In many respects, Michael Moore's new movie, Sicko, is like a trial for those who oversee healthcare in the United States.
The industry -- doctors, drug makers, hospitals, insurers -- is charged with greed and putting personal interests above patients'. Moore heard from thousands of people who had maddening and heartbreaking brushes with this system.
As chief prosecutor, Moore lets them do most of the talking and weaves their stories into the film with wit, compassion and humor.
But one aspect missing from the film is the defense.
Do not expect to hear anyone speak well of the care they received in the United States.
On the other hand, patients and doctors from Canada, Britain, France and Cuba marvel at their healthcare.
Moore tells viewers there are about 50 million people in the United States without health insurance.
In the last week of June, the Centers for Disease Control and Prevention estimated there were about 43.6 million uninsured people in the country. In March, the Census Bureau put the number at 44.8 million.
Moore noted that about 18,000 people die each year as a result of the lack of health insurance.
That number comes from a January 2004 report from the Institute of Medicine. The report said the uninsured do not get the care they need and are more likely to die prematurely.
Taking on the pharmaceutical industry, Moore says it spent millions of dollars lobbying Congress for a Medicare prescription drug benefit. ''Of course, it was really a bill to hand over $800 billion of our tax dollars to the drug and health insurance industry,'' he said.
MEDICARE DRUG COSTS
Moore is citing the projected cost for the Medicare drug benefit's first 10 years.
Last year, however, Medicare officials told The Associated Press that the projected cost of the benefit through 2015 stood at about $729 billion, a substantial drop compared with original estimates.
Moore also noted that the some of the elderly in the drug program could end up paying more for their prescriptions than they did before.
That is true. But the vast majority do save because of the tens of billions of dollars in annual government subsidies to help cover the cost of their medicine. The Centers for Medicare and Medicaid Services says people save about $1,200 a year on average by participating in the program, called Medicare Part D.
At one point, Moore notes where the United States ranks in terms of healthcare around the world. ''The United States slipped to No. 37 in healthcare around the world, just slightly ahead of Slovenia,'' he said.
That ranking is based on a 2000 report from the World Health Organization that some health analysts viewed as misleading.
Moore does not say that one of the countries he highlighted, Cuba, is ranked 39th, below the United States. Among the others, France is ranked No. 1, the United Kingdom ranked 18th and Canada ranked 30th. He does not give those rankings, either.
The report, based on 1997 data, measured not just the quality of care provided, but how well the countries prevented illness and how fairly the poor, minorities and other special populations are treated.
Moore's film includes security video showing a disoriented elderly woman in a hospital gown and slippers wandering in the gutter of a busy Los Angeles street. Kaiser Permanente Bellflower Medical Center near Los Angeles had discharged her and sent her off in a cab. Eventually, a staff member from the Union Rescue Mission in the city's crime-ridden Skid Row area comes out to help the woman.
The March 2006 incident was widely documented. This May, Kaiser Permanente, the country's biggest health maintenance organization, reached a settlement with Los Angeles prosecutors requiring Kaiser to make changes to end the dumping of homeless patients on streets.
Los Angeles authorities are investigating allegations that a dozen area hospitals have dumped more than 50 homeless patients downtown. Last month, prosecutors filed civil complaints against two other hospitals and a transportation service accusing them of dumping homeless patients in Skid Row.
TOP EXECS' SALARIES
In the movie, Moore correctly states that the chief executives of health insurance companies make millions of dollars a year.
Among the insurers mentioned are Humana Inc., where chief executive Michael McCallister received about $5.9 million in salary and other compensation in 2006, and Aetna Inc., where chief executive Ronald Williams last year received salary and other compensation totaling about $30.9 million. Those figures were determined by an AP analysis of company filings with the Securities and Exchange Commission.
Huge executive salaries are the norm in all of corporate America. An AP analysis of 386 Fortune 500 companies' executive compensa- tion reports showed that half the CEOs made more than $8.3 million last year.
In the film, an insurance company call center employee says her company has a list of preexisting conditions that would ''wrap around this house.'' The conditions, including diabetes, heart disease and cancer, make applicants ineligible for coverage. Numerous disorders then scroll up a black screen in yellow letters -- think of the Star Wars movie introductions.
Karen Ignagni, president and chief executive of the trade group America's Health Insurance Plans, said Moore does not identify the plan involved but that it is not a typical one. She said about 17 million people in the United States are insured under individual plans and an additional 200 million under group plans.
''If that list were true, none of those people would be getting health insurance,'' Ignagni said. She said decisions about which treatments are covered by a plan are made by the sponsor, such as an employer, not by the insurer.
Moore also takes on the notion that universal health coverage leads to longer waits in hospital emergency rooms and to see doctors.
He visited a crowded emergency room in Canada and asked patients how long they had to wait. One said 20 minutes; a second said 45 minutes. ''I got help right away,'' a third said. Yet a recent report from the Commonwealth Fund indicates that wait times in the United States are clearly shorter than they are in Canada.
In all areas measured, the United States fared better than Canada.
For example, 24 percent of Canadians waited four hours or longer to be seen in the emergency room versus 12 percent in the United States. The difference was more acute when it came time to see a specialist. Fifty-seven percent of Canadians waited four weeks or longer to see a specialist versus 23 percent in the United States.
The Commonwealth Fund also monitored wait times in Britain, which has universal healthcare. The wait times for emergency-room care were comparable to those in the United States. There was a big difference when it came time to see a specialist: 60 percent in Britain waited a month or more.
The film concludes with a trip to Cuba, where Moore seeks care for a group of workers who have experienced health problems after responding to 2001 terrorist attacks. They are greeted with open arms at a hospital in Havana and given what appears to be top-notch care that they could not get in the United States.
The question left for viewers to ponder is whe- ther Cubans are given such red carpet treatment, too.