some thoughts on seeing SICKO

[topaz]

First of all, if you are already getting set to tell me that Michael Moore is a crackhead, or that his films are propaganda rather than documentary, please save yourself the trouble.  Moore has said as much himself, with his "I am the balance" speech.  I don't have a problem with calling his films "documentary," but I think he's best described as a "video essayist."

1. Michael Moore makes an ironic counterpoint to talk radio.

Commercial talk radio is overwhelmingly right-wing (cf. Rush Limbaugh, Bill O'Reilly, Michael Savage, Jay Severin, ad nauseam).  A common liberal complaint is that talk radio is dominated by right-wing voices.  The answer most frequently given is that if liberals don't like it they should come up with their own damn show.

(That's actually the right answer.  Yes, I know Air America sucks.  The left wing's failure to come up with a consistently entertaining radio voice is a huge embarrassment to the whole of Blue America, believe me.)

The funny thing is that Michael Moore's overwhelmingly left-wing stance in film has led conservatives to complain for years about his liberal bias raging unchecked in our nation's movie theaters.  Surely the right wing's solution to Michael Moore is the same as the left wing's solution to Rush Limbaugh.  Why haven't they figured that out yet?

2. The most widely publicized criticisms of the movie studiously avoid addressing its main point.

This is the core claim of SiCKO:  when a health care system is based on a simple profit-and-loss model — that is, ours — then the corporate goal of maximizing profit and minimizing loss will inevitably translate to denying people access to medicine, even medicine they need desperately.

The first third of the movie builds that argument with interviews of former and current HMO employees who describe a corporate culture of systematically denying medical care even to patients in critical need.  The second third explores potential counterexamples: interviewing patients who have moved to Canada for medical care, American expatriates and doctors in France, and the staff of a British hospital.  The final third is classic Michael Moore theater: he loads most of the people interviewed in the first two-thirds of the film onto a small boat and takes them first to Guantanamo Bay and then to Cuba in an attempt to find doctors who can help them.

Given all that, I probably shouldn't be surprised that most of the criticism of the movie amounts to "OMG can you believe it he compared us to CUBA!!"  But it is hard not to notice that no one has yet found fault with Moore's assertions about the shortcomings of the U.S. managed care system.  That seems to me like a deeply telling omission.

Comments

[crouchback.livejournal.com]

I haven't seen it yet, and probably won't until it is out on DVD, unles they show it captioned at our local movie theater.

With regard to 1, I regard all those right-wing figures as petulant slimebags, and I am amused by the whole "it's okay when my guy does it, but wrong when your guy does it!" bit.

A few right-wing filmmakers have tried to become anti-Moores, but they've not produced anything terribly entertaining or watchable.

With regard to 2, I'd like to point out that we already have some socialism in our health care system. (Finding this out surprised Bernard-Henri Lévy, who had thought that the poor had no coverage whatsoever in the US. He wrote about this in one of his "In the Footsteps of Tocqueville" articles for the Atlantic Monthly last year. I was pretty surprised to find out that a guy usually regarded as an Americophile, who is a noted academic, was so ignorant about some things in the US.)

I am annoyed that he went to Cuba, mainly because I suspect Cuba pulls the same trick the USSR used to pull: making sure that foreigners only see the parts of the system that cater to party bigwigs, and ensuring that foreigners who come there for treatment get the care that the nomenklatura get. (Anyone reading this who is interested in how that worked can pick up a copy of Klass (http://www.abebooks.com/sm-search-0312457634-klass-how-russians-really-live--is!0312457634.html).)I also think Moore is more than smart enough to figure this out if he doesn't know it already, and he could have made his point by comparing the US to Canada, the UK, and France. (Although, given the way Tony Blair managed to get one of his health problems treated by, apparently, bypassing NHS wait lines, maybe Cuba and the UK deserve to get compared....)

the other problem I have is that at least one of those systems, the UK, is having problems with finance, and the solution that has been bandied about (but not yet implemented) is to deny care to some people (http://www.timesonline.co.uk/tol/news/uk/health/article1364697.ece).

I assume you've seen it: what do you think of Johnathan Rosenbaum's take (http://www.chicagoreader.com/features/stories/moviereviews/2007/070629/) on the movie?

[opadit.livejournal.com]

Cuba's government made some disastrous decisions when AIDS first showed up there -- basically putting patients in leper colonies. But on the other hand, the country's infant mortality rate is lower than that of the U.S. (if I recall correctly) and they have more doctors per capita than the U.S.

Except that a lot of doctors make more money driving cabs than being doctors. But on the other hand, Cuba distributes meningitis vaccines in South America, and not just Venezuela.

It's interesting to think what Cuba could do without the embargo.

[muckefuck.livejournal.com]

when a health care system is based on a simple profit-and-loss model

What health care system would that be? Certainly not the confused private-public chimaera we have here. A friend who was nearly bankrupted by health woes explained her situation to e. (who, as you may remember, works for the American Hospital Association), and she told her that she might've been better off with no health insurance, since then the hospital would've written off the cost of the care provided rather than billing her (inadequate) insurance, which had her pay a ruinous percentage. Any way you look at it, it's a messed-up system, but if that's Moore's whole point, then he's focussing in on one flaw and ignoring all the other interconnected issues--in other words, being Michael Moore.

