In this blog post, I will analyze how the documentary ‘SICKO’ portrays the reality of healthcare privatization and the welfare system in the United States.
Logline
‘SICKO’ takes the form of a narrative documentary in which director Michael Moore provides commentary on the film’s imagery, story, and interviews. Within the theme of healthcare privatization, the director explores the plight of the uninsured, the dark side of a system where coverage is denied despite having insurance, examples of countries with social welfare systems rather than privatized healthcare, and his own journey to Cuba—a Third World country—where he personally takes patients for treatment.
Strengths of the Film
1. Criticism and satire are skillfully blended with information delivery, creating a balance of tension and relaxation that keeps the audience engaged by effectively pacing the film. 2. Furthermore, I feel that criticism and satire were used cleverly to highlight contradictions and expose flaws. 3. The director’s narration serves as the primary driving force of the film, giving the impression that he is actually speaking to us face-to-face. Furthermore, by leveraging his social standing as Michael Moore, he manages to strike a balance between being critical and creating a humorous, casual tone, as if he were chatting with the director. 4. Archival footage is often perceived as serious and heavy due to its role in conveying facts, but when combined with the director’s narration—which either clarifies it or highlights contradictory situations—it takes on a comedic quality. 5. Although it is a documentary, the narrative style and episodic structure made it feel like watching a drama, which was interesting. In contrast, the sequences where the director himself appears on screen to criticize the reality of healthcare welfare allowed me to feel the reality firsthand. 6. I appreciated the approach of using the topic of healthcare privatization to realistically critique broader aspects of the state, effectively shining a magnifying glass on the subject.
Sequence Analysis
1st Sequence
The first sequence is an opening sequence consisting of images of accident victims, the director’s narration about them, and the statement that this is a film about those with health insurance. Using a narrative style that starts with a single tree and expands to show the forest, it discusses health insurance—which applies to the entire population—through small anecdotes that audiences might hear in their daily lives. While the audience seems to praise this as the “American Dream,” the theme the director will now address is, paradoxically, the negative reality of health insurance.
Second Sequence
The second sequence begins by recounting the story of Donna and Larry. They were once a happy middle-class couple, but when cancer and a heart attack struck, they found themselves penniless despite having insurance. Mr. Frank works grueling jobs at an advanced age to cover medication costs, even though a healthcare system exists. Laura was in an accident but was denied coverage because she failed to report it when calling an ambulance. Although they are customers of the healthcare system, they are denied coverage when they actually need it. Is health insurance nothing more than a fig leaf to them? Furthermore, many people are unable to obtain insurance due to physical reasons, such as weight. Just as viewers begin to doubt the healthcare system—which is supposed to save lives—evidence emerges to support those doubts. These are interviews with medical consultants hired by insurance companies. They discuss how they deny coverage to customers by citing various clauses, and following their interviews, a medical contractor appears, revealing the true nature of the health insurance industry. Director Michael Moore adds archival footage of Dr. Linda Pino—a real-life figure—speaking courageously at a public event, demonstrating just how cruel the reality of health insurance can be.
These interviews and archival footage answer the question posed in the second sequence: “Why is healthcare privatization a bad thing?” Through this exchange, the audience absorbs the negative reality of healthcare privatization that the director is trying to convey and prepares to understand the next sequence.
Third Sequence
A sequence discussing the origins of healthcare privatization. To pique the audience’s interest in the origins of healthcare privatization, director Michael Moore plays a recording from February 17, 1971, capturing their attention. Along with the recording, a photo of the Vice President—the subject of the recording—appears. The combination of the fact that this is an actual recording and the corresponding image instills greater trust in the audience. The content of this recording opposes a national healthcare system and shows how Hillary Clinton’s attempt to establish such a system was thwarted. Showing actual footage of Hillary Clinton allowed the audience to feel the vividness of her arguments at the time. However, alongside the recording at the beginning of the sequence, footage of a Hillary Clinton effigy being burned was shown, and images of socialism were used to convey to the audience that those who supported the privatization of healthcare had blocked the national healthcare system by stoking the public’s fear of socialism. What is the U.S. Congress doing after Hillary Clinton’s attempt was thwarted? By showing Congress discussing “holey marshmallows,” the director satirizes and criticizes them. The film then adopts the style of a documentary narration, using the director’s voiceover to connect scenes showing how they subsequently became part of pharmaceutical companies.
4th Sequence
The fourth sequence examines healthcare systems in other countries. Unlike the previous sequences, this one shifts focus to nations other than the U.S., which might seem jarring; however, the director chose an American protagonist married to a Canadian to seamlessly connect the content of this sequence. This sequence describes the healthcare systems of Canada, the UK, and France in that order. To minimize the contrast with the U.S., it begins with Canada—a country whose healthcare system has some flaws—and presents interviews that highlight both its strengths and weaknesses, aligning with the tone of the previous sequences that exposed the flaws of the U.S. healthcare system. However, by showcasing the high-quality UK healthcare system, it once again gives the impression of mocking the U.S. healthcare system. To express this, the third sequence uses a montage that contrasts the socialism Americans feared with their own displays of loyalty to the state, criticizing the contradictory nature of the United States. Furthermore, the question posed in this sequence is, “Why can’t we enjoy the social welfare we need most?” The answer is provided through an interview with a former British Member of Parliament. Archival footage showing that the UK began its healthcare welfare system after World War II is cross-cut with the interview, further highlighting the contrast with the corruption shown in the third sequence. To illustrate the vicious cycle of recurring corruption, the director adds a montage editing the absolute capitalism of the U.S. and a narration that pierces reality, heightening the tension of the sequence. To conclude this sequence, the film shifts to France, which has the most comprehensive welfare system. The director not only shows the welfare benefits enjoyed by native French citizens but also includes interviews with Korean expatriates in France, highlighting the stark contrast with the American welfare system.
