Sicko

Sicko (or SiCKO) is a 2007 movie by American filmmaker Michael Moore that investigates the American health care system, focusing on its for-profit health insurance and pharmaceutical industry. The film compares the non-universal and for-profit U.S. system with the universal and non-profit systems of Canada, the United Kingdom, France and Cuba.

Sicko opened to positive reviews, but also generated criticism and controversy. Some policy specialists have praised the film while others have criticised the film for its positive portrayal of the publicly funded health systems of Canada, the United Kingdom and Cuba, and for its negative portrayal of the health care system in the United States.

Sicko opened in the U.S. exclusively on a single screen at the AMC Lincoln Square theater in Manhattan the weekend of June 22–4, 2007, earning $68,969 per screen, then opened nationwide the weekend of June 29–July 1, 2007, earning $4,501,712 in 441 theaters and achieving the second highest nationwide opening weekend for a documentary, after Fahrenheit 9/11.^[1][2][3] A pirated copy of the film was leaked onto the Internet just prior to its release.

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Synopsis

Fifty million Americans are uninsured, and those who are covered (whom Moore states at the beginning are what the film is about rather than the uninsured) are subject to becoming victims of insurance company fraud and red tape, with real case costs shown ranging from loss of fingertips or coverage to loss of life. Interviews are conducted with both people who have been denied care who thought they had adequate coverage as well as former employees of insurance companies who describe cost-cutting initiatives that encourage bonuses for insurance company physicians to deny medical treatments for policy holders.

Moving to Canada, Moore then describes the case of Tommy Douglas, who was voted the Greatest Canadian in 2004 for his contributions to the Canadian health system, and interviews a microsurgeon and people waiting in the emergency room of a Canadian public hospital.

The history of health care debate in the U.S. is explained, with the stance against universal health care systems set against the backdrop of 1950s-style anti-communist propaganda. A 1960s record distributed by the American Medical Association and narrated by Ronald Reagan is cited, which claimed universal health care could lead to communism. Moore cites examples such as the American police, fire service, postal service, public education and community libraries, which are said to be "socialized" services and have not led to communism. Further evidence of the origins of the Health Maintenance Organization Act of 1973 are presented using a taped conversation between John Ehrlichman and President Richard Nixon on February 17, 1971; Ehrlichman is heard telling Nixon that "...the less care they give them, the more money they make", a plan that Nixon remarked "appeals to me". This led to the expansion of the modern HMO-based health care system. Connections are highlighted between Pharmaceutical Research and Manufacturers of America (PhRMA), the lobbying arm of the largest drug companies in the United States, lobbying groups in Washington D.C., and the United States Congress. Hillary Clinton, who once championed the Clinton health care plan, is cited as the Senate's second-highest recipient of health care industry campaign donations.

Moving to the United Kingdom, another country with a comprehensive free healthcare system, Moore interviews patients and inquires about in-hospital expenses incurred by patients, only to be told laughingly that there are no out-of-pocket payments. Moore visits a UK pharmacy, where pharmaceuticals are free of charge for persons under 16 or over 60, and subsidized in most cases for everyone else; only a fixed amount of £6.65 per prescription is charged (about $13 U.S.), irrespective of cost to the NHS. Further, NHS hospitals employ a cashier, part of whose job is to reimburse low-income patients for their out-of-pocket travel costs to the hospital. Interviews include an NHS general practitioner, an American woman residing in London, and Tony Benn, a socialist politician and former Member of Parliament. Benn compares any attempt to dismantle the NHS with reversing women's suffrage and says it would result in a revolution.

In France, Moore interviews the head of Obstetrics and Gynecology in a French hospital, and a group of Americans living in France. He also rides with "SOS Médecins", a 24-hour French medical service that provides house calls by physicians.^[4] According to Moore, the French government provides exceptional social services, such as day care for $1 an hour, and neonatal support that includes cooking, cleaning, and laundry services for new mothers.

