US doctors, Moore is out to show they have nothing to fear.
In a short interview, Tony Benn disputes the notion that state-run healthcare means lack of choice. "Choice depends on freedom to choose. If you¹re shackled with debt, you don't have choice," he says.
France, likewise, provides universal healthcare as well as 5 weeks' paid vacation a year, a 35 hour week (even for part-timers), seven days off for a honeymoon, and a day's pay for moving house. The SOS Medecins system, established 40 years ago, provides emergency house-calls within the hour. This level of welfare is possible because, with a tradition of mass protest, "the government is afraid of the people" not the other way round, says Moore.
Tony Benn echoes the idea that welfare is a democratic issue: "Before you had the vote, all the power was with the rich people. Democracy moved power from the market place. If you can find money to kill people, you can find money to help people."
Meanwhile, in the US, poor patients are being turfed out of hospital onto the pavement, or dropped off at homeless shelters with infections, unhealed wounds and broken bones.
9/11 heroes in Cuba
In the film's tour de force last act, Moore introduces us to some of the 9/11 heroes, reserve nurses and firefighters, some of who worked for months recovering bodies and cleaning up Ground Zero. Because many are not New York city employees, they have no cover. Dust-inhalation has caused conditions ranging from lung conditions to cancer, while post-traumatic stress is another consequence of the clear-up work. All now rely on raffles and charity to fund their healthcare.
Moore, in an ironic gesture, takes this group to Guantanamo Bay, where the prison hospital provides what the authorities boast is excellent treatment for the inmates. Of course, Moore is refused access, so the group move on to Cuba proper, where "every block has a pharmacy". Though it's a Third World country, which can only afford to spend $1251 per person per year on health compared to the US figure of $7000, the Cuban system, with its emphasis on preventative medicine, manages to provide a longer life-span.
In Havana, the American group are given first-rate care for free, the same treatment ordinary Cubans receive, with no bureaucratic questions asked and no insurance company "murder hunt" investigation. One woman weeps as she speaks of the "big insult" of having to pay $120 at home for a prescription out of her $1000 per month income, when in Cuba she can get the drugs for 5 cents. She fills up her bag.
Later, Havana firefighters salute the group of rescue workers in an emotional scene of solidarity.
Moore's film makes the unlikely subject of healthcare extremely watchable, putting well-honed American mass entertainment techniques to good use. His questions as to whether there might be a better way than the market reverberate beyond the issue of healthcare. It's no accident that his mini-survey of countries ends up in Cuba.
For us in Britain, the main effect of Sicko is to show us what we have to lose in spite of all the losses we've already endured, and the lining up of major US healthcare corporations to take over large slices of the NHS.
Even Thatcher had to promise that the NHS was safe in her hands. Benn says there'd be a revolution if it were destroyed. Yet, so far, marketisation is being driven through without effective resistance. So far. Sicko inspires us to fight harder for what we've got.
Sicko, Michael Moore, US, (123 mins).