There are over 300 million citizens in the USA. They have no state or social medical provision. In the political parlance of the US establishment, social is a dirty word. Individualism is exalted as choice, leading to competition, and is thus synonymous with excellence.
Does this logic sound familiar? Blairite or Brownite? Certainly, it is the model of public-service provision championed relentlessly by both Labour and Tory; the model reshaping our NHS and schooling system.
Freedom to choose: health or wealth?
We are asked to sidestep the obvious fallacy of the ‘freedom of choice’ argument: namely, that a choice of ‘excellence’ pre-supposes the coexistence of ‘non-excellence’ – mediocre and, frankly, appalling care – which must therefore be foisted on some patients; and that no-one is in a position to ‘choose’ a good service when they are having, say, a heart attack.
We all hope and pray to avoid such personal calamity, but, if such is our lot, we hope that medical care is rapidly and locally accessible, universally comprehensive and of the highest quality – life- (or limb-) saving and, preferably, dignity-preserving.
The seriously, chronically or terminally ill are poorly placed to start flexing their puny (because individual) consumer-rights muscles. Caveat emptor! (Buyer, beware!)
It was Nixon, himself epitomising the corrupt nature of bourgeois politics and politicians alike (graphically revealed during the Watergate affair), who led the successful campaign to institute the US’s current medical system.
He did so, aptly, in the communist witch-hunting days of the 1950s, while other imperialist nations were busy adopting the post-war Keynesian consensus to appease their workers with comprehensive educational and healthcare concessions.
The US system – as Michael Moore points out – encourages people not to indulge in medical care: incentivises suffering in obscurity, and it penalises ‘sickos’ severely. The US makes its citizens responsible for providing for all their healthcare needs – preferably in advance, by anticipating their medical illnesses and emergencies before they arise, and making the appropriate financial provision.
For most, this means insurance, and insurance is no laughing matter, for medicine here is mercenary – and charges are exorbitant.
Medicare, the state insurance system, designed for the elderly and the needy, and widely reviled as offering sub-standard care (many of the best hospitals refusing to participate in the scheme – which covers only selected conditions) is itself by no means cheap. The following is an excerpt from the ‘deductible’ surcharge schedule – payments demanded of poor patients over and above Medicare payouts (to private hospitals) for treatment, ie, for having the temerity to get unwell:
“Part A — For each benefit period [‘episode of care’ – admission with an illness], a beneficiary [patient] will pay:
“A Part A deductible of $1,024 (in 2008) for a hospital stay of 1-60 days.
“A $256 per day co-pay (in 2008) for days 61-90 of a hospital stay.
“A $512 per day co-pay (in 2008) for days 91-150 of a hospital stay, as part of their limited lifetime reserve days.
“All costs for each day beyond 150 days.
“Coinsurance for a skilled nursing facility is $128 per day (in 2008) for days 21 through 100 for each benefit period.”
And so on. The list of “deductibles” or extra charges for “covered” items is interminable. And, as any medical professional will testify, the event of a prolonged admission on intensive care can happen entirely out of the blue to any one of us (who contracted septicaemia or meningitis, say), or as a result of complications of the most routine ‘episode of care’.
Medicine too expensive for the sick
The simple and inescapable fact remains that modern medical treatment of major illness – particularly chronic or debilitating illness – is prohibitively expensive for working and even middle-class families. The medicine-for-profit model either prices them out of the market entirely or, very often, having fleeced them for all they’re worth, cuts off further treatment, leaving them to suffer disability or even face a premature death.
Meanwhile, companies and directors, and (to a lesser degree) private practitioners get rich. Truly, one can say of the capitalist class: their wealth is built upon our poverty, their happiness upon our misery.
One in six citizens in the US has no medical insurance; some 50 million citizens of the largest imperial power, which carries home blood-soaked tribute from the entire world, can afford no health insurance whatsoever.
They live, like much of the third world, in terror of injury. Around 18,000 of them die each year just because they don’t have health insurance.
