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Hofstra Professors Weigh in on Sicko

Documentary filmmaker Michael Moore saw the release of his newest film Sicko in June 2007. Whether you are or are not a fan of his work, there is little argument that the picture he presents of America's health care industry is disturbing.

Here at Hofstra, we asked some members of the faculty who are knowledgeable about the health care system to see the movie and provide their own reviews.

Corinne Kyriacou | Richard Himelfarb | David M. Weiss

Corinne Kyriacou, Ph.D.
Assistant Professor of Community Health

Michael Moore's documentary Sicko is an important movie with the potential to make a real contribution to the health care reform debate. Powerful examples of people who were denied needed care are used to illustrate health system failures, due primarily to the profit motive underlying health insurance. These personal stories tap into widespread public concern about problems within the health care system - for both the uninsured and the insured - crystallizing how deep the problems are, how vulnerable all Americans are, and how far we can fall.

While Moore's positive portrayals of health systems in Canada, France, England and Cuba are exaggerated and one-sided, the movie challenges viewers to ask the question: Is it really better over there? What's the real story?

If viewers do a simple investigation they'll find that there are indeed problems with access and quality in those countries. However, they will also find that Moore's data on health care system performance indicators - lower life expectancy and higher infant mortality in the U.S. to be true; they'll find that we spend at least twice as much as other countries for those poor outcomes; they'll find the number of uninsured non-elderly adults growing due to rising health insurance costs that are causing employers to drop coverage; they'll find their own safety net riddled with holes.

So, the real question becomes: Do the pros outweigh the cons? Given the magnitude of the problems we face here in the U.S., the answer is certain: universal coverage is better and necessary. Of course, this begs another question: How should universal coverage be achieved? Moore is clearly advocating for socialized health insurance where the government is the single-payer. While this approach would likely be the most efficient there are other ways to achieve universal coverage. Reforming the current private insurance business, capping prices, negotiating with pharmaceutical companies, using a global budget, and/or using tax credits and benefits to enforce employer and individual mandates, are some of the alternative strategies. Concerned over the decades-long gridlock in Washington, states have begun to experiment with improved public-private partnerships.

The bottom line is that we can no longer leave health care to the private, mostly unregulated market. It is not like any other product where Americans with more wealth can purchase more and Americans with less wealth should go without. All of society suffers when health care is treated this way. Health care is different and therefore requires a different approach. We desperately need wise political leadership to emerge and recognize the shift in support for change that is occurring among middle class Americans, the provider community and corporate America.

Hopefully Michael Moore's provocative message will generate intellectual dialogue about how to get at change and move us away from the futile discussions of "if" and "when."

Richard Himelfarb
Associate Professor of Political Science

At the most simplistic level, Michael Moore’s polemic on American health care is correct: there are sick and needy people who lack insurance or are denied health care by greedy insurers, doctors and hospitals, abetted by uncaring politicians. However, when it comes to more complicated matters such as how pervasive this phenomenon is, its causes, and whether the socialized medicine that exists in other countries is the antidote, Sicko is replete with half truths and misrepresentations.

For example, Mr. Moore never acknowledges, that for all its flaws, the vast majority of Americans express satisfaction with the quality of health care they receive. Moreover, many of the complaints Americans make about our health care system concern rapidly rising costs caused by an extraordinary degree of government regulation that stifles innovation and competition in our health care system.

The most laughable aspects of Sicko involve Moore’s efforts to argue that other countries with socialized medicine offer more compassionate and effective care than our own. In Canada, patients may be forced to wait weeks for heart bypass surgery and even longer for elective procedures such as joint replacement. Great Britain’s National Health Service offers cancer treatment that is vastly inferior to that which is widely available in the United States and consequently survival rates lag well behind ours. France, which Mr. Moore proudly tells us not only provides free health care but extended paid vacations for workers and even laundry service for new mothers, is an increasingly dysfunctional nation marked by social unrest and a stagnant economy (Apparently, the French themselves realize this as the recent election of conservative Nicolas Sarkozy attests.). As for Cuba, if you actually believe the health care available to average citizens in this brutally repressive police state is superior to that of the United States, no one – including me – will be able to persuade you otherwise.

