Workers Vanguard No. 896

3 August 2007


Michael Moore's Sicko: Good Diagnosis, Quack Cure

A Review by Cliff Edwards

Sicko is a compelling movie. By expressed intent, its focus is not on the 50,000,000 Americans who lack any form of health coverage but primarily on the more than 60 percent of the population supposedly covered by employer-paid medical plans. If utter destitution is thereby, for the most part, neglected in the film, what is shown evokes disgust, tears and rage.

There is the ludicrous: a woman denied coverage for an ambulance transporting her from an auto accident because the service was not pre-approved. There is the grotesque: a man without insurance coverage is forced to choose between having his ring finger reattached for a mere $12,000 or spending $60,000 for the reunion of his middle finger with his hand (the ring finger survived). And then there is what can only be described as corporate murder. A black woman who took her desperately ill child to a hospital was denied service because the facility was out of her HMO’s network. The black husband of a white woman is refused a bone marrow transplant for kidney cancer because their insurer proscribed the treatment as “experimental.” Both victims died, the latter slowly and painfully.

All of this has elicited no outraged cries of malicious muckraking (except from a few mainly right-wing media yahoos). Virtually everyone acknowledges that the U.S. health care “system”—ranked 37th in the world—sucks, and almost all know someone who has similarly suffered its abuses. For Moore, the cure for this social cancer is readily at hand. To illustrate, he takes us on a tour of countries much like the U.S.—Canada, England and France—save that in these societies medical care is available to all at no or little cost. Extremely comfortable middle-class types seem to abound in these lands, where all interviewed appear satisfied and happy with the medical care they receive and none are stressed by the onerous rates of taxation or by any of life’s vicissitudes except, perhaps, the price of fish. Disappeared is the wretchedness and despair of Canada’s Native peoples in the cities and on the reserves, and the segregation and deprivation of the denizens of England’s slums and France’s banlieues.

The film gives Tony Benn, onetime darling of the left wing of Britain’s Labour Party, the task of explaining how the wonders of state-paid, universal health care originated. Benn quotes from the 1948 manifesto proclaiming the National Health Service and avows that a country that could kill and maim in the World Wars could also heal. How? According to Benn, all that is required is “democracy,” which he says is “far more revolutionary than socialist ideas or anybody else’s idea.” Benn counsels the ballot, a simple trip to the polls, to cure society’s ills.

Unmentioned by Benn is the decades-long assault on the trade unions and the social benefits available to working people and the less fortunate in Britain, an assault that was massively accelerated with the defeat of the British coal miners strike of the mid 1980s. Benn’s omission is no accident, for the miners strike, in a no less nationalized industry than health care, was knifed by the Labour Party, including its left wing, abandoning workers to the merciless, all-out onslaught by the “democratic” bourgeois order. (Benn is rather outrageously filmed sitting before a National Union of Mineworkers commemorative plate, reminding one that Iago was Othello’s loyal lieutenant.)

In the last segment of Sicko, Moore takes several volunteer rescue workers—impaired due to their heroic attempts to extricate survivors from the ruins of the World Trade Center after the September 11 attacks and then abandoned in their efforts to get their health care paid for—to Cuba. The first stop is the U.S. prison camp at Guantánamo, where Moore apparently bought into assurance by the authorities that nothing but the best in health care is being provided to detainees. Fortunately the rescue workers, who were not in search of being rehabbed for the next water-boarding torture session or in need of forced feeding, were denied entrance when they arrived. Then it’s off to Cuba proper, where the volunteers received thorough, competent and free medical workups and treatment. One woman who required inhalers to assist in breathing, at more than $120 a pop in the U.S., obtained these for a nickel each in Cuba.

Moore cannot explain how this small, poor and essentially resource-less island nation can provide such care to all, while sending its doctors and medical technological know-how to countries in Africa and Latin America, and even offering help for the U.S. Immediately after Hurricane Katrina’s devastation of New Orleans and the Gulf Coast, and the indelible images broadcast worldwide of victims, overwhelmingly black people, abandoned to die by the U.S. government, Cuban doctors mobilized, packed their medical kits...and were forbidden to enter the U.S.

The answer is that the 1960-61 Cuban Revolution created a workers state by expropriating the domestic and imperialist capitalists. The establishment of proletarian property forms—e.g., collectivized property and a planned economy, the nationalization of industry and a monopoly of foreign trade—set the stage for an advance in the well-being of the working masses unobtainable in other backward, underdeveloped countries where the chains of imperialist domination have not been broken. Where they have, as in Cuba, China, Vietnam and North Korea, these countries must be defended unconditionally against imperialism and domestic capitalist counterrevolution.

