Brief Review of Michael Moore's Sicko (updated)

I should be working, but I can't stop thinking about Sicko, Michael Moore's new film, which (last night, but not this morning) could be viewed in its entirety here.  (I link because it says that the video may become available again.  I doubt it.  I did download it, however, and will share it, so long as you have some server space to spare.)  Why can't I stop thinking about it?  Because it embodies everything that infuriates me about Moore.  Before I say why, let me outline what it does well.  It is devastating as propaganda.  Only someone who's been denied coverage because doctors and lawyers quibble over the difference between "cured" and "in remission" can believe in this cause as I strongly as I do.  Which cause is that?

Socialized Medicine

We already have socialist programs in America: police and fire departments, public schools, libraries, &c.  Moore points out that just because they're not called socialist doesn't mean they're not socialist in spirit.  They are.  With the exception of talk surrounding home-schooling and vouchers, no one is calling for a return to the days of private armies.  (Not that they don't exist, only that there's no outcry that our military is too inefficient to get the job done, and that it'd be better if privatized.)

Long Lines, Poor Care

Moore does a fantastic job debunking the central myth of socialized medicine: that it leads interminable waits for routine procedures, and that even when performed, they are not up to American standards.  As anyone who's ever known a Canadian or British citizen living in the US has long known, they find the quality of care in the United States abominable.  They complain about the long waits for simple procedures—not in the hospitals themselves, but for insurance authorization, statements of coverage, and then the interminable ex post facto wrangling about the procedures covered.  That all takes time, which Americans conveniently forget when convincing themselves of the superiority of our system.  As for the quality of care, while there's an argument to be made that advances in medical care require profit incentive, there's no argument that for 99 percent of all problems, adequate treatments exist.  Better is better, you'll get no argument from me there, but I doubt medical researchers will stop their work if it suddenly becomes only extremely as opposed to obscenely profitable.  (As Moore documents in the case of a British M.D. who only drives one fancy car, lives in a house which only costs one million dollars, and only has one high definition television.)

Treatment of 9/11 Survivors and First-Responders

Most outside of New York are unaware that many private individuals rushed to the Twin Towers on 9/11.  They were not N.Y.P.D. or F.D.N.Y., they were medical professionals, or from police and firefighters from New Jersey, who answered the dispatchers' calls for any and all trained personnel  to respond.  And they did.  As you may or may not know, almost everyone who worked on the pile in the hours, days and months after 9/11 now suffers from a host of lung and mental illness.  Federal, state, and city officials have been slow to acknowledge the fact—as recently as September of last year, Mayor Bloomberg said "I don't believe that you can say specifically a particular problem came from this particular event"—and slower to act upon it.  If you think the N.Y.P.D. and F.D.N.Y. have had difficulty finding and paying for the treatment of their own, you can imagine how difficult it is for the unaffiliated first-responders to do so.  That he then takes them to Cuba is propagandistic gold: the whole sequence of military officials assuring Congress that the prisoners at Gitmo have access to the best care money can buy, that they are treated humanely, positively stings when juxtaposed against the plight of first-responders (official and unofficial alike).  They would receive better treatment if they'd been captured trying to kill enlisted men and women in Afghanistan.  Some crucial differences are downplayed, but the point plays beautifully.

Nixon: Still Evil

Not sure elaboration's necessary, but I will say this: Nixon was thinking man's evil.  Moore's juxtaposition of Ehrlichman and Nixon's conversation about how an HMO works ("all the incentives are toward less medical care, because ... the less care they give them, the more money they make") and Nixon's description of it the next day is powerful.  It hammers home the difference in the incentive systems between the US and England, in which, apparently, the pay rate for doctors increases based on the health of their patients.  (I'm not sure this is true, and it seems oversimplified and likely to create its own set of malicious disincentives, but that's how it's presented, and it's quite effective.)  To reiterate, however: Nixon's still evil.

