Sicko And The Senator

We Oregonians Must Solve Our Moral And Economic Health Care Crisis.

Oregon's moral and economic health care crisis will not be solved by Michael Moore, Ron Wyden, any of the Democrats running for president or our dysfunctional federal government. Oregon's moral and economic health care crisis must be solved by us, Oregonians. Unfortunately, the Democratic leadership in our state legislature has passed a health care reform bill, SB329, which will take us in exactly the wrong direction. Its foundation is fundamentally flawed. SB329 protects and enriches the failed private health insurance industry. SB329 adds additional burdens to Oregon businesses. SB329 perpetuates our current multitiered health insurance class system. SB329 fails to address the loss of more than $625,000,000 in public services that will not be delivered by Oregon's public institutions during governor Ted Kulongoski's current term because of increased public employee health care costs.

Below is a letter sent to the Democratic leadership of our Oregon legislature by several elected officials throughout our state. The request was ignored. The signatories disrespected. The Democratic Party of Oregon needs to take a long hard look at what those who claim the label of Democrat are doing. The voters of Oregon need to take a long hard look at every candidate for every public office and ask them to discuss and defend the values within SB329 or the Oregon Community Health Care Bill.

Richard Ellmyer

Oregon Community Health Care Bill author and project champion

President, MacSolutions Inc. - A Macintosh computer consulting business providing web hosting for artists and very small businesses.

Writer/Publisher - Oregon Health Watcher commentary - Published on the Internet and distributed to 17,000 readers interested in public health care policy in Oregon.

www.goodgrowthnw.org/health.html

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March 12, 2007

Dear House Speaker Merkley and Senate President Courtney:

The current legislative debate over health care reform in our state does not include our view that the profit oriented private health insurance industry must not be the model upon which a solution to Oregon's moral and economic health care crisis should be based and that Oregon elected officials - public employees - voters and taxpayers must have equal access to the same level of health care not a perpetuation of our current multitiered health insurance class system.

We request that you find a place holder bill in each chamber which would substitute in its entirety the language of the Oregon Community Health Care Bill (see attached) so that an alternative choice may be discussed and debated this session. The Oregon Community Health Care Bill is the only current fully formed piece of proposed legislation which supports our vision of health care reform. We would welcome others that also meet our requirements.

Thank you for your attention.

Sincerely,

Richard Ellmyer - Oregon Community Health Care Bill author

Sam Adams - Portland City Council

Jeff Cogen - Multnomah County Commissioner

Edwars "Chip" Enbody - Hubbard City Council

Darrell Flood - Mayor of Lafayette

Bill Hall - Lincoln County Commissioner

Jim Needham - Mollala City Council

Michelle Ripple - Wilsonville City Council

Mary Schamehorn - Mayor of Bandon

Pete Sorenson - Lane County Commissioner

Senator Wyden says his "model is the health insurance plan he enjoys as a member of U.S. Congress. Paid for with tax dollars, it still relies on private insurance companies to provide the coverage."

Wyden seems to be saying that since he and other elected political leaders have a good deal, they find it "unrealistic" to challenge the health insurance industry's existence.

So let's see just what kind of deal their employer (the US government) offers them. According to Don Sloan's (MD)new book, "Practicing Medicine Without a License"

"Unlimited doctor office visits of your choosing; covers all accidents, routine exams, physical therapy, labs and X-rays; and the like; unlimited hospital visits and stays; certain chronic care and rehab; full prescription coverage; and unlimited specialty consultations. For the employee and the entire family. There are no deductibles, no co-pays, and only a $35 monthly fee taken from their annual salaries of $158,000."

If Wyden's plan offers his deal to the rest of us, I for one will take it.

Great article, it really got my blood pumping. I'm sure most people in this country, even the wealthy ones, would agree that our healthcare system needs to be overhauled. I liked the comment about not simply importing a system from another country. The Italian system, which I’m familiar with, is similar to the one in France and definitely has its share of problems that come from total governmental control. I think the suggestion of mixing government control with private sector implementation is the best of both worlds and the way to go for America. And while we’re at it, something needs to be done with the relationship between law and the private sector. We Americans are in desperate need of a legal mechanism to prevent corporations from influencing politics in their financial favor at the expense of the average joe. Allowing the legal system to be used as a tool to reduce the middle-classes to serfs in a twisted, twenty-first century revival of the feudalism system is far from what our forefathers intended for this nation.

