By PHILIP M. BOFFEY
  Published: July 5, 2007
  New York Times
    As the author of many health care editorials, I was eager to see Michael Moore’s “Sicko,” a polemical attack on undeniable flaws in the way this country provides health care. The film is unashamedly one-sided, superficial, overstated and occasionally suspect in its details. But on the big picture — the failure to ensure that everyone who needs medical care gets it — Mr. Moore is right.
  This is not just a matter of uninsured Americans, who now number some 45 million, forgoing needed treatment because it costs too much. There is some of that in the film, notably a vignette in which an uninsured man who accidentally lopped off the ends of two fingers on a power saw was told at the hospital that it would cost $12,000 to reattach one and $60,000 to reattach the other. He chose only the $12,000 option. A Canadian man had five fingers reattached without paying a dime.
  For the most part, however, the film focuses on what happens to the 250 million Americans who do have health insurance. It delivers powerful anecdotes about middle-class Americans who are denied or can’t afford care even with their insurance and teary-eyed confessions from former insurance industry workers guilt-ridden over their role in consigning policyholders to severe illness or death.
  A mother relates how she whisked her feverish toddler to the nearest hospital by ambulance only to find that her insurer would not cover treatment there. She was redirected to an in-network hospital where her child died shortly after arrival.
  Although there are swipes at the pharmaceutical industry and at craven, industry-financed politicians, the main target is the health insurance industry, particularly the for-profit insurers and the managed care companies. A former insurance company “hit man” talks about combing through a patient’s past medical records and life history, looking for excuses to deny coverage. A young women says she was denied coverage because of a trivial yeast infection years earlier that she had not thought to mention when applying for coverage.
  Yet it is hard to know how true the stories are — Mr. Moore never gives enough details to help viewers determine — or how common the abuses may be. The stories are told from the viewpoint of the victims, with nary a peep from the insurers and not much from doctors who might know whether the refused care was appropriate.
  After all these depressing tales, the second half of the film ushers us into a nirvana of humane and caring treatment supposedly provided to the citizens of Canada, France, Britain and even Cuba, a needlessly provocative choice that detracts from the main message.
  While Mr. Moore could find almost nothing good to say about American health care, he can find almost nothing bad to say about the government-run national health systems abroad. There is no acknowledgement of the months-long waits to see specialists in Canada and Britain, of the sick people who fall through the cracks in every system or of rising costs in virtually all countries.
  The French system comes off as best, where the government dispatches home aides to help new mothers do the laundry and American expatriates extol the quality and promptness of care. We are left with the impression that these foreign systems are geared up to provide care, while our insurance companies are motivated to deny it.
  As for Cuba, can it really be true that three volunteers who worked on the smoldering World Trade Center pile after 9/11 were unable to afford care in this country and had to visit Cuba to get it? The hospital they went to reportedly caters to dignitaries and foreign tourists and is hardly representative of health care for the Cuban masses.
  Mr. Moore makes much of the fact that the World Health Organization ranked the United States 37th in an evaluation of health systems, only one notch above Slovenia. He failed to mention that it was two notches above Cuba.
  Mr. Moore’s heart clearly lies with the single-payer, tax-supported, governmental health systems abroad. That solution would be hard to sell here, where suspicion of the insurance companies is matched if not exceeded by suspicion of the government. Yet the case for some form of universal coverage is strong. The claim that we provide the best medical care in the world is hollow; international comparisons rank us below other industrialized countries on measures of quality, access and clinical outcomes. Mr. Moore is right to ask how a country that spends so much more on health care than any other nation can’t take care of everyone who is sick.

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