The Cuban workers state was, however, bureaucratically deformed from its inception by the Castro-led regime, which has continued to suppress the working class in the interest of maintaining its bureaucratic caste privileges. A complete victory over backwardness and want cannot be obtained absent the spread of working-class revolution to the advanced countries and the institution of a worldwide planned, socialist economy. Such a perspective is anathema to the Cuban Stalinist bureaucracy, which must be overthrown through proletarian political revolution.

Wealth Care U.S.A.

Socialist revolution is decidedly not the model, in any of its variations, that Michael Moore envisions or desires. Moore, after all, is what he is: a liberal populist with a decided taste for the Democratic Party, although he expresses disenchantment with what he sees as the weak-kneed politicos who currently inhabit its positions. In the film, he portrays Democratic president Harry Truman as virtuous because, after World War II, he proposed a national health insurance plan supposedly unrivaled in its comprehensiveness and generosity by anything previously or subsequently put on the table. In fact, Truman’s proposal was made amid a bitter series of strikes by the United Mine Workers for union-controlled health benefits, part of a massive postwar strike wave in which millions of workers poured out of the factories and onto the picket lines.

Moore attributes the failure of Truman’s plan to the American Medical Association (AMA) and a cabal of corporate interests that employed Ronald Reagan, then an actor and spokesman for General Electric, to combat the supposed threat of “creeping socialism” posed by the legislation. Sicko is in no small part an attempt to expose this fear as unfounded. The experience in the former Soviet Union—the world’s first workers state—is dispensed with by anti-communist mockery: a mildly absurd socialist-realist film clip of hundreds of singing, smiling and quite attractive Russian workers happily toiling in concert to bring in an award-winning bumper harvest.

Despite its bureaucratic degeneration, the Soviet workers state with its planned economy had provided all with a job, housing, health care and education. An examination of the tragedy that has befallen the peoples of the former Soviet Union since capitalist counterrevolution in 1991-92 speaks volumes about the “magic of the marketplace.” In capitalist Russia today, millions are starving, almost a quarter of the population lives below the official poverty line, infant mortality has skyrocketed and life expectancy has plummeted.

None of this is mentioned by Moore, who turns to the pulpit near the end of Sicko and asks: “Who are we?” Not surprisingly, it turns out that Americans are a decent and generous people who are all in the same boat. Why then, he righteously queries, can’t we simply take care of each other: “Why can’t we do that?”

The answer is simply that when it comes to divvying up the social product there is no “we,” not in America and not in any other capitalist country on the planet. In such societies there are fundamentally two classes, the capitalists who own the means of production and the workers who produce the mass of commodities that fuel the profit system. The profits that accrue from the capitalists’ exploitation of the labor power of the workers belong to the owners and to them alone. The workers in turn receive approximately what they require to be able to work another day, and if death or illness intervenes they are simply replaced.

For that reason, health benefits on a national scale have always been the by-product of class struggle by the workers to combat the depredations of capitalism. The first such national plan was enacted in late 19th-century Germany by Bismarck in an effort to placate workers after the government enacted the Anti-Socialist Laws aimed at squashing the German Social Democratic Party (which in spite of the laws continued to grow apace). Similar plans followed in several countries in Europe, roughly coinciding with the spread and growth of socialist parties (in England, with the growth of the Labour Party).

The greatest expansion of such national coverage occurred in the aftermath of the Red Army’s victory over Nazi Germany, a victory that ended World War II in Europe. On the part of the United States, Britain, France, Germany, Japan and other advanced capitalist countries, WWII was an interimperialist conflict in which revolutionary Marxists (Trotskyists) had no side. With regard to the Soviet Union, however, the Trotskyists did have a side: in defense of the workers state. In the aftermath of the war, working-class militancy swept through the industrialized countries, including the U.S. Not infrequently on the European continent, this militancy was coupled with workers’ aspirations—fueled, in no small degree, by the Soviet victory—to euthanize the capitalist order.

The seeming cornucopia of improvements in the social well-being of European workers, as contrasted to their American counterparts, was aimed at both placating working-class militancy and counteracting the influence of the Soviet Union. It is, thus, no accident that since the collapse of the Soviet workers state in 1991-92, the capitalist rulers in Europe have launched an offensive to reverse the gains conceded in the postwar period.

Things went quite differently in the U.S. Shortly after WWII, the American imperialists under Truman launched the Cold War against the Soviet Union. With full government backing, the Democrats and their social-democratic hangers-on in the CIO (Congress of Industrial Organizations) collaborated to drive the reds—the very people who had built the giant industrial unions during the class battles of the 1930s—out of the trade-union movement. To be sure, Truman was, at least in contrast to Ronald Reagan, something of a liberal. But it was the Truman administration’s Cold War that set the stage for McCarthyism and his government that sponsored the purge that gutted the CIO of its militant core.

