Moore's tactics are as provocative as always — a trip to Guantanamo, for instance, to demand that three ailing Ground Zero rescue workers get the same free health care the U.S. government affords suspected terrorists. There's plenty of grandstanding, most of it very funny. And in this instance, all that sizzle is selling the steak.
Michael Moore's new movie Sicko details problems in the U.S. health care system. At one point, he asks, plaintively, "Who are we?" He's asking how is it that Americans, as a people, are supporting the current system.
NPR's Madeleine Brand interviews Michael Moore before a premiere of Sicko on Skid Row in Los Angeles, a notorious location for so-called "patient dumping" by local hospitals. Moore says he believes his movie will motivate Americans to fix the health-care system.
Director Michael Moore has found critical and popular success with documentaries that blend comedy and pathos to attack powerful interest groups. But those films are nearly always challenged as misleading. His latest work, Sicko, is an indictment of the U.S. health care system, highlighting insurance horror stories and profiling countries with universal health care.
Melissa Block sizes up Sicko — as entertainment and expose — with film critic Bob Mondello and science correspondent Joanne Silberner, who covers the health industry for NPR.
Melissa Block: Michael Moore does what he does quite well, which is to mix tragedy and comedy, back to back.
BOB MONDELLO: At the very beginning, he starts out with a whole bunch of horror stories; they're absolutely grim, and you look at people who are deprived of care because they can't afford it. And he does a lot of clever things to make the reasons for this funny. For instance, he uses the Star Wars theme, and he shows all of the various reasons you can be denied coverage by your insurance company, rolling away on the screen — it's thousands of them. Then Moore starts suggesting that there are other places where health care works better, for instance, Canada, Britain and France, and even — this is the shocking one — Cuba. As he shows other systems, I think it is a very persuasively put-together picture of the health care problem, and it's also very, very funny.
I wonder if there is a moment in this movie that you thought worked especially well?
MONDELLO: The sequence when he goes to Britain. He talks to the people at the National Health Service hospital about the cost of the care they're getting. And you can see that as soon as he mentions money, their brows furrow, and they can't get their head around the questions. They have almost literally never thought about money and medicine in the same breath. I think that is so telling, because I know when I go to a doctor or to a hospital, it is almost the first thing I'm thinking of — "Oh my God, how much is this going to cost?"
Let's talk about some of the medical cases Michael Moore describes in this film. At the very beginning, there is one about an American man who loses the ends of two of his fingers in an accident with an electric saw. He did not have insurance. The man must choose between having his middle finger reattached for $60,000, or his ring finger for $12,000. The man chooses his ring finger. How can a man be put into the position of making that choice?
JOANNE SILBERNER: [In the U.S.,] the hospital doesn't have to give him care unless it's lifesaving care, and his life wasn't threatened by the loss of two digits. So the hospital was within its rights to say, "We can reattach your two digits, but it's going to cost you." The irony is that if he had insurance, the insurance company would have paid far less than $12,000 or $60,000. The insurers can negotiate rates with hospitals that individuals can't.
There are also a number of times in the movie where we hear from people who either work or used to work inside the health care system, either turning down applicants for insurance, denying claims...
SILBERNER: He had an insurance company employee who started crying when she described what she had to do in terms of talking with people who called in.
Moore contrasts the U.S. system with the systems in France, Britain and Cuba, where care is free. He claims there's no waiting, and you can choose your own doctor. And in France, he says, there are doctors who make house calls in the middle of the night. How accurate are those claims?
SILBERNER: I think some of the things that those countries are willing to pay for are things that we Americans would not be willing to pay for. There was also the remarkable revelation that in France, when you're a new mother, a government employee will come to your house and maybe even do your laundry and make you soup. That's not going to go over well in this country.
What about the notion that long lines for health care in other countries are a myth?
SILBERNER: Moore didn't really look at the other side of that. What happens in each of these countries is that they get near to crisis situations, where there are lines — this has happened in Canada, too. And then the government, under pressure, puts more money into the system, and the lines go away. But then they come back. It's a cyclical thing; those lines come and go.
One thing did bother me with presenting Cuba as a paragon of health care, while showing the 9/11 workers who couldn't get care in this country: Moore didn't point out that, on that famous chart where the U.S. comes out 37th in health care, Cuba comes out 39th. So I'm not sure that was the best comparison for him to make.
MONDELLO: On the other hand, that is not necessarily something we should be terribly proud of — being 37th in a chart where France is No. 1.
One of the things he does that's very clever is to try to destroy the myth that socialized medicine is so terrifying. When you see what is probably the most impressive hospital I've ever seen, in Cuba, and it looks like a gigantic Hyatt hotel, it's simply not what you were picturing. We were joking when we came out of the film that it was probably the only MRI machine in all of Cuba, and it may very well have been. But the fact of the matter is that it was there and it was able to help a patient. The rooms there did not look decrepit and old, which is kind of what I expected.