Sicko illustrates the point graphically with the case of Rick, who cut two of his fingers off while working with a power saw and, ‘on presentation’ to his local hospital’s Emergency Department (ED), was offered a stark choice: “We can repair your middle finger for $60,000, or patch up the ring finger for just $12,000.”
Sacrificing his car and holiday, Rick managed to stump up the cash for the ring finger and accept disfigurement (throwing away the middle finger) over bankruptcy and destitution.
“It’s an awful feeling, having to put a value on your body,” says Rick. Yes, indeed.
This illustration tells us much of the law of capitalist distribution, and what it means in practice; of what the majority of the world’s population can expect under the tender administration of such an order.
The insurance racket
But, sickening though this state of affairs is in the richest country in the world, it is not what the film is really about.
Sicko focuses on the 80 percent of US citizens who do have medical insurance. It tells the stories of the companies (BCS, Sigma, Blue Shield, Humana, United Health et al) that willingly accept money for insurance, but go to extraordinary lengths to avoid paying out when people get sick.
They do this through the use of exclusion clauses in healthcare policies, which deny all care for “chronic” and “pre-existing” conditions (including diabetes, atherosclerosis, previous heart problems, many cancers, or just having a “high risk body mass index” – being too fat or thin), by employing aggressive medical officers to veto bills on the basis of obscure loopholes, by classifying modern treatments as “experimental” and, where all else fails, by employing ‘fraud hitmen’ to reclaim previous pay-outs.
We are introduced to Frank, who, aged 79, still works in a supermarket, and faces the prospect of working till he dies because the medicines he and his wife need are not covered by Medicare. This, then, turns out to be the true meaning of the American Dream – the opportunity to exploit the old and needy with impunity. And this is extolled as the highest civilisation in the world.
No wonder that the US is the most litigious nation on earth – the most basic ‘rights’ have to be fought for, against massive corporate vested interests.
The film shows how the American Medical Association, together with the insurance and pharmaceutical industries, lobbied congress in the late 90 and early 00s. Massive bribes were paid out ($100,000s per congressman, in the form of ‘contributions’ to congressional campaigns) to protect the private system and stop a state subsidy being introduced.
The Medicare Prescription Drug Improvement and Modernization Act 2003 protected the massive profits of the pharmaceutical industry, and left two thirds of pensioners paying over $2,000 per year for medicines.
At the end of the campaign, 14 congressional aides left Washington for lucrative posts in the health-insurance industry, and one congressman (Billy “I love my mother – that’s why I support this bill” Tozen, instrumental in drafting and defending the bill) became the new CEO of Pharma, a drug industry lobby, for the princely sum of $2m.
Ah, democracy! This is the ‘revolving door’ between government and business – and always in favour of the latter.
In the domain of political economy, free scientific inquiry does not merely meet the same enemies as in all other domains. The peculiar nature of the material it deals with summons into the fray on the opposing side the most violent, sordid, and malignant passions of the human breast, the Furies of private interest.
As Karl Marx pointed out, the established church, for instance, will more readily pardon an attack on thirty-eight of its thirty-nine articles than on one thirty-ninth of its income.
The US represents the pinnacle of monopoly capitalism. The most developed form of what Lenin so aptly described as the “highest stage of capitalism – decadent parasitic, moribund capitalism”. It is the image in which the capitalist world moulds itself. It is our future, as long as we pursue the capitalist path of ‘development’.
We have come to expect hard-hitting documentaries from Michael Moore; films that examine the reality of American foreign and domestic policy and reveal some of the unpleasant realities of the ‘American Dream’.
Moore finds the ‘antithesis’ to the US private capitalistic medical system in the Canadian, French and British NHS systems. And to the extent that these offer ‘cradle-to-grave’ treatment, available on demand at the point of need and paid for out of social contributions, the contrast is striking and valid.
He points out that in France, new parents are entitled to state-sponsored home help (“the government pays for someone to do your laundry?!”), and that higher education is free.
It was, perhaps, not his remit to discuss it, but Moore makes no mention of the increasing privatisation, piecemeal at first, but growing in momentum, that is pushing the NHS into the arms of just the same insurance companies that are lambasted in Sicko. Perhaps this makes the film especially crucial viewing for the British public at this time.