Returning to the United States, interviews disclose that 9/11 rescue workers who volunteered after the September 11, 2001 attacks were denied government funds to care for physical and psychological maladies they subsequently developed, including respiratory disease and PTSD. Unable to receive and afford medical care in the U.S., the 9/11 rescue workers, as well as all of Moore's friends in the film needing medical attention, sail from Miami to Cuba on three speedboats in order to obtain free medical care provided for the enemy combatants detained at the U.S. Guantanamo Bay detainment camp. The group arrives at the entrance channel to "Gitmo" and Moore uses a megaphone to request access, pleading for the 9/11 victims to receive treatment that is on par with the medical attention the "evildoers" are receiving. The attempt ceases when a siren is blown from the base, and the group moves on to Havana, where they purchase inexpensive medicine and receive free medical treatment.^[5] Providing only their name and birth date, the volunteers are hospitalized and receive medical attention.

Moore then addresses the audience himself, emphasizing that he feels people should be "taking care of each other, no matter the differences". To demonstrate his personal commitment to this theme, Moore sends an anonymous US $12,000 cheque to Jim Kenefick, webmaster of MooreWatch, which Moore describes as "the biggest anti-Moore website on the internet." Moore shows the blog entries from Keneficks site saying that he would have to shut down the website because he needed US $12,000 to pay for his wife's medical treatment. Moore explains why he paid this adversary's medical costs in full saying he doesn't want the health care system to trump the first amendment. Upon receipt of the cheque, Kenefick sent "a very gracious note" to his "Guardian Angel", thanking him^[6].

Release

Sicko premiered on May 19 2007 at the 2007 Cannes Film Festival, receiving a 15-minute standing ovation^[7] from 2,000 people at the Grand Theatre Lumiere.^[8] The North American premiere of Sicko was held in London, Ontario (where some scenes from the movie were filmed) at the Silver City movie theatre at Masonville Place on June 8 2007, with Moore in attendance.^[9] It also had an early premiere in Washington D.C. on June 20, two days before its U.S. release, with Moore appearing at a Capitol Hill press conference to promote the film.^[10]

The European premiere was held in Great Britain on October 24, 2007 at the Odeon Leicester Square as part of the 51st London Film Festival. Moore was to introduce the film, but remained in America due to a 'family issue,' sending a lengthy letter to be read in his stead. Part of the letter gave thanks to the Rt Hon Tony Benn, featured in the film, who delivered a succinct speech before the showing.

Box office

Sicko earned $4.5 million on its opening weekend.^[11] In 441 theaters, it took in an average of $10,204 per theater, the second highest average gross of the weekend. As of October 17, 2007, Sicko has grossed $24,535,082 in the United States. It has been named the third-highest grossing documentary in USA since 1982 excluding concert movies, reality films, and "large-format" documentaries.^[12]

Critical reaction

The movie received a 93% "certified fresh" rating on Rotten Tomatoes,^[13] After its Cannes release, Variety described Sicko as "an affecting and entertaining dissection of the American health care industry".^[14]

In an early review a week before the premiere, Richard Roeper and Michael Phillips gave the film two thumbs up. Roger Friedman of Fox News called the film a "brilliant and uplifting new documentary" and praised Moore for the way in which he lets "very articulate average Americans tell their personal horror stories at the hands of insurance companies" and "criticizes both Democrats and Republicans for their inaction and in some cases their willingness to be bribed by pharmaceutical companies and insurance carriers."^[15]

British film magazine Empire praised Moore's filmmaking and personal artistic vision, exclaiming "Sicko is the film that truly reveals Moore as an auteur."^[16]

David Denby of the New Yorker called the film "feeble, even inane"^[17] while film critic Stephen Schaefer of the Boston Globe described Sicko as "a very strong and very honest documentary about a health system that's totally corrupt and that is without any care for its patients."^[18]

On November 19, 2007, Sicko was named by the Academy of Motion Picture Arts and Sciences as one of 15 films on its documentary feature Oscar shortlist. The list will be narrowed to five films on January 22, 2008.^[19]

