The Doctor Is In
Leading up to the Oscars on Feb. 24, we will be highlighting the nominated films that have appeared in the magazine or on the Website in the last year. Howard Feinstein interviewed Sicko director Michael Moore for our Web Exclusives section of the Website. Sicko is nominated for Best Feature Documentary.
Timely is the release of Michael Moore’s long-gestating Sicko, an exposé of the U.S. health insurance industry, especially its efforts to withhold benefits to subscribers. Americans rank health insurance as their number two concern after the war in Iraq. Democratic presidential candidates are whipping up health care plans; so far all rely on the private carriers that Moore skewers. (He does a good job of pillorying Hillary, who shifted from advocacy to partnership with the big companies.)
Some of the best bits are the archival material chronicling the momentum toward HMOs, which outline the conflict of interest between politicos and pharmaceutical firms and HMOs, and testimony from whistleblowers like Dr. Linda Peeno, whom Humana employed to find loopholes to deny payment. Dr. Peeno is but a small piece of a pitiful, immoral systemic problem. We are the only industrialized western nation without universal care, and have a high infant mortality rate to boot. Moore, who believes health care should be in the hands of the people and not in the private sector, sticks to the topic of insured Americans, mostly middle-class. He claims the 50,000,000 uninsured would be another film.
Moore’s gimmicks come off calculated, perhaps the result of collaborating with hands-on producers. The Dick-and-Jane-like voiceovers accompanying examples of individuals being absurdly screwed by the system feels imposed for cuteness, as does the Star Wars-ian scrolling of the litany of preexisting conditions that eliminate an applicant’s eligibility for coverage. What is most troubling is the presentation, for purposes of comparison, of health care in four other countries: the U.K., France, Cuba, and Canada. Granted, in each case every citizen is entitled to free treatment, and longevity in all these places is higher than in the U.S. Yet Moore glosses over kinks in their systems, so much so that for some it undermines his valid arguments about the state of affairs here. Many fed-up Brits choose the private sector, Canadians often come to the U.S. for surgery, and as for Cuba’s pharmacies being well-stocked, that is a myth that I can personally attest to (unless you are a member of the elite or a diplomat). Prescriptions si, medicine no. And though he should be saluted for paying attention to the Ground Zero rescuers who have been abandoned by our system even though they contracted horrid lung diseases on site, he knows full well that the government hounds anyone who goes to Cuba without official permission.
Nevertheless, Moore is passionate about the issue. Many of the insurance and pharmaceutical companies put up red flags to their employees warning them about Moore. With their grotesque profits and cynical attitude, they have good reason to be nervous. The Weinstein Company will open Sicko in limited release this weekend.
Filmmaker: Why did you leave out a lot of explanatory material, especially regarding the health care situation in other countries?
Moore: I’m making a movie. I’m not writing a book. I have a 90-120 minute time frame. I call it a rockin’ good way to tell a story that leaves no one bored and wanting more at the end of the movie.
Filmmaker: How many people helped you gather information?
Moore: I have five or six field producers, a couple of senior field producers. I have four researchers. I have four or five people in the archival department. And then I have four independent vetters who come in who are not on staff, not connected to the film. Then two sets of lawyers go through it, first my lawyers, then Harvey’s (Weinstein) lawyers. Then we hire an outside firm to go through it. Then the insurance company who insures it sends their lawyer to look at it. And we have some interns helping out.
Filmmaker: American doctors don’t come across so well.
Moore: They were opposed to Social Security. They opposed Medicare. That speech in the film that the AMA president is giving in ’62, he’s railing against Medicare. Doctors did not want free health care for the elderly. They fought Medicaid, they didn’t want it for the poor. Doctors have been on the wrong side of this issue for a long time. They supported HMOs at first. Remember that, doctors were behind managed care. They got convinced by the insurance companies that they were going to make more money. They didn’t realize that the insurance companies are a lot smarter than they are. The insurance companies made out like bandits. Doctors are going to be among the biggest supporters of this film because of how demoralized they are these days.
Filmmaker: Are you addressing a particular class of American viewer?
Moore: I state at the beginning of the film that it is not going to primarily deal with the poor, that I want to talk to middle-class Americans who think everything is hunky-dory here. And when I went to these other countries, I wanted to show people who make a similar amount of money. I’m trying to appeal to an American middle-class audience and show them middle-class families, middle-class doctors. The hospital I go to in London, Hammersmith Hospital, is not in the poor section, it’s not in Brixton, it’s in Hammersmith. I do that because I want the American audience to see themselves in this. So I go to London, Ontario, not, say, a bad section of Vancouver.
Filmmaker: Some feel your depiction of the Canadian system is too rosy.
