Diagnosing SiCKO

Much ink will be spilled -- or computer pixels lit, I suppose -- over Michael Moore's new film, SiCKO. Billed as a look at what's wrong with the American health care industry, the film makes a passionate plea for "free" universal health care. I saw the film at a crowded Wednesday night showing here in New York a few days before the official release (Moore is great at building buzz) so here I am adding my thoughts to the mix.

First, even though I'm as pro-free market as they come, I have to say that Sicko is an entertaining film. Loews forced us to sit through approximately 36 previews before the film started, which was a reminder of how much most movies suck. Sicko did not suck. The action is quick, the commentary witty and deadpan, and certain sequences -- like the already famous Moore journey to Cuba with the 9/11 rescue workers in tow -- are brilliant. While I'm inclined to agree with P.J. O'Rourke's observation that "If you think health care is expensive now, wait until you see what it costs when it's free," Moore makes a reasonable case that the American system combines the efficiency of the public sector with the compassion of the private -- in other words, the worst of both worlds.

But Sicko falls short in a lot of ways that have nothing to do with politics. The American health care system has plenty of big targets. Moore focused on the easiest one: health insurance companies. This is because he does his research by asking individuals for their stories, and many people have horrible stories of being denied coverage. But being denied coverage is not the same as being denied treatment. Hospitals and doctors can always choose to provide care at a "discount" (i.e., at a reasonable cost, as opposed to their completely jacked-up rates) to the un- or under-insured. I would have liked to see Moore film a surgeon's $3 million home after the practice went after, say, a teacher for a $5,000 bill for a 30-minute procedure. But Americans tend to like their doctors. Better to focus on health insurance companies, since no one likes them.

Of course, no one likes the pharmaceutical industry either, but Moore pretty much lets these companies off the hook. One of the 9/11 rescue workers discovers that her inhaler -- which costs $120 in the states -- costs five cents in Cuba, but Moore doesn't probe why this might be. My guess is that infiltrating pharmaceutical companies is a lot harder than interviewing aggrieved consumers. Filming the lobster and champagne at Pfizer's Christmas party, then filming a man deciding whether to buy Lipitor or groceries, would have been devastating. But the vagaries of research vs. marketing costs, patent laws, doctor kickbacks and cleverly designed clinical trials don't translate well into the unsubtle medium of film. It's far easier to film a 30 minute love letter to France where, apparently, the government sends someone to do new moms' laundry. Did you know that in France, you get five weeks of vacation and unlimited sick days? Did you know that France also has a 25 percent youth unemployment rate? The two are related, but Moore, of course, does not go there.

The portly gentleman also does not point his camera at another huge driver of America's health care costs: our own unhealthy lifestyles. Plenty of studies have shown that exercise and dietary choices are as effective at combating high cholesterol, Type 2 diabetes, insomnia and mild depression as drugs. These choices also reduce your chances of landing in the hospital for heart attacks or diabetic complications where the bills really add up. There's a reason almost all of Moore's subjects are children or accident victims. They're more sympathetic than a 50-year-old overweight diabetic who persists in downing two-liter Cokes. Moore also doesn't really deal with the reality that American medicine is half-socialized anyway through Medicare and other programs. If politically active seniors haven't managed to make Medicare services all that great, it's unclear why shoving all Americans into similar coverage would make public services more cheerful and efficient. And hey, last time I checked, our tax dollars are already funding a lot of health care perks. New York City, for instance, does have a program that sends government nurses to new, low-income moms' homes to help out. I don't think they do laundry, but again, the situation is hardly black and white.

Nuances don't make for good films, though, and so SiCKO skips them. As someone who bought her own health insurance policy for years (as many self-employed people do), I'm no fan of companies that made me pay premiums of nearly $300 a month as a perfectly healthy 24-year-old. Having recently seen the bills for my son's birth, and having experienced American hospitals' love of probably unnecessary procedures first hand, I'm no more enamored with American health care than anyone else. But there's more to the story than SiCKO. My guess is that Moore was having too much fun noshing French baguettes to ask the complicated questions.