Response

Media

Sicko received a standing ovation at Cannes. Canadian journalists attending the premiere were less complimentary, objecting to the depiction of Canadian, French and British health care system as "flawless."^[20]

WBAI Radio, part of the Pacifica Radio Network, reported that Sicko was revitalizing the debate for universal health care within the United States, calling the film "adrenaline for healthcare activists." It named individuals and entities ranging from U.S. Congressman John Conyers, Jr., to the California Nurses Association. It reported that the latter "began traveling the country to leaflet moviegoers as Sicko opens in theaters to support a 'single-payer' health care system."^[21]

John Stossel of ABC's 20/20 wrote an article in the Wall Street Journal on September 13, 2007 entitled "Sick Sob Stories" that claimed Julie Pierce's husband, Tracy, featured in 'Sicko' would not have been saved by the bone marrow transplant denied by his insurer. This drew an angry response from Julie Pierce on Moore's website, who claimed Stossel never contacted her and that the insurer denied other treatments as well. ^[22]

In an article published in both The New Yorker and Reason Magazine, Michael C. Moynihan calls the film "touching, naïve and maddeningly mendacious, a clumsy piece of agitprop that will likely have little lasting effect on the health care debate".^[23] Yet in another article in the The New Yorker "Sick and Twisted", Atul Gawande, states "his movie about the American health-care system, Sicko, is a revelation. And what makes this especially odd to say is that the movie brings to light nothing that the media haven’t covered extensively for years."^[24]

Michael Hodgberg of the American Spectator called the box office results for Sicko "a bit of a dud" because of Moore's previous box-office track record and "the attendant hype and publicity" surrounding the film, which drew only a fraction of the audience for Moore's previous effort.^[25] The Weinstein Company stated before Sicko was released that they did not expect the film to do as well as Fahrenheit 9/11.^[26]

Rich Lowry, writing in the National Review accused Moore of distorting the differences between American and Canadian healthcare systems in order to further a "socialist agenda."^[27]

Industry

In a letter responding to a Wall Street Journal op-ed by David Gratzer that was critical of the film,^[28] Robert S. Bell, M.D., President and CEO of University Health Network, Toronto, said that while Moore "exaggerated the performance of the Canadian health system," it provides universal coverage of a similar quality to that enjoyed by only some Americans.^[29] Michael Moore posted a leaked memo from a Capital Blue Cross employee about the likely consequences of the film. The memo expresses concern that the movie turns people against Capital Blue Cross by linking it to abuses by for-profit HMOs.^[30]

A July 9 2007 broadcast of CNN's "The Situation Room" aired a "fact check" segment by CNN's senior health correspondent Dr. Sanjay Gupta on Sicko.^[31] Immediately following the segment, Moore was interviewed live on CNN by Wolf Blitzer.^[32] Moore stated that Gupta's report was inaccurate and biased. Moore posted a point-by-point response on his website.^[33] After a debate with Moore on Larry King Live,^[34] Gupta posted a message about his position on Sicko and CNN's coverage.^[35]

Think tanks

The conservative think tanks, such as the Manhattan Institute said that Sicko misrepresented the health systems of Canada, the United Kingdom and Cuba, and criticized it for its negative portrayal of the American health insurance system compared to these countries.^[36][37] Brett J. Skinner of the Fraser Institute said that healthcare in these countries is characterized by long waiting lists.^[38] The National Center for Policy Analysis, a conservative American think tank, has also been critical of Moore's claims, focusing particularly on lengthy waiting lists and purported unavailability of new treatments in the publicly-funded health systems of the United Kingdom and Canada, an aspect of those systems which they allege Moore failed to address.^[39][40]

The Centrist Urban Institute (UI) largely agreed with Moore regarding the need for a universal health care system and failure of the current system. UI economist Linda Blumberg, stated that Moore correctly provides evidence that the current systems fails and a universal system is needed, but points out that any system will face budget constraints. Overall, Blumberg stated that "Americans as a whole have yet to buy the philosophy that health care is a right and not a privilege" and if Moore succeeded in doing so "Moore will have done the country a tremendous service." Bradford Gary agrees with the main points made by Moore but criticizes for making various omissions and lacking attention to detail, stating that "though Moore is not interested in the details behind the outrages he has assembled, many of his fundamental points are nevertheless accurate."^[41]