Health-Care Crisis

No matter what you think of Moore, you know there is a national health-care crisis.  You know the system is broken, and you know the current group of health-care providers wants it remain broken.  You know they hire people to sift through applications to deny coverage, and that even once covered, people must fight to receive the treatments they need (oftentimes even after they've been approved).  The needless deaths of the working-class Americans portrayed in the film are consequences of the health-care industry's bottom-line mentality.  The man who died of kidney cancer after finding a bone-marrow match and the man whose job it was to scour applications for unreported illnesses so that his company might void coverage for an undocumented yeast infection from 1991 are symptomatic.  No matter what you think of Moore, you know the problems he points to are valid and endemic.  That said:

Cuba

I don't mind cheap (but effective) showmanship.  Anonymously paying the founder of Moore Watch $12,000 so he can pay to keep the site up and his wife insured is both classy and opportunistic.  Such is the life of the showman.  Bringing victims of 9/11 to Gitmo so that they might retrieve the same quality health-care as the terrorists works.  Bringing them to a Havana hospital for treatment?  Not so much.  It has long been known that foreigners paying in hard currencies receive preferential treatment in Cuban hospitals.  Despite the benefits brought about the emphasis on preventative medicine, one of the highest doctor-to-patient ratios in the world, and the availability of cheap generic drugs, Moore neglects to mention that he was taking advantage of the system, that the people with him only received the treatment they did because they weren't Cuban.  Just as I was furious when I learned that he had met Roger while filming Roger & Me, I'm pre-incensed at his future revelation that he knew all about Cuba's medical tourism industry.  In both films, he overreaches, providing his detractors with ammunition against him.  He undermines the valid points he raises about the outsourcing of American jobs and the crisis in American health-care for what can only be seen as narrative goals.  He wants the perfect ending, the perfect finish, the perfect irony.  He doesn't need it.  When I taught literary journalism, I convinced my students, and myself, that the most human story is human by virtue of its imperfections, by the way its mundane realities defy the simplistic narrative conventions of the Hollywood hack.  Would that Moore could learn this.

UPDATE: Gerry Canavan notes that if this encounter is the foundation of my criticism of Roger & Me, my criticism may be unfair.  He says that because I lacked a little clarity.  It's not that Moore met Roger Smith while filming the movie—the film was in preproduction at the time—it is that he never offers his ambushing of Smith at the GM shareholders meeting because doing so would provide Smith with an understandable reason for refusing to meet with him.  It is not because Moore is a man of the people, but because a few months previous Moore had publicly hectored him, so Smith knew what was coming, i.e. he was smart enough not to decline an invitation to his own lynching.  This is different from what Moore did in The Awful Truth—those corporate executives didn't know what was coming, and avoided him on (poor) principle—so the series hammers home the impression that the same thing was done in Roger & Me.  (Again, this may be the former journalism teacher in my quibbling over minor details.  Having twice taught a journalistic ethics class will do that to you.)

Comments

[Karl Steel]

Bringing victims of 9/11 to Gitmo so that they might retrieve the same quality health-care as the terrorists who victimized them works

"the terrorists who victimized them"?

[SEK]

Half a homology I left lying around there. Removed.

[Jim McCulloch]

I don't know about this movie, but I see no reason to think Michael Moore here proceeds any differently than he has in the past. If so, the movie should be highly effective just because he always presents a very, _very_ simple point that most Americans can't fail to agree with. It's wrong to give guns to crazy people and murderers. It's wrong to let people die or suffer because they are poor. And so forth.

Because he presents things very simply, and powerfully, he places those who disagree in the position of having to _explain_ why he is wrong. The more complex and convoluted the explanation is, the deeper the hole they dig for themselves.

He's unfair, of course. But given that the Right thinks of their kulturkampf as a war, not a discussion, Moore presumably believes he is justified in coming back at them in the same way. I hate to admit it, but it's kinda refreshing, if you believe in his message, to see a man of the left being both unfair and effective.

Speaking of moral cred, Moore's deficits of which seem to have (somewhat) informed your critique of the movie, you could have waited 11 days and paid to see the film instead of jumping the gun with a pirated copy.

Just saying.

[Adam Kotsko]

Yeah, that fucking sucks that Moore is right about all the main points but fudges around the edges. The fact remains that there is a huge double standard in our national discourse, where left-wing figures are not allowed even the smallest innocent mistake, but right-wingers lie about literally everything and are never called on it. If Moore was rigorous and scholarly about everything, he would still wind up making a mistake somewhere that would "totally discredit him." This kind of stuff that reasonable liberals do about Moore every damn time he does a movie just feeds into the dynamic. He has released a powerful propaganda film for a cause that is absolutely essential, a life and death issue. If he fudges on the details to produce better surface level flow, that's forgiveable in my view. Save your ire for the Republicans.

