Louis Proyect: The Unrepentant Marxist

August 29, 2007

“Sicko” follow-up

Filed under: health and fitness — louisproyect @ 9:45 pm

(My review of “Sicko” was intended for a left newspaper in New Zealand, but it required some modification to be meaningful to readers there. This is correspondence between Phil Ferguson, who requested the review, and me that was forwarded to Marxmail.)

I’d like to add a few comments about ‘Sicko’ in relation to its relevance outside the US. It seems to be a great exposure of how screwed up the health system is in the USA, but it’s not so relevant in a lot of other imperialist countries which have long had a large public health sector.

Below are two emails I sent Louis on this subject which he suggested I share with the list:


. . . in NZ where we have long had a public health system.

I also realised that a NZ leftist would probably review the film differently from an American and I hadn’t really thought about that when I asked you for a review. The film is made really for American audiences and the arguments are ones that make sense in that context but our experience is quite different.

For instance, what has happened here (and in Britain and Oz) is that the public health system, while obviously being an important gain for workers, has increasingly been used to assist and subsidise the private health sector. Since 1984 chunks of the public health system have also been commodified. Our experience is that capitalism can’t actually deliver a top-notch public health system or certainly not over a long period of time. It is totally dependent on the economic health of capitalism at any one time. Since it’s financed out of deductions on surplus-value, it faces being undermined every time there is a profitability problem in the private sector.

So what Marxists in NZ would emphasise is the incapacity of capitalism to deliver.

Moore’s film therefore makes more sense in the USA than here. Here it’s received as just another example of how crazy American society is (like ‘Bowling for Columbine’).

LOUIS: I actually googled New Zealand and health care out of curiosity but couldn’t exactly figure out what was up there