Th writer is dead wrong in the way she characterizes Single Payer approaches advocated by people like Kucinich and the Physicians group she mentions. It is modeled on Medicare, where the Single Payer is the government, but care is provided by private physicians, hospitals and HMOs. It is not at all like the Canadian and UK and French plans, where the government employes the doctors -- although that approach certain could make sense if it were done right.

Although I enjoyed the article, one word put me off. Oxford American Dictionary defines "nebbish" as a person, esp. a man, who is regarded as pitifully ineffectual, timid, or submissive.

I do not believe this is an accurate characterization of Oregon's senior senator, and hope the author considers using less denigratory language in the future.

According to Senator Wyden, "employer-based coverage is just melting away like a Popsicle on a summer sidewalk.” That sounds like a looming disaster for the health insurance—as distinguished from health care—industry. Combined with populist calls for universal coverage, the health insurance industry can presumably read the writing on the wall, and is prepared to once again counter those populist calls for universal coverage. Last time around, the insurance industry countered with the infamous “Harry and Louise” ads. This time around, the industry appears to be adopting a different strategy—co-opting the populists with its own "reform" plan. We need look no further than Senator Wyden for how the industry will co-opt populist reform of our health care system.

Here’s the Health Insurance industry’s proposal, as put forth by Senator Wyden:

1) “shift the responsibility of seeking insurance to individuals, who would be required to have coverage.”

2) “revamp the tax code by erasing the old incentives for businesses and giving new tax breaks to individuals. At first, companies would be required to transfer the savings (from getting rid of health benefits) to their workers in the form of higher wages. Employees would then use that extra money to pay for insurance premiums. At the same time, individuals could deduct that expense from their income taxes.”

3) “impose new rules on insurance companies to prevent them from cherry-picking the healthiest consumers and dumping the sickest clients.”

So let’s see how Senator Wyden’s “reform” affects me, one of the 46 million Americans without health insurance. Let’s start with part one, with the government requiring me to have coverage. That sounds great. I’d LIKE to have coverage. So if I’d LIKE to have coverage, why don’t I have coverage?

Because I can’t afford it, and I don’t have health insurance provided as an employee benefit. In fact, that’s why my fellow 46 million Americans ALSO don’t have coverage. Of course, if you’re a member of that most exclusive of clubs—the United States Senate—the reason people are uninsured may be beyond your comprehension. Or maybe if you’re a member of that most exclusive of clubs, you just don’t give a damn. Either way, 46 million of us have no coverage, even though we desperately WANT to be covered.

So what does Senator Wyden’s first part of his reform proposal do for me and my 46 million fellow uninsured Americans? It criminalizes us for not being insured. Well, even though the first part of Senator Wyden’s “reform” proposal sounds more like guaranteed universal premiums for the insurance industry than legitimate reform, maybe the rest of his plan does something for me and my 46 million fellow uninsured Americans. Let’s see.

Part two of his proposal gives new tax breaks to individuals who buy health insurance. Businesses will pay their employees higher wages with the savings from the premiums they are no longer paying, and the employees will spend that money on health insurance. How do we know this? Because they will be required by law to have health insurance, and they will receive tax breaks for using that money to buy health insurance. Sounds foolproof, doesn’t it?

Uh, Senator, I don’t have health insurance now, nor do 46 million other Americans, so exactly WHO is going to be paying me “higher wages” from the “savings” they get by not paying for my premiums? If a company is already “saving” by not paying health benefits, exactly HOW does your plan work, Senator?

Finally, the Senator proposes rules to prevent “cherry-picking.” Throw in a very small smidgen of populism, and hope it doesn’t smell like the insurance industry co-opt it really is, eh Senator?

To summarize, what Senator Wyden proposes in the way of “reform” for me and 46 million other uninsured Americans is to criminalize us for not having health insurance, and to allow us to deduct money we don’t currently have from benefits we’re not currently receiving when we fill out our tax forms at the end of the year. Just the kind of phony populism you’d expect from one of the health insurance meat puppets in the world’s most exclusive club.

Senator, why don’t you do us a favor, and leave health CARE reform to somebody who gets it?

Require everyone to have health coverage = mandatory National ID cards and/or mandatory implanted RFID chips.