Luckily, except for the Kool-Aid drinkers on the far left, the vast majority of Americans are likely to remain skeptical of Mr. Moore’s utopian vision of socialized medicine where health care is free and government compassion abundant. Even with all its shortcomings, the American health care system offers quick access to advanced medical technology and practice that surpasses any other nation. If, God forbid, you or someone you love is diagnosed with a serious illness no nation in the world offers better prospects for survival and recovery.

David M. Weiss, Ph.D.
Associate Professor, Health Professions & Family Studies Dept.

Michael Moore's latest foray into the American conscience needn't be seen by everyone. Sicko should be seen only by those who currently are, who have been, or who may become patients in the American health care system. The documentary is a look at the underbelly of a coveted, fundamental, and revered American institution and human service system. And as an underbelly look, it ain't a pretty sight especially when seen through the eyes and lens of director Moore.

Through Sicko, Michael Moore becomes again social critic as he previously had been in Roger & Me (1989) examining corporate greed, The Big One (1998) besmearing corporate downsizing and practices, Bowling for Columbine (2002) championing gun control, Fahrenheit 9/11 (2004) chastising the President's handling of the WTC attack.

In brief, the film is CPR, MD: Compelling, Provocative, Rousing, Maddening, and Disturbing. And all because it is the truth. But recall the wisdom of our Founding Fathers, and I suspect our Founding Mothers, when they crafted the swearing-in phrase, "Do you solemnly swear to tell the truth, the whole truth, and nothing but the truth?" While Sicko is the truth, it isn't the whole truth, and surely it is not nothing but the truth.

Some health statistics are inflated and dated, while personal vignettes and archival clips weave Moore's cinematic diatribe via the heart and soul of his personal and political values. Thus his account of our health care system is vulnerable to the criticism that it violates the principle of reasoning and fairness that "for example is not a proof."

To grapple with the enormity of our health care system requires confronting four areas: costs, access, quality and ethics. All academic, policy, barroom and personal railings essentially are commentaries on one or more of these. That's it. But to whittle a consensus toward action among the system's players and their myriad political and personal proclivities is daunting, which to date we have been unable to achieve. Consider, for example, that since 1912 we have been trying to achieve universal health insurance coverage when it was proposed by our Long Island friend and neighbor Teddy Roosevelt.

Moore understands the complexity of societal health systems, but, like so many others, he slips into a simplicity scenario to avoid having to wrangle with opposing sides. Single payer is his salvation, as championed by Canada, England, France, and Cuba. But Moore fails to educate his audience that these four approaches achieve their universal health coverage through very different means, structures and organization. Spinning from these systems is his often used descriptor "free" - free health care, free education, free day care, and even free government laundry services. But Moore only fleetingly whispers that it's their tax systems that pay for these services and "free" really means only at the point of service. Do you think that their doctors, nurses, pharmacists, teachers, etc., work for no wages? Thus he's silent about the contentious political battles endured in these countries to achieve universal health care, as well as other essential safety net human services.

Understandably, many film viewers around me muttered, "Damn it, why can't it be free here too?" While Moore surely knows it just isn't that simple, he has left his audience envying, terrified, and angered. Left unnoted, too, are the single payer features of our current health system that remain problematic, such as Medicare, Medicaid, and the VA and Indian Health Services.

Comedy, albeit black comedy, abounds, as well as Moore's clever extrapolation of videos, photos, quotes, and statistics. The comedic tone provides needed relief and escape from the profound sadness of our health insurance situation and the stark realization that we all are only a health event away from personal bankruptcy. To counter such an outcome, for example, Moore provides us with a Web site, www.hookacanuck.com, a dating/mating service to showcase Canadians available for sharing romance, love, marriage, and health benefits.

In the end we're left longing for a Medical-Management-Messiah who can lead us to the health security promised land, not to rid us of sickness, aging, and death, but to make confronting these more humane. Is he/she sequestered in the presidential polls? In the mean time, our contact with doctors, hospitals, health insurance and pharmaceutical companies should carry a familiar label: Warning: The American Health Care System may be hazardous to your health.

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