SiCKO, Part I: The Human Tragedy

When word got out that Michael Moore was working on a movie with the working title SiCKO, about the U.S. healthcare industry, the industry went bananas.

Memos started shooting around, warning insurance and drug company executives and representatives to keep looking over their shoulders, to make sure they avoided being ambushed by Moore and a camera crew. Indeed, they had something to fear, for they have a great deal of needless misery and suffering to answer for.

But it turns out that Moore didn't need them after all.

Instead, he's made a movie driven by heart-breaking story after heart-breaking story. SiCKO presents a devastating indictment of the U.S. healthcare system by letting victimized patients speak for themselves.

When Moore announced on his web page that he was doing a movie about outrages in the U.S. healthcare system and was looking for examples, he was flooded with 25,000 responses.

He profiles Dawnelle, whose 18-month-old daughter Michelle died because her health plan, Kaiser, insisted Michelle not be treated at the hospital to which an ambulance had taken her, but instead be transferred to a Kaiser hospital. Fifteen minutes after arriving at the next hospital, Michelle died, probably from a bacterial infection that could have been treated with antibiotics.

Julie, who works at a hospital, explains how her insurance plan refused to authorize a bone marrow transplant recommended for her cancer-riven husband. He died quickly.

Larry and Donna, a late-middle-age couple, find that co-payments and deductibles for treatment after Donna has cancer add up to such a burden that they have to sell their house and move into a small room in their adult daughter's house. The day they move into their daughter's house, her husband leaves to work as a contractor in Iraq.

Moore's camera captures the pain, chaos and forced indignity imposed upon every day people who do their best to deal with an impossible situation.

Moore's web page announcement also attracted responses from hundreds of employees in the health insurance industry, explaining how their jobs forced them to do things of which they were ashamed.

Lee, a former industry employee whose job was to find ways to deny or rescind coverage for healthcare, explains how hard insurers work to deny care, searching for any pretense. About denials of care and coverage, he says, "It is not unintentional. It is not a mistake. It is not somebody slipping through the cracks. Somebody made that crack, and swept you to it."

Becky, another industry employee, says through tears that she's a "bitch" on the phone with clients because she doesn't want to know anything about their families or personal situations -- that knowledge makes the inevitable denial of care too hard to stomach.

And Dr. Linda Peeno, a former medical reviewer for Humana, testifies before a Congressional committee in 1996 that her denial of needed treatment to a patient led to the patient's death. "I am here," she told the committee, "primarily today to make a public confession. In the spring of 1987 as a physician, I denied a man a necessary operation that would have saved his life and thus caused his death. No person and no group has held me accountable for this. Because, in fact, what I did was I saved a company a half a million dollars with this."

With some exceptions, SiCKO's victims aren't people without insurance. As Moore narrates, the movie is instead about the travails of the 250 million people in the United States with insurance.

There are some in the movie without insurance, however. A hospital places a destitute and disoriented woman in a taxicab, which drives away and literally dumps her on the street, near a shelter.

Rich, who has no insurance, has an accident in which he saws off the tips of two fingers. He is told sewing the ring fingertip back on will cost $12,000. The middle finger will cost $60,000. "Being a hopeless romantic," Moore narrates, Rich chooses the ring finger.

The publicity for SiCKO says the movie sticks to Michael Moore's "tried-and-true one-man approach" and "promises to be every bit as indicting as Moore's previous films."

This is actually somewhat misleading. The approach is a little different. There's humor, but there aren't many gimmicks in SiCKO. There's no effort by Moore to confront industry executives. Moore himself has a much smaller role than in previous films.

It is also a bit deceptive -- as an understatement -- to say SiCKO is as indicting as Moore's previous films. No matter how big a fan you may have been of Moore's earlier movies, you'll find that SiCKO cuts deeper and is more powerful and profound. SiCKO is, by far, his best movie.

This is, simply, a masterful work. It is deeply respectful of and compassionate towards the victims. It seethes with outrage, but its fury is conveyed by all of the horrifying stories it presents. The narrative is, by and large, understated. It overflows with raw emotion, but manages to explain clearly the systemic imperatives that lead the richest nation in the history of the world to fail so miserably at delivering healthcare to all.

Could things be different in the United States?

Yes.

The second half of SiCKO looks at other countries' healthcare systems, and finds that national, single-payer insurance delivers far better care. More on this in my next column.

Sneak previews for SiCKO are being shown around the United States on June 23. The movie opens nationally on June 29. Be ready to be driven to tears and rage.