It also means more money (and more greed) to the already-existing insurance companies; and more lawbreakers, so more prisons.

If anyone actually thinks employers are going to pay people more to cover health insurance costs, think again. In fact, most employers would love to say "you're on your own... with the money I pay you now," and cut the coverage you're able to get through them. Savings? Ha ha ha - if it's a corporation, they'll look at it as more money for shareholders, if it's a small business, they'll look at it as more money for themselves.

Time to reprise a saying from 1995 - Ron Wyden, you've been in Washington TOO LONG!

The system is broken all right but not by the bean counters and insurance companies. It is broken by the bleeding hearts who insist we give free care to everyone from illegal aliens to homeless junkies. The rest of us pay their bills. It is broken by the ambulence chasing lawyers who are constantly looking for someone to sue.

Wyden doesn't get it any more than the intellectually challenged poster above.

Unless and until insurers are cut out of the basic benefits package, the system will remain grossly inefficient- and costs will continue to soar.

Insurers add no value; not one dollar paid to them "produces health care." Indeed, as Moore amply demonstrates a considerable amount of money is actually aimed at DENYING people care.

Even worse due to what's known as ERISA preemption- often times people have no recourse when their claims are denied in bad faith....

No More Health Insurance Companies. I will not support any candidate who does not have a 100% universal health care plan and neither should any other American. I'm tired of hearing people say things can't be done. It's beyond that with our health care system - It MUST be done.

Thanks for a well-written article showing a good grasp of a complicated topic. I do think more ink should have been given to HR 676, the single payer bill now before Congress sponsored by Rep. John Conyers and co-sponsored by 75 of his colleagues in the House.

Take the time to read the bill. It spells out how we would transition to a public, taxpayer-funded system. Nurses and physicians who now work for insurers will be employed providing care for those drawn into a universal system. Clerical assistants and those who sell plans will be able to use their skills in other sectors of the economy. The latter are not, after all, health care providers.

As long as we keep the private insurers in the mix, we can expect them to siphon off approximately 30 cents of every health care dollar. (Has Sen Wyden forgotten those CEO salaries?) Comparatively speaking, Medicare spends approx. three percent on administration.

HR 676 also spells out how a single payer system would be funded. Economists tell us we already have enough money flowing through our system--much of it our own tax dollars--to incorporate and improve on the Canadian or French model.

Reform advocates such as Sen. Wyden and former Gov. Kitzhaber want to include all stakeholders in the discussion--to frame a workable solution built on consensus. Policymakers and citizens must be very vigilant to ensure that the powerful health insurance lobby does not skew the "consensus" in their favor.

See SiCKO. Support HR 676.

Michael Moore is right: We can be a better people--we can take care of each other.

Michael Moore a “Documentarian?….get real! How could you print something that you should know has no basis in reality or fact…this story cost me my lunch ...as in all over the sidewalk ...you have got to be kidding me? Michael Moore is alot of things ...(quite possibly the side effects of the things he has eaten ...like New York or Wyoming)...What he is not (as you described him) is a "lumbering muckraker-turned-documentarian" Here is the definition of Documentary making the person who does this the documentarian...

“Presenting facts objectively without editorializing or inserting fictional matter, as in a book or film. A work, such as a film or television program, presenting political, social, or historical subject matter in a factual and informative manner and often consisting of actual news films or interviews accompanied by narration.” See the first line “objectively without editorializing or inserting fictional matter” Calling him a documentarian therefore is not true …it’s a lie

