"Socialism kills!" roared the guy dressed up like Fidel Castro. The six nurses in miniskirts and high heels who flanked his wheelchair winked coquettishly and passed out literature meant to prove the point. An older woman behind me in line for the premiere of Michael Moore's Sicko softly clucked at them. "Ain't no nurse who could wear heels like that and be on her feet for 12 hours," she said.
But whether government-run medicine really kills, or in fact just turns our nurses into a cadre of propagandists in stilettos, is actually a bit beside the point. Contrary to its billing, Sicko is not a movie about health care policy. It does not spend time examining inefficiencies, or incentive structures, or public-private hybrids. It does not offer a methodologically rigorous cross-national comparison of health care systems. (Its portrayal of Cuba is, indeed, absurdly rosy.) That's not its point.
Its point, of course, is to arouse passion, to force debate, and on that, it succeeds. A few hours before, I'd been on Larry Kudlow's TV show, ostensibly to discuss health care and Moore's new movie. "I hate it," barked Kudlow. "Michael Moore's movie Sicko calls for socialized medicine." He hadn't seen it, of course, but felt perfectly comfortable assuming, and judging, its arguments.
The film is more radical, and more troubling, than he'd even imagined. Moore's movie is only superficially about health care. It uses the subject -- and also sick days, and vacations, and child care, and maternal support policies -- as a way to critique unthinking American exceptionalism, to challenge the tautology that states that the way we do things is the best way to do things because … it's the way we do things. The particulars of the account all add up to the larger question: Is the America we live in the America we think we live in, and the America we want to live in?
In this, it fits well with the Michael Moore oeuvre, which has always been more complex and incisive than either critics or supporters gave him credit for. Moore has routinely explored the dark edges of the country that don't fit with his, or our, conception of what America is. Roger and Me, his breakthrough film on the decline of American manufacturing and the abandonment of Rust Belt economies, asked how we could allow a once-proud city like Flint, Michigan, to collapse in on itself, and how we could permit those most culpable to blithely ignore its demise. Bowling for Columbine was about our casual acceptance of violence and fear as permanent residents in our towns and neighborhoods. And Fahrenheit 9/11 was about our peculiar willingness to tacitly accept our leaders' relentless dishonesty.
In all cases, Moore, using his slightly comical and unthreatening bulk to full effect, wanders around the nation, playing, essentially, a disillusioned child: "Mommy, how can you say America is so good, when this is so bad?" His disembodied voice, with its arch and peculiarly idealistic lilt, narrates a running travelogue of his ambles through the forgotten America. In his new film, though, Moore expands his purview, bringing the same tone of wide-eyed, faux-naive innocence to accounts of Canada, England, France, and Cuba.
It's compelling stuff, and funny, too. Intercepting two new parents as they exit an English hospital, he asks, "How much did they charge you for that baby?" "This isn't America," they laughingly reply. He asks a doctor how much he'll charge a nearby patient with a broken ankle. The doctor chuckles and looks at him in disbelief. He finally tracks down the hospital's cashier's office, certain he's ferreted out where patients come to pay. No, he's assured, this is a National Health Service hospital; they treat patients, they don't charge them. "So why does it say cashier up there?" This, it turns out, is where patients go for reimbursement of travel expenses. It's like one of those old "In Soviet Russia…" jokes: In socialist England, the hospital cashier pays you!
In France, Moore sits around with a group of ex-pats, as they detail some of the benefits they're afforded by the government. They explain that they get five weeks of paid vacation, and an extra week during whatever year they get married -- the better to honeymoon with. Moore rubs his face. They talk about the part-time nanny the government sends out to new parents, who helps with not only child care, but cooking and cleaning. He begins agitatedly futzing with his baseball cap. They tell him about their sick days, and stare in disbelief when he asks if there isn't some limit. "They're sick days," one of them exclaims. They tell him about doctors making house calls at any time of day or night. He plugs his ears and begins humming to drown out their social democratic propaganda.
In Canada, he visits with some elderly relatives who purchase out-of-country insurance every time they go for an afternoon visit to America. Middle-class Canadians, they tell him, just can't risk it. Moore next visits a retired friend of theirs who suffered a recent golf injury. Moore and the friend begin talking through the Canadian health system, and Moore asks why he should have to pay for the man's bad luck and choices. "Because I'd do the same for you," replies the man. Later on, Moore's interlocutor reveals that he's a Conservative. Moore gapes at him. "Is that bad?" Asks the man. "No, just confusing," replies Moore.
And yes, Moore goes to Cuba. He juxtaposes a series of uninsured 9/11 workers who wheeze and struggle through seared airways and weak lungs with the Cadillac medical care the government claims we give to the prisoners at Guantanamo Bay. Sailing to within megaphone distance, Moore calls out: "They just want the same medical care as the evildoers! No more!" Hearing sirens, Moore and his party scatter back to Cuba, where they're given apparently excellent, and very cheap, medical care. Is this an accurate representation of the Cuban health care system? Of course not. It's an attempt to shame us into caring for our own.
Every story, every tale, every vignette asks the same question: "Who are we?" Who are we that our fellow citizens have to decide which fingers they'll pay to get reattached? Who are we that our hospitals push the ill and indigent into cabs, and drop them off, disoriented and clad in a paper-thin gown, on skid row? Who are we that we let insurers deny coverage to our neighbors because they are too tall, or have too many seasonal allergies? Who are we that we don't guarantee paid sick leave, or vacations, or child care, leaving that all instead to the whims of employers? And most of all, who are we to have let national pride blind us to these better alternatives, and let moneyed interests and powerful lobbies construct a country that best serves their needs rather than ours?
It is possible, of course, that Americans will see this movie and disagree with its implications. They will not think that the volunteer rescue workers who shredded their lungs inhaling the debris of the 9/11 attacks should be given health care. They will not think that all working Americans deserve paid vacations. They will not think that health care would be better if the first thing the hospital biopsied was your broken ankle, rather than your wallet. But Moore clearly doesn't believe that. This is not a movie of arguments, but of examples -- of practices Moore thinks more humane, and more in accordance with his countrymen's preferences. In that way, his critique of America is, itself, dependent on a glittering view of the country. In the end, he is an idealist, and a patriot -- confident that if he can just remind us of the forgotten America, it will be forgotten no more.