So I took in Michael Moore's latest on Saturday evening. Some of the criticism the movie is receiving is deserved, and some of it is not. Please be warned that the following will contain some "spoilers" inasmuch as that concept applies to a documentary (hint: there is no universal healthcare by the end of the film)
Before I talk about the specifics, it's confession time. For 3.5 years prior to my graduate career, I was a manager at a collection agency that dealt solely with medical accounts. Nothing in Sicko shocked me. A casual viewer might be tempted (especially a casual Rush Limbaugh-loving viewer) to treat Moore's anecdotal evidence as mere anomalies in an otherwise functional system. I cannot stress enough how false that assumption is. We did not deal with uninsured people (neither does Sicko). What we did was simple. Joe has Insurance. Joe gets in a car wreck and needs $18,000 in surgery, ER, and rehab. Insurance investigators locate a technicality that allows them to retroactively void what Joe thought was a legally binding contract. Hospital returns money to Insurer, refers Joe's account to Collectors. Collectors take Joe's assets – liquid or extremely un-liquid (read: house, car, etc) to pay bill.
As you can imagine, this job did not make me feel particularly good. I graduated college with a lot of debt and I needed to make some money. Real money. It paid very well (as you might imagine, it is hard to get people to do such a job for very long). I do not, as the PI Moore interviews in the film stated, believe that bad-mouthing the system atones for my participation in it. Nor do my excuses excuse it. I'll probably be guilty about some of the things I saw for the rest of my life. Truthfully, I try not to think about a lot of it.
I digress. My point is that the tragedies Moore discusses – even though he certainly cherry-picked the available anecdotal evidence to find shocking and/or ludicrous examples – happen all the damn time. Every day. My personal experience is that the entire health insurance industry would like nothing more than to reject every claim they have ever been asked to pay, and there is no depth to which they will not stoop to avoid paying whatever they can feasibly avoid.
The criticisms of the film are, broadly speaking, as follows:
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And they sure as hell wouldn't be shuttled into a lobby and forced to wait for hours. So the Cuban healthcare system did in fact put on a show for the cameras. That's an unavoidable consequence of recording anything: the mere act of observing something fundamentally changes it.
I mean the system as described by Gingrich/Frist/et al sounds like something that only slaves and peasants would have to endure. Yet Canadian single-payer and the British NHS both enjoy almost unanimous, thoroughly bipartisan support (Stephen Harper is a supporter, albeit he proposes more provincial discretion). Britain has privatized 50 different industries since the fall of Labor in the 1970s. If people hated the NHS, it would have been the 51st. But Thatcher didn't dare touch it.
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Why not?
The crux of the film, in my opinion, addresses the American psyche moreso than the healthcare system. Why are we the only industrialized nation that lacks universal care? When we see Haves and Have-Nots, why is our reaction "the American dream" of succeeding and making sure we end up as a Have? Why do we accept massive amounts of bureaucratic interdiction in healthcare decisions (HMOs, mandatory pre-approval of services, denial of benefits) so long as those bureaucrats wear Aetna name tags rather than Government ones? Why do we believe that paying for something means we are exercising choice? Why do we bristle at the government telling us which doctor to see but call it a "free market" system when Blue Cross does so?
As I constantly remind my students, the fact that we have elections is not prima facie evidence that we have Democracy and Freedom and all that other happy horseshit. They had elections in the Soviet Union, after all. Likewise, the fact that we as Americans pay out the collective ass for the services of private healthcare providers does not mean that our system is, in even the loosest sense of the term, a "free market" solution.
Isn't that the grand dilemma in post-industrial America? We're so goddamn Free. And with that magnificent freedom – freedom from the government controlling our lives – we've chosen to privatize everything that wasn't bolted to the floor so that a handful of corporations can control our lives. We are a nation-sized insane asylum in which we, the inmates, are ready to fight to the death to protect our right to have a healthcare system we can't afford.
Peggy says:
Excellent. I saw the film earlier today, in fact, so imagine my joy upon seeing this posted! Hurrah!
When we see Haves and Have-Nots, why is our reaction "the American dream" of succeeding and making sure we end up as a Have?
I definitely wish he had spent more time on this. Tony Benn was brilliant in his segments, and there's Moore's bit at the end, but that's the thing, isn't it? Absolutely the crux.
Somewhere else I was reading something to the effect that "In the US, we live well not *while* other people live in terrible conditions and extreme poverty, but *because* of that." I think it's possible that in some way, we realize that (much as we deny it to ourselves), and that is what makes us fear having the "freedom" to "choose" taken away from us (becuase doesn't a lack of choices automatically make us Have-Nots? Never mind that we were never Haves anyway, and half of our "choices" were totally illusory).
I also wished he'd spend a little more time on the education/childcare aspects–how that stuff plays in is important. While I was watching the young woman from the insurance co phone center cry, I was thinking: she had that job because she needed to pay off student loans. There is no other explanation.
None of the stuff I saw was particularly surprising, because I've been reading those first-hand accounts on the LJ Poor Skills community (many, many of whom are there because of their medical bills); every bit of it was still painful, though.
What a fucked-up country. I left the movie feeling glad I'd seen it, but also pretty helpless and saddened. What a fucked-up country we live in.
William K. Wolfrum says:
Good stuff Ed. Haven't seen the film yet.
One thing:
"The VA scandal proves only that a woefully-underfunded program will provide substandard care. Stunning, really."
Walter Reed had its support staff privatized. To say the government provided substandard care ignores that.
Nonetheless, good stuff, and I agree with you about Cuba and wonder why its supporters never blink an eye when quoting Cuban stats.
–WKW
Ed says:
Good catch. I didn't realize that they were farming out VA work, although I must say it comes as almost no surprise.
Batocchio says:
I saw Sicko on Saturday as well, and had a similar reaction. Moore raises serious issues in an informative and often entertaining way. His critics don't even want to have the discussion, and are trying to shut him down. Sicko is meant to start talking (and it did in the theater I was in), not to be the last word on the issue.
peggy says:
Batocchio, word. As I was coming out of the theater, I was behind a middle-aged woman and another woman, almost certainly her mother. The older woman ("Mom") was saying, "But they have to wait! They have to wait THREE MONTHS! That's what [name] said! In Canada, they do!"
Daughter responded with, "But that wasn't an emergency, Mom," and "But at least they're treating everyone!"
To which Older Man ("Dad"?) replied, "That's the problem. They just treat *anybody* up there."
Wait… that's the *problem*???