Michael Moore has never made a film that did anything more than spoof a documentary ...his films generally are not factual ...rely on heavily edited news clips that are taken way way way out of context in such a way as to mislead his viewers into thinking and believing that things that are not true and did not happen actually did. You pigeon brains bow down to him like he's Buddha ...or as algore is now called (after his 'documentary" based on junk science made him an oscar winner) "The Goracle..." Michael Moore is a third rate radical left wing political hack…. Michael Moore, who has said he hopes more Americans, will die in Iraq. His last “documentary” movie, "Fahrenheit 7/11" as the rest of the world calls it, Moore has also accused the American people of being the stupidest, most naive people on the face of the Earth. And after this last debut of another tell it like it “really isn’t” “documentary (for those people who can’t read or share a brain) his box office numbers thankfully prove that he is 100% wrong about that as well….but judging from the gushing star struck piece that WW did on him you would have thought he was a “goracle “ or something at least he got the box office numbers to prove it! The fat slob keeps whining about all the right-wing hit groups out to get him. Granted he's a large target (or what's known in baseball as a "fat pitch"). But conservatives are frankly relieved we finally have a liberal who tells the truth about what he thinks of America. You guys need to realize that simply saying something doesn’t make it true …you need to turn your brains on everyday and think for yourselves …Sicko was crappo just like Fahrenheit 7/11 and Michael Moore has never made any films that fall under the definition of ‘documentary” NONE! Get off your knees girls and find out what’s going on for yourselves …or the next thing you know you will be buying up all of the available land in Burns waiting for Global Warming to make it the new coastline!

rogerisright, I have a degree in Film & Television Production. It's obvious from your definition of "documentary" that you don't have a degree in the field. There's no such thing as "presenting facts objectively without editorializing." Every documentaruy presents a viewpoint.

rogerisright, I have a degree in Film & Television Production. From your proffered definition of "documentary," it's obvious that you do not.

Here's what "Directing the Documentary" (author: Michael Rabiger) has to say about what a documentary is:

"For the wealthy TV network or funding agency safeguarding itself against lawsuits, the documentary must contain only what can be defended in a court of law. Not surprisingly, these organizations are much readier to produce informational films or carfeully controlled jourmnalism than they are true documentary, which includes an element of social criticism and implies an individual rather than a corporate point of view."

Now why don't you tell us all another fat joke, hoping that we won't notice that your lengthy comments contain no discussion of the American health care system?

everywhere it has been tried socialized medicine doesn't work long waits to see a physician ... rationed health care etc. A person doesn't need to fawn over Cuba's health care system to finmd the glaring examples of why it doesn't work and why its not a viable alternative for us ...look 45 miles south to salem oregon where this has been tried and failed due to the huge costs my god people name one thing the government has ever done ...one sector of our economy it has ever been given that they havent screwed up? Providing everything for everyone is not the Governments job ....read the constitution! If its the Governments job to do everything for everybody then I sure don't see it (probably right next to the clause on abortion on demand that also isnt there) and everytime we give anything to the govt to do for us what we should do for ourselves then we have become a little bit less free ... I would rather have a system that doesn't guarantee everyone mediocre health care just for being alive and living here. What you are proposing is dumbing down the healthcare system so that everyone can have a little and societies bottom feeders can mooch along for the ride at the expense of those of us who are productive. I worked hard through school and college and grad school so that I would be able to work for an employer who paid me well and supplied me with great medical coverage and benefits ...if other people want that as well then they should go earn it like I did. Why should I work hard al my life if at the end and all along the way I am forced to share the fruits of my labors with someone who isn't willing to work at all. The promise of this country isn't "everything is free come on over" the promise of this country is "opportunity" I took advantage of my opportunities and I don't think its my job to pay for those who haven't. I don't want to donate 40-50-60% of my income to pay for those people I am sorry ....btw michael moore's movie is fiction and couldn't be supported in a court of law mr. film maker it falls woefully short even based upon your definition of documentary. It was algore whop tried and almost succeeded instealing the 2000 election get real!

Actually, I have read the Constitution. It's kind of required reading for one of my other degrees. Thanks for asking.

And thanks for addressing health care, finally, although you apparently know nothing about health care either. One example:

"What you are proposing is dumbing down the healthcare system so that everyone can have a little and societies bottom feeders can mooch along for the ride at the expense of those of us who are productive."

The "bottom feeders" you are referring to already have access to health care. It's the "people who are productive" who often do not have access to health care, because in this country, unless you are a "bottom feeder" as you so compassionately put it, you either have access to health care given to you by your employer, you buy it yourself, or you go without. And 46 million Americans-- 46 million "productive" Americans-- are going without, because they work for a living, at jobs that don't provide health insurance benefits, and that don't pay enough wages to allow those 46 million Americans to buy their own health insurance.

Finally, you claim, without the least shred of evidence, that "everywhere it has been tried socialized medicine doesn't work." That would be news indeed to the citizens of the western deomcracies who enjoy the benefits of socialized medicine. Perhaps you can present us with some evidence that the populations of these western democracies are clamoring for an American-style system?