[kmriley.livejournal.com]

Regarding comparing to UK, Canada or France (or another, more open, country). I flip-flop on socialized medicine, but I know my mothers family does not. My family has a lot of experience with socialized health care - both working and being patients in the system. There is little trust of it and little expectation of very good care.

[qwrrty.livejournal.com]

I hadn't seen Rosenbaum's review before (I haven't read him much since leaving Chicago, and his reviews tend to annoy me with their grandstanding). For the most part I think he gets it right. Moore's self-aggrandizement in this movie doesn't bother me as much as it does Rosenbaum, because it seems obvious that it's part of the theater.

[qwrrty.livejournal.com]

The insurance system, however, is strictly capitalist, and that's what the film is really about. Moore says as much in the first few minutes -- it's not about people who don't have health insurance, it's about the millions of people who do and yet still can't get coverage for the problems they have. Not unlike your friend.

[kcatalyst.livejournal.com]

As I understand it (fuzzily at best) it's not strictly capitalist-- aren't there are lots of legal restrictions on how insurances companies can do business? Like when states require companies to cover infertility treatments (or presumably lots of other things, I just have seen discussions of that one).

Now, that's not to say that a truly capitalist system would be better, since I have no idea what happens under one. But I don't think that's what we have.

[qwrrty.livejournal.com]

It's been pretty well established that using that definition, there is no such thing as a "strictly free market" and never has been, since almost every enterprise is subject to some degree of regulation. You're welcome to take that argument if you want but it strikes me as a profoundly uninteresting semantic game.

[kcatalyst.livejournal.com]

You're not paying a lot of attention if you think that a linguist should accept the phrase "profoundly uninteresting semantic game" as anything other than a statement of deeply misguided personal preference. The terms we use and where and how we use them have profound impact on the conversations we have and the decisions we make based on them. You're using the brokenness of the current US system as evidence to indict a class of systems. It is basic to that project to establish that your exemplar actually belongs to the class in in question, let alone that it is representative of that class.

It doesn't make sense to me to say that something should qualify as a particular label because tokens of it are scarce (goofily enough, isn't this exactly the argument we just saw about organic hops?). If what you mean is that there are some kinds of regulations that are so basic that they don't qualify as changing the structure away from "free market", then I could certainly see that, but it needs more argumentation than you've given.

I should point out, since you seem to be stuck in the traditional American us/them rhetoric, that I actually would like to see socialized medicine in the US, at least based on my current understanding, which I know to be sketchy. But I also would like (even more strongly, since I know more about this part) to see some respect for the reasoned pursuit of knowledge.

[qwrrty.livejournal.com]

You're using the brokenness of the current US system as evidence to indict a class of systems. It is basic to that project to establish that your exemplar actually belongs to the class in in question, let alone that it is representative of that class.

Actually, Michael Moore is the one who's using the U.S. health care system as a proxy for privatized health care in general. I came back here to summarize what I understood the movie's main message to be, and to comment on how I think the media reports about the film are missing the point it's trying to make.

The question of whether HMOs are really "strictly capitalist" entities because they're subject to regulation is about as interesting to me as asking whether Wal-Mart is a "strictly capitalist" entity because it's also subject to regulation. The question Moore implicitly raises (and explicitly answers) is whether a capitalist structure is the most effective or appropriate one for providing medical care.

[kcatalyst.livejournal.com]

Sorry, I thought you were saying that you agreed with Moore's argument and so that you were also making the argument. Regardless, I don't understand how you think that you or Moore can make an argument about "whether a capitalist structure is the most effective or appropriate one for providing medical care" without caring what counts as a capitalist structure.

[dbang.livejournal.com]

I think what Tim is saying (or, at least, what I'd be saying if I were Tim) is that the health care system in this country is as "capitalist" as the rest of the business world -- which is to say, a softened form of the non-existent "pure" capitalism. Our economy is a "real world" capitalist economy, just as the Soviet Union was "real world" communist -- neither one theoretically pure, and yet the closest real world examples to the theoretical concept.

So I read Tim as saying that Moore was saying that real-world-capitalism-as-practiced-within-the-US is a suboptimal model for providing health care, especially as compared to the real-world-socialized-medicine-as-practiced-within-certain-other-economies. (their health systems are no more perfectly socialized than our systems are perfectly free market.)

[kcatalyst.livejournal.com]

See, that's an argument that has content. :-)

[dbang.livejournal.com]

Oh, and I would say that the discussion about how our system differs from a "pure" capitalist model is not "semantic" but rather "academic" and, as Tim says, profoundly uninteresting (to me).

[docstrange.livejournal.com]

Yes, but now we have to agree on the content of "optimal" in terms of a "health care system."

8-) As a cultural anthro/legal type, thanks for pointing out that "merely semantic" is like saying "merely about our experiences and ability to relate to or discuss them."

