The American Patient

Sicko. Written and directed by Michael Moore.

What a devastating indictment of the US health care system this film is! Fifty million Americans have no health insurance, and eighteen thousand die because of this each year. The focus of the film, however, is on those who do have such insurance - and are therefore not the most badly off - but find it of little use when they need it most.

The insurance is with health maintenance organisations or HMOs, though they should really be called wealth maintenance organisations, as they are most concerned about the wealth of their owners and top executives. People pay for health insurance or have it provided by their employer but, when it comes to the crunch and they fall ill or have an accident, the HMO will try every trick in the book to avoid paying up. Surgical procedures may be categorised as experimental and therefore not covered, or people may be denied treatment because they did not disclose some prior medical condition or even failed to diagnose it themselves.

It is the individual cases Moore presents that give the film its impact. One child died because the HMO insisted she be treated in one of their own establishments rather than the hospital that the ambulance had taken her to. A man who had lost the tips of two fingers in an accident with a saw had to choose which one should be replaced, as he could not afford both. A sick and disoriented woman was dumped in the street by the hospital when she could not pay her bills.

Moore contrasts the American system with those in Canada, Cuba, France and the UK. He makes great play with the fact that the cashier in an NHS hospital doesn't receive payments from patients but instead pays out, reimbursing some of them for their travel expenses. The original NHS idea of free treatment is trotted out, courtesy of Tony Benn, but disappointingly there is no discussion of the extent to which it no longer applies. Further, there's little if any investigation of the real quality of health treatment in these countries.

All in all, though, this is a forceful attack on the idea that medical treatment should be based on considerations of profit. And just before the end comes a refreshing thought, that society should be more concerned with 'we' than with 'me'.

PB