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In 1971, Edgar Kaiser, the son of the founder of Kaiser Permanente, one of the first big HMOs, went to see John Ehrlichman, a top aide to President Nixon, to lobby the Nixon White House to pass legislation that would expand the market for health maintenance organizations (HMOs). Ehrlichman reported this conversation to Nixon on February 17, 1971. The discussion, which was taped, went like this:
Ehrlichman: I had Edgar Kaiser come in...talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because the less care they give them, the more money they make.
President Nixon: Fine.
The next day, Nixon publicly announced he would be pushing legislation that would provide Americans "the finest health care in the world."
When tapes of the Nixon-Ehrlichman conversation and Nixon's subsequent public statement are played halfway through Michael Moore's new movie SiCKO, it is one of the film's more revealing moments. By this point in the film, Moore has already demonstrated that health insurance companies and HMOs are parasitic villains that routinely deny necessary medical care to make more bucks -- even when their money-grubbing leads to the death of patients. Looking for the original sin that led to the present mess, Moore zeroes in on this Nixonian moment, which encapsulates the film's premise that the United States health care system is defined by a fundamental conflict: profit versus care, and -- no surprise -- profit beats care.
Moore makes this point magnificently in SiCKO, which is the best film in the Moore canon. I say this as one who had a mixed reaction to Fahrenheit 9/11. (See here.) This time around, Moore has crafted a tour de force that his enemies will have a tough time blasting (though they will still try). It's not as tendentious as his earlier works. It posits no conspiracy theories. The film skillfully blends straight comedy, black humor, tragedy, and advocacy. You laugh, you cry -- literally. And you get mad.
The film stitches together a string of health care horror stories. Moore opens the movie by looking at two cases involving Americans who don't have health insurance. One fellow who sliced off the tips of two fingers is told at the hospital that he can attach the ring finger for $12,000 and the middle finger for $60,000. He can't afford both. Ever the romantic, Moore reports, this man opts to save his ring finger.
But SiCKO is not about the uninsured. It's about those who have insurance and who have been screwed. Moore began this project by advertising on the Web for tales of health care woe. Within a week, he had received 25,000 emails. That's plenty of raw material. One enterprising father of a child who was going deaf and whose insurance company would only pay for one ear implant wrote his insurance firm and asked if its CEOs would like to appear in Moore's film. The company -- whaddayaknow -- quickly authorized payment for the other implant.
From this flood of complaints, Moore drew compelling and heartbreaking stories. A woman is denied payment for a major procedure because she neglected to mention on her insurance application that she once had a yeast infection (which was, of course, unrelated to the procedure she needed). A mother loses her 18-month-old daughter because a hospital won't treat her without authorization from her insurance company and her insurer insists she takes the child (during an emergency situation) to an in-network hospital. A woman who was in a car crash is denied payment for an ambulance trip because she did not receive pre-approval for that cost. A man is denied a bone-marrow transplant that could save his life and dies.
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David Corn is the Washington editor of The Nation and author of The Lies of George W. Bush and is the co-author of Hubris: The Inside Story of Spin, Scandal, and the Selling of the Iraq War. He writes a blog at davidcorn.com.
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