Healthcare as horror movie

Healthcare as horror movie
By Christopher Caldwell
Copyright The Financial Times Limited 2007
Published: July 7 2007 03:00 | Last updated: July 7 2007 03:00


Americans are of two minds about their healthcare system. Only 38 per cent are satisfied with it, according to a New York Times poll taken earlier this year. A main source of worry is the uncertainty that besets the uninsured, whose numbers reach into the tens of millions. But when the same poll asked about the more concrete matter of how people's own healthcare works, respondents professed themselves delighted. Fully77 per cent were satisfied, a tally that compares favourably with other western countries.

One of the ways in which Michael Moore's latest documentary, Sicko, is disturbing is that it tries to show how the system fails even those who think they have a comfortable place within it. We meet a 79-year-old man who works loading a trash-compacter to pay for his wife's prescription drugs; a whistleblower from Humana, the health insurer, who 10 years ago told Congress that employees were promoted for their resistance to approving necessary procedures; and several workers who volunteered to work at Ground Zero after the attacks of September 11 2001 and who now suffer ailments ranging from teeth-grinding to what looks like emphysema. Mr Moore believes the rescue workers would be better off in Canada, Britain or France. He ends the movie with a stunt: taking them by boat for treatment in a hospital in Cuba.

Sicko is disturbing in another way. The movie is not communist propaganda. But in a playful, postmodern way, it is a homage to communist propaganda. Lengthy clips are spliced in from old Soviet socialist-realist films full of peasants harvesting grain - for parodic purposes, one assumes. Somewhat less parodically, Mr Moore makes dewy-eyed pronouncements from Cuba, ("They live in a world of we, not me," he says.) There is nothing wrong with making a movie that uses this style of argument. What is unsettling is how much people seem to like it. The warmth with which the movie has been received (certainly in the theatre where I saw it) shows that there is a steady, even growing taste for what propaganda does - inciting outrage rather than provoking reflection.

The US healthcare system is indeed suboptimal even for those it treats best. It is illogical. Corporations get a big tax deduction for insuring their employees, but the self-insured are not entitled to it. The principles for pricing hospital services are opaque. The indigent get charged more for hospital stays than the insured do. Pharmaceutical companies can pay doctors for drug endorsements and testimonials. Since all these problems are the result of market abuses within a system of over-regulation, there is no consensus on whether it is the market or the regulation that is to blame, as a look at recent policy books shows. There are plausible free-market solutions, such as those from David Gratzer, a Canadian physician, in The Cure. Jonathan Cohn, an editor at The New Republic, has written a plea for universal healthcare, Sick. Regina Herzlinger of Harvard Business School has summarised the problems sector-by-sector in a probing book called Who Killed Health Care? Whether one chooses a market or government solution, the challenges of paying for it grow steadily more complex as baby boomers age.

Mr Moore makes some constructive points. At least a dozen congressional staffers, he notes, have passed from legislating on healthcare into jobs at pharmaceutical companies, which usually involve lobbying their former colleagues. But it is difficult to isolate these gems amid the omissions, inconsistencies and preaching.

Mr Moore implies, for example, that Richard Nixon began the ruination of the healthcare system in February 1971 by supporting insurance plans on the cost-containing model developed by the entrepreneur Henry Kaiser, after the 1930s. However, he lauds Hillary Clinton's proposed 1993 healthcare reform, which used the same model. Average waiting lists in the Canadian medical system have stretched to months for certain procedures and have become the subject of Supreme Court cases there. But Mr Moore uses his own experience in one hospital waiting room to dismiss the talk of waiting lists as a canard. The US offers free healthcare to the inmates at Guantánamo because it is bound by conventions and civilised norms regarding custody of wards, not because it esteems al-Qaeda terrorists more highly than its own citizens.

What makes propaganda is never the argument so much as the spirit in which it is presented. It is not the US healthcare problem that is

Mr Moore's enemy, it is the complexity of it. He rejects subtleties. His goal is not to break through to those who do not agree with him but to drown out the doubts of those who do. Those who sit down to watch Sicko without a broad knowledge of the US healthcare system will leave the theatre with a shallower understanding of the crisis than the one they arrived with.

One should face up to the fact that this is the way Americans increasingly choose to get their information on all sorts of issues, not just healthcare policy. The appetite for slanted ideological dramas grows. Mr Moore is not alone in satisfying it. His anti-Bush documentary, Fahrenheit 9/11, was met with the anti-Kerry adverts of Swift Boat Veterans for Truth. Perhaps the internet has made this kind of journalism easier. Mr Moore has been described as a "tireless researcher", but you do not have to be, nowadays. He notes in his film that an online appeal for healthcare horror stories yielded 25,000 of them within a week. In a country of 300m people, any such appeal will provide enough anecdotal evidence to edit into a plausible and even rollicking case for pretty much anything - and to liberate a grateful populace from the heavy burden of level-headedness.

The writer is a senior editor at The Weekly Standard