July 06, 2007

As someone deeply interested in marketing, communications and social activism, I have long been intrigued by the works of Michael Moore. Earlier this week, I had the occasion to check out his latest offering, Sicko, while visiting my hometown of London, Ontario, a city that happens to be featured in the film. As his audience has come to expect, Sicko exhibits Moore’s savvy in satire, stunt and shock, this time taking aim at the health care system in the United States. Few would take issue with the central thesis underlying Sicko: the United States must immediately, perhaps radically rethink its approach to health care. But Moore uses a falsely simplified compare and contrast exercise to make his point. In the film, he visits Canada, the UK and France to document real life experiences of citizens of those countries being served by their state-run health care systems. Moore glorifies the speed of care, universality of access and richness of services of those countries, but ignores their deficiencies.

In my opinion, the Canadian system is superior to that of its American neighbors, if only in that is addresses medical needs without any financial consideration, let alone transaction of cash. In a Canadian hospital or clinic, the process of prioritizing medical situations in accordance with need is not influenced by a patient’s income or insurance policy. If a patient is denied care, it’s because they are perfectly healthy. As Sicko shows, this universality of access to health care also exists the UK, France and elsewhere. But Moore’s analysis of the health care systems of these countries is partial. As a recent recipient of care at a walk-in clinic and hospital in Montreal, I am speaking from experience when I say that the so called socialized health care is not without its shortcomings.

This recent experience consisted of a 5 hour wait period at a walk-in clinic, resulting in a 6 week wait for an appointment to see a specialist. Finally, I’m now in the midst of a 3 to 9 month wait before a surgeon will be able to operate on a recurring tendon injury I’ve had for several years. The good news is that in each case, once I was seen by the nurse or doctor for whom I was waiting, my experiences in Canada’s health care system have always been positive. I’ve always been treated with care, competence and respect. And I’ve paid for his level of care only in the form of my personal income taxes, never out of pocket. But Sicko focuses on these positive characteristics, ignoring that Canada’s system is under-funded, suffering from a doctor, nurse and equipment shortage, and is not adequately equipped for the impending increase in health care demands that the baby boom generation will bring as it ages in the coming years.

Sicko selects patient care success stories from the Canadian, British and French health care systems because Moore’s mission is to convince Americans that their system ought to more closely resemble those of other industrialized Western nations. But Moore goes a little over the top in his positive assessment of these countries’ systems. Several minutes of the film is devoted to a casual focus group set in a café in Paris, where Moore interviews a handful of American ex-patriots living in France. Over Evian, filet mignon and a few bottles of Bordeaux, the group shares their experiences, first of the horrors of the American Health Maintenance Organization (HMO) delivery model, then of the wonders of the French socialized health care system. The focus group ignores the failings of France’s health care system, such as the increasing costs of drugs to the government.

I doubt that anyone would expect Moore to present a diligent analysis of the health care systems of four countries in a two-hour film, much less a film that is trying to be a box office success. But Moore could have done more to present a balanced analysis and expose the shortcomings of other health care systems. If his goal is to bring about a meaningful discussion on improving the American system, Moore’s film would have been well served with a less romanticized view of other countries’ universal health care systems.

Many argue that Moore’s lack of rigor is justified by his worthy goal: to evoke a rejection of America’s health care system among its citizens. If that’s true, the next step in the process of first challenging and then rebuilding America’s health care system is to foster a meaningful debate and conduct a critical analysis. A more methodical approach must be taken, one that sets aside sensationalism and takes as objective a look as possible at the best practices in health care delivery around the world. If the Unites States is to create a health care system that leads the world as the country does in other areas, surely the end result will go well beyond the successes achieved in Canada and other countries, taking universal health care to innovative new heights.