About the Production
SiCKO had its origin almost a decade ago, when Michael Moore shot a segment for the premiere episode of his 1999 TV show THE AWFUL TRUTH about Chris Donahue, a dying man battling his insurance company over a pancreas transplant. The story detailed how Donahue made seven years of payments to health care provider Humana, only to be denied coverage for the life-saving
operation--that is, until Moore intervened by proposing a mock funeral and the company relented to avoid a total PR disaster. After the back-to-back success of his Academy Award winning BOWLING FOR COLUMBINE and the top-grossing documentary FAHRENHEIT 9/11, Moore is returning to the American health care crisis, this time flaring it up for the big screen.
"The film is about health care, and it isn't," says Moore. "As with all my films, I take a subject and use it as a vehicle to address larger issues and bigger ideas. In this case, I'm trying to answer a larger question: why are we, the largest western industrialized country, without free universal health coverage for everyone? Why us? What is it about us?"
As word spread of Moore's latest film concept, the U.S. corporations whose massive profits come from health care began having aneurisms. Ken Johnson, senior vice president of the Pharmaceutical Researchers & Manufacturers of America trade group told a journalist that industry executives were "freaking out and pulling their hair out." Indeed, Big Pharma went on lockdown. "Michael Alerts" were sent out to company employees working for at least six major drug companies, warning them to watch out for Moore and his film crews. "We ran a story in our online newspaper saying Moore is embarking on a documentary - and if you see a scruffy guy in a baseball cap, you'll know who it is," a Pfizer spokesman told the L.A. Times. Late last year, CNBC reporter Mike Huckman noted "the level of paranoia was extreme" when he covered a drug company's analyst conference, questioning the reason for the high anxiety as "The Michael Moore Effect."
Yet, from the very start of his project, Moore was always just as interested in honoring the victims our health care system as in unmasking its villains. In February 2006, he issued a call on his website michaelmoore.com, asking readers and fans to send in their personal health care horror stories. His message read, in part, "If you'd like me to know what you've been through with your insurance company, or what it's been like to have no insurance at all, or how the hospitals and doctors wouldn't treat you (or if they did, how they sent you into poverty trying to pay their crazy bills) ...if you have been abused in any way by this sick, greedy, grubby system and it has caused you or your loved ones great sorrow and pain, let me know." Nothing could have prepared him for the response - a deluge of more than 25,000 e-mails in just the first week.
A close friend told cancer survivor Donna Smith about Moore's website request, and since Smith had enjoyed Fahrenheit 9/11 she thought she'd check it out. "I fired off a quick, curt e-mail, just around two or three paragraphs, and didn't think anything would come of it or that anyone would care," says Smith, the wife of a cardiac patient who moved into their daughter's home after insurance costs devastated them financially. "I was venting in that e-mail, it was just sheer frustration. But I was also hoping, against all odds, that somebody would hear from those of us who played by the rules and made it a priority to pay their premiums--and yet were still going under. To have someone like Michael listen and expose a problem that millions of Americans are facing every day gave us a dignity we haven't had for years."
Early on during production, Moore made an important decision--to focus on one particular area of health care rather than covering the unwieldy issue from every conceivable angle.
"We had our own 'Axis of Evil': the pharmaceutical industry, the hospital business, and the insurance carriers," says producer Meghan O'Hara. While major pharmaceutical firms are profitobsessed corporations that bankroll Washington politicians and often lie about their research and development costs, the filmmakers viewed prescription drugs as "a necessary evil" that may ultimately help patients. The same can be said for hospitals--though they, like Pharma, should be regulated and run more efficiently, people obviously need them.
Such allowances, however, couldn't be made for private insurance--"a completely unnecessary factor when it comes to health care," says O'Hara. To make his point even more emphatic, Moore decided not to concentrate his efforts on the 45 million Americans who lacked medical insurance, but instead on the majority who are covered and were denied benefits or became strangled with ridiculous bureaucratic red tape.
The stories speak for themselves. But behind the stories lies the question of how insurance companies literally can get away with murder. Scores of industry insiders and whistleblowers contacted Moore, eager to share their stories on the record about how insurance companies make billions in profits by keeping needed benefits away from those patients who deserved them. "I was told I was not denying care, I was denying payment," went one familiar refrain.
Fortunately, when the medical madness got too heavy or too dreary around Moore's offices, a healthy dose of humor would help lighten things up. A large sign stating "This Is A Comedy" was posted near the entrance to remind sleep-deprived staffers that laughter is the best medicine.
Even a sad little houseplant that wilted in a corner office for weeks provided comic relief when someone hung a note on it that said "This Plant Needs Health Care."
