MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

MELISSA BLOCK, host:

And I'm Melissa Block.

Filmmaker Michael Moore has made a career of playing David to institutional Goliaths. He's taken on General Motors, the National Rifle Association and the Bush administration in his documentaries. And now, in the film titled "Sicko," he's going after America's healthcare industry, especially insurance and drug companies.

(Soundbite of documentary "Sicko")

Mr. MICHAEL MOORE (Director): Four health care lobbyists for every member of Congress. Here's what it costs to buy this man and this woman. This guy. And this guy. And the United States slipped to 37th in healthcare around the world, just slightly ahead of Slovenia.

BLOCK: Michael Moore's films have been popular and critical successes. But perhaps because he's attacking powerful interest groups, they're nearly always challenged as misleading. We're going to talk about "Sicko" now, first on the level of entertainment with our film critic, Bob Mondello. Hi, Bob.

BOB MONDELLO: It's good to be here.

BLOCK: And we're also going to truth squad some of the claims Michael Moore makes with our science correspondent, Joanne Silberner, who covers the health industry for NPR. Joanne, welcome.

JOANNE SILBERNER: Thank you.

BLOCK: And let's start on the level of entertainment. Bob, I saw this movie the other night, and Michael Moore does what he does quite well - which is mix tragedy and comedy back-to-back.

MONDELLO: Yeah. He really does. At the very beginning, he starts out with a whole bunch of horror stories, and they're just - they're absolutely grim. And you look at people who are deprived of various forms of care because they simply can't afford it. And he does a lot of very clever things about making the reasons for this funny. I mean, for instance, he uses the Star Wars theme, and he has the - all of the various reasons you can be denied coverage by your insurance company, rolling away and it's thousands...

BLOCK: Vanishing into the universe.

MONDELLO: Exactly. And then he starts suggesting that there are other places where this works better. For instance, he says in Canada and in Britain and in France and even - and this is the, sort of, shocking one - in Cuba. And as he shows you this various other systems, you sort of are marveling at it. I think it's a very persuasively put-together picture of the health care problem, which is - always struck me as something so complicated that I can't get my head around it. And it's also very, very funny.

BLOCK: I wonder - and Joanne, jump in here, too, if you have some thoughts - if there is a moment in this movie that you thought worked especially well. Bob?

MONDELLO: The sequence where he goes to Britain. And he talks to the people there 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 question. They have almost literally never thought of money and medicine in the same breath.

(Soundbite of documentary "Sicko")

Mr. MOORE: What do they charge you for that (unintelligible)?

Unidentified Man: Everything's on NHS. And you don't...

Unidentified Woman: This is NHS. No, You don't.

Unidentified Man: It's not America.

BLOCK: Joanne, what about you? You cover this industry all the time. Was there any point in this movie that made you think about this question in a different way?

SILBERNER: Yeah. It was, at one point when Michael Moore said, who are we? Are we people who know what's going on, who know that our neighbors are suffering? Or are we people who don't know? And that's why things aren't changing. It's really an important question. Why is this happening? Who are we?

BLOCK: Who are we as a country.

SILBERNER: Yeah.

BLOCK: Let's talk about some of the medical cases, Joanne, that Michael Moore describes in this film, and one, at the very beginning, is about a man who loses the ends of two of his fingers in an accident with an electric saw and he did not have insurance. Let's take a listen.

(Soundbite of documentary "Sicko")

Mr. MOORE: The hospital gave him a choice. Reattach the middle finger for $60,000 or do the ring finger for $12,000. Being a hopeless romantic, Rick(ph) chose the ring finger for the bargain price of 12 grand. The top of his middle finger now enjoys its new home in an Oregon landfill.

BLOCK: And, Joanne, how can this happen? How can a man be put in the position of making that choice?

SILBERNER: Well, the hospital doesn't have to give him care unless it's life-saving care. And his life wasn't threatened by the loss of the two digits. So the hospital was in its rights to say, we can reattach your two digits, but it's going to cost you.