Now, if you're going to insist that Sicko is fiction, please so us all the courtesy of providing some examples.

I didn't see where you mentioned the part of the constitution that your exhaustive reading uncovered but that aside I understand what you are saying and you are correct on a few important points ...here is what I suggest you consider as well...you are correct in agreeing that we are all paying for the bottom feeders to have access to medical care at virtually no cost at all ...if we were to do somthing ...like enforce the laws currently the books ...with regards to illegal immigration both in this state and in this country we could expand that "bottom feeder" coverage to the work a day blue collar har working americans and legal immigrants who would be able and willing to make some sort of contribution to their own care and who do make such a huge contribution to our economy and way of life. It doesn't seem to matter what the problem is anymore it always finds part of its solution if not all of it in simply enforcing the immigrationlaws of this country...not enough money for k-12 schools and univerities?- kick the illegals off and send them back with orders to respect and follow our laws if they want to come back ....Meth problems? Cocaine problems ...ditto...Health car issues ...once aghain ditto...our social programs are over worked and over utilized by people who have broken our laws and march in our streets demanding rights and benefits they do not have and have not earned and no no legitimate leg to stand on ...you want to make the biggest impact on all of these problems at one time and bring alot of the people who it was intended for back under the umbrella ....start enforcing the immigration laws ...I had the misfortune of having to go to St Vee's ER one night a few months ago on a Saturday night ...it was filled with non english speaking people in fact I commented to my wife that it wasn't until we had been there for at least an hour that I saw anyone I would guess spoke english as their first language ...and 1/2 of the people in their were pregnant ...we don't need the government to do anything new and they don't need more money or to nationalize 40% of our economy. there is no example in history of the government doing anything for anyone that couldn't be done more cheaply and efficiently privately ...except waste money! Bigger government and more government programs is never the answer to any problem as in this case it is more likely that the problem is due to failed government programs (immigration) see we aren't that far apart

sorry didn't spell check first ...typing fast isnt my strong suit

I wouldn't call my reading of the constitution exhaustive-- just two semesters worth in grad school. Not even enough to call myself a constitutional scholar.

Know what I mean?

But it was enough to know that the Government has limited powers; however, the health and welfare of the people is certainly one of the powers of government. In fact, if you look at the preamble, the "general welfare" was one of the purposes for which the constitution was established.

You seem to be arguing that the "bottom feeders" are, or at least include, illegal immigrants. This is an interesting claim. "Bottom feeders" presumably implies people who are unwilling to work, while illegal immigrants are clearly people who come here to work. And in fact, who pay taxes. But because they're here illegally, they're not eligible for free medical care, nor would they be if they were here legally, because they have jobs. Therefore, you are incorrect in your assertion that enforcing the immigration laws would allow us to somehow magically include blue collar workers in the medicare program. The availability of socialized medicine to working Americans isn't dependent upon enforcing the immigration laws, because illegal immigrants don't receive socialized medicine now.

I'm glad you mentioned the emergency room. Do you know why it was filled with "non english speaking people"? Because they don't have access to health care, so they put off anything that isn't an emergency. What would you propose they do when they have a medical emergency?

Your comments about the inability of government to provide medical care are soundly defeated by the evidence available in every other western democracy.

Considering health insurance carriers based in Oregon currently pay out .88 to .90 cents of every premium dollar on claims, it's silly to think we could have "free" coverage offered through the feds.

Medicare currently pays out .76 cents of every dollar taken in (the 4% administrative cost often cited only accounts for the actual cost of processing claims and ignores massive overhead costs and those incurred by Social Security for administering medicare funds).

To date, our government has shown an inability to manage healthcare efficiently. If we were to hand over control in all capacities, we'd no doubt see a net increase in healthcare costs.

All of the anecdotal accounts of success over seas and in Canada can't change the numbers we're dealing with. Wishful thinking doesn't help either. Single payer is not the solution. We need to address the cost of services and Rx before positive change is made (something most proponents of a national system are oblivious to).

Consider the cost of medications in America. NIH, supported by American tax payers, subsidizes R&D for pharmaceutical makers. The rest of the R&D is paid for again, by Americans through jacked up Rx prices and higher health insurance premiums. Countries like Canada get off easy and are able to offer the same medications for much less. Why? Because Americans are essentially subsidizing their medications. Nationalized healthcare won't solve this problem. We'll still get stuck with the bill. We'll just have an even harder time paying it as the cost of administration more than doubles.

