The Rogue Voice


October 01, 2007

Rogue movie review: Sicko

Photo courtesy of Dr. Steve Sainsbury

What made Sicko, the brainchild of Flint, Michigan’s favorite son, a nondocumentary? Let me count the ways.

Health care in the ‘evil’ empire

By Dr. Steve Sainsbury

Despite being a physician, and part of the complex medical institution skewered by Michael Moore in the movie “Sicko,” I actually liked this film. It was interesting and entertaining. Of course, I also loved all three “Lord of the Rings” movies, “Harry Potter,” and most of the “Star Wars” series. I guess I just like a good fantasy. Sicko certainly fits the bill.
What made Sicko, the brainchild of Flint, Michigan’s favorite son, a non-documentary?
Let me count the ways.
The main contention of Moore’s movie is that 50 million Americans have no health insurance. What he conveniently fails to mention is that nearly half of all uninsured Americans go without coverage for four months or less, often while between jobs. Eighteen million are between 18-34 years old, and presumably healthy. Fourteen million make more than $50,000 a year, and 7 million make more than $75,000 annually—a group that can obviously afford insurance (but choose to spend their money elsewhere). Finally, 10-20 million are illegal aliens, who by definition have illegally entered our country and are not able to get insurance through conventional employment. Guess those stats were left on the cutting room floor. Must have been a big room.
Moore puts forth Canada, France, and Britain as shining lights of successful socialized medicine. Yet the cameras must have been out of film when it was time to show the massive lines, cash shortages, and extended waits for “elective” procedures that plague all the systems celebrated in Sicko. Need your gallbladder out? Sorry, it might take years to get around to it, but those crippling gall bladder attacks will just keep on coming. Hip worn out, causing excruciating pain with every step? Sorry, but hip replacements in the socialized system of medicine are elective. How does the spring of 2012 sound for your surgery? You have a nice day, now.
In Canada, Moore’s medical-care nirvana, only half of all ER patients felt that they received medical care in a timely fashion. One of my colleagues worked in an ER in Detroit, where he saw hordes of Canadians cross the border into the U.S. for their surgeries, CT scans, MRIs, and specialty care that were too hard to get in their home country northward. Care that we take for granted here in Moore’s evil empire.
Most laughable however, was Moore’s visit to Cuba. Does anyone honestly think that he received the same level of care that the average Cuban receives? Do you imagine that maybe, just maybe, the Cuba government might have used his visit as an opportunity to skewer their formidable brother to the north.
I was in Cuba last year. I went there legally as a volunteer to determine what emergency medicine needs could be supplemented by the relief organization that sent me (Caribbean Medical Transport). I went alone, but met up with some friends of the organization who arranged for me to talk with doctors, nurses, and hospital administrators. I went into several facilities, observing and talking with patients and medical caregivers alike. No one from the government knew who I was or what I was doing there. This was all accomplished in a very low-key, informal way, so as not to antagonize the government, and in order to get a true perspective.
What did I find?
I found an abundance of wonderful, well-trained physicians, so many in fact that they are exported to Venezuela and other Third World countries in order to provide hard currency to a financially beleaguered nation. I also found long lines of people waiting hour after hour for simple medical care, many with nothing else to do but wait and then wait some more. I found dilapidated, ramshackle infrastructures—hospitals that at one time must have been truly impressive, now mired in neglect. Paint peeling from the walls, plaster dust laying everywhere, and huge piles of crumbling columns and bricks—pushed to the side so patients can walk by.
I found shortages of medicines, supplies and technology. Remember the firefighter from New York in Sicko, who got a CT scan while the impressive white-coated Cuban physician solved all of his medical problems? He must have been a very lucky man as there are only two CT scans in the whole country, and only one in the entire city of Havana (2-3 million people). Amazing that he was able to get to the head of what must have been an extremely long line. And don’t you find it just a little revealing that Fidel himself called in doctors from outside Cuba to treat his recent abdominal ailments?
Finally, I’m amazed at the myth that Moore perpetuates when he implies that those without insurance cannot receive medical care. First of all, seniors are covered by Medicare, a well-defined form of socialized medicine, which covers them from retirement to death as long as they jump through the Medicare hoops established by that giant government bureaucracy. Secondly, many of the medically indigent are eligible for Medicaid, a state and federal form of socialized medicine that covers emergency and routine medical care.
But most annoying is the blind eye he turns to this fact—no one is turned away from emergency care. Whether you are fully insured or completely un-insured, it is illegal to refuse care in any emergency room in the nation. You can beam down from Mars, lacking identification and without a penny to your name, and still receive care in any ER. I know this—it has been my profession for more than 20 years.
Ahhh, you say, sure you have to see everyone, but they won’t all get the same care.
Wrong again! When I see a patient in the ER, I have no idea what their insurance status, or lack thereof, might be. The rich (well insured) tourist and the homeless (uninsured) alcoholic will both get all the X-rays, lab tests, and operations they need. In over 20 years of providing emergency care, I have never been pressured by anyone, including hospital administrators, on how to triage my care according to the ability of the patient to pay. The principle of equal care for all prevails in the emergency room. Is it free? No, of course not, just like food, clothing, and shelter are not free. But unlike those other necessities, payment for emergency medical care is requested only after the care has been given. Try that at Vons or Mervyns—give me the food and clothing first, and I’ll pay you later.
Will Michael Moore to be traveling to England, or France anytime soon for his gastric stapling? I doubt it. No, I strongly suspect that his surgeons will be U.S. trained, and his hospital bed will be found in one of the fifty United States, all of his Sicko posturing notwithstanding. Or maybe he will just go to Cuba where everyone was so darn nice. A guy can dream can’t he? §

