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Sicko
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Sicko is a 2007 documentary film by filmmaker Michael Moore that 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, and grossed $24.5 million theatrically in the United States. This box office result met the official expectation of The Weinstein Company, which hoped for a gross in line with Bowling for Columbines $21.5 million US box office gross.
SynopsisFifty 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 (the National Health Service), 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 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 interviews the head of obstetrics and gynaecology 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. The French government provides 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. 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 check to Jim Kenefick, webmaster of MooreWatch, which he describes as "the biggest anti-Moore website on the Internet". Moore shows the blog entries from Kenefick saying he would have to shut down the website because he needed US $12,000.00 to pay for his wife Donna's medical treatment. Moore explained that he did not want the health care system to trump Kenefick's ability to express his opinion.
ReleaseSicko premiered on May 19 2007 at the 2007 Cannes Film Festival, receiving a 15-minute standing ovation from 2,000 people at the Grand Theatre Lumiere. 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. 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.
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 officeMade on a budget of $9 million USD, Sicko earned $4.5 million on its opening weekend. 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.
Critical reaction
The review aggregator Rotten Tomatoes reported that 93% of critics gave the film positive reviews, based on 181 reviews. Metacritic reported the film had an average score of 74 out of 100, based on 39 reviews. After its Cannes release, Variety described Sicko as "an affecting and entertaining dissection of the American health care industry".
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."
British film magazine Empire praised Moore's filmmaking and personal artistic vision, exclaiming "Sicko is the film that truly reveals Moore as an auteur."
David Denby of the New Yorker called the film "feeble, even inane", 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."
The film was nominated for an Academy Award for Documentary Feature. Sicko was commended in the Australian Film Critics Association 2007 Film Award for Best Documentary.
Marjorie Baumgarten of The Austin Chronicle named it the 8th best film of 2007.
ResponseMediaSicko received a standing ovation when it premiered at the 2007 Cannes Film Festival. Some Canadian journalists attending the premiere were less complimentary, objecting to his depiction of the Canadian health care system, which according to journalist Peter Howell, "praised" it as "flawless".
Roger Ebert gave the film three and a half out of four stars, observing that Moore was less "cocky" than in his previous films, and placed less emphasis on humor. Ebert opined that the film would strike a chord with anyone whose family has experienced a serious illness, regardless of political persuasion.
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."
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, arguing that the history of treatment of cancer patients with bone-marrow transplants has shown it to be unreliable, citing a 1999 report by the American Society of Clinical Oncology showing it to be ineffective. Stossel also questioned whether this treatment would have been given in a socialized system, citing rationing long waiting lists in Canada and Britain. Julie Pierce claimed Stossel never contacted her or her husband's doctors, and that the insurer denied other treatments as well. Pierce argued that Stossel's statements were based on outdated studies on breast cancer, not kidney cancer, which is what her husband had, and that this became a last option only after their insurer repeatedly denied other treatments, citing doctors at the Blood and Marrow Transplant Program at the University of Kansas Hospital who referred to past successes when opining that it could have saved Tracy Pierce. Pierce 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. Stossel, despite conceding that health care in the U.S. is a "mess", disputed Pierce's claim about Canadian transplants, citing The Center for International Blood and Marrow Transplant Research, which reports 16,700 U.S. transplants in 2006 versus 1,520 in Canada, with a 16% greater incidence of transplants per capita. Stossels related testimony from a dozen Canadian medical organizations that indicated it was unlikely to be performed in Canada with any frequency, given the underwhelming results of clinical trials.
In a 20/20 report Stossel provided evidence that typical Cubans citizens receive poor health care, and only richer ones who can pay for the care shown in Sicko receive it. When Moore cited a United Nations report that contradicted this, Stossel pointed out that the U.N. merely repeated what the Cuban government reported, and cited how dictatorships are known to suppress unfavorable information. Stossel also showed testimonials that lower Cuban infant mortality rates are due to the fact that pregnant women are often given abortions if the fetus shows any sign of problems, and 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 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". 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."
MTV's Kurt Loder criticized what he perceived as the film's cherry-picked facts, manipulative interviews, and unsubstantiated assertions, such as the assertion that 18,000 people will die each year because of no insurance. (A 2002 USA Today story on an Institute of Medicine report, however, corroborates this assertion.) 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. Its subjects include people who became addicted to pain medication they were prescribed while waiting for surgery, who went to other countries for treatment, or who died while on the waiting lists. Loder points to calls for reform in Britain and France due to the same rationing, which Loder says has hurt France's economy. Loder also criticized Moore’s depiction of Cuba, and the human rights violations by its ruling regime. Loder points out that a Cuban doctor was imprisoned in the late 1990’s for criticizing the government for its failure to respond to a viral epidemic, and that when Fidel Castro became ill in 2006, he had a specialist flown in from Spain.
On July 15, 2007, Fox News's Sean Hannity interviewed Stuart Browning, whose film, Uninsured in America, profiles Canadians placed on long waiting lists for care, including a cancer patient who was forced to go to the U.S. to receive an MRI scan to detect his cancer, and a woman who lost her bladder because she was on a three-year waiting list for a device that would've prevented this. Browning criticized Moore for showing Canadians who did not experience long waits for care, to the exclusion of those who did, asserting that the nature of Canada's system is widely known, though not in the U.S.
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 films. The Weinstein Company stated before Sicko was released that they did not expect the film to do as well as Fahrenheit 9/11.
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."
IndustryIn a letter responding to a Wall Street Journal op-ed by David Gratzer that was critical of the film, 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. 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.
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. Immediately following the segment, Moore was interviewed live on CNN by Wolf Blitzer. Moore stated that Gupta's report was inaccurate and biased. Moore posted a point-by-point response on his website. After a debate with Moore on Larry King Live, Gupta posted a message about his position on Sicko and CNN's coverage.
Think tanksThe 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. Brett J. Skinner of the Fraser Institute said that healthcare in these countries is characterized by long waiting lists. 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.
The nonpartisan 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."
MoorewatchRegarding Moore's donation to Jim and Donna Kenefick of Moorewatch.com, while Donna Kenefick thanked Moore, Jim Kenefick disputes Moore's account of these events, saying that his insurance would have paid for his wife's needs, that the danger faced by his sites occurred at an entirely different point in time than what was implied by Moore, 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 administrator, 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.
Legal controversyPiracy Although the film was released on June 29 2007, a copy was leaked onto the Internet earlier that month. Moore, who previously stated his support for Internet downloading, denies leaking the video himself, and an investigation was made into the source of the Internet leak. 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 bands or filmmakers…who oppose sharing, hav[ing] 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 sharing them, and I think that's great."
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.
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. 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.
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."
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. Norway hires a government ethicist to determine how to invest government funds, because they want to do it in an ethical way.
A scene in which Moore visits a Norwegian island prison, Bastøy 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 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.
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), , 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.
See also
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