Something needs to happen here. Between Moore and Wyden I'll go with Wyden hands down. It still hardly seems ideal.

Look, this is superior reporting. Somebody give Beth a raise. When WW raises an issue that connects with all the readers who don't have health insurance, provoking this much comment, and making the cover, it deserves a nod.

I'll also go with Wyden. No, it isn't ideal. But this story, and the online commentary, has helped me make up my mind who to support.

LTR TO THE EDITOR re: Who has the solution for healthcare?

According to your article in today's cover story, Senator Wyden's plan would shift the cost for health insurance from the employer to the employee. This would continue to support the FOR PROFIT health insurance companies who have created the current debacle. There is no motivation to cure diseases when profits are the motive. It is a contradiction in terms. It is the goal of insurance companies is to profit from your disease.

Until the American people understand that, we will continue to flounder around in versions of the failed system we find ourselves now mired within.

Your coverage neglected to mention the only plan that will actually work: HR 676 — the Conyers-Kucinich bill, (MEDICARE FOR ALL) written by Dennis Kucinich & John Conyers. This plan is supported by 75 Members of Congress, more than 260 Union Locals, 14,000 physicians, and Michael Moore. This legislation currently sits in the House Energy and Commerce Committee, Referred to the Subcommittee on Health, on Feb 2, 2007.

"Everyone should have health insurance? I say everyone should have health care. I'm not selling insurance." Dennis Kucinich

As long as our country continues to support the current for-profit insurance industry, America will continue to be the only developed nation that does not provide comprehensive health care to all its citizens. Shifting this responsibility to low paid employees is not a solution.

For more information on the Conyers/Kucinich Health Care Plan (HR 676) readers can visit www.kucinich.us/ and click on issues. To volunteer in Oregon - phone the Kucinich campaign office (216) 409-8992 and ask for Oregon contact info.

Dennis Kucinich has a record of integrity, and analytical ability to read the facts and arrive at the right decisions. Every time. I back this up with the statement that he is the only Democratic Presidential contender who has voted against every authorization and funding appropriation for the war in Iraq since 2002. They all had access to the same information regarding the upcoming war, but he alone was not confused or misled.

rixtir your going to have to decide whether your degrees are in filmaking or you have graduate degrees where two semeters of con law are required..because it isn't required of film and TV majors lets look at facts over fiction ...a review of moores 'documentary reveals nothing less than that Unfortunately, Moore is also a con man of a very brazen sort, and never more so than in this film. His cherry-picked facts, manipulative interviews (with lingering close-ups of distraught people breaking down in tears) and blithe assertions (how does he know 18,000* people will die this year because they have no health insurance?) are so stacked that you can feel his whole argument sliding sideways as the picture unspools. The American health-care system is in urgent need of reform, no question. Some 47 million people are uninsured (although many are only temporarily so, being either in-between jobs or young enough not to feel a pressing need to buy health insurance). There are a number of proposals as to what might be done to correct this situation. Moore has no use for any of them, save one.

As a proud socialist, the director appears to feel that there are few problems in life that can't be solved by government regulation (that would be the same government that's already given us the U.S. Postal Service and the Department of Motor Vehicles). In the case of health care, though, Americans have never been keen on socialized medicine. In 1993, when one of Moore's heroes, Hillary Clinton (he actually blurts out the word "sexy!" in describing her in the movie), tried to create a government-controlled health care system, her failed attempt to do so helped deliver the U.S. Senate and House of Representatives into Republican control for the next dozen years. (thank you very much!) Moore still looks upon Clinton's plan as a grand idea, one that Americans, being not very bright, unwisely rejected. (He may be having second thoughts about Hillary herself, though: In the movie he heavily emphasizes the fact that, among politicians, she accepts the second-largest amount of political money from the health care industry.)

The problem with American health care, Moore argues, is that people are charged money to avail themselves of it. In other countries, like Canada, France and Britain, health systems are far superior — and they're free. He takes us to these countries to see a few clean, efficient hospitals, where treatment is quick and caring; and to meet a few doctors, who are delighted with their government-regulated salaries; and to listen to patients express their beaming happiness with a socialized health system. It sounds great. As one patient in a British hospital run by the country's National Health Service says, "No one pays. It's all on the NHS. It's not America."