Moore: I do have a rosy picture of it because I’m an American. I see that Canadians live three years longer than we do, that their babies don’t die as quickly as babies die in an American city. Canada made a decision a number of years ago that if you get sick, you have a right to see a doctor and not have to worry about paying for it. That’s a basic Canadian core value. What I’m saying is, we should aspire to that.
The studies that have been done about the Canadian health care system, the things that they do right, show that in an emergency like a man getting his fingers sawed off, they’re going to take care of you very quickly and very well. Other things, such as if you need a knee replacement, hip replacement, liposuction, stuff that is not life-threatening but would make your life nicer if you had better knees or whatever, that takes a little while longer.
The American right wing, the Republicans, and the insurance companies use Canada as the bogeyman. They never use France, by the way, because they know that the French system is near perfect in terms of its delivery and the way it works.
Filmmaker: How did you manage to get to Cuba?
Moore: We first approached the Bush Administration last October about wanting to go down there. They kept stalling and putting us off. Finally by last March, six months later, we decided, well, it’s legal for us to go down there as journalists, so that’s what we’re going to do.
Filmmaker: In the sequence when the 9/11 workers get to Cuba and the doctors there smile so pleasantly, did you consider that you might be making propaganda footage?
Moore: The whole purpose of the trip was to ask for the same medical care that we’re giving the Al-Qaeda detainees. It’s just an accident that it was in Guantanamo. As far as the health care that they received from the Cuban doctors, we asked for the same treatment that they would give the Cuban people. You see in the film they don’t have a private room. There are four to a room. All the health organizations around the world have documented this fact that the Cuban health care system is probably the best in the Third World.
Filmmaker: Do you see any solutions to our health care mess?
Moore: Well, one thing we really need to do is to get the money out of politics, I mean, we really need reform so that these pharmaceutical companies and health insurance companies can’t buy our Congress. If we took the money out, we’d have a better chance of getting the bills passed of the legislation we need to have free universal health care, not-for-profit health care.
Filmmaker: Why do the French and British systems, with higher taxes, work better than ours?
Moore: They pay their taxes, and Americans don’t want to pay taxes. I don’t blame Americans for not wanting to pay taxes, because what do we ever see? We pay these taxes, and we can’t even get a pothole fixed. So the idea of the government running our health care, suddenly we’re not going to find ourselves in a hospital, but on an Amtrak train. In France and in Britain, and in other places, they actually see some tangible results from the money they pay in taxes. I think if Americans actually saw a tangible result for the amount of taxes they pay, they’d probably be willing to pay even more if it meant people would be covered.
We are going to have to restructure our thinking so that we feel that, yes, it is important that we share, and sometimes we may have to stand in line if it means standing in line so that everyone is covered. Are we willing to do that? No. I don’t think that kind of mentality has done us well.
Filmmaker: Those countries with good health care don’t spend billions on the military.
Moore: The $100 billion that we’re spending now in Iraq would cover those 50 million without insurance for three to five years, and that’s $100 billion a year. So if we have the money to kill people…. I don’t ever want to be told that America doesn’t have the money.
Filmmaker: Can the government cover health care without it becoming unwieldy?
Moore: There’s so much waste that goes on in the health insurance companies. Medicare and Medicaid spend 3% on administrative costs. Canada spends 1.7% on the bureaucracy that runs the Canadian health care system. Aetna, Blue Cross, and Humana spend anywhere from 15-25% on their administrative costs. The myth is that private is better, private is less expensive. Not true. It’s more expensive, and if this was in the hands of the government it would be run more efficiently. Your parents’ Social Security check comes every month on the same day, and it does via the crappy U.S. mail. That’s a behemoth system paying out millions of dollars every month to millions of senior citizens and it works. Just because it’s the government running it doesn’t mean it has to be Amtrak.
Filmmaker: What is your next project?
Moore: I made the mistake of answering that question here in Cannes three years ago and saying it was the health care system, and the pharmaceutical and insurance companies went on high alert. They started issuing these memos to their employees not to talk to me. But because a number of the employees hated working there, they sent me company memos. Pfizer set up a Michael Moore hotline: “If you see Michael Moore at any Pfizer location, call this number.” Somebody hired a guy to do a psychological profile on me, and it said, “Try to get him off the subject by talking about Detroit sports teams, or compliment him on his recent weight loss.” I read that and I thought, This was genius, this would absolutely work!
So I decided I’m not going to talk about what the next film is. It’s hard enough for me, as you can imagine, to just get in anywhere anymore. The irony is that I had decided for Sicko not to go into these places, not to bang on the door of the CEO or the congressional office — and here they were all scurrying around getting ready for me.