Dog Eat Dog Films, 2007
written and directed by Michael Moore
123 minutes, rated PG-13

The Movie:

Almost everyone knows who Michael Moore is, and "knows" either that he is an outrageous lying propagandist commie who hates America, or that he's the mightiest and most heroic truth-exposing muckraker to ever use the film medium.  His previous documentaries have all been as confrontational and controversial as documentaries ever get -- for him, a subject isn't worth even bringing up unless his view is way outside the normally accepted view of reality presented in mainstream media.  For this reason, any attempt to review his films almost always comes down to whether the reviewer thinks the content is truthful or untruthful -- his level of skill as a filmmaker, which is considerable and makes most documentarians seem utterly drab, is almost considered irrelevant.  This polarization of views about Moore was brought to a peak by his previous film, Fahrenheit 9/11, an attack on the presidency of George W. Bush... a man no less polarizing, and no less aggressive as a propagandist for his own views, than Moore himself.  That film was Moore at his most politically partisan... and least focused.  Being a fan or critic of Michael Moore was impossible to separate from whether you were a critic or fan of Dubya.

His new film, Sicko, is quite another matter.  Though it is certainly political, it is far less partisan, and as a result has gained a degree of acceptance and approval among conservatives that was quite absent last time.  Also, it makes a stronger case than Fahrenheit 9/11 did.  It's harder to deny the thesis that, when it comes to health care, we're paying top dollar and not getting what we're paying for, than it is to deny the foul nature of the Iraq war and how we got into it.  Because this is an area where so many of us have firsthand experience of the shortcomings of the system.

Sicko is about the question of how to cover people's medical expenses.  It makes two major claims: first, that our present health insurance system has become "a racket", a system to squeeze as much money as possible out of people in return for promises of protection from medical bills, while providing as little real protection as they can get away with.  And second, that we can cure this problem with socialized medicine, as used in Canada or Cuba or European countries.  In outline, the film goes more or less like this:

The second thesis, that socialized medicine is the answer, is the more arguable of the two... and there's a distinct hole in Moore's case in that he never contrasts the range of options used by other countries -- some such as Canda using a single-payer system, others using private insurance with public regulation of the sort we use with utility companies, others using a two-tier combination of public and private coverage, and so on.  Moore is happy to let a less-informed viewer assume that every other country that supports coverage for the poor are all using a single-payer system.  Moore would probably be pleased overall if the USA adopted a two-tier system so that the poor can get basic coverage, but it's clear that he won't be fully satisfied until the private insurance companies are out of the picture entirely -- it's for this reason that he focuses most of the film not on the plight of the uninsured, but on those who do have coverage and yet still end up untreated or bankrupted when they get sick.

And that's where the film's strong suit is -- in showing how often all the coverage you're supposed to have can leave you with necessary treatments denied, preventive measures neglected, and copayments that take everything you own -- putting you in a position where you might as well have simply left yourself uninsured, for all the good it did.  Between the countless case stories of ripped-off insurance customers, and the testimony of insurance industry insiders, the case that the system has become an abusive racket is now very difficult to deny.

Of course, many do deny it, especially those who are paid to.  And in order to do that, they often end up insisting that ours is the best health care system that has ever been, that nobody could do better... and that all those countries that have socialized their medical systems are leaving their people worse off rather than better.  Some of the assertions made by those advocating for the continuation of the system we've got are outrageous slanders.  These tales told about other countries, in fact, become the organizing framework for the largest section of the film -- the part where he travels to Canada, Britain, and France, and attempts to "verify" these complaints, only to be "astonished" when he finds them to be untrue.

Unfortunately, this leads directly to the film's greatest weakness: that in defending socialized medicine, he wanders a bit into defending socialism in general, which finally concludes in what looks like some definite whitewashing of the situation in Cuba.  This leaves him wide open for red-baiting.  Of course, it probably wouldn't help much if he avoided this... red-baiters don't need justification.  I am certainly no socialist myself, I'm just a Democrat, and that doesn't stop people from telling me that my having marched against going to war with Iraq is irrefutable proof that I hate America and am a Marxist.  So, this also leads to the greatest weakness of criticisms against Moore.  With all the red-baiting and you-hate-America-ing, most of his critics end up far less credible than Moore himself is.  They're so partisan and prejudicial that in most cases, they could never begin to hold up to the same standards of debate that they demand Moore ought to meet.

