Sicko is a 2007 documentary film by American film maker Michael Moore. The film investigates the American health care system, focusing on its health insurance and pharmaceutical industry. The film compares the for-profit, non-universal U.S. system with the non-profit universal health care 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 criticized 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 was made on a budget of approximately $9 million, [1] and grossed $24.5 million theatrically in the United States. [2] This box office result met the official expectation of The Weinstein Company, which hoped for a gross in line with Bowling for Columbine s $21.5 million US box office gross. [3]

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Synopsis

According to Sicko , almost fifty million Americans are uninsured and those who are covered are often victims of insurance company fraud and red tape. Interviews are conducted with people who thought they had adequate coverage but were denied care. Former employees of insurance companies describe cost-cutting initiatives that give bonuses to insurance company physicians and others to find reasons for the company to avoid meeting the cost of medically necessary treatments for policy holders, and thus increase company profitability.

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

Against the backdrop of the history of the American health care debate, opponents of universal health care are set in the context of 1950s-style anti-communist propaganda. A 1960s record distributed by the American Medical Association and narrated by Ronald Reagan warns that universal health care could lead to communism. In response, Moore shows that socialized public services like police, fire service, postal service, public education and community libraries have not led to communism in the United States.

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 "fine" and "not bad". 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, a champion of the Clinton health care plan, is shown as a crusader for change, appointed to reform the health care system in the United States by her husband, newly elected President Bill Clinton. Her efforts are met with heavy-handed criticisms by Republicans on Capitol Hill, and right-wing media throughout the country, who characterize her plan as the harbinger of socialism. When she is defeated, her punishment is to "never speak of it again while in the White House." Seven years later, her silence is rewarded, as she becomes a Senator for the State of New York, a victory made possible in part by money from the health care industry; she is second only to Rick Santorum as the Senate's highest recipient of health care industry campaign donations.

In the United Kingdom, a country whose National Health Service is a comprehensive publicly-funded health care system, Moore interviews patients and inquires about in-hospital expenses incurred by patients, only to be told 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 subsidised in most cases for everyone else; only a fixed amount of £6.65 per item on a prescription is charged, 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 Labour politician and former Member of Parliament. Benn compares a hypothetical attempt to dismantle the NHS with reversing women's suffrage and says it would result in a revolution.

In France, Moore visits a hospital and interviews the head of obstetrics and gynaecology and a group of American expatriates. Moore rides with the "SOS Médecins", a 24-hour French medical service that provides house calls by physicians. ^[5] Moore discovers that the French government provides many social services, such as health care, public education (including universities), vacation and 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, appear to 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. ^[6] Providing only their name and birth date, the volunteers are hospitalized and receive medical attention. Before they leave, the 9/11 rescue workers are honored by a local Havana fire station.

Finally, Moore addresses the audience, emphasizing that people should be "taking care of each other, no matter the differences". To demonstrate his personal commitment to this theme, Moore decides to help one of his biggest critics, Jim Kenefick, webmaster of MooreWatch. According to a blog posting, Kenefick feared he may have to shut down his anti-Moore website because he needed US $12,000 to cover the costs of medical treatment for his sick wife. Not wanting the U.S. health care system to trump Kenefick's ability to express his opinion, Moore sends Kenefick the money anonymously.

This film ends with Moore walking towards the United States Capitol with a basket full of his clothes, sarcastically claiming he will get the government to do his laundry until a better day comes for the sick and hopeless who are unable to receive health care.

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 première 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 première 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 première 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 the United States 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

Made on a budget of $9 million USD, ^[11] Sicko earned $4.5 million on its opening weekend. ^[12] In 441 theaters, it took in an average of $10,204 per theater, the second highest average gross of the weekend. As of February 24, 2008, Sicko has grossed $24,540,079 in the United States and $11,105,296 in foreign markets. It has been named the third-highest grossing documentary in the USA since 1982 excluding concert movies, reality films, and "large-format" documentaries. ^[13]

Critical reaction

According to the review aggregator Rotten Tomatoes, the film boasts a 93% positive rating, based on 181 reviews. ^[14] Metacritic reported the film had an average score of 74 out of 100, based on 39 reviews. ^[15] After its Cannes release, Variety described Sicko as "an affecting and entertaining dissection of the American health care industry". ^[16]

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." ^[17]

British film magazine Empire praised Moore's filmmaking and personal artistic vision, exclaiming "Sicko is the film that truly reveals Moore as an auteur." ^[18]

David Denby of the New Yorker called the film "feeble, even inane" ^[19], but 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." ^[20]

The film was listed as the 4th best film of 2007 by Carina Chocano of Los Angeles Times , as well as 8th best by Marjorie Baumgarten of ''The Austin Chronicle. ^[21]

Awards

The film was nominated for an Academy Award for Documentary Feature. ^[22] Sicko was commended in the Australian Film Critics Association 2007 Film Award for Best Documentary.