The uncritical eulogy of “socialised medicine” in the UK and France is particularly nauseating when it descends to a Tony Benn diatribe on the liberating nature of democracy “taking power from the market place to the polling station, from the wallet to the ballot”.
This neatly side-steps the real reasons “socialised medicine” was ever granted under conditions of capitalism in Europe and Canada. Those peculiar conditions were a post-war world in which the revolutionary and armed working class had overthrown capitalism and provided the real benefits of workers’ power – in health, education, culture, development, work, industry, dignity and a many-sided and meaningful, truly free life – to hundreds of millions; had awoken downtrodden masses to new life and opened up new horizons and real opportunities.
At that time, Greece, France and Italy all stood on the brink of following the example of the Soviet Union and the eastern European people’s democracies, while the post-war prestige of socialism was bringing the old colonial system to its knees as the oppressed peoples rose in revolt, one after another.
World capitalism was in a life-and-death struggle for survival, and socialised medicine was granted incompletely, partially, and, above all, temporarily, in order to stabilise its tottering rule. Now, having bought themselves the requisite breathing space to regroup and replenish, Europe’s capitalists are feeling more stable – following the collapse of the socialist bloc in Europe, arrogantly and aggressively so – and state provision is being rapidly asset-stripped across the board.
Also, though a useful device to put his point to the nationalistic US proletariat, Moore’s point that in Guantanamo Bay (declared to be “US soil”) the “evil doers” get free care, while 11 September rescue workers (avowed pride of the nation) languish with respiratory conditions but no treatment, sticks in the gullet.
The ‘treatment’ they get follows psychiatric and physical trauma, owing to years of incessant torture. It would be hard to make foreign nationals with no source of income, illegally detained and abused in contravention of international (Geneva) conventions, pay for the privilege of receiving medical treatment.
However, he uses these as a stepping stone to bring US audience closer to ideas of social and cooperative care, finding the far more accurate opposite of US inequality in the Cuban medical system: truly comprehensive, universal, free, and of excellent quality despite the tiny population and relatively small GDP per capita of this heroic nation, still suffering economically from the US-led blockade, but defiantly leading the countries of Latin America in the direction of socialism, through its concrete, practical example.
It is not without reason that the US vents its wrath (with terrorist attacks as well as economic embargo) on plucky Cuba, for it lives in fear of Cuba’s vivid example of the better life offered by expropriating the exploiters – to the US workers as well as the entire hemisphere. That is why the US continues to imprison the Miami 5, Cubans who went to Miami to investigate terrorist (mafia) rings encouraged by the US political establishment to destabilise their island, in contravention of international law – to which, of course, the US does not subscribe.
Moore takes the self-same 11 September rescue workers denied care in the US to Cuba, where they are gifted comprehensive treatment by their Cuban comrades and accorded honours by a Cuban brigade of firemen.
Visiting a pharmacy, one American lady breaks down upon realising that the inhalers for which she pays $150 each in the US (she needs several each month) cost just 5 cents when supplied by Cuban socialism.
The American delegation literally weep for the gift of health, granted by people they have meekly accepted to be their ‘enemies’, yet denied to them by their relative poverty in the US.
The real conclusion lies here, powerfully illustrated, but unstated: if you want the economic productivity, the wealth of society, to provide for the needs of the people, you need a revolution to overthrow the Batistas, Bushes (Clintons, Obamas), Blairs and Browns (and Camerons) of this world, who act as corporate mouthpieces and will never champion the rights and interests of the working people.
When working people truly exercise power, all injustices visited upon us can be resolved in our favour. All else flows from this central point: “Political power grows out of the barrel of a gun,” as Chairman Mao famously said.
At the moment, the imperialists are wielding the big guns, and – with the exception of certain liberated zones such as China, DPR Korea, Cuba, Venezuela, etc – the masses cower, all too often unarmed ideologically, politically and militarily, before them.
If we want to consign such obscenities as are depicted in Sicko to the dustbin of history, we must educate and organise ourselves. This is our urgent task.
> Conditions for the working class in 21st century Britain: Health – October 2008