Michael Moore: Health care should not be based on corporate profits

by Joe Auciello / August 2007 issue of Socialist Action Newspaper

The most terrible and telling fact about the American health care system is that it works fine, just as it is intended. If this statement seems surprising, simply remember that medicine is a business and thus operates by the dictates of any commercial enterprise. Medicine is an industry that sees clients, not patients; its goal is profit, not cures. Think of hospitals as factories, and everything will fall into place.

Of course, such comparisons are inhumane, and the values underlying these analogies stir up a healthy sense of outrage: human beings are not commodities like auto parts or t-shirts. At the very least, people resent being handled like an object, a thing. They do not acquiesce willingly. Simple self-respect and human decency demand more.

Though the "health-for-profit" system under American capitalism (a necessary distinction, as will be shown later) finds it useful to treat patients like products, people find it necessary to resist.

Feelings of compassion, outrage, and resistance prompted Michael Moore to make this film. "At the end of the movie," he told the Boston Globe, "I’m hoping that we as Americans can start operating with the concept of ‘we’ not ‘me.’ If I have any agenda, that’s what it is" (June 24, 2007). These same feelings have created its large audience. Whether the film can succeed in activating a social conscience—that is, serve as the catalyst for a mass movement for reform—remains to be seen.

"Sicko" condemns the American health-care, pharmaceutical, and insurance industries, and the political system—vigorously sustained by Republicans and Democrats alike—that creates laws that make the whole sordid mess legal.

The facts come to life and speak for themselves in the form of anecdotes and stories by victims of American medicine. Moore includes the relevant information, drawn from authoritative sources and included on his website (www.michaelmoore.com), to show that the individual stories are typical and stand in for countless others.

The film begins with case histories of the uninsured (some 47 million to 50 million people are without health insurance for part of the year), but soon Moore shifts his attention to the plight of the majority of Americans who do have some form of health insurance.

Here is the crux of the story. After all, it is hardly a secret that the uninsured suffer. Instead,

Moore reveals the tragedies of people who did have health insurance, who believed they were covered, and who discovered that their coverage was partial, inadequate, or, for all practical purposes, non-existent. Further, Moore shows just how the insurance industry works energetically and ruthlessly to deny claims, retrieve benefits, and throw the sick out of the insurance system.

Part of the emotional impact of "Sicko" lies in Moore’s juxtaposition of consoling—but false—myths and expectations with a far harsher reality. One such myth is the belief that government need not play a role because family members can and will cheerfully pitch in and tend to the sick.

An early segment shows a husband and wife who have lost their savings and their home due to exorbitant medical bills. The couple is reduced to moving in with their daughter and seeking assistance from a son. Both of these adult children clearly resent having to help their parents and, what little they give, they give grudgingly. The mother’s tears of humiliation are caught on camera in a scene that is almost unwatchable.

And yet, it is hard to fault this family’s children. Their homes are far from lavish or large, and the care of their parents is a burden for which they are unprepared. It is a prospect that frightens them, and, since jobs today are not at all secure, their fear may well be justified. The parents’ economic collapse may take down the children, too, since these young adults clearly have little in the way of personal savings or financial resources.

The American way of life denies a social responsibility (adequate care and housing of the elderly, including affordable medical care), and shifts that responsibility onto the family, even if the family is not capable of bearing that burden. Blame—and there is much to blame—is also shifted from government policy to individual families. The result is not surprising: the medical industry prospers, the family suffers. The victims all blame each other while capitalism gets away with another crime and functions as it was intended to all along.

A more central myth is the fallacy that the United States boasts the finest health-care system in the world. A glance at World Health Organization data blasts that notion. The U.S. actually ranks 37th, far behind Canada, France, and Britain and only slightly ahead of Cuba. Telling the truth about this little-understood reality comprises most of the action and commentary of the film.

Moore’s film-making method is quite unique, and effective. He simply visits these countries with his film crew and talks to people. His subjects include patients, doctors, political leaders (the retired left British Labour Party MP Tony Benn, who concisely spells out a health-reform program) and workers. A round-table discussion with American expatriates in France heightens the difference between the medical systems of the two countries.