5th Sequence
Unlike the positive portrayals of other countries, the fifth sequence returns to the United States to discuss the methods the director discovered for handling patients without health insurance. The director uses CCTV footage as source material, lending a sense of realism and credibility. Furthermore, this direct and factual footage is sufficient to reveal the harsh reality of the American healthcare system. However, the director’s sarcasm resurfaces when he mentions the medical facilities in prisons designed to house dangerous individuals, such as terrorists. While society secretly abandons uninsured patients on the streets, prisons are fully equipped to perform any surgery or treatment immediately. To focus on saving criminals rather than those who need saving! While we cannot assign a value to every life, I felt that the American healthcare system is deeply contradictory. Director Michael Moore stepped forward to criticize this.
Sequence 6
The director takes patients who have been denied medical care in the U.S. to a detention center. However, despite his cries, only the sound of sirens echoes through the facility. Although his cries fell on deaf ears, the very courage of his actions served as an arrow piercing the dark side of healthcare privatization. The fact that he and his patients traveled to Cuba—a country Americans often overlook and which actually ranks far below the U.S. in global healthcare rankings—to receive genuine medical care and treatment must have come as a shock to Americans. The film unfolds the reality of healthcare, sometimes seriously and sometimes humorously. Through an episode where the operator of the director’s own anti-fan site couldn’t run the site because he lacked healthcare benefits, the film finds a resolution: by helping this anti-fan—who, despite his opposition, was also suffering from the realities of the healthcare system—the director brings the film to a humorous conclusion.
Analysis of the Narrative Aspects
‘SICKO’ features a variety of characters. However, what they all have in common is that they either did not receive benefits from the national welfare system or suffered from the abuses of private corporations. To connect these characters, the director employed a common approach: presenting their stories through interviews or adding narration to images to provide commentary. Additionally, he added variations by incorporating criticism of national-level realities into the small, individual anecdotes of each person. The national-level episodes were presented using images and archival footage that conveyed a sense of contradiction, ensuring the narrative did not become overly solemn. Conversely, the individual anecdotes were portrayed in a serious and tragic manner through interviews, creating a contrast in directing styles. Unlike fictional films, the documentary featured prominent realistic imagery such as actual news clips, interviews, and archival footage, and the sequences where the director personally confronts the realities of the healthcare system further enhanced the sense of realism.
Analysis of Formal Aspects
Notable documentary elements: archival footage, reference footage, interviews, sound design, music 1. In the opening sequence, a film depicting the American Dream appears in contrast to the previously shown tragic accident, offering a contradictory and paradoxical critique. 2. In the scene explaining health insurance requirements, rather than tediously listing the details, the director mimics the opening sequence of *Star Wars* to subtly convey that these conditions are absurdly numerous and unreasonable by common sense standards—a creative and efficient directorial choice. 3. Although the film tackles the heavy topic of healthcare privatization, it skillfully incorporates humor throughout to relieve tension, resulting in excellent pacing. 4. While the director appears very serious and cynical about reality during actual interviews, the voiceover narrating to the audience from off-screen is humorous and delivered in a storytelling style, creating a narrative approach that keeps viewers immersed and focused on the film.
Conclusion, Theme, and Implications
On the surface, ‘SICKO’ appears to address the single topic of healthcare privatization, but it also explores the broader reality of the welfare system and the hidden side of capitalism and democracy in the United States. The director poses a total of six questions: 1. What lies behind the American Dream? 2. Why does healthcare privatization have such negative effects? 3. Where did the privatization of healthcare begin? 4. What are the differences between the U.S. welfare system and those of other countries, and how do these differences play out? 5. What are the contradictions within the U.S. healthcare system? 6. What would happen if one were to directly confront the reality of the healthcare system? The director addresses these questions by conducting interviews, presenting data, and sometimes stepping in to experience the issues firsthand before offering his answers. This prompts viewers—who might initially feel indifferent to healthcare privatization and the quality of care they receive if they haven’t experienced it themselves—to reconsider these issues and awakens them to problems that are actually right before their eyes but which they hadn’t noticed. This leads to the ultimate theme: that the state must fear its citizens. From watching the film multiple times, I felt that while the director is discussing the topic of healthcare privatization, the underlying message he is conveying is that the people must reclaim their sovereignty to make the state fear them, and that the people themselves must break the vicious cycle of the state’s arbitrary policies. Therefore, even though Korean citizens live in Korea and hold citizenship, the reality that could be imposed by the government is a reality where they are unable to properly exercise their sovereignty. Korean citizens must recognize that the state should fear the people and put this into practice through small, concrete actions.