I've also seen some convincing argument that the "better" systems are able to function in part because the US system is there as a value for overpressure, through direct buy-in by those with sufficient capital in the socialized system countries. Australia might be a better model system (hybrid socialized with open/insurance-based capitaloid system), but I guess one still has to define and agree on what's better/optimal.

[docstrange.livejournal.com]

It's not academic if the differences are a) causing sub-optimal function, or b) are the levers by which the system can be brought up to something more like "optimal."

Simplistic categorization of complex systems may be interesting, but it's also kind of useless in the long run when trying to solve complex problems in the complex system.

[kcatalyst.livejournal.com]

Yes, but now we have to agree on the content of "optimal" in terms of a "health care system."

I don't! :-) I was merely trying (unsuccessfully, I think) to strike a blow for not talking out one's ass about things of great import to the country. But since I know squat about health care systems, I will model the behavior I desire by not talking about them. Though I will listen eagerly.

But when it comes to valuing meaning (both semantic and social) I've got your back.

[kcatalyst.livejournal.com]

Right, that. What he said.

[jacflash.livejournal.com]

The US managed care system has shortcomings.

I fail to be convinced that replacing it with a managed care system run by government bureaucrats (those well-known beacons of efficiency and fairness!) would be any better. Among other charming consequences, new-drug research would be likely to grind to something close to a halt without a profit motive to spur it on.

[dbang.livejournal.com]

now we have to agree on the content of "optimal"

Indeed, which is one of the reasons I've stayed mostly agnostic in this argument for years.

When I took one of my two graduate courses on social policy (which is to say: I'm not an expert but I'm also not JUST blowing smoke) we looked at this in some depth. In particular we compared Canadian medicine to US. Each was spectacularly successful for some different definition of success.

Canada, for instance, has an exceptionally low infant mortality rate, nearly universal pre-natal care (I was surprised to discover how many women in this country get no pre-natal care whatsoever) and highly successful screening programs for things like high blood pressure and breast cancer.

America, on the other hand, has much more innovative health care: more new treatments and medications and techniques. If you have an unusual condition, you'll be much better off here (assuming you can get it covered, of course). If you need something requiring expensive, high tech equipment, you're better of here.

10 years ago when I took social policy, the wait in Canada for an MRI was over 12 months. People were dying while waiting. The monied folks were coming here.

So, which is a higher goal? Basic general health care and health screening for everyone? Or really top-notch special care for those who can afford it?

American society has always leaned more in favor of the individual than most other western cultures.

[dbang.livejournal.com]

You're using the brokenness of the current US system as evidence to indict a class of systems.

I don't know if Tim or Moore was doing this, but I look at it differently. You are assuming evidence-based/inductive logic, whereas I think "pure" capitalism can be shown deductively to not only allow but to require that a subset of citizens forms an underclass that have very limited access to the benefits of society. From there it isn't a great leap to identify "health care" as being such a benefit, and argue that the very nature of capitalism is going to result in a class of citizens who get inadequate health care. Then having formulated a theory, you could look to real life systems (such as the ones Moore looked at) to see if the ones that had more in common with pure capitalism were more likely to show the predicted effects.

Starting from this theoretical stance (which I do) means that I don't have to label us as "Capitalist" (as a binary yes/no category) but just see if we are comparatively "more" or "less" capitalist than some other society.

[docstrange.livejournal.com]

All that gives you is correlation tested against a preconceived theory, with way, way, way too few data points to deduce causation from the gathered information. Better to describe an optimal, desired result and then do an in-depth analysis of the particular system (ours) to find what aspects of it fail to meet the optimal standard, and how the characteristics of its function could be changed to reach the desired goals.

The comparison method you describe is useful for politics, which is where we see it used. One can agree that one system is better than another and that there's a correlation between better and similarity to some platonic referent, but it still tells one nothing about why.

[dbang.livejournal.com]

All that gives you is correlation tested against a preconceived theory

Indeed but in the absence of the ability to do a true experimental study (hard to do at a social level)... what else is there?

You say "preconcieved" like it's a bad thing. Starting with a theoretical framework, using it to build a hypothesis, and then gathering data to support (or fail to support) the hypothesis is part of the old time-tested scientific method. :-)

Anyway, my point was just to refute the claim that one must be able to back up a claim that our society (or health system) is "capitalist" before one can decide that capitalist health systems produce suboptimal health care.

[points.livejournal.com]

But at the same time, many drugs that need development are -not- being developed, because the target audience is either too small, or too poor, to promise the profits needed to engage in the expense business of drug development. So, I would say that 'obviously' the current model is hardly a guiding light in this respect, either. If one wants to argue that 'no' drug research would be done at all, I'm not sure I could agree with that.

[vespid-interest.livejournal.com]

I have had friends studying to become naturopathic doctors and they wanted to visit Cuba in order to study that style of medicine. Since cuba doesn't have the medical tech we do, the doctors there do a much better job with naturopathic medicine than we do.

This doesn't have a bearing on the movie as far as I know, except to say that in some ways Cuba does have very good doctors.