Dr. Steve Sainsbury is a physician who works in the South County. He can be reached by email at


At 8:07 PM, Blogger Steve said...

Here’s a few facts for Dr. Sainsbury, who seems more interested in attacking Michael Moore than commenting on the substance of his documentary (yes, all documentaries have a bias, but that doesn’t make them “nondocumentaries”). First of all, the movie was not about uninsured Americans. Most of the individuals featured actually had health insurance. Their lack of health care was DESPITE being covered.
The average family health insurance policy is $12,000 per year. If Dr. Sainsbury thinks that is affordable on a $50,000 per year income, then he must be very frugal. Currently, 11.2% of children have no health insurance. Maybe they are between jobs, too? Notably, 40% of those with jobs do not get health insurance as a benefit.
Michael Moore openly acknowledges in Sicko that U.S. health care is superior to that in Cuba, when he points out that Cuba is ranked #38 by the WHO, whereas the U.S. is #37 (despite the fact that the average lifespan is longer in Cuba and they have a lower infant mortality rate). The very fact that you have to make an argument about whether the U.S. health care system is superior to that of a third world country that has been under economic sanctions for half a century is a sad commentary on our health care system.
When Dr. Sainsbury discusses his trip to Cuba where he “found dilapidated, ramshackle infrastructures—hospitals that at one time must have been truly impressive, now mired in neglect. Paint peeling from the walls, plaster dust laying everywhere, and huge piles of crumbling columns and bricks—pushed to the side so patients can walk by,” he might as easily made a trip to Walter Reed Hospital, where he could have seen the same thing (along with a few rodents and cockroaches) afforded our returning, wounded Iraq veterans – Support the Troops!
While it is certainly magnanimous of Dr. Sainsbury to treat everyone who comes into his emergency room (leaving aside the fact that in many places, which emergency room and hospital one goes to is decided by whether and what kind of health insurance one has), these people are eventually going to be sent a bill for services rendered. And like Von’s (where yes, Dr. Sainsbury, you can purchase your food by credit card and pay later), they do in fact have to pay for it. Thus, they are often put in the position of weighing whether to seek care in the first place or take their chances. I am also still trying to get my head around Dr. Sainsbury’s argument that healthy people don’t need health insurance.
Having spent two years in New Zealand, a country (like almost all industrialized nations) that has national health insurance, I found a fine quality of care. In fact, when I came back to the U.S. for a visit, I had to get myself pricey travel insurance, so that I wouldn’t be caught up in the U.S., my native country, with no health insurance.
You can’t have it both ways and say that it is too expensive to have national health care but then argue that the number of uninsured is negligible. If the number of uninsured in this country is such a small number, as Dr. Sainsbury implies, then why not just insure them?
Steve Pittelli, M.D.

At 12:10 PM, Blogger stacey said...

see an expanded version of steve's response to dr. sainsbury in the november '07 edition of the rogue voice, on the stands Nov. 1: "Mired in neglect?"


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