Legal controversy

Piracy

Although the film was released on June 29 2007, a copy was leaked onto the Internet in early to mid June 2007.^[42] Moore, who previously stated his support for Internet downloading, denies leaking the video himself and an investigation has been held as to the source of the Internet leak.^[43] When asked about the leak, Moore said: "I'm just happy that people get to see my movies...I'm not a big supporter of copyright laws in this country...I don't understand filmmakers...who oppose sharing, having their work being shared by people, because it only increases your fanbase...I've always been happy in the past when teenagers have downloaded pirated copies of my movies...They've been downloading them and they've been sharing them, and I think that's great."^[44]

Treasury Department probe

  In a May 2, 2007 letter, the Office of Foreign Assets Control informed Moore that he was the subject of a civil investigation stemming from the filmmaker's March trip to Cuba. In the letter to Moore, a Treasury official noted that the department had no record of Moore obtaining a license that authorized him to "engage in travel-related transactions involving Cuba," alleging that Moore violated the United States embargo against Cuba.^[45][46] A duplicate master copy of the film was being held in Canada in case American authorities attempt to seize the film as part of the investigation against Moore that arose from taking American 9/11 rescue workers to Cuba for medical treatment.^[47] Moore has said that if any trip to Cuba is for journalism reasons, the U.S. allows it. Moore states that his intentions were to travel to the US Naval base in Guantánamo Bay. Upon Moore's arrival at Guantánamo Bay, a siren was sounded and Moore decided to turn around for safety.

On the The Tonight Show, Moore reported that he was notified that a subpoena regarding his trip to Cuba had already been issued. According to an anonymous source at Reuters, Moore has not been served; rather, the government contacted his attorney, David Boies, to discuss the logistics of serving a subpoena.^[48]

Deleted scenes

Moore filmed but did not use several scenes from the section about health care in the United Kingdom. According to Moore, "There's footage of a homeless shelter in Britain where you get acupuncture and foot massages. And I had a scene in France, interviewing a woman who works for General Electric, who tells me they all get benefits that GE employees don't get in the United States."^[49]

In addition to filming the health care systems of Canada, the United Kingdom and France, Moore also filmed scenes in Norway, whose health care system is supervised by the Norwegian Board of Health Supervision. Norway was removed from the film because its health care system possess numerous benefits similar to the French system. For example, Norwegian patients treated for an illness like psoriasis or rheumatism are eligible for two weeks paid vacation at a spa in the Canary Islands.^[50] Norway hires a government ethicist to determine who they should spend their money on, because they want to do it in an ethical way.^[51]

A scene in which Moore visits a Norwegian island prison, in which inmates reside in small group homes and focus on rehabilitation through manual labor and farming, was also cut.

Additional deleted scenes include interviews with Marcia Angell, former editor of the New England Journal of Medicine, in which she criticized various practices of pharmaceutical companies and the Federal Drug Administration.

Executive producer Harvey Weinstein asked Moore to remove a scene critical of Hillary Clinton, but Moore refused. Weinstein, whose company provided financing for the film, is a friend of the Clinton family.^[52][53]

In the home video edition of the film, Moore also included a segment (Sicko Goes To Washington) promoting the United States National Health Insurance Act (Expanded and Improved Medicare for All Act), HR 676, a piece of legislation which Moore endorses for the creation of the sort of single-payer health care system that the film has been documenting in other nations within the USA.

Another special feature available on the home DVD release documents the story of an uninsured woman who was offered a 50% discount for treatment of spinal cancer, but had her discount revoked when the hospital discovered that she had obtained the money to pay for her treatment through fundraising, which the hospital considered to be earned income.

These deleted scenes are available as special features on the DVD release.

Notes and references