That last statement is even truer than you'd know from watching "Sicko." In the case of Canada — which Moore, like many other political activists, holds up as a utopian ideal of benevolent health-care regulation — a very different picture is conveyed by a short 2005 documentary called "Dead Meat," by Stuart Browning and Blaine Greenberg. These two filmmakers talked to a number of Canadians of a kind that Moore's movie would have you believe don't exist:

A 52-year-old woman in Calgary recalls being in severe need of joint-replacement surgery after the cartilage in her knee wore out. She was put on a wait list and wound up waiting 16 months for the surgery. Her pain was so excruciating, she says, that she was prescribed large doses of Oxycontin, and soon became addicted. After finally getting her operation, she was put on another wait list — this time for drug rehab.

A man tells about his mother waiting two years for life-saving cancer surgery — and then twice having her surgical appointments canceled. She was still waiting when she died.

A man in critical need of neck surgery plays a voicemail message from a doctor he'd contacted: "As of today," she says, "it's a two-year wait-list to see me for an initial consultation." Later, when the man and his wife both needed hip-replacement surgery and grew exasperated after spending two years on a waiting list, they finally mortgaged their home and flew to Belgium to have the operations done there, with no more waiting.

Rick Baker, the owner of a Toronto company called Timely Medical Alternatives, specializes in transporting Canadians who don't want to wait for medical care to Buffalo, New York, two hours away, where they won't have to. Baker's business is apparently thriving.

And Dr. Brian Day, now the president of the Canadian Medical Association, muses about the bizarre distortions created by a law that prohibits Canadians from paying for even urgently-needed medical treatments, or from obtaining private health insurance. "It's legal to buy health insurance for your pets," Day says, "but illegal to buy health insurance for yourself." (Even more pointedly, Day was quoted in the Wall Street Journal this week as saying, "This is a country in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.")

Actually, this aspect of the Canadian health-care system is changing. In 2005, the Canadian Supreme Court ruled in favor of a man who had filed suit in Quebec over being kept on an interminable waiting list for treatment. In striking down the government health care monopoly in that province, Chief Justice Beverley McLachlin said, "Access to a waiting list is not access to health care." Now a similar suit has been filed in Ontario.

What's the problem with government health systems? Moore's movie doesn't ask that question, although it does unintentionally provide an answer. When governments attempt to regulate the balance between a limited supply of health care and an unlimited demand for it they're inevitably forced to ration treatment. This is certainly the situation in Britain. Writing in the Chicago Tribune this week, Helen Evans, a 20-year veteran of the country's National Health Service and now the director of a London-based group called Nurses for Reform, said that nearly 1 million Britons are currently on waiting lists for medical care — and another 200,000 are waiting to get on waiting lists. Evans also says the NHS cancels about 100,000 operations each year because of shortages of various sorts. Last March, the BBC reported on the results of a Healthcare Commission poll of 128,000 NHS workers: two thirds of them said they "would not be happy" to be patients in their own hospitals. James Christopher, the film critic of the Times of London, thinks he knows why. After marveling at Moore's rosy view of the British health care system in "Sicko," Christopher wrote, "What he hasn't done is lie in a corridor all night at the Royal Free [Hospital] watching his severed toe disintegrate in a plastic cup of melted ice. I have." Last month, the Associated Press reported that Gordon Brown — just installed this week as Britain's new prime minister — had promised to inaugurate "sweeping domestic reforms" to, among other things, "improve health care."

Moore's most ardent enthusiasm is reserved for the French health care system, which he portrays as the crowning glory of a Gallic lifestyle far superior to our own. The French! They work only 35 hours a week, by law. They get at least five weeks' vacation every year. Their health care is free, and they can take an unlimited number of sick days. It is here that Moore shoots himself in the foot. He introduces us to a young man who's reached the end of three months of paid sick leave and is asked by his doctor if he's finally ready to return to work. No, not yet, he says. So the doctor gives him another three months of paid leave — and the young man immediately decamps for the South of France, where we see him lounging on the sunny Riviera, chatting up babes and generally enjoying what would be for most people a very expensive vacation. Moore apparently expects us to witness this dumbfounding spectacle and ask why we can't have such a great health care system, too. I think a more common response would be, how can any country afford such economic insanity?