[SEK]

Jim:

First, I should say that all indications are that Moore leaked the copy himself, because he wants as many people to see it as possible. One of the interviews with him about it has him doing an "aw shucks, wouldn't it be terrible if anyone could the movie for free" schtick. The copy itself is also a flawless DVD capture, not a screener.

Because he presents things very simply, and powerfully, he places those who disagree in the position of having to _explain_ why he is wrong. The more complex and convoluted the explanation is, the deeper the hole they dig for themselves.

That's a damn fine point, but I'm not entirely sure it's true. Mainstream coverage of Fahrenheit 9/11 focused quite a bit on conservatives debating the veracity of some very minor points—the dates Saudis left the country—such that they were able to drown the overall impact of the film in a sea of quibbles. Bush did win in 2004, which says something about the relative effectiveness of the film.

I remember reading an interview with a demoralized Moore in December or January 2005, and he took himself to task for pushing in a few instances, for not anticipating conservative talking points. I'd hoped he'd take his own words to heart, and for all I know, maybe he has. He could use what happened in Cuba as a trap, a way to say "this medical tourism is the injustice of the Cuban system, but it's only possible because of cheap generic drugs, which we could have in the States, &c." That said:

I hate to admit it, but it's kinda refreshing, if you believe in his message, to see a man of the left being both unfair and effective.

Much as I hate to agree, it certainly is.

Adam:

Yeah, that fucking sucks that Moore is right about all the main points but fudges around the edges.

If it means that the edges become the issue instead of the main point, yes, your profanity's warranted.

The fact remains that there is a huge double standard in our national discourse, where left-wing figures are not allowed even the smallest innocent mistake, but right-wingers lie about literally everything and are never called on it.

You have to work within the system you have, not the one you'd like to. I'd love to see the nightly news do skewer Tony Snow the way John Stewart had Snow skewer himself last Thursday. More of that would be wonderful. I'd love to live in that world.

This kind of stuff that reasonable liberals do about Moore every damn time he does a movie just feeds into the dynamic. He has released a powerful propaganda film for a cause that is absolutely essential, a life and death issue. If he fudges on the details to produce better surface level flow, that's forgiveable in my view.

I think I make it abundantly clear that I have no problem with it being propaganda. I do have a problem—one I didn't elaborate on above nearly as much as I'd like to—with the way Moore knowingly exploits the flaws in the Cuban system in order to reform the American. I know as well as anyone that there's no purity in politics, but to make it seem as if all Cubans receive the kind of treatment the American tourists did is simply wrong. He could've gone about it differently. He could've pointed out that because Cubans practice preventative medicine and have ready access to basic medical care, they have the same life-expectancy as Americans. The fact that despite the inequitable treatment of Cubans and foreigners—Operación Milagro, the doctors-for-oil exchange with Venezuela—Cubans are as healthy as Americans speaks powerfully in and of itself. He needn't have whitewashed the Cuban health industry in order to try to change ours.

That said—and this is partly in response to Jim, too—I don't think this film is aimed at all Americans. The fact that he specifically shames Hillary Clinton for accepting cash from the people she went to war against in Bill's first term leads me to believe Sicko is aimed to force health care to be the single most important issue in the Democratic primaries. It's far less divisive than, say, Iraq, and creates a way for the Democratic candidate to appeal to more conservatives and moderates.

[Tim Lacy]

SEK: Contrary assessments notwithstanding, thanks for the preview. I've been curious about this project since first seeing a trailer a while back. - TL

[Page]

Save your ire for the Republicans.

Posted by: Adam Kotsko | Monday, 18 June 2007 at 12:22 PM

"Ditto."

[Gerry Canavan]

It is not because Moore is a man of the people, but because a few months previous Moore had publicly hectored him, so Smith knew what was coming, i.e. he was smart enough not to decline an invitation to his own lynching.

Given the way in which Roger Smith's refusal to meet with him is at the core of that film, you've convinced me it's a lapse in documentary judgment—especially since he easily could have put the confrontation in the movie, edited as yet another self-aggrandizement, and still positioned himself as the man of the people Big Business can't dare face. Only the scene's absence makes him look bad; if it had been there in the first place it probably would have gone mostly unremarked.

