The headline isn't a reference to Premier Campbell's Conversation on Health; it's about Michael Moore's latest film, Sicko, which argues that even those with health insurance in the United States can end up dead or bankrupt because of claims denied. He contrasts the relative utopian situation enjoyed by citizens of Canada, the UK, France and Cuba with horror stories from people (or dramatizations of people) whose U.S. insurers refused payment. You might chuckle about the Cuban example because medical director of the Cambie Surgery Centre and President of the Canadian Medical Association, Dr. Brian Day, is fond of saying that Cuba is the only country other than Canada and North Korea that doesn't let its citizens buy private health insurance for services covered by its public plan. It looks like Moore used Cuba to stick a sharp stick in the eye of his government while generating more publicity for his film. He took volunteer 9-11 rescue workers there to get medical attention their insurance plans wouldn't cover at home.

Moore's website provides a "checkup" on assertions contained in his movie. It does not quantify the number of Americans whose health is made worse as a result of the rejection of insurance claims, and it doesn't say how many Americans face financial hardship, let alone bankruptcy, because of illness or injury even though they have health insurance. Moore doesn't need to do that in order to advocate for tax paid universal health care that would replace all U.S. insurance companies, since a large audience in the U.S. has called for a plan like that for decades. Nevertheless, those who want to rally to his call to make U.S. public health insurance more like Canada's, or like what is found in dozens of other countries, need to fill in a lot of gaps in the "documentary".

In British Columbia, as in most of the world that has universal public health insurance, we are debating how to improve the system. What should be covered, how long should waits be, and when are user fees justified? Moore's film is aimed at a more fundamental question, but if the Canadian system is allowed to deteriorate to the point that private insurers are able to take advantage of the Chaoulli v. Quebec (Attorney General) decision of the Supreme Court of Canada, then we might be back to dealing with the need for public health insurance on the level addressed by the film.

Canadians can get a superficial sense of superiority when viewing the film. There were plenty of chuckles in the audience I was part of, and much relief that the kind of health stories that make the news here are rarely as bad as the examples offered by Moore in the U.S. system. There can be a big problem, however, when powerful interests are provoked. Moore took aim at presidential hopeful Hilary Clinton, criticizing her for appearing to give up after her health care plan was defeated, but he also gave examples of opponents who contributed tens of millions of dollars to defeat her. Some of that fight spilled over in to Canada where opponents of public health insurance were encouraged to undermine Medicare; they were helped by Paul Martin cutting health funding so as to balance the budget. Canada won't be isolated from the controversy that Moore's film generates or from the 2008 U.S. presidential campaign debate if universal health care becomes an issue. Canadian defenders of public health insurance will need to do much of the work that Moore neglected in order to protect against an anti-public health insurance campaign that reaction to his movie is likely to generate. In his defense, those forces are always at work, so it is probably better to have the fight in the open with a public that is as informed as possible.