Michael Moore as himself
In the richest country by GDP in the world, 50 million people -- one-sixth of the population -- are currently without healthcare because they do not have the means, despite the fact that 38 million of them are employed, or (more insidiously) because their insurance companies refuse to cover them (particularly the elderly) in order to keep their profits up. This is the world of modern American healthcare as presented by Michael Moore.
When it comes to the problems of the healthcare system, and in particular the debate between private and social health insurance, there is much opinion and little fact, and "Sicko" certainly adds to that. Which is clearly Moore's intent. He's interested not so much in illuminating the differences between the two sides and fostering educational debate on the merits of one system over another, so much as making a strong plea for the adoption of some sort of universal healthcare.
And it's a very good plea. As Moore points out, the reality of the insurance situation is a losing game for someone, and the insurance companies are going to do their best to make sure it isn't them. They can only make money as long as the odds of payouts are low, but at a certain level of market capitalization payouts become a certainty, unless the companies game the system. Which they do, lobbying Congress for friendly legislation while simultaneously denying claims under the (correct) assumption that most of their clients can't afford the legal costs of challenging them. It is a racket, plain and simple, only providing insurance to people who don't need it and denying them coverage (despite the premiums they've paid) when they do. The free market is a tool for earning money and, Moore suggests, when it comes to healthcare for ourselves and our neighbors, that may not be the best criteria for designing an insurance system.
Against that he presents three major western universal healthcare systems, from Canada, England, and France, systems where prices are cheap and healthcare is available to everyone without the capitalistic concerns that push the poor towards the cracks. Moore suggests that the advantages of these systems have largely been hidden in America because of the threat they pose to the wealthy patrons of private healthcare management who would suddenly find themselves out of business, leaving universal healthcare to be demonized by ideology that refuses to admit that anything coming from socialism could be better than what the free market offers. "Life is tough," Moore says, "and maybe the only way to get through it is to pull together."
It's powerful and grim stuff, and essential viewing if for no other reason than to be made aware of the serious problems facing this country, which are only going to get worse as the baby boom generation begins to retire.
Unfortunately, it's not clear how useful it all is. Moore makes his points with generalizations built from anecdotal evidence, with little effort made towards real analysis. Clearly, his decision about healthcare systems was made before hand, and everything in the film must fit into that decision. He makes no effort to look at the downsides of the national systems he hoists as examples of universal healthcare. To hear Moore tell it, healthcare in France and England is perfect, which does not fit at all with reports of the problems they have developed, let alone the everyday public's experience with human nature and government bureaucracy. In his earnestness to show what's good about them he's left out the bad, which ultimately keeps them from being adequately contrasted to the U.S. system, which is unfortunate, as viewing the two systems on balance could have made his argument stronger.
More useful, and just as absent, would have been a discussion about the tangible costs and savings of a socialized medicine program and what life under such a system would honestly be like, absent the hyperbole that usually gets tossed around. That kind of discussion would have been incredibly dull, and Moore wants to entertain as much as any filmmaker does, but it's ultimately necessary. Ignorance about the specifics of socialized medicine is what it makes it so easy to demonize, with vague warnings about letting the government not only pay for healthcare but manage it as well, as if one de facto required the other. But if he can at least get people to talk about, then he's accomplished something.
Moore's normal trademark irony and wit is still in full force and if he sometimes goes after easy targets, that doesn't necessarily mean they deserve it any less. Anyone with even a little knowledge about what insurance companies have been doing for the past decade and more should be outraged. His instincts get the better of him towards the end as he takes a group of 9/11 rescue workers who can get insurance coverage for their 9/11 related illnesses to Cuba; first to Guantanamo Bay to try and get the same medical care the U.S. Army provides to al-Qaeda, and failing that, into communist Cuba, where even a third world dictatorship has supposedly figured out how to administer universal healthcare. It's funny but extremely heavy-handed and doesn't really bolster his point any.
While much of "Sicko" is certainly propaganda, that should not deter anyone from seeing it or giving some credence to what Moore is saying, because what he is talking about is very real and very important. Paradoxically, if not everything he suggests is entirely true, it doesn't mean he's not still right. The modern healthcare system is broken and suggesting that the market will correct itself is probably wishful fantasy. Something is going to have to be done and soon and if "Sicko" at least makes more people aware of that, then it will have served it's purpose admirably.