Briefly put, in Canada and Europe access to medical treatment, including doctors, hospitalization, and medication, is provided for through income taxes and requires from patients no or only small additional cost. This means that no one is denied treatment.

Doctors are not required to obtain insurance company approval before they treat patients thoroughly and properly. Sufficient time is allowed in hospitals for full recovery.

In other words, even in capitalist countries like France and Britain, the profit incentive has been largely removed from health care. The difference between their system and the system in the U.S. is enormous, like entirely different worlds.

This is not to say that other countries have created a medical utopia. Reforms are still needed in Canada and Europe, such as allocating a greater part of the national budget to health services. Yet, the struggle abroad is to maintain and improve a system that is already superior to the world’s only superpower. And programs that work well abroad can work well here. First, though, corporations would have to be taken out of the system.

Private insurance companies make money by insuring the healthy while they are still healthy and dumping them onto the public purse while they are sick. (In "Sicko" Moore uses web-cam footage to show uninsured patients who are literally dumped onto the sidewalk). Less medical care and less coverage mean more profit. And a corporation exists to provide investors with a healthy financial return on their investment, not to provide patients with a healthy life.

Instead, there needs to be a single-pool system like that in Canada. A single-pool system insures everyone, young or old, healthy or ill, for their entire lives. Through taxes, everyone pays into the program. In this way the cost burden is spread out over the entire population, not just the sick in times of need or crisis.

No one can predict, for instance, a broken hip five years from now requiring surgery and hip replacement. Even if it could be predicted, few have the means from their salary to save enough money to cover the expenses. A single, large pool guarantees that those who are in need of medical attention can receive it.

The American medical system needs to be set up something like the American military. Soldiers do not buy their uniforms, bullets, and rifles. Tank gunners do not purchase machine guns and contribute to the cost of building and fueling the tank. Pilots don’t pay for the planes they fly. These costs are all borne by taxpayer expense.

The theory justifying military expenditure is that of social need. It is maintained that the military serves a public purpose for the benefit of all; therefore, it is publicly funded. Countries like Italy, France, and Britain extend this principle to the health of their citizens. The purpose of Moore’s film is to show that the same system can be created here.

Tax the rich! Eliminate the military budget!

Wouldn’t an American national health service create huge tax increases and thereby harm the very people it was intended to help? The answer is likely yes, if new federal health insurance taxes were merely added to the existing taxes. Socialists call for taxing the wealthy, not working people.

In addition, in order to succeed, the shift in a national priority to better health care would require a significant shift elsewhere in the national budget. One good place to begin would be with the military budget. It is customary in the United States for lawmakers to fund projects and programs that inflate the annual defense bill, which the armed forces do not even demand.

One such item, according to an article in the Boston Globe, would be the "$480 million to develop a spare engine for the F-35 Joint Strike Fighter even though the Air Force concluded in 2005 that it was redundant—and two independent review boards agreed" (July 6, 2007). Senator Ted Kennedy, liberal Democrat from Massachusetts, earmarked $100 million for the engine that may never fly; other senators, anticipating pork-barrel benefits for their states, inserted the remaining $380 million.

Taxpayers for Common Sense estimates the Senate Armed Services Committee members alone (that is, not counting other congressional committees) added $5.6 billion to congressional legislation for unnecessary, extra projects.

Of course, in addition to these costs, there are the billions spent every year to fund the wars in Afghanistan and Iraq.

Moore visits health facilities in Cuba

Moore’s critics are especially incensed by his favorable coverage of the health-care system in Cuba and by the way he reported on it. Moore contrasted the quality health care allegedly provided to prisoners at Guantanamo (using several news clips quoting senior government officials) to the plight of 9/11 volunteers who have been refused treatment because they were not on a city or government payroll when they pitched in to help. So, Moore took them and others to Miami, and three boats set off for Cuba.

To no one’s surprise, Moore’s "fleet" was refused entry into Guantanamo Bay, so, by previous arrangement with the Cuban government, the ailing 9/11 volunteers were taken to a Cuban hospital. There, the doctors and nurses conducted tests, prescribed medication, and provided the patients with what they needed.

