He's nailed the diagnosis, but I'm not sure he's got the right prescription...

So I did a bit of a naughty thing a couple of evenings ago, and watched a pirated copy of Sicko off the Internet instead of waiting for its premiere in theaters today.

A couple of my earlier posts and comments should have clued you into the fact that I went into this viewing a bit skeptical as to how Michael Moore would portray the health care crisis here in the United States. As a whole, though, I thought it was a pretty good movie. He makes a solid argument that the health care system in America is so inherently broken that, in comparison, medical care in Canada, the United Kingdom, France, and even Cuba looks downright Utopian. Unfortunately, in painting such a rosy picture of medical services and its universal access in other countries, I was left still wondering if I had been manipulated. I can't say he lied about anything, but am I getting the whole picture? I mean, you've always got to be just a wee bit skeptical when you can't find anyone that's not completely in love with how your government does things. There's always at least a handful of people that like to complain about something, right?

One would expect that in countries where there's no bills to pay, no cashiers at the hospital to collect your money, and cheap medications, people would be burdened by higher taxation. Whether or not they truly are, however, was kind of glossed over from my perspective. Instead, Michael Moore cleverly shows an "average" French family living a comfortable life in a comfortable house able to afford the comfortable number of two cars, and all the while enjoying the comfortable benefits of free health care, cheap daycare, 35 hour work weeks, and lots of holiday time. And as if this wasn't enough, they get free physician house calls, too (which obviously would never work in our litigious American society). Do they worry about taxes? Didn't seem like it--I'll give him that. But I'd also argue that this has become the lifestyle expectation in France, and perhaps something the "average" American would not tolerate easily. Could you really imagine turning over more than a third of your pay for income taxes AND paying an additional 20% in sales tax on most products you buy in the store? You'd have rioting in the streets, and not the peaceful protest marches Moore shows in France.

Should physicians under universal health care worry about being underpaid? Well, a general practitioner in the UK makes roughly $170K, according to an "average" physician Michael Moore interviews in a London hospital. And that's a pretty comfortable living for him, his wife, and their baby. Why? Well, because he can still drive a new Audi and living in a $1 million home on that salary. Sounded pretty good until I did the math. If he's making only $170K and having to payoff such a high mortgage and the car payment for a nice German luxury car, what does he really have left over at the end of the day? Doesn't seem so comfortable to me, after all. And as far as Canadian physicians? Moore never tells you that they get substantially less salary than American ones do, which is probably why you see a large number of Canuck doctors crossing over the border to work in the U.S.

What about cheaper drugs? The last segment of the film has Moore taking a group of 9/11 volunteer workers with chronic medical problems to Cuba in hopes of getting them medical care that they were denied in the United States. In Havana, they visit a local pharmacy where an inhaled medication that costs $120 in the U.S. ended up being only five cents in Cuba. Five cents! This brought the woman who needed this medication to tears. That just about made me want to cry, too. But then I wondered, how could it possibly be only five cents? I can't even get a can of Coke for that cheap. So who's flipping the bill? A similar story happens in the United Kingdom where the National Health Service issues a flat rate of around $12 for any medication prescription, whether it's 120 pills of anti hypertensives or 60 pills of aspirin. Well, in the case of Cuba, five cents might sound like chump change to us, but remember that an average Cuban probably only makes somewhere in the ballpark of $15/month. As far as the U.K.? Well, the government negotiates wholesale prices from the drug companies and allows the NHS to essentially subsidize the medications costs for the general public. That's all well and good, but if the U.S. did the same, I'm wondering if the negotiated costs would go up globally to increase the profit margin, since they're not making the money from the American market. After all, pharmaceutical companies rely on profits to invest in research and development. Take away the profits, and making drugs becomes a losing endeavour when you think about the money lost in the research of failed medications that never come to market.

Well, but what about the story of a cancer patient that can't get coverage for his chemotherapy because it was deemed "experimental" by his insurance company? A sad case, but Moore never really tells us whether such treatment would have been covered in his other Utopian systems. Part of the reason that France can afford to provide universal health care is because there's a strict system of what is standard of care and what is not. An "experimental" therapy might not be covered in their system either, which is why a significant number of the French actually buy supplemental health care to cover such things that fall out of the guidelines of the governmental system.

And as far as a governmental single-payer system being the savior of the U.S. health care crisis, all I can say is we already have examples of such methods in this country in the form of Medicare and the Veteran's Affairs Hospitals, neither of which inspires confidence to me that this is the answer.

Anywho, my purpose here is not to poo-poo all over Sicko. I think Michael Moore has put together a powerful movie that really does pull viewers into the emotions and pain that many Americans must endure as they try and navigate through a medical system that doesn't seem to care. I'm not sure he's convinced me that a single-payer system is the answer, but he certainly makes the case that we can't continue to be so indifferent about our current way of doing things. Perhaps the best idea he puts forth is this notion that this country needs to become more "we" than "me." Ultimately, I think Michael Moore has nothing but the best intentions with all of his movies, and truly is trying to make us think with a more "we" attitude. But unfortunately, because of his divisive reputation, this movie may not be the catalyst to get there no matter how good it is.

*** (out of *****)