[SEK]

Adam & Page, you act like I've near exhausted my ire. No shortage, I assure you. We conserve water in Southern California; ire, we have to spare.

Gerry, it wouldn't even to have been footage. From what I remember, it wasn't his camera crew that had it on tape, but another. Conceivably, it's possible that he didn't know anyone had the film ... and I still would've wanted him to mention the encounter, in a throwaway sentence, as opposed to hiding it. It's only ammunition when you lie about it. Sin of omission, you know.

[George]

"It's wrong to give guns to crazy people and murderers."

I'm not at all a Michael Moore fan, but that's not at all a fair description of the thesis of Bowling for Columbine. In fact, I'm not sure that movie even had a thesis beyond, "Americans are a people who scare easily."

[josefwoodman]

I appreciated seeing your comments on Cuba, which rise above the already over-worked "travel legality" issue and begin to address some of the realities of Americans heading abroad for healthcare.

As author of "Patients Beyond Borders," I quickly eliminated Cuba from our list of medical travel destinations, simply because it's not legal for Americans to travel there, or to spend money on goods and services in Cuba. Yet, his point that better care can be had overseas at a fraction of the US cost is well-taken.

Hopefully, Sicko will not only enlighten healthcare consumers to the realities of our broken system, but also point to choices that might provide hope for millions. Heading abroad for medical treatment is one of those choices--tho Cuba isn't a reasonable example.

[CR]

Scott, actally, I think your line of attack on Cuba is really unfair. Lots of places have a medical tourism industry, and lots of them are places with socialized medicine. (My dad received treatment for prostate cancer last year in Toronto - a new, non-invasive form of intervention that is basically an outpatient procedure. Gee, I wonder why the FDA won't approve this knife-free, easy, apparently very safe and ultimately extremely cost-effective form of treatment here?)

It's no secret why Cuba does the medical tourism thing. It's the same reason why they've compromised on tourism in general: hard currency. But if there's a critique to be made of this, it's that the system is insufficiently socialized, right? But that's hard to make because Cuba's WHO scores are so damned high, considering the situation that the country is in economically, that it sounds a bit ridiculous. If it's through alternative medicine and prevention rather than fancy MRI machines, well, that's just another thing to think about, not really a critique of the system itself in terms of its effectiveness.

In other words, Adam's right. It's showmanship, it is a bit over the top, but it is definitely not worth pissing on Moore over this. He did it to trigger controversy, which triggers in turn media attention, which in turn brings butts to theater seats, and, in the long run, I hope, a nice National Health card to my wallet in a few years. Without the overthetopness, he's looking at an audience of 2,000. Now, it's going to open to huge crowds.

In short, I think you're falling into the trap of ridiculously high expectations for MMoore that we all first experienced with Fahrenheit. This sense that if he had just done a few things differently, we'd be complaining about President Kerry now. Here: the Cuba thing leads you to infuriation first rather than any other feeling, despite the fact that already a bunch of Oprah viewers were "you go girling" over frigging socialism on one of the most influential shows on television the other day? And the damn movie hasn't even come out yet. Very high expectations, Scott.

[Anthony Paul Smith]

'But that's hard to make because Cuba's WHO scores are so damned high, considering the situation that the country is in economically, that it sounds a bit ridiculous.'

Let's not forget that the economic situation Cuba is in would likely be very different without a US embargo.

[Adam Kotsko]

Doubtless someone is going to take away the message that we should lift the embargo on Cuba so that people can go there to take advantage of the great medical care.

[SEK]

It's showmanship, it is a bit over the top, but it is definitely not worth pissing on Moore over this.

I don't think I'm pissing on Moore here. In the comments, maybe, but of the 1,217 words I originally wrote, 273 of them were critical. Twenty-two percent critical means I was seventy-eight percent positive. I don't see how that qualifies as "pissing."

The Cuba thing leads you to infuriation first rather than any other feeling, despite the fact that already a bunch of Oprah viewers were "you go girling" over frigging socialism on one of the most influential shows on television the other day? And the damn movie hasn't even come out yet. Very high expectations, Scott.