To the disbelief of the Americans, the Cubans treated them with sympathy, respect, and professional care. One woman, who is on $1000-a-month disability, must normally pay $240 each month for her medication. For the same medicine, the Cuban hospital charged pennies. Her shock, outrage, and helplessness about the difference provided one of the more moving scenes in the film.

Cuba is a poor country that spends about $230-$250 a year per person on medical expenses. The United States spends approximately $7000 per person. According to the World Health Organization, the U.S. ranks just slightly ahead of Cuba in quality of health care.

U.S. citizens live, on average, seven months longer than Cubans, but Cuba has a lower infant mortality rate. They also have twice as many doctors per capita as the U.S. What Cuba does not have is a profit system that bleeds patients even more than an injury that would have brought them to a doctor in the first place.

Moore is no socialist; he does not seek to do away with the private ownership of the sources of wealth, nor does he call for the end to capitalism as a system and its replacement by a rationally reorganized society based on the power of the working class. The filmmaker who worked for John Kerry in the last election is hoping Al Gore will run in 2008.

As Moore told the Boston Globe, "I’d like to see the system that Jesus proposed, which is we take care of each other. … I’m trying to say to everyone, if other countries can do this, we can, too" (June 24, 2007).

Moore is a radical reformer: "… that’s my job, to be right on top of the leaders of this country and make sure they do the right thing" (The Boston Phoenix, June 29, 2007). He is a muckraker in the tradition of Michael Harrington ("The Other America,"); Lincoln Steffens ("The Shame of the Cities"); and Jacob Riis ("How the Other Half Lives"). All of these writers bravely exposed the harm done by the profit system to the poor, the newly arrived immigrants. They hoped that exposure of social ills would compel the country to cure them.

Moore has brought this tradition up to date by expanding beyond print to include the internet and film. He also brings an element of entertainment to his work through his boldness, wit, and satire. Nonetheless, the political themes and the focus on everyday Americans are always uppermost. In contemporary U.S. culture, that alone is a radical act.

In the United States, where there are more millionaires now ever before, average people who are struggling to get by, who are hurting, are supposed to make up some small, even insignificant, part of the population. Even more, according to popular wisdom, since the U.S. is so prosperous, so rich, and since opportunities are so abundant, then those who do not succeed really have only themselves to blame.

Media attention does not focus on such people. Celebrity gossip, fawning profiles of the super-rich, "reality TV," and true-crime, etc. make up the greater part of "human interest" stories. People who have lost their jobs, their benefits, their pensions—well, they are just not that interesting. It’s not that the statistics are hidden; news of layoffs, pension cuts, and so forth is reported (in 30-second segments), but then it is just ignored.

Television news magazines like "60 Minutes" and "20-20" don’t bother to produce a program showing what life is like for working-class individuals and families who have been kicked out of the "American Dream." Cameras do not record the lives of immigrants who pick strawberries in California or oranges in Florida or who clean hotel rooms all over the United States.

Mike Wallace does not interview a family that has lost their home and gone bankrupt because medical insurance did not cover their expenses. Andy Rooney, who finds life so whimsical and curious, is not at all curious about the millions who live in hardship or who die from everyday neglect.

Forty-five years ago, Michael Harrington noted, "the poor are politically invisible. … They are without lobbies of their own; they put forward no legislative program. As a group, they are atomized. They have no face; they have no voice."

Michael Moore gives a voice to the poor and the ill and gives hope to everyone willing to combat the inhumane conditions that a decent, just society would never countenance. His film shows that these conditions can change when enough people demand a change.

It’s a simple enough demand: Quality health care available for all Americans as a basic human right. Yet, to make this goal come true, "the American way of life" needs to be turned on its head.

No wonder, then, that Michael Moore and a film like "Sicko" are so controversial and so roundly denounced. It’s the reward for exposing and challenging the health-care and political systems in the United States and for showing how the two systems combine for their benefit at the expense of the suffering and the needy. The applause and the attacks alike are the well-deserved reward for telling an inconvenient truth.