Photo courtesy: The Weinstein
Does the film give an
accurate picture of Canada's healthcare?
Not in the least. Consider
Moore's claim that ERs don't overcrowd in Canada. A
Canadian government study recently found that one in
10 patients waits more than a dozen hours for care.
McBane: A lot of that is anecdotal he
happened to run into people who were not waiting long.
But it's not a film about wait times.
Chaoulli: He should also have interviewed patients
and relatives of those who have died as a result of
the waiting lists.
Martin: The two basic messages about Canadian
healthcare in the movie remain true: first, insurance
companies do not interfere with our clinical practice
here as physicians. Second, access to care here is based
on clinical need, not ability to pay.
Oberlander: I also think it's important to understand
this in an American context: we hear almost nothing
about other nations' health systems, and when we do
it is often exaggerated claims about how bad they are
claims promoted by our own insurance industry.
What can Canadians learn from
SiCKO's a wake-up call for Canadians to get real
about how private healthcare works. The notion that
the private sector is the solution to our wait times
is totally blown out of the water in the film.
Gratzer: Unfortunately, Moore's analysis is so
superficial that I don't think Canadians can learn much
of substance. As a country lawyer once wrote, people
who like this sort of thing will like this sort of thing.
Brown: I think SiCKO will be a non-event
Meet NRM's expert panellists
Brown, PhD, Ontario's
Assistant Deputy Minister for Health System Strategy
Chaoulli, MD, successfully
sued Quebec government to legalize private health
Gratzer, MD, Toronto
psychiatrist, fellow at conservative think tank
Manhattan Institute and author of The Cure:
How Capitalism Can Save American Health Care
Martin, MD, president,
Canadian Doctors for Medicare
coordinator of the Canadian Health Coalition
B Oberlander, PhD,
US political scientist and author of The Political
Life of Medicare
What was the most powerful message
of the film for you?
That the American healthcare system is broken. What
can we say of a health system that forces people to
choose which finger to get reattached because they don't
have health insurance? Or a hospital that dumps homeless
patients onto skid row?
Martin: I think the film has helped Americans
begin to understand that while private markets work
in most parts of life, in healthcare they do not lead
to improved access.
Chaoulli: The lack of morality of some private
insurance companies in the United States. In my view,
that refers to the need of independent watchdogs acting
as health advocates on behalf of consumers, like the
organization I am in the process of establishing in
Quebec, the Chaoulli Group.
McBane: To maximize profits and to care are irreconcilable
purposes. You can't do both. That's what we see emerging
with Jacques Chaoulli and Brian Day physicians
and owners of for profit facilities, are they putting
profits first or patients first? Traditionally, arms
dealers are not Ministers of Defence.
Gratzer: That government-run healthcare is beautiful
And the film's most dubious
That government-run healthcare is beautiful and compassionate!
Chaoulli: That other countries provide "free"
healthcare. That's not true. There is no free healthcare.
It is paid for through public or private insurance.
Oberlander: The implicit claim that everything
is perfect in Britain, France and Canada is obviously
Martin: The Cuban segment of the film was interesting,
but likely fairly inflammatory to American audiences.
that the private sector is the solution to
our wait times is totally blown out of the
water in the film"
"Michael Moore should
also have interviewed relatives of those
who have died as a result of the waiting
Dr Jacques Chaoulli
"We cannot risk a system
where some people can benefit and others
"All healthcare systems
have problems but the US is unique in its
inequity and failure to secure universal
coverage for its population"
"While the system we
work in is far from perfect, Moore accurately
depicts the dangers of the alternative"
Dr Danielle Martin
Moore's analysis is so superficial that
I don't think Canadians can learn much of
Dr David Gratzer
For those of you who are physicians,
how did you feel watching your American colleagues who
served as medical directors for insurance companies
admit their job is primarily to deny care?
I was very shocked. It's a shame.
Martin: Any healthcare system that functions
with the goal of denying medically necessary care to
patients should serve as a cautionary tale to all physicians
whose first obligation is to do no harm.
Gratzer: I'm not sure our approach here in Canada
has been so tremendously different. From new drug approvals
to investments in cutting-edge technology, bureaucrats
are making decisions for patients but with an
eye on the budget line.
Isn't it rather odd that as
Americans are looking at creating a universal healthcare
system, many Canadians are talking about increased private
That's oversimplified. Canadians aren't privatizing
their system, they are debating where the boundary should
be between public and private and whether private clinics
and so forth should have an expanded role. And Americans
are talking about universal coverage, but don't hold
your breathwe have been debating this for nearly
McBane: A small number of ideologues are trying
to Americanize our healthcare. What Chaoulli is proposing
is the emergence of a two-tier system, a way for the
rich to jump the line. But 80% of Canadians believe
in our system.
Brown: With tens of millions of uninsured and
under-insured citizens, the US healthcare system is
a wedge between the haves and the have-nots and it can
create a risk to a sense of national solidarity. We
cannot risk a system where some people can benefit and
In the US, physicians are not
exactly clamouring for universal healthcare. Canadian
doctors opposed medicare when it began. Do doctors care
more about their pocketbooks than their patients?
In the US that statement is certainly true historically
of organized medicine (ie, the American Medical Association).
However, it's self evidently not true of many individual
Gratzer: Governor Schwarzenegger is running into
problems [with his univsersal healthcare proposal for
California]. He's proposing a host of "fees," the largest
would be on the gross revenue of physicians. Needless
to say, while many docs support his overall efforts,
they aren't thrilled about this fee.
Chaoulli: Most doctors feel, rightly, that the
quality of care requires a basic freedom of relationship
between them and their patients. That freedom is profoundly
lacking in many countries, due to the excessive government
interference. Few doctors are greedy, like in any section
of the society.
McBane: We've seen US physicians testify to Congress
that they've killed patients on behalf of insurance
companies. That could happen in Montreal just as easily
If someone were to make a Canadian
version of SiCKO, about the horrors of Canadian
healthcare, who would you suggest for the job? George
Stroumboulopoulos? Rick Mercer? Sacha Trudeau?
Rick Mercer certainly has the satire skills to pull
What did you think
of the movie? Send us your thoughts at [email protected]
or by fax at 514-397-0228. We'll publish selected
comments in our next issue.
Gratzer: How about Jacques Chaoulli?
Chaoulli: I would suggest myself should
money be there for the financing of it.
Martin: Judging by the Canadian vote for Tommy
Douglas as the "Greatest Canadian" in the CBC's competition,
I think it would be pretty difficult to find a high-profile
and well-respected Canadian who would want to make a
movie slamming medicare.
Oberlander: Okay, you've lost me here!
Questions by Sam Solomon