Should Michael Moore attempt to be fair and present both sides of each question as honestly as possible?  Should we as an audience insist that he show the negatives to go with every positive, and the positives to go with every negative?  I really don't think that's necessary.  It's not a newscast, nobody is mistaking it for one, and when the discourse is dominated by a drumbeat of bought-and-paid-for misinformation on one side, I think it's quite salubrious to have an alternate viewpoint which contrasts so strongly that you know there has to be more to the story than you're being told elsewhere, even if you have doubts about the source.

And Michael Moore certainly does that, no matter how much you distrust him -- he comes up with incident after incident which, if our system is great as we're told it is, should never happen.  There is no "other side" that can make these crimes go away.

Besides, scrupulous even-handedness makes a boring movie.  Moore certainly knows how to keep controversy entertaining rather than grating.  And if you think that the appearance of even-handedness equates to reliable reporting, I recommend closer study of any typical newscast.

The question of how to pay for health care is a damned difficult one, because the hard truth that can't be escaped is that it costs a lot no matter how you pay for it, and every research advance that makes another condition treatable adds to the demand for care and the cost of meeting that demand.  (It doesn't help that in any industrialized economy, prices of services will rise over time relative to prices of manufactured goods.  Production costs constantly decrease, masking how high inflation is elsewhere.)  Some might say the best response is a competitive system, others that the best is to have a fair, regulated system.  It may well be that today we actually haven't got either: there is precious little sign in our health care market that any real competition of the sort that would push prices down is taking place.  Instead, our system seems to accomplish nothing but to add additional rakeoffs to our medical bills.  For instance, the fact that we allow perscription drug companies to advertise on TV nowadays adds fifteen percent to our medication costs without bringing us any real medical benefits.  Moore makes the case that the profits generated for insurance company stockholders are now amounting to nothing but another rakeoff, a theft from everyone who fears ill health, and that there would be nothing to lose if we eliminated it.  Outside of the film, in promotional appearances and so on, he argues that privatizing health insurance makes no more sense than privatizing fire departments.  They're both there for protection against emergencies -- emergencies that may primarily threaten individuals but secondarily may endanger whole communities.  A simple comparison of how much people in other countries pay for their health care, and how much sickness they have, makes such an assertion hard to dispute on any but ideological grounds.

Sicko is recommended no matter what side of the issue, if any, you're on.  You may find it invigorating or infuriating, but in neither case will it leave you complacent about things as they stand.

The DVD:

When I saw the claim "over 80 minutes of additional material", I was excited.  Maybe there's a three hour version of Sicko that he could have made but didn't.  Alas, that's not how it is: the bonus material is more like that you'd find on a conventional feature film DVD.  For instance, there's promotional-tour footage (in this case, featuring unions and activists and congressmen pushing their favored remedy legislation), a music-video of the theme song, etc.  There are also extended versions of several interviews that the movie included highlights of, and a couple of postscript addenda made afterwards, such as a piece about a certain European country which is even more of a socialist paradise than France is.  There are only a few true deleted segments: one about a priest in a poor town in Texas where nobody has any insurance, an interview with a Cuban nun, a bit where Mike acts incredulous that General Electric in France provides health coverage they don't give employees in America... the one piece that might have really contributed to the movie is a segment about those who try to pay their medical bills by community fundraising.  It follows the story of one lady who was hit with a $12,000 bill that she couldn't pay; the hospital said that because she was poor they'd give her a discount to $6,000.  She rallies her friends and does fundraising and finally gets the $6,000 together... only to have the hospital tell her that since she is "able to raise funds", they now demand the whole $12,000.

The added interview material is rather interesting... it features people like Marcia Angell M.D. (author of The Truth About Drug Companies) and Harvard law professor Elizabeth Warren.  It also features quite a bit of footage of prominent foreign lefties like Tony Benn in England and Aleida Guevara M.D. (daughter of Ché).  Benn makes the key point that if you're worried about socialism leading to tyranny, the answer is to root it in democracy.  Guevara, when asked about whether Cuba is free, gives a convoluted answer but does make one salient point: free speech in America isn't worth that much if nobody listens to you.  So the unifying theme of all these socialists and French people and so on is that the key way their governments differ from ours is not a matter of left wing ideology, but of responsiveness -- a simple question of whether the institutions do or do not pay attention to the needs of the people they serve.