In that reactionary climate, there was simply no way that America’s capitalist rulers would bow to the call for national health care. Employer-paid health care was a sop to the working-class militancy that had followed the war, facilitated by making the cost of the benefits non-taxable for both the employer and the employee. This was a gain, although a stinting one compared to the improvements in Europe. By 1958 75 percent of Americans were insured. While the population may have become healthier as a result of being insured, physicians became financially obese. (We refer interested readers to “Wealth Care USA” in Women and Revolution No. 39, Summer 1991, for a history of the AMA’s despicable and largely successful efforts to combat health care reform.)

Pushed by liberal Democrat Ted Kennedy, the bill creating the life-sucking HMOs that are so starkly portrayed in Sicko was signed into law by Nixon in 1971. But it was in the aftermath of Reagan’s 1981 smashing of the PATCO air traffic controllers union, and the precipitous decline in strike activity that followed immediately in its wake, that the bosses began a concerted effort to roll back health costs and HMOs proliferated. Today, given the dearth of social struggle and the continued quiescence of the trade unions, it is the willingness of a section of the bourgeoisie to consider some form of national health plan that has led many, in the main Democratic, presidential hopefuls to offer some reform proposals. Many U.S. corporations seek to improve their competitive position vis-à-vis their competitors in other imperialist countries by shedding the burdensome costs associated with employer-paid insurance. In the current social context, health care “reform” could well result in an actual worsening of the benefits available to unionized workers.

ISO Sickophants

Much left commentary on Sicko is not just laudatory, it’s goo-goo-eyed sycophancy. Both the rad-lib Nation (16 July) and the newspaper of the International Socialist Organization (ISO), Socialist Worker (16 July), covered the film at length, the former in an article by a self-professed social democrat, Christopher Hayes, the latter in articles by Helen Redmond and Alan Maass. The fawning is understandable, for there is little apparent difference in the worldview promulgated in these articles from that portrayed in the movie. Both Hayes and the ISO praise Harry Truman’s health care plan; the ISO observes that it was even more radical than that of Dennis Kucinich, who captivates the ISO as the only Democratic presidential candidate currently proposing single-payer legislation. Both Hayes and the ISO find Tony Benn to be powerfully persuasive, and both are sold on the possibility of fundamentally taming the capitalist order through reform. In the lingo of the ISO and many other left types, the struggle is in the service of constructing a system where people come before profits.

There is, however, some falling out around Cuba. Hayes, who viewed the film with Moore, criticizes the director for going to Cuba and thereby reinforcing “the decades-old slander that equates social democracy with repressive socialism.” The ISO is content to acknowledge that health care in Cuba is pretty good. Not to worry—these skin-deep differences are simply designed to appeal to different audiences.

The Social Democracy ensconced itself as the opponent of working-class revolution in reaction to the proletarian overturn of imperialist rule in Russia in October 1917. The ISO’s political tendency originated in the McCarthy period, when it refused to defend the USSR, China and North Korea against U.S. imperialism during the Korean War (promulgated by Truman—no wonder the Socialist Worker review is partial to Truman). The ISO danced on the grave of the Soviet workers state in 1991-92. For these social democrats, a Stalinist dictatorship is, after all, a Stalinist dictatorship, which goes for Cuba, too. The benefits to the toiling masses from the overturn of capitalism are of little consequence when contrasted to these threats to imperialist “democracy.”

More intriguing is the ISO’s view of Sicko as the modern-day counterpart of Uncle Tom’s Cabin. The miserable circumstances of black people that go unmentioned by both Hayes and the ISO will not be alleviated through moral suasion. For the starry-eyed reformists of the ISO, pressure by whomever is preferable to class conflict.

The current situation cries out for a revival of labor struggle to stop the attacks on health and pension benefits. Virtually every strike in the past two decades has been over defense of workers’ health and pension benefits, and the United Auto Workers today faces major attacks on union gains in contract negotiations with Ford, GM and Chrysler. The labor movement must fight for free, quality health care for all, including free abortion on demand. (Women are another portion of the population omitted in the Nation and Socialist Worker reviews.) Every significant reform extracted from the capitalist order has been wrested through hard class and other social struggles. And if class struggles do not culminate in socialist revolution, the capitalist exploiters will attempt to whittle at or wrench away such reforms after the conflicts subside.

The main reason that workers in this country suffer in comparison to what is available to their counterparts in other advanced industrial societies is that the race-caste oppression of black people is a powerful tool in the hands of the bosses in dismantling unified class struggle. It is necessary to build a revolutionary party that yokes the struggle against exploitation and oppression to the fight for black freedom. As we wrote in “Wealth Care USA”:

“The crisis of medical care cries out for a socialist revolution which will lay the basis for a society which will end all exploitation and social oppression. Health means much more than shots and pills and surgical knives: it is a decent place to live; plenty of good food to eat; knowledge of human biology; air clean of pollution; safe, decent working conditions; the principles of public health rigorously applied.…

“When we have thrown out the vicious capitalist system which sells human life for dollars, we will be able to build a new socialist society where human life, human worth and human dignity count.”