Sick and Twisted.(The Talk of the Town)(Michael Moore's Sicko)

The documentary filmmaker Michael Moore has more than a few insufferable traits. He is manipulative, smug, and self-righteous. He has no interest in complexity. And he mocks the weak as well as the powerful. (Recall his derision, in "Roger and Me," for an impoverished woman in Flint, Michigan, who slaughtered rabbits to make ends meet.) For all that, 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.

Few will be surprised, surely, to learn that insurance companies routinely deny people individual coverage, or jack up applicants' rates, if they have diabetes or are obese or produced a weird blood-test result in the sixth grade. It's just that a lot of us haven't met those people, or seen what happens to them afterward. Moore makes sure that we do.

Their travails are by turns depressing, blackly comical, and infuriating. There's the twenty-two-year-old who was denied reimbursement for her cervical-cancer treatment because someone at her insurance company thought that she was "too young" to have the disease; the seventy-nine-year-old on Medicare who works picking up trash at his local Pathmark store to pay for the medicines that he and his wife need; the thirty-something-year-old who matter-of-factly sews up a trickling five-inch gash in his leg with kitchen thread, because he doesn't have insurance to cover an emergency-room visit.

These have become ordinary tales in America. Just this year, in my own surgical practice, I have seen a college student who couldn't afford the radiation treatment she needed for her thyroid cancer, because her insurance coverage maxed out after the surgery; a breast-cancer patient who didn't have the cash for the hormone therapy she needed; and a man denied Medicare coverage for an ambulance ride, because the chest pain he thought was caused by a heart attack wasn't--it was caused by a tumor. The universal human experience of falling ill and seeking treatment--frightening and difficult enough--has been warped by our dysfunctional insurance system.

"Sicko" doesn't really offer solutions. Yes, it visits France. But it doesn't discuss the difficulties of reforming a system that encompasses sixteen per cent of the economy. It doesn't investigate the tradeoffs that universal health care will inevitably require. It's an outrage machine. Moore hopes that once people grasp the inhumanity of our system we will replace it. But will we? The movie is so effective in depicting the inhumanity that it makes our failure to act seem baffling. Moore blames the familiar villains: insurance companies, pharmaceutical-industry lobbyists, politicians. But plenty of countries have private insurance--not to mention politicians and lobbyists--and nonetheless have health-care systems that cover all their residents, at a lower cost, and with higher levels of satisfaction. Israel, the Netherlands, and Switzerland all provide universal coverage through multiple private insurers and, like Moore's France, spend between half and three-quarters of what we do. The finger of blame points to an obstacle different from the one the movie suggests: us.

Our health-care morass is like the problems of global warming and the national debt--the kind of vast policy failure that is far easier to get into than to get out of. Americans say that they want leaders who will take on these problems. Large majorities profess support for fundamental change. Yet when it comes to specific solutions we balk. A big reason is the cost. Even though universal health coverage can reduce the system's over-all expense--for instance, by granting ...