Shooting first began across the United States, with crews sent out to shoot various patients' stories region by region--for instance, a West Coast jaunt took the production to Los Angeles and San Francisco, a Texas whirlwind included shoots in Houston, Austin, Brownsville, McAllen and Dallas, while another Southern trek filmed people across Florida and elsewhere. To demonstrate how US health care has become so acutely diseased compared to much of the civilized world, the crew visited several other countries including France, England and Canada.
In the end, between 150 and 200 unique stories were documented over more than 130 days of shooting--compared to a mere 38 days of filming on FAHRENHEIT 9/11. More than 500 hours of film were eventually shot--the most ever exposed by Moore for a single movie project.
When Moore and his crew returned from shooting, the real surgery began: editing those hundreds of hours of interviews and other footage into a movie. Joining Moore again in the cutting room was FAHRENHEIT 9/11 editor Chris Seward, along with new team members Dan Swietlik (winner of an ACE Award for his work on AN INCONVENIENT TRUTH) and Geoffrey Richman (GOD GREW TIRED OF US, MURDERBALL).
Ultimately, believes Moore, SiCKO will not only expose a failing system and offer solid alternatives, but also show his growth as a filmmaker. "BOWLING FOR COLUMBINE was not ROGER & ME, and this is not FAHRENHEIT 9/11," he says. "When people go to the movies they expect something that will make them laugh or cry or think. They want something fresh and new, and I'm not interested in doing the same thing over again. I think some people will be surprised by the tome of this film."
"I knew this would be a challenge," he concludes. "There's not one character or one company to hate in SiCKO, there's no single antagonist like Roger Smith or Charlton Heston--it's an entire system. Both the audience and I have to work a little harder with this film because it's not so black and white. Let's face it: me marching up the steps to the CEO's headquarters for the umpteenth time isn't very interesting. It's not that I wouldn't do that again, but with SiCKO I wanted to get through a whole film without having to bang on the door of power. I don't want the audience going out into the lobby saying 'Gee, Mike really kicked some ass.' They have to kick the ass themselves. This situation is only going to end when everyone stands up and says, Enough!'"
Facts About Health Care in America
• The United States is the only industrialized country in the world without a universal health insurance system.i
• In 2006, the U.S. census reported that 46 million Americans (recently revised downward to 45 million) have no health insurance.ii
• "Over a third (36%) of families living below the poverty line are uninsured. Hispanic Americans (34%) are more than twice as likely to be uninsured as white Americans, (13%) while 21% of black Americans have no health insurance."iii
• More than 9 million children lack health insurance in America.iv
• Eighteen thousand people die each year because they are uninsured.v
• According to the UN Human Development Report, "The uninsured are less likely to have regular outpatient care, so they are more likely to be hospitalized for avoidable health problems. Once in hospital, they receive fewer services and are more likely to die in the hospital than are insured patients. They also receive less preventive care. Over 40% of the uninsured do not have a regular place to go when they are sick and over a third of the uninsured say that they or someone in their family went without needed care, including recommended treatments or prescription drugs in the last year, because of cost."vi
• Half of all bankruptcies are caused by medical bills. Three-quarters of those filings are people with health insurance.vii
• U.S. health care spending is approximately $2 trillion per year, or $6,697 per person.viii
The United States continues to spend significantly more on health care than other countries in the world.ix
• Administrative costs account for 31 percent of all health care expenditures in the United States. The average overhead for U.S. private health insurers is 11.7 percent; for Medicare, it is 3.6 percent; for Canada's national health insurance program, it is 1.3 percent.x
• According to the UN Human Development Report, while the United States leads the world in spending on health care, "countries spending substantially less than the US have healthier populations.… The infant mortality rate for the U.S. is now higher than for many other industrial countries."xi
• A baby born in El Salvador has a better chance of surviving than a baby in Detroit. The infant mortality rate in Detroit is 15.5, compared to El Salvador's rate of 9.7.xii
• Canadians live three years longer on average than we do.xiii
• A study in the Journal of the American Medical Association found that older Americans are significantly less healthy than their British counterparts - we have more diabetes, heart attacks, strokes, lung disease and cancer. Even the poorest Brits can expect to live longer than the richest Americans.xiv
• Cubans have a lower infant mortality rate than the United States and according to the U.N. Human Development Report, a longer average lifespan.xv
• Over the next decade, the federal government will give the drug and health care industries an estimated $822 billion as a result of the 2003 enactment of Medicare Part D (the Medicare prescription drug plan).xvi
• There are four times as many health care lobbyists in Washington as there are members of Congress.xvii
• Ninety percent of Americans believe the American health care system needs fundamental changes or needs to be completely rebuilt. Two-thirds of Americans believe the federal government should guarantee universal health care for all citizens.xviii
THE ART OF DOCUMENTARY FILMMAKING
READ A QUESTION AND ANSWER WITH MICHAEL MOORE