"Moderation is a fatal thing. Nothing succeeds like excess." Oscar Wilde
Michael Moore has taken Wilde's words to heart in his new movie Sicko. And well he should. Moderate voices have urged changes in our healthcare system for years, but to no avail. Whatever the virtues of the movie as art, it is bound to have an impact in the arena of public opinion.
As someone who has spent her professional life in healthcare communications, I know messages that resonate and make a difference. This movie is one. It grabs you by the throat and demands that you look at America's dysfunctional healthcare system in a way that high-brow policy briefs have not.
If you are looking for a balanced and highly nuanced perspective on America's healthcare system, this is not your movie. Sicko is Michael Moore's film as op-ed piece, an impassioned plea for a single payer system.
Like other Moore movies, it is a head-on assault with a populist point of view. Therein lies its strength and its weakness. It is a valentine to people who already share his views, but its lack of balance is a liability in moving more neutral opinion on the issue.
Regardless of whether you agree with his conclusions, Sicko makes a very compelling case that our healthcare system is in dire need of fixing. If the movie spurs a sense of urgency on this point alone, it is worth the ticket sales and the government should do Mr. Moore's laundry (see movie).
The statistics are familiar enough - 44 million Americans without health insurance, more money spent per capita on healthcare than any other country, yet the US is number 37 among nations in health outcomes. What Moore does brilliantly is tell us the human cost in the stories of average Americans, who in most cases had insurance, but faced financial and emotional devastation as the result of major illnesses.
The images are harrowing. A man who must choose which of two fingers to have reattached after an industrial accident - he could not afford to have surgery on both, so he chose his ring finger (the less expensive one); a husband and wife with solid jobs (and insurance) who are forced to declare bankruptcy as the result of major illnesses and have to move in with their none-too-welcoming children; 9/11 workers with lung disorders who are denied health benefits from the city of New York.
Moore takes some swipes at the pharmaceutical industry, notably charging that members of Congress are "paid for" by lobbyists and berating the lack of price negotiating on Medicare drugs. This is a mild jab compared to his body blows aimed at the insurance industry. He accuses these companies of ruthless profiteering through human misery and decries the incentives in HMO's to deny care. Although this is markedly one-sided, the demonization of the industry is bound to resonate with millions of Americans who have been denied claims or who have had a bad experience with their health plans.
After introducing us to individuals who are living the nightmare of our healthcare system, Moore takes us on a travelogue through countries with a single payer system. We meet smiling individuals in Canada, the UK, France, and Cuba who seem very happy with their healthcare and are mystified at the US system which seems so callous in comparison. This is the movie's weakest point. It presents these systems as unmitigated successes without a hint of a downside. We never see the long waits in Canada; no one mentions that the National Health Service has dismal outcomes for breast cancer; or that France is sinking economically under the weight of its social programs.
The "piece de resistance", however, is the trip to Cuba. Moore clearly enjoys thumbing his nose at the government by bringing 9/11 rescue workers into Castro's heart of darkness for what is excellent medical care. These scenes are poignant and funny - the best in the movie.
There are funny moments punctuated throughout Sicko. This is a necessary counterpoint to the heartbreak of the stories, offering the audience a relief valve. Moore understands the power of humor as a communications tool and employs it skillfully. I suspect, however, that the more liberally inclined will laugh the loudest.
Oscar Wilde is right; there is virtue in excess. Michael Moore has produced a provocative, outrageous, and important movie. It is a scorching indictment of our healthcare system that is bound to fuel debate on the great societal issue of our time.
Whatever your political leanings, the train wreck of our current system cannot be denied.
The solutions are more complex than Sicko would suggest, yet the movie leaves you pondering some very big questions. Is the hallmark of a great society how we treat the weakest among us? Do we all sacrifice a little for the greater common good? How do you put a monetary value on a finger, a life?
After the movie, my friends and I had dinner at the Harbor in Georgetown. It was a beautiful tableau with people of all ages laughing, drinking wine, enjoying a spectacular summer evening. Yet the images in the film stayed with me. Looking out at the crowd, and at my own table, I couldn't help but wonder - how many of us are one illness away from life-altering disaster? In America, you can certainly enjoy the good life.
Just don't get sick.
Nancy Hicks is the associate director of Ketchum's North America healthcare practice and a board member of the American Medical Women's Association. (This review does not necessarily reflect the views of Ketchum)