The irony here is that if he had insurance, the insurance company would have paid far less than $12,000 or $60,000. The insurers negotiate rates with the hospitals that individuals can't. He would have been stuck with the whole bill unsubsidized, which is, obviously, a lot more difficult to pay.

BLOCK: And the insurance companies would have gotten something cheaper?

SILBERNER: They would have gotten a much better deal.

BLOCK: There are also a number of times in the movie where we hear from people who either work or used to work inside the system, either turning down applicants for insurance, denying claims.

SILBERNER: He had an insurance company employee in there who started crying when she described what she had to do in terms of talking with people who called in. And he also included tape from a congressional session in which Linda Peeno, who is a medical director at insurance giant Humana - she made a remarkable confession.

(Soundbite of documentary "Sicko")

Dr. LINDA PEENO (Medical Director, Humana): I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this because, in fact, what I did was, I saved the company a half a million dollars.

BLOCK: Linda Peeno goes on to say, the mantra there was, we're not denying care, we're denying payment.

SILBERNER: Which is, in effect, denying care when you're otherwise hitting people with bills they can't pay.

BLOCK: Joanne, Bob mentioned this earlier that Michael Moore contrasts the U.S. system with the system in Britain and France and Cuba where the care is free. And he claims there is no waiting; you can choose your own doctor. In France, there are doctors who buzz around, making house calls in the middle of the night. How accurate are those claims, really?

SILBERNER: I think some of those things are things that we 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 and maybe even do your laundry.

BLOCK: Make you soup.

SILBERNER: Make you soup. Do your laundry. That's not going to go over well in this country.

BLOCK: But what about the notion that you don't have to wait? There are no long lines, that that's a myth?

SILBERNER: Well, he didn't look to the other side for that. Lines have come and gone. What happens is they get near to crisis situations where there are lines - and this has happened in Canada too. And then the government, under pressure, puts more money and the lines go away, but they come and go.

One thing that did bother me a little bit, though, was in bringing up Cuba as this paragon of health care, and bringing the 9/11 workers who couldn't get care in this country. There, he 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: Although, on the other hand, that is not necessarily something that we should be terribly proud of.

BLOCK: What Michael Moore is advocating for in this movie is eliminate the insurance companies entirely. Go to a single-payer, government-funded system. This is not what most of the mainstream really - any of the mainstream presidential candidates this year are talking about when they're talking about healthcare reform.

SILBERNER: No, they're talking about various packages that would make insurance more affordable, give a little more government assistance in some cases.

MONDELLO: I think one of the things that these documentaries can do - I mean, we've had a lot of pictures recently about Iraq. We had, of course, "An Inconvenient Truth" last year about climate change. And it's not going to change policy. I don't think that politicians are going to change what they're doing about it right away. But it certainly does change the debate.

BLOCK: There is the question, then, of Michael Moore's own character as this, sort of, agent provocateur. Does he help or does he hinder his own cause?

MONDELLO: Well, you either love him or hate him, don't you? I mean, there - at some point, you know, he keeps himself out of the picture for the first 15, 20 minutes, and part of the reason is that he is such a polarizing figure that he wants to get some anecdotal evidence out there before you see him so that you're not arguing with him from the very beginning.

SILBERNER: I'd like to see how it plays, though, to people who don't like Michael Moore to begin with. A lot of them won't go see the movie. And I'd be interested to see how convincing it is for people who disagree with him or have problems with him, you know. Whether they'll go to see it and whether that will make them change.

BLOCK: Joanne Silberner and Bob Mondello, thanks to you both for coming in to talk about the new Michael Moore film "Sicko."

MONDELLO: It's a pleasure.

SILBERNER: Thank you.

BLOCK: You can see a clip from Michael Moore's film and get a by-the-numbers comparison about how the US health care system ranks with other countries at out website, npr.org.

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