As it turns out, France can't. In 2004, French Health Minister Philippe Douste-Blazy told a government commission, "Our health system has gone mad. Profound reforms are urgent." Agence France-Presse recently reported that the French health-care system is running a deficit of $2.7 billion. And in the French presidential election in May, voters in surprising numbers rejected the Socialist candidate, Ségolène Royal, who had promised actually to raise some health benefits, and elected instead the center-right politician Nicolas Sarkozy, who, according to Agence France-Presse again, "plans to move fast to overhaul the economy, with the deficit-ridden health care system a primary target." Possibly Sarkozy should first consult with Michael Moore. After all, the tax-stoked French health care system may be expensive, but at least it's "free."

Having driven his bring-on-government-health care argument into a ditch outside of Paris, Moore next pilots it right off a cliff and into the Caribbean on the final stop on his tour: Cuba. Here it must also be said that the director performs a valuable service. He rounds up a group of 9/11 rescue workers — firefighters and selfless volunteers — who risked their lives and ruined their health in the aftermath of the New York terrorist attacks. These people — there's no other way of putting it — have been screwed, mainly by the politicians who were at such photo-op pains to praise them at the time. (This makes Moore's faith in government medical compassion seem all the more inexplicable.) These people's lives have been devastated — wracked by chronic illnesses, some can no longer hold down jobs and none can afford to buy the various expensive medicines they need. Moore does them an admirable service by bringing their plight before a large audience.

However, there's never a moment when we doubt that he's also using these people as props in his film, and as talking points in his agenda. Renting some boats, he leads them all off to Cuba. Upon arrival they stop briefly outside the American military enclave on Guantanamo Bay so that Moore can have himself filmed begging, through a bullhorn, for some of the free, top-notch medical care that's currently being lavished on the detainees there. Having no luck, he then moves on to Cuba proper.

Fidel Castro's island dictatorship, now in its 40th year of being listed as a human-rights violator by Amnesty International, is here depicted as a balmy paradise not unlike the Iraq of Saddam Hussein that Moore showed us in his earlier film, "Fahrenheit 9/11." He and his charges make their way — their pre-arranged way, if it need be said — to a state-of-the-art hospital where they receive a picturesquely warm welcome. In a voiceover, Moore, shown beaming at his little band of visitors, says he told the Cuban doctors to "give them the same care they'd give Cuban citizens." Then he adds, dramatically: "And they did."

If Moore really believes this, he may be a greater fool than even his most feverish detractors claim him to be. Nevertheless, medical care is provided to the visiting Americans, and it is indeed excellent. Cuba is in fact the site of some world-class medical facilities (surprising in a country that, as Ricardo Alonso-Zaldivar noted in the Los Angeles Times last month, "imprisoned a doctor in the late 1990s for speaking out against government failure to respond to an epidemic of a mosquito-borne virus"). What Moore doesn't mention is the flourishing Cuban industry of "health tourism" — a system in which foreigners (including self-admitted multimillionaire film directors and, of course, government bigwigs) who are willing to pay cash for anything from brain-surgery to dental work can purchase a level of treatment that's unavailable to the majority of Cubans with no hard currency at their disposal. The Cuban American National Foundation (admittedly a group with no love for the Castro regime) calls this "medical apartheid." And in a 2004 article in Canada's National Post, writer Isabel Vincent quoted a dissident Cuban neurosurgeon, Doctor Hilda Molina, as saying, "Cubans should be treated the same as foreigners. Cubans have less rights in their own country than foreigners who visit here."

As the Caribbean sun sank down on Moore's breathtakingly meretricious movie, I couldn't help recalling that when Fidel Castro became gravely ill last year, he didn't put himself in the hands of a Cuban surgeon. No. Instead, he had a specialist flown in — from Spain.

Design a system to secure perfect health for everyone, what could you lose? If you're going for perfect health for everyone, and fail, at least you'd be doing everyone some good. Plus the closer you get to perfect health for everyone the cheaper your health care system would cost. Folks with perfect health don't need to see doctors so often, stay in hospitals, or take drugs. If we truly have the best health care system in the world, going for perfect health for everyone is the only kind of challenge we'd accept - right?