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Sticking to his tried-and-true one-man approach, Michael Moore's new documentary sets out to investigate the American healthcare system.
Michael Moore, 30th October 07
"If you want to stay healthy in America, don't get sick."
Review by the Guardian: A State of Ill Health, by Ed Pilkington
This is a public health warning. If you are the chief executive of the Humana or Aetna health insurance companies, if you are a medical lobbyist on Capitol Hill, oh, and if you are Hillary Clinton, you have just two more weeks of normal life left.
Michael Moore is coming to get you. Flush from the hurricane of devastation that the film-maker wrought on General Motors (Roger and Me), the gun lobby (Bowling for Columbine) and the Bush administration (Fahrenheit 9/11), his next target is the American health service, or what passes for one. Sicko will blast its way across the United States on June 29. Judging from the reception it received at Cannes last month, it promises to be explosive.
The movie displays the by now familiar Michael Moore technique: take one double-barrelled shotgun; load one barrel with humour, the other with outrage; point at target; pull trigger.
Conceived in four acts, it begins with the cautionary tales of American patients. There is the woman who was knocked unconscious in a car crash and was sent a bill after her casualty treatment because the ambulance that carried her had not been "pre-approved". The mother whose daughter was turned away by the nearest hospital and died. The uninsured man who lost two fingers in an accident and was offered the choice of reattaching his ring finger for $12,000 or middle finger for $60,000. (He went for the cheaper option.) The accusation could not be plainer: in America, where there is no such thing as the NHS, only the rich get good healthcare.
In the other three acts, Moore exposes the iniquitous role of healthcare lobbyists who outnumber members of Congress by four to one, and looks at how the richest country in the world has slipped to 37th in the world league of healthcare providers.
Cuba that sets the scene for the final and most controversial segment of the movie. In a passage that has already earned the film-maker threats of legal action from the US government, and accusations of naivety and bias from his detractors, he takes a group of patients with respiratory problems contracted during the perilous cleanup in the wake of 9/11 to Cuba for treatment, to underline the gross inadequacies of their own system that has failed them.
Britain makes an appearance too, in the form of the National Health Service - which comes out of Sicko smelling of roses. The film's release in the UK later in the summer may come as a reminder to the British that, despite the faults of the NHS, the provision of free healthcare is something to be fought for. And perhaps a warning against the creeping privatisation of the health service, too.
Moore's stated aim behind Sicko is to "ignite a fire for free, universal health care". Nearly 47 million Americans - including 9 million children - have no health insurance. That condemns many Americans who fall ill to the choice of either foregoing treatment or going bankrupt. As Ron Pollack, director of the national body for healthcare consumers, Families USA, points out: "Our system is by far the most expensive in the world, and yet millions of people are left behind. That's not a healthcare system anyone should emulate."
Even families who do have insurance often find that when they need to make use of their policies they are hit by thousands of dollars of hidden medical costs which they must pay for themselves.
The twin problems of lack of or underinsurance are rapidly getting worse. According to the National Coalition on Health Care, the average costs of medical insurance have doubled in the past seven years. The cost of cover for a family of four is now $12,000 (£6,000) a year.
As a result, each year an extra 1.5 million people are going uninsured because they cannot afford the premiums. Employers, too, are beginning to cut back on the insurance that many provide because of the rapidly increasing drain on their bottom line.
Consensus is growing that this is a system in crisis that needs fixing now. Key political figures at both local and federal level are starting seriously to engage with the idea of reform. Massachusetts and California have made unilateral moves to introduce health cover for all their citizens. At national level, several presidential candidates have embraced health reform, even on the Republican side, where both John McCain and Rudy Giuliani are toying with tax credits as a way of extending health cover. Among the Democrats, Barack Obama and John Edwards have developed their own proposals for universal coverage through employment-related schemes.
Hillary Clinton is a more complicated case. She has promised to bring forward her own plan later in the summer, though she has been understandably cautious, bearing in mind the catastrophe that befell her when she tried to push through healthcare reform as First Lady in the 1990s. Moore gives a more uncharitable interpretation of her position, pointing to the fact that she is now a big recipient of donations from the same healthcare industry that stymied her earlier attempts to change it.
Time will tell whether these winds of change will come to anything, or fade away as they have so often in the past. Whatever happens, it will come too late for the individuals we profile here. Each has come unstuck simply because they fell ill in America. The lesson is clear. There is a human cost involved when the first question asked as you enter the hospital is not "How can we help you?" but "Who is going to pay?"
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