SILBERNER: I think there's an issue of expectations. What do the Cubans expect? What do the French expect? What do the British expect? We expect to be able to get drugs like a recently approved drug for cancer that adds 13 days to life at a cost of $4,000 a month. I don't think people would expect that in France or Germany or Cuba. Thirteen days of added life with some side effects for $4,000 a month? We want it, and they don't. When we stop wanting things like that, I think we can move ahead.
In this movie, Moore advocates eliminating insurance companies entirely and going to a single-payer, government-funded system. This is not what any of the mainstream candidates this year are talking about.
SILBERNER: No, they're talking about various packages that would make insurance more affordable, give a little more government assistance, and in some cases, create a bit more regulation. They are talking about incremental changes, and this comes from the experience of '93 and '94, when attempts to change the system got nothing changed.
MONDELLO: We've had a lot of pictures recently about Iraq, and we had An Inconvenient Truth last year about climate change. These movies are not going to change policy. But it certainly does change the debate. If you think about the way the administration talked about climate change prior to An Inconvenient Truth, and the way it's talking about it now, I think it's clear that there was a major shift. I'm not sure if the movie is responsible for that, but certainly it changed the way the media dealt with it. It was a very persuasive case. And I think this will be a very persuasive case for a lot of people, too.
This transcript has been edited for length and clarity and may include portions of the conversation not broadcast on NPR.
hide captionThe United States spends more of its gross domestic product on heath care than any other country. The WHO came up with these estimates in 1997, showing that the U.S. spends more than twice as much of its GDP on health care compared with the United Kingdom, with Cuba and France in the middle. Most of the medical costs in the U.K, Cuba and France are paid by the government, respectively 97 percent, 87 percent, and 77 percent. In the U.S., government spending accounts for 44 percent of the nation's health care bill, with most of that going to Medicare and Medicaid.
Lindsay Mangum, NPR
The United States spends more of its gross domestic product on heath care than any other country. The WHO came up with these estimates in 1997, showing that the U.S. spends more than twice as much of its GDP on health care compared with the United Kingdom, with Cuba and France in the middle. Most of the medical costs in the U.K, Cuba and France are paid by the government, respectively 97 percent, 87 percent, and 77 percent. In the U.S., government spending accounts for 44 percent of the nation's health care bill, with most of that going to Medicare and Medicaid.
Lindsay Mangum, NPR
hide captionA WHO survey ranked the health care systems of 191 countries, based on factors such as the health of the general population, patient satisfaction and equality of access. France ranked first overall, the United States placed 37th, and Nigeria was near the end of the list at 187.
Lindsay Mangum, NPR
Michael Moore's new movie Sicko details problems in the U.S. health care system. (Hear NPR's Joanne Silberner and Bob Mondello discuss the film.) At one point, Moore asks, plaintively, "Who are we?" He's asking how is it that Americans, as a people, are supporting the current system.
Here, some statistics on who we are:
Snapshot of America's Uninsured
Moore starts the movie with the stories of two people who don't have health insurance. They're not alone:
— Nearly 47 million Americans, or 16 percent of the population, were without health insurance at some point in 2005.
— The number of uninsured rose 1.3 million between 2004 and 2005 and has increased by almost 7 million people since 2000.
— In 2005, nearly 15 percent of employees had no employer-sponsored health coverage available to them, either through their own job or through a family member.
— Young adults (18 to 24 years old) remained the least likely of any age group to have health insurance in 2005 – 30.6 percent of this group did not have health insurance.
— Nearly 40 percent of the uninsured population reside in households that earn $50,000 or more. A growing number of middle-income families cannot afford health insurance payments even when coverage is offered by their employers.
Source: National Coalition Health Care
Snapshot of America's Insured
Sicko focuses on people who do have insurance, but insurance that doesn't serve them well. Statistics show that health insurance is becoming more expensive and fewer insurers are offering it.
— Fewer employers are offering coverage to workers, down from 69 percent of employers in 2000 to 60 percent in 2005. The drop stems almost entirely from fewer small businesses offering health benefits.
— Insurance premiums increased an average of 9.2 percent in 2005.
— Annual premiums for family coverage reached $10,880 in 2005, eclipsing the gross earnings for a full-time minimum-wage worker ($10,712).
— 61 percent of all employees with health coverage in 2005 were enrolled in a PPO (up from 55 percent in 2004). Enrollment in HMOs, which generally cost less than PPOs, fell to 21 percent of people with insurance in 2005.
The survey looked at the health care systems of 191 countries based on factors such as the general level of population health, patient satisfaction, equality of access, and health care financing.
And while the U.S. health system spends a higher portion of its gross domestic product than any other country, it ranked 37. The United Kingdom, which spends just 6 percent of GDP on health services, ranked 18. France ranked first. And Cuba, which Moore describes as a great place to get health care, ranked 39.
— A key recommendation from the report is for countries to extend health insurance to as large a percentage of the population as possible, whether in the form of insurance or taxes.
— The United States ranked highest on patient satisfaction, followed by Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden.
— On the consumer affordability of health care, Colombia ranked No. 1, followed by Luxembourg, Belgium, Djibouti, Denmark, Ireland, Germany, Norway, Japan and Finland. The United States ranked 54.