Sicko (2007)

Michael Moore stands on the deck of a small boat he’s motored from Florida to Cuba, the sea stretching behind him. Framed by his stalwart-looking passengers, three 9/11 rescue workers now suffering an array of health ailments, he puts bullhorn to mouth, as the camera cuts to a watchtower on Guantanamo Bay. Moore pleads, “They just want some medical attention, the same kind that Al Qaeda is getting. They don’t want any more than you’re giving the evildoers, just the same.” It’s one of several slow-motion-gonzo moments in Sicko, Moore’s documentary on the business of US medical insurance. The bullhorn and far-away prison camp form an apt embellishment, as Moore stands opposed not only to the institutional neglect of ailing patients, but also, and again, to the Bush administration. His impatience with the government’s ongoing ineptitude, ignorance, and iniquity — expressed most vociferously in Fahrenheit 9/11 — here finds a mini-perfect storm. Preceded by shots of orange-jump-suited detainees at Gitmo playing soccer inside their cages, and a tour of the hospital unit showing operating room, ample medicines, and doctors in white coats, the shout to the watchtower takes aim at the US war on terror, as well as border anxieties, military posturing, alarmism and imperialism.

Turned away from the rocky-beached, barbed-wired camp (or, as he explains, responding to the sound of a siren), Moore takes his passengers on to Cuba, where they find clean white facilities, attentive doctors, and affordable medications. It is this scene that has reportedly inspired the US Treasury Department to investigate “possible violations of the US trade embargo restricting travel to Cuba,” and incidentally, provide free publicity for the film. The quite literally feel-good sequence closes with a tribute to the US rescue workers by firefighters in Havana, a scene where tearful embraces are augmented by the fact that one of the US workers, medical technician Reggie Cervantes (currently suffering from “pulmonary and bronchial problems,” according to the team of Cuban doctors who examine her), speaks Spanish. “Mi hermanos,” they agree, all rescue workers a global family. Really, if only the US might learn not only to get along with its neighbors, but also take them as models for good behavior, the world would be a better place.

This would be the most reductive point to take away from Sicko, which, like Moore’s previous documentaries, mounts a righteously angry, alternately sentimental, blowhardy, often effective argument. Using anecdotal evidence and occasional numbers to make the case that US health insurance companies, in the words of one emailer to Moore, “flat suck.” The focus on the broken system appeals directly to “those of you who are living the American Dream.” If you’re like Larry and Donna, a two-career couple who put six children through college, you will be bankrupted if you depend on insurance companies when your health gives out. It’s a neat bit of timing that on the very day they arrive at their daughter’s doorstep (they’ve lost their house), their son-in-law, “a contractor,” is leaving for work “out of town.” When asked why daddy’s going to Iraq, a tearful child answers, “To do some plumbing.”

Such coincidence grants Moore’s film a narrative structure with a familiar political point: the crises facing regular citizens are connected, as well as ongoing. And most insistently, the crises have to do with class. Again taking up the cause of the working class victims and heroes he’s made his focus since Roger & Me, Moore offers up some familiar villains. The first versions of medical profiteering trace back to the Nixon administration, specifically a 1971 conversation between John Erlichmann and the president (courtesy of the notorious White House tapes) concerning Edgar Kaiser’s proposal that health insurance could make money — lots of it. The film includes brief digs at Ronald Reagan (who appears to have been a paid spokesperson for the industry, before he was president) and temporarily rambunctious “little lady” Hillary Clinton, who famously fought back, for a minute. But, after a slew of white men decried her plan for “socialist medicine” (and protestors burned her in effigy), now appears to have accepted enough financing from lobbyists that she’ll never again propose anything like “universal health care.”

She’s hardly the only figure with such odious association. As the film shows congresspeople making their way to a stage show with president, each is followed by a little green dollar amount, indicating the campaign monies they’ve accepted from health insurance and drug company lobbyists (Bush, unsurprisingly, is followed by a gigantic number). Cute as well as accusatory, the bit connects fear and money by way of politics. It’s an incisive analysis, in its way, more nuanced than the most obvious conclusion, that congresspeople are greedy, conformist, or categorically unthoughtful. Here the system, recounted by victims as well as former workers within it, looks dismal and dishonest. It’s supported by individuals who don’t or can’t see past dictates handed down from on high: insurance employees are rewarded for turning down claims, doctors for treating patients who can pay.

The film’s alternative systems — Cuban, British, and French — offer “free” care and unfailingly friendly caregivers. Recipients express their gratitude and expectation: the system makes sense, after all. “It all began with democracy,” beams former member of Parliament Tony Benn, which “gave the poor the vote” and “moved the power from the wallet to the ballot.” Imagine, Moore submits, that a government would look after its people before its businesses, noting that after WWII, England decided to pull together by mandating free health care. By contrast, after 9/11, the US rejected such “pulling together” and focused instead on going to war.

Though Moore purports to seek the costs (the higher taxes in France and England), he doesn’t find an interview subject to complain about it. Instead, citizens speak to the reasonable lives they lead, their affordable rent, and their vacations (one woman keeps a collection of sand from the many beaches she’s visited). If the scene seems like gimmicky overkill, it leads to the more pithy point: in France, says an expatriate interviewee, “The government is afraid of the people, they’re afraid of protests, they’re afraid of reactions from the people, whereas in the States people are afraid of the government. They’re afraid of acting up, they’re afraid of protesting, they’re afraid of getting out.”

As Sicko has it, the most effective resistance in the States is not highly visible. The examples are sympathetic, tragic, and sometimes fierce. Again, the overt case-making looks simplistic, but the film’s narrative is crafty. A 22-year-old cancer patient marries a Canadian so she can afford treatment by crossing the Detroit River periodically. While she notes that she’s telling “little white lies,” Moore again makes the broader point: “Yes, what Adrienne was doing was illegal. But we’re Americans. We go into other countries when we need to.” Looking at street surveillance tape of an impoverished patient being dumped by hospital employees onto Skid Row, he submits that a nation might be judged both by how it treats “those who are worst off” and those it deems its “best,” that is, the 9/11 heroes.

While it articulates all kinds of individual rage at these consistent failures, the film’s most effective moment is also self-congratulatory. Denied coverage for his daughter’s treatment, a man writes Cigna (“without my permission,” notes Moore), announcing that Michael Moore is making a movie about health care. “Have you ever been in a film before?”, he writes, at which point, the company calls to reverse the denial. If a movie not even made yet had such effect, maybe Sicko will inspire someone else, somewhere, to make a right decision.