Wednesday, September 10, 2008


Wednesday, August 22, 2007
Dear Friends:

Michael Moore ends the movie "Sicko" with a lie. It may not be an intentional lie, but it is a falsehood, nonetheless. Michael Moore ends the movie saying that every European country offers "free" health coverage to their citizens and every European country provides such coverage through a "single payer" system.

Both statements are untrue. It is a sad commentary on the pathetically, uninformed state of the health care policy debate in America that health care journalists and American political leaders do not simply know that both of the statements are untrue and that they have not responded clearly and quickly to correct the error.

So what makes these statements untrue? Reality. Most European countries directly charge their citizens for their health coverage. It is not "free" anywhere. Some nations require people to buy coverage from health insurance companies that look very much like American health insurance companies. Other countries use a payroll tax on everyone's paycheck to pay for health coverage. In those countries, each citizen pays a portion of their weekly paycheck for health insurance - - just like our Social Security payroll deduction. In Germany, each employee pays 7 percent of each paycheck for health care and each employer matches that 7 percent. People also can spend additional money to buy better coverage.

The government of the Netherlands takes 9 percent of a worker's paycheck every week to purchase health coverage - - it's hard to figure out how Michael Moore can legitimately call such a payroll deduction "free."

Also, when the government of the Netherlands deducts that 9 percent, or when Germany deducts their 14 percent -- they do not use, as Mr. Moore incorrectly claims, a "single payer system" like Canada to provide the actual health insurance for each citizen. Each of those countries has multiple health plans - or "sickness funds" -- that people choose among. Citizens of Switzerland and the Netherlands choose between competing health plans to purchase their coverage.

So "Sicko" ends with a double lie: Coverage in Europe is not "free," nor is it provided through a pure, Canadian-like single payer system. "Sicko" either deliberately misleads us or is unintentionally wrong.

Each country in Europe has found its own unique path to universal coverage. Switzerland has no government health program at all. Everyone in Switzerland is required to purchase from one of nearly 100 competing insurance companies. (The Swiss government pays for coverage for the poor.)

What about France - - a country Michael Moore described as Eden in "Sicko?" The government uses a sales tax approach and uses that money to buy a basic (not comprehensive) package of coverage for about 80 percent of the French people. The basic government benefit coverage is somewhat incomplete, however, so 92 percent of the people in France now purchase additional private insurance to fill in the 20 - 40 percent gap in various parts of their government benefits. About 20 percent of the French people skip the government program completely and purchase only private coverage. In either case, the coverage isn't free and is not handled through a Canadian single-payer model.

It's unclear from the movie whether Mr. Moore knows that he is not telling the truth about Europe's health care systems, or whether he is still low on a learning curve relative to health care financing and delivery. The learning curve seems pretty steep. He criticizes the U.S. government Medicare drug benefit in "Sicko," and he claims with some passion that the Canadians handle drug coverage much better. So how does the Canadian government actually handle drug coverage? Seven out of eight provinces do not cover non-hospital drug costs for anyone other than low income seniors. The federal government does not cover anyone.

People in those seven Canadian provinces might actually prefer the American Medicare system of partial coverage (favored by over 80 percent of enrollees), which Mr. Moore seems to sneer at in the movie. American Medicare drug coverage can have a "donut hole" in the middle. Seven of eight Canadian provinces skip the donut and give the citizens only the hole.

"Sicko" also tells the story of a Canadian on a golf vacation in Florida to illustrate the alleged superiority of the Canadian insurance and care delivery system because - - Mr. Moore claims in the movie - - the Canadian actually rushed home to Canada when he needed health care rather than getting that care in Florida. A valuable piece of information that "Sicko" conveniently does not mention at that point is that the Canadian government health coverage does not travel. Americans who are insured almost always have health coverage that covers at least emergencies whenever we travel. Canadians, however, have such long backlogs for care in so many places that the Canadian government benefit program can't afford to let people simply leave Canada to access care elsewhere. So the Canadian system that Mr. Moore so eagerly advocates decided not to let its health care benefits "travel" outside of Canada. Canadians in Florida, therefore, actually do return to Canada for care when they can... not because they don't think Americans deliver quality care, rather because their government does not cover care in America.

Again, it's not clear if Mr. Moore is low on the learning curve on that point, or more directly duplicitous. We will probably learn which statement is true as the debate progresses.

There are rumors Mr. Moore offers $10,000 rewards for anyone who can prove that any point in his movies is untrue. Since he says that "every" country in Europe uses the Canadian model, and since there are quite a few countries in Europe, does he owe $10,000 per country or just $10,000 for getting Europe wrong as a package? Or is it $10,000 per country on "single payer" and another $10,000 per country for "free"?

We can let his conscience decide. Money is owed, however.

Thank you.

Sarah Berk
Executive Director, Health Care America

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