Why wealthy, cigar-chomping Republicans hate Mike Moore (and Cuba)

Documentary maker Michael Moore has made headlines again with his latest film, SiCKO!, which premiered at the Cannes Film festival on May 23. The documentary is a loaded gun aimed at the US health-care system, which is the most expensive in the world and yet provides the worst cover in the First World, according to the latest World Health Organisation scorecard.

That there is a health crisis is uncontested by the US corporate media. But despite this, and the fact that the film is not even hitting US cinemas until late June, SiCKO! is already under fire. This is because Moore doesn't make nice, safe academic critiques of systems in crisis: he makes heart-wrenching documentaries that detail human suffering in emotionally laden minutiae.

Moore chooses as representative of the victims of the US health-care system emergency services personnel who contracted illnesses as a result of breathing in toxic fumes during the clean-up of the Twin Towers rubble after 9/11. They lacked the right medical coverage to access treatment for their ailments.

In typical Moore style, the film-maker takes them to various US medical providers and asks them to justify their denial of treatment. He even takes them to the US naval base at Guantanamo Bay. The US claims that Guantanamo Bay prisoners receive some of the best medical care in the world. Through a megaphone, Moore requests medical aid for his "patients" but is rebuffed.

Moore's final option provides his patients with world-class medical care, without requiring money, or a check of health insurance records, or even filling out forms: being treated by the health system of a nation that is one of the most frequent targets for vilification by Washington — Cuba.

It appears that it is at this point that Moore overstepped the bounds of "responsible" criticism set by the US establishment. The US Treasury sent the film-maker a letter claiming that he was in breach of US economic embargo placed against Cuba and could be liable for fines or imprisonment.

Right-wing pundits began to claim that Moore was a "traitor", unleashing a string of articles, almost exactly the same in both form and content, criticising the Cuban health care system and denying that it could in any way be superior to the US's.

Most amusing of all was the response of Fred Thompson, an actor on US crime series Law & Order. He is also a potential presidential nominee for the Republicans. In order to promote the film, Moore challenged Thompson to a public debate on health care. Thompson posted a video response on YouTube, thoughtfully chewing (no doubt ironically) on a Cuban cigar (illegal to purchase in the US). Thompson claimed he had no time in his schedule to debate Moore and then attacked Cuba for a lack of democratic rights.

In a May 2 article (probably written while sucking thoughtfully on a contraband stogie) for the National Review, Thompson wrote: "What is it that leads people to value theoretically 'free' health care, even when it's lousy or nonexistent, over a free society that actually delivers health care? You might have to deal with creditors after you go to the emergency ward in America, but no one is denied medical care here. I guarantee even the poorest Americans are getting far better medical services than many Cubans."

Thompson, a well-paid and financially secure lawyer-cum-"actor"-cum-senator-cum-presidential-wannabe, has little to worry about when it comes to health care. If a health crisis occurs he can re-negotiate his insurance and maybe make a few sacrifices to fund whatever outside expenses may be necessary. Perhaps he decides not to get a new car that year, or maybe cuts back on those illegal and expensive cigars. But for most people in the US, health care and its costs are a serious matter.

According to the 2006 US census, 46.6 million people in the US (15.9% of the population) had no medical insurance in 2005. Two-thirds of these people had full-time employment. Most health care coverage systems in the US are linked to employment — medical insurance is most often provided by employers as part of an employment contract, and not provided by the state. This system leaves a massive gap between the very poorest in US society who qualify for the small Medicaid system and those who can afford to be covered by a private system.

On May 23, Reuters reported on the case of volunteer firefighter Cindy Holland, a full-time worker with two children and a husband who also works full time. Together they earn too much to get Medicaid, but they earn too little to get decent health insurance. He has health insurance through his work, but it doesn't cover the whole family.

For Cindy to insure the rest of the family, on a basic level that doesn't include such "luxuries" as dental care, it would cost the family US$1000 a month. This is far more than the family can afford, so instead they "roll the dice", as Cindy puts it, and hope no-one gets sick. That these skilled, socially useful workers cannot provide health insurance for their family should be a wake-up call. However, there are far worse stories.

In 2003, the US Socialist Worker reported on Harold Kilpatrick Jr, a 26-year-old schizophrenia sufferer who tried to get treatment for his mental illness from a counselling service. Kilpatrick was told that he would need health insurance. However he had lost his job at FedEx, and his health care coverage along with it.

When he applied to TennCare, Tennessee's low-income medical program, he was knocked back repeatedly. Kilpatrick's schizophrenia worsened and he took a room full of college students hostage, injuring two people before he was shot to death by police.

On some levels, the US may be able to claim good medical standards. For example, it has some of the best specialists and diagnostic equipment in the world. But the ability for these resources to be employed to improve the health of people in the US is hampered by the profit motive. Health is treated as both a profitable industry and as something the individual must pay for, despite society as a whole having an interest in maintaining health standards.

Despite the vast gap in the wealth of the US and Cuba — a Third World nation — the average life expectancy of people in the two countries is roughly equal (78 years in the US, 77 in Cuba). The United States ranks among the bottom of industrialised countries on health at age 60 — meaning US people spend more years living in poor health resulting from chronic illness or disability. Cuba scores much higher on healthy adults at age 60. According to WHO's 2006 world health report, the US had a higher infant mortality rate than Cuba.

Abcnews.go.com reported on October 13 that less than half of US adults receive recommended preventive care and screening tests according to guidelines for their age and sex. By comparison, all Cubans receive free medical check-ups every three months, which includes detailed cell studies and bloodwork to check for cancers or infectious diseases.

How does Cuba do this? The Cuban health system emphasises preventive, personalised care and treats access to health care as a democratic right. This is not to say the Cuban system doesn't suffer extreme limitations. The US blockade specifically bans any US corporation from selling medical supplies or technology to the island's government, which means that basics like painkillers and antibiotics are extremely difficult to get. Cuba has attempted to manufacture its own medical supplies, but this is very expensive and supplies are still short.

But what it lacks in medical capital, Cuba makes up for in human resources. With little capacity to develop industry due to Washington's economic blockade, Cuba instead invested in its people, providing high quality education for its doctors, nurses and engineers. Many doctors produced by this system work overseas in various relief and emergency aid programs to aid other Third World nations. Cuba has the highest number of doctors working overseas of any country in the world.

As a way to further develop its economy, Cuba has entered into an agreement with Venezuela to provide doctors for the poorest and most deprived parts of Venezuela in exchange for discounted oil.

However, the overseas aid program has strained the Cuban system and some Cubans have had to wait to receive medical care — for some of them, this is an unprecedented experience. But Cuba shows that by treating health care as a social priority, rather than a profit-making venture, vast advances in health can be made. Moore is not a supporter of Cuba's government, however his film may open more people's eyes to this reality of what is possible when society is organised on the basis of the needs of the majority, not the profits of a minority. Some of the emergency workers who were treated in Cuba were amazed at what they saw. "This trip opened my eyes", Bill Maher, a ground zero volunteer who had extensive dental work done in Cuba, told Associated Press. The May 19 article quoted the 54-year-old as saying: "I was uneducated. I remembered the Cuban missile crisis. Now, you know what? I'm going back!"