Too Much Shtick-o in

Gary Baldwin, for HealthLeaders News , July 31, 2007

Sicko, populist film director Michael Moore's take on the illnesses of our employer-based insurance system, does a fine job of documenting of how ordinary people can suffer--both from bureaucratic obstacles and heartless health insurance bean counters who deny treatment.

There's the woman knocked unconscious who winds up in the ED, only to find her payment denied because of lack of pre-approval. She wonders aloud how she was supposed to have obtained the pre-approval. Then there's the elderly man, who still works in order to pay for drugs beyond the reach of his Medicare plan. Pushing his broom, he wistfully ponders the meaning of "retirement." And there's the hospital worker whose husband is denied coverage for bone marrow transplant, only to die shortly afterwards. Her voice just trails off.

Only the heartless among us can not be moved by these tales and Moore should be congratulated for capturing them.

But move beyond these stories-- as gripping as they are--and consider the film's main message, that government-sponsored universal health insurance is a healthcare panacea. At this juncture, the film begins to wobble like its rotund director. The movie builds to a climax in which Moore escorts a cadre of sick people--including heroic 9-11 workers who no longer have health insurance--to Guantanamo Bay, home of the Bush administration's terrorist prison camp.

Moore describes how the alleged terrorists at the prison are receiving the best care the U.S. can offer--while ordinary citizens like those in his boat suffer. But Moore's unsuccessful attempt to gain access to the prison hospital is a mere plot foil. Did he really think the prison would open its doors to him? Moore's entourage retreats--to Cuba! Healthcare there, we learn, is utopia, part of the people's paradise under Fidel Castro.

Gosh, and all along, I thought it was a dictatorship.

The sequence plays out as a massive publicity stunt, with Moore exploiting the sick people in his boat to his own cinematic--and ideological--ends. In Havana, the sick are treated and ostensibly sent on the road to recovery, aided by dirt-cheap Cuban drugs and other unexplained treatment plans that somehow will come to fruition once they return home. It's Hollywood pure and simple, and has little substance to offer any debate on the industry's woes.

Moore is most effective when he stays off-camera. When the story becomes about him, as it often does, it spirals downward into propaganda for single-payer healthcare. I would have liked some sense of the taxes they pay in France for their generous social benefit package. And I would have liked an interview that discussed all the charity care that U.S. hospitals routinely deliver.

Despite Moore's fawning, not all is well in England's National Health Service: its effort to implement a nation-wide electronic health record is teetering with cost over-runs and delays.

It's true that we have a big problem with uninsured people. But is that what is really driving up cost and causing all the subsequent aftershocks? What about the high-end--and pricey -- medical technology that we love? What about our predilection to sue providers when outcomes don't go our way? Both figure heavily in the equation.

On the quality issue, Moore sidesteps our various self-destructive habits--our crummy diets, our ballooning waistlines, our aversion to exercise--that also burden our healthcare system. As I watched Moore (who told the Chicago Tribune he weighs 300 pounds) lumber around the Havana hospital, eyes heavenly as if he had discovered healthcare nirvana, I wondered: What is this man doing for his own health? What responsibility do we, as individuals, have in holding down healthcare costs? Is healthcare a mere commodity that we buy, something that is done to us? Or is healthcare something we participate in jointly, with our families, with our physicians and with our own unique genetic hand dealt to us at birth? How indeed can we allocate finite healthcare resources in the face of infinite demand?

For me, these are difficult questions that deserve more than comic book answers.Conspiracies, and bad guys, and greedy corporations--that's the stuff of Hollywood. Overworked caregivers, harried administrators, and ever growing numbers of people in denial about their own wellness--that's the stuff of the healthcare system. Such complexity, I suppose, would not do well at the box office.

P.S. Thanks to the numerous well-wishers who wrote to me about my ED episode. I'll print some of your comments - on this and other columns -- in next week's edition.

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at

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