I have the same expectations of him as I do undergraduates in my introduction to literary journalism class. It's not that high. The problem with moves like this is that makes the response so predictable—unless, of course, that's the point. If Moore's engaging in the old debating tactic of leaving himself very vulnerable to the very criticism he has an elaborate and convincing response to, that's one thing. But I don't think that's what's he done here. Look, just because we have to "rise" to the tactical manipulativeness of our opponents to be politically efficacious doesn't mean I have to be happy about it.

But if there's a critique to be made of this, it's that the system is insufficiently socialized, right?

Certainly. That's what I said up there, and I'm sticking by myself.

He did it to trigger controversy, which triggers in turn media attention, which in turn brings butts to theater seats, and, in the long run, I hope, a nice National Health card to my wallet in a few years. Without the overthetopness, he's looking at an audience of 2,000. Now, it's going to open to huge crowds.

The movie gets into theaters even if he doesn't have patients treated in a Cuban hospital. The rest of it is inflammatory enough and has the benefit of not misrepresenting and exploiting the Cuban health-care system.

[Karl Steel]

Without the overthetopness, he's looking at an audience of 2,000

The followup film from the director of the highest grossing documentary of all time would draw only 2,000? Michael Moore could make "Horton Hears a Poo" and it would draw 20 times that.

[CR]

Yes, 2000 was stupidly hyperbolic (hypobolic?)... But the point is to generate media attention and thus break beyond the arthouse scene, which isn't guaranteed. MMoore is a canny attention graber. The very first thing I heard, and heard repeatedly, about this movie was that "it is about America's medical system and Moore goes to Cuba and is in trouble with the government for doing so." The second part of that sentence is what drew the attention of the papers / talking heads - it's what made it into a "story." "America's medical system" by itself isn't enough. There's no way you get the airtime with the rest of that sentence being "and he interviews a lot of people who were screwed by their insurance companies." That sounds very responsible and very, very boring.

Whatever customs official hinted to the media that they were thinking about going after Moore for Cuba (if the entire story, of course, wasn't self-generated by Moore) is currently headed to her/his new job at the US-Russia border checkpoint (winter-only, when the straits freeze) at Little Diomede Island, Alaska. That I guarantee...

[Tomemos]

"...of the 1,217 words I originally wrote, 273 of them were critical. Twenty-two percent critical means I was seventy-eight percent positive. I don't see how that qualifies as 'pissing.'"

Please don't be disingenous, Scott. The introduction for this entry gave your reason for talking about the film at all as follows:

"Why can't I stop thinking about it? Because it embodies everything that infuriates me about Moore. Before I say why…"

If one of your Lit J students used that as a thesis, you wouldn't accept their claim that their essay was a positive treatment overall, regardless of what came afterwards.

[SEK]

I'm not being disingenuous in the least. This is a positive treatment of the film overall. Yes, annoyance motivated the post, and I kvetch at the end, but let me put this another way: I wouldn't be annoyed if his actions didn't undermine his message. An analogy:

Down by six with one second on the clock, the punt returner for the NY Giants catches a ball in his own end zone. Time expires the second he catches it, so he can't take a knee. He has to run, and run he does. He follows his blockers masterfully, throws off a few tackles, then sprints toward the end zone. At the five, he showboats just a little and veers dangerously close to the sideline. He stumbles, maybe steps out of bounds, regains his balance, trots into the end zone. Game over. But wait! The referees want to talk about it. The announcers start replaying those last five yards from fifteen different angles. No one can definitively tell whether he stepped out or not. Since the ruling on the field was touchdown, the play stands as called, the Giants win.

I'm happy. It was a marvelous return: stellar blocking, a few balletic moves, a tremendous burst of speed but his showboating damn near cost his team the game. Giants still win, which makes me happy, but the return man needlessly endangered the win, which annoys me. I'm more annoyed because the return man has a reputation for showboating, but still, I'm happy.

I think Moore wins the game, but I know people will be talking about the last five yards instead of the first ninety-five, and that bothers me. Still, I'm happy.

[abb1]

Maybe it was mentioned in the comments and I missed it, but is there any evidence that those guys got preferential treatment in Cuba? I'm sure one can buy better healthcare, but how do you know that they did?

Thanks.