sicko.jpgI saw Michael Moore's SiCKO last weekend, and I strongly recommend it to all. It's Moore at his best -- or worst, if you're on the receiving end -- because it makes its main points powerfully and convincingly. It's hilarious, infuriating, saddening and enlightening all at once. But more than anything else, it is a devastating indictment of how health care is provided in America and a wakeup call about the upside-down way most Americans have been encouraged to think about the problem. This movie turns the current discussion of "universal coverage" on its head. It's about time.

As today's New York Times article notes, most of the Democratic candidates are gravitating towards some plan for universal health insurance. You'd get insurance through your job, or on your own, or perhaps through a pool of insurance providers in which insurance premiums are subsidized. The candidates may disagree on details about how this is done, exceptions or incentives for small businesses, whether it's mandatory or not, or how long it takes to phase in. Lots of details.

The problem is that these details are complicated for voters, and what's worse, they're dealing with the wrong questions from the voters' perspectives. Why should voters have to sort through these complicated details about insurance coverage? They want health care when they need it, not insurance that may or may not cover them, depending on pre-existing conditions and arbitrary coverage decisions over which they have no control, decisions that can leave them financially devastated.

The Republican candidates are even worse; they're struggling to define their proposals without having to confront the problems of "universal coverage." But mostly they're adamant about keeping the government out of the health care system, even though the most successful and popular system in America -- Medicare -- is essentially government managed. Remember, these are the bozos who want to replace Social Security with -- remember -- private insurance. The American people loved that one.

Moore's SiCKO very cleverly starts from this peculiarly Republican obsession against government-provided health care. It then examines how the private insurance system actually works in America -- and it's one infuriating and heartbreaking horror story after another; real stories, real people, consistently denied care by a system of perverse incentives that rewards insurance companies for denying claims. We listen as administrators and even doctors working for the insurance companies -- not for patients -- explain how the entire system has become morally corrupted by a system in which insurance companies tell practicing doctors what treatments make sense, based on what makes the insurance company healthy. Bring your anti-angry pills for this part. But then Moore hooks up with friends/relatives in Canada, and all of sudden, the conversation completely changes.

You see, the Canadians didn't start by asking how we can get everyone insured, or how we could force employers to provide insurance. Instead, they started by asking, "How can we assure quality health care for everyone?" When you start with the right question, you get a very different answer. Moore then drives this distinction home with amusing scenes of him wandering around trying to figure out how his patient friends -- who quickly get treated without question by the Canadian system -- will be charged, how they will pay, what insurance forms they have to fill out, how they qualify, how they defend against insurance claim denials, and so on. The answer is: They don't; none of that nonsense exists.

When you start with the right question, "how can we provide health care for everyone without hassle," the system you get provides you health care for everyone without hassle. The patient needs care; the patient gets care. Questions about how it's paid for are not something the patient ever deals with, other than participating/voting in the political process to determine how taxes are raised and allocated for all government services. Because that's what health care is: an essential public service to which every person (not just citizens) is entitled, just like police and fire protection, and health and safety inspectors, and schools and dozens of other essential public services.

The rest of the movie has Moore checking out the systems in the UK, France, and eventually Cuba (including Guantanamo!). Everywhere he goes, their governments asked the right question first, and they got universal, no hassle health care -- all the time, for everyone, no questions asked -- plus free house calls if needed, and extended maternity leave and support, and . . . If you've traveled abroad and needed care, you know.

Along with this powerful message, Moore provides the humor by continually asking questions in each country that only make sense in America's perverse and inhumane system, questions that are just nonsensical everywhere else. Everyone looks at him in bewilderment, because America's health care debate is not about health care. It's about nonsense. No one else is confused by the wrong questions.

It's time we insisted our Democratic candidates stopped talking nonsense and started answering the right questions. All the candidates should throw out their current proposals and sit down together and come up with a Democratic plan, based on universal care. Start with the right question: Don't tell us how we're going to get insurance. Tell us how we're going to get care, with no hassle, no forms, no worries, no denials, no discrimination. Health care for everyone, when they need it, where they need it. That's what Democrats should offer to the American people. We can figure out how to pay for it, and how to make the transition, just as our friends and neighbors did, in committee hearings later. But first things first.

America is ready for universal health care, and if they're shown a good model, they'll pay for it. If the Democrats answer those questions intelligently, and just look at what our neighbors and allies do, we can have a Democratic plan that will bury the Republican party in 2008. And if our Party needs help fending off the anti-government crazies and their allies in the other party who will do everything they can to keep something that enriches them but doesn't work, costs too much, and benefits only a few, don't worry. We'd like that fight.

Go see SiCKO, and then ask your Party leaders to start answering the right questions.