Response

News media

John Stossel wrote an article in the Wall Street Journal that claimed Julie Pierce's husband, Tracy, featured in Sicko , would not have been saved by the bone marrow transplant denied by his insurer. Stossel also questioned whether this treatment would have been given in a socialized system, citing rationing and long waiting lists in Canada and Britain. ^[23] Julie Pierce claimed Stossel never contacted her or her husband's doctors, and that the insurer denied other treatments as well and questioned Stossel's assertion that Tracy would not have received this in a socialized system, arguing that they are performed more frequently in Canada than in the U.S. ^[24]

In a 20/20 report Stossel provided evidence that typical Cuban citizens receive poor health care, and only richer ones who can pay for the care shown in Sicko receive it. Moore cited a United Nations report that contradicted this. Stossel also presented testimonials that lower Cuban infant mortality rates are due to pregnant women receiving abortions if the fetus shows any sign of problems, and that infants who die hours after birth are not recorded in mortality rates. When Moore claimed the C.I.A. corroborated his assertions, Stossel responded that the C.I.A. denied this, and that their data contradict Moore's assertion.

In response to criticism that only well-to-do Cuban citizens receive a decent standard of health care, Michael Moore adduced on his website the result of an independent Gallup Poll in which "a near unanimous 96 percent of respondents say that health care in Cuba is accessible to everyone". ^{[25] [26]}

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". ^[27] Surgeon and Associate Director of Brigham and Women's Hospital's Center for Surgery and Public Health Atul Gawande commented, "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." ^[28]

MTV's Kurt Loder criticized the film as presenting cherry-picked facts, manipulative interviews, and unsubstantiated assertions. ^[29] While admitting that the U.S. health care system needs reform, Loder criticized Moore’s advocacy of government control, arguing that many services controlled by the government are not considered efficient by the American public. Loder points to a 2005 documentary, Dead Meat , by Stuart Browning and Blaine Greenberg, which documents long waiting lists for care in Canada. Loder points to calls for reform in Britain and France due to the same rationing. ^[30]

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." ^[31]

Healthcare industry

Wendell Potter, the former Head of Corporate Communications at CIGNA has admitted that America's Health Insurance Plans or AHIP (the umbrella organization for the health insurance industry) had developed a campaign to discredit Michael Moore and the movie. When asked what he thought about the documentary Potter said that "I thought that he hit the nail on the head with his movie. But the industry, from the moment that the industry learned that Michael Moore was taking on the health care industry, it was really concerned....They were afraid that people would believe Michael Moore."

Bill Moyers, interviewing Potter revealed that PBS had obtained a copy of the "game plan" that was adopted by the industry's trade association, America's Health Insurance Plans which spelt out the industry strategies to "Highlight horror stories of government-run systems." Potter explained "The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that even if you even consider that, you're heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program now, it could potentially reduce the profits of these big companies. So that is their biggest concern."

Moyers reported and Potter confirmed that there were attempts to radicalize Moore in an effort to discredit the film’s message. Moore would be referred to as a "Hollywood entertainer" or "Hollywood moviemaker" to associate the documentary as being grounded in entertainment without any basis in objective reality. "They would want you to see this as just some fantasy that a Hollywood filmmaker had come up with. That's part of the strategy." Potter said that the strategy worked beautifully and the impact of the film was "blunted" by the public relations campaign. He agreed that Sicko contained "a great truth" which, he said was "that we shouldn't fear government involvement in our health care system. That there is an appropriate role for government, and it's been proven in the countries that were in that movie. You know, we have more people who are uninsured in this country than the entire population of Canada. And that if you include the people who are underinsured, more people than in the United Kingdom. We have huge numbers of people who are also just a lay-off away from joining the ranks of the uninsured, or being purged by their insurance company, and winding up there." ^[32]

In a letter responding to a Wall Street Journal op-ed by David Gratzer that was critical of the film, ^[33] 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. ^[34] 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. ^[35]

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 . ^[36] Immediately following the segment, Moore was interviewed live on CNN by Wolf Blitzer. ^[37] Moore stated that Gupta's report was inaccurate and biased. Moore posted a point-by-point response on his website. ^[38] After a debate with Moore on Larry King Live , ^[39] Gupta posted a message about his position on Sicko and CNN's coverage. ^[40]

Think tanks

The free market 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. ^{[41] [42]} Brett J. Skinner of the Fraser Institute said that healthcare in these countries is characterized by long waiting lists. ^[43] The National Center for Policy Analysis, a conservative American think tank, has also been critical of Moore's claims, focusing particularly on alleged 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. ^{[44] [45]}

The non-partisan Urban Institute (UI) largely agreed with Moore regarding the need for a universal health care system and failure of the current system. Urban Institute economist Linda Blumberg stated that Moore correctly provides evidence that the current system fails and a universal system is needed, adding 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 popularizing the idea, he "will have done the country a tremendous service." Bradford Gary agrees with the main points made by Moore but criticizes the film 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." ^[46]

Moorewatch

Regarding Moore's donation to Jim and Donna Kenefick of Moorewatch.com, while Donna Kenefick thanked Moore, saying his money "paid for our health insurance premiums and gave us the financial breathing room to both deal with our debts", ^[47] Jim Kenefick disputed Moore's account of these events, saying that his insurance would have paid for his wife's needs, and that his sites were in operation again thanks to reader donations long before he ever received Moore's check. Kenefick accuses Moore of presenting his words out of context in order to defame him, and both Kenefick and his co-blogger, Lee, criticize Moore for claiming to make this donation anonymously, only to highlight it in his film, for which they accuse him of being motivated by a desire for publicity and self-aggrandizement rather than altruism. ^{[48] [49]} Kenefick even said that the amount of money Moore gave him was equal to Moore's "ding-dong budget for the week". ^[50]

At a Cannes press conference, after the identity of the donor was revealed, Moore said: "I had to ask myself, 'Would you write this check if this wasn't in the film?' I decided this is what I would do, and what I should do, and this is the way I want Americans to live." ^[51]

Legal controversy

Piracy

The film was leaked onto the Internet two weeks before its official release on June 29 2007. ^[52] Moore denied leaking the film for publicity, and an investigation was made into the source of the Internet leak. ^[53] 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 the copyright laws in this country…I don't understand bands or filmmakers…who oppose sharing, hav[ing] their work being shared by people, because it only increases your fanbase." ^[54]

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. ^{[55] [56]} A duplicate master copy of the film was being held in Canada should an attempt have been made by American authorities to seize the film as part of the investigation against Moore that arose from taking the American 9/11 rescue workers to Cuba for medical treatment. ^[57] Moore has said that trips made for conduction journalism are usually covered under a general license, which does not require preauthorization by the State Department. 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 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. ^[58]

Deleted scenes and extras

The DVD release includes deleted segments that Moore filmed but did not use in the theatrical release. Several scenes from the section about health care in the United Kingdom feature footage of a homeless shelter where people received acupuncture and foot massages. Discarded scenes in France include an interview with an employee from General Electric, who tells Moore they get benefits in France that GE employees don't receive in the United States. ^[59] Scenes depicting an overview of the Norwegian health care system, which is supervised by the Norwegian Board of Health Supervision were removed from the film because its health care system possesses numerous benefits similar to the French system. Like the French health care system, Norwegian patients treated for illnesses such as psoriasis or rheumatism are shown eligible for two weeks' paid vacation at a spa in the Canary Islands. ^[60] In these scenes, Norway hires a government ethicist to determine how to invest government funds, because they want to do it in an ethical manner. A scene where Moore visits Bastøy Prison, a Norwegian island prison, was also deleted. Here, inmates reside in small group homes and focus on rehabilitation through manual labor and farming.

Deleted American health care scenes include an uninsured woman who was offered a 50% discount for treatment of spinal cancer. She still could not afford the initial consultations, so she held a fundraiser to pay for it. After the initial visit, the 50 percent discount was 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. An interview with Marcia Angell was also deleted. The former editor of the New England Journal of Medicine criticizes various practices of pharmaceutical companies and the Food and 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. ^{[61] [62]}

In the DVD edition of the film, Moore added a segment called "Sicko Goes To Washington". This extra promotes the United States National Health Care Act, legislation that would create a single-payer health care system within the United States.

See also

• List of documentaries
• List of healthcare reform advocacy groups in the United States
• National health insurance
• National Physicians Alliance
• Scandinavian welfare model

References

1. Cieply, Michael; "Some Cities Will Get Early Look at ‘Sicko’"; nytimes.com; June 20, 2007.
2. Box Information for ''Sicko'' at boxofficemojo.com
3. Hayes, Dadd; "TWC, Moore stand behind 'Sicko'"; variety.com; June 11, 2007
4. Healing Our Sicko Health Care System
5. Shticko
6. Moore unveils Sicko at Cannes
7. Sicko: Secrets de tournage
8. Michael Moore's Sicko gets audience thumbs-up at Cannes
9. ''Sicko'' features patients from the London, Ontario area.
10. Michael Moore visits Capitol Hill to promote 'Sicko'
11. Sack, Kevin; "For Filmmaker, ‘Sicko’ Is a Jumping-Off Point for Health Care Change "; nytimes.com; June 24, 2007
12. 'Ratatouille' Swarms Weekend Box Office
13. Documentary Movies
14. Sicko - Rotten Tomatoes
15. Sicko (2007): Reviews
16. Title Unavailable
17. 'Sicko' Shows Michael Moore's Maturity as a Filmmaker
18. No Country For Old Men and Sicko
19. New Yorker review of ''Sicko''.
20. Sicko debut for Michael Moore
21. Metacritic: 2007 Film Critic Top Ten Lists
22. Shortlist for docu Oscar unveiled
23. Sick Sob Stories
24. An Open Letter to John Stossel
25. Cubans Show Little Satisfaction with Opportunities and Individual Freedom World Public Opinion. January 10 2007.
26. ''Sicko'' Factual Backup michaelmoore.com, July 10 2007.
27. Michael Moore's Shticko:His health care jeremiad won't win any converts
28. Sick and Twisted
29. Insuring America's Health: Principles and Recommendations
30. Loder, Kurt; "Sicko': Heavily Doctored: Is Michael Moore's prescription worse than the disease?"; mtv.com; June 29, 2007.
31. SICKO: Damn those Insurance Companies, where the heck are they when you’re sick?
32. ''Bill Moyers Journal'': Wendell Potter on Profits Before Patients
33. Who's Really Sicko?
34. Canadian and U.S. Health Services -- Let's Compare the Two
35. Leaked Internal Memo; 'SiCKO' Has Capital BlueCross Exec Scrambling to Respond
36. "Sicko" and Some Facts Are Incorrect.
37. Video of Michael Moore on CNN FactCheck Response
38. 'SiCKO' Truth Squad Sets CNN Straight
39. Larry King Live
40. My conversation with Michael Moore, Sanjay Gupta, CNN.com, July 11, 2007, retrieved on July 11, 2007.
41. A Story Michael Moore Didn't Tell
42. Who's the real sicko?
43. Hidden costs of Canadian health care system
44. Moore's "Sicko" Could Put Lives at Risk
45. John Goodman: Film buffs may praise Moore's 'Sicko,' but policy buffs can see all its defects
46. Urban Institute. (2007). ''UI Health Care Experts Comment on Sicko''.
47. Kenefick, Donna. "Hello, my name is…" moorewatch.com. June 20, 2007.
48. "Jim Kenefick and Moorewatch as presented by Michael Moore in Sicko"; June 12, 2007.
49. "Mikey's Motive"; moorewatch.com June 20, 2007.
50. Jim Kenefick. "Well, if you insist…" Moorewatch; May 18, 2008
51. Mottram, James. "Michael Moore's healthy scepticism", ''The Times''. October 6, 2007.
52. Pirated "Sicko" surfaces on YouTube
53. 'Sicko' leaks have studios crying malpractice
54. Michael Moore Brushes Off 'Sicko' Leak
55. Uncle Sam Probes Michael Moore (Treasury Department investigating director's unauthorized Cuba trip)
56. Michael Moore In Trouble For Cuba Trip (Treasury Investigation; Moore Took Sept. 11 Workers To Banned Island For Treatment)
57. Moore fears film seizure after Cuba trip
58. U.S. officials may subpoena filmmaker Moore
59. Moore in Motion
60. Test apartment on the Canary Islands in cases of asthma, allergies, fatigue and health problems
61. Moore Says Weinstein Wanted Clinton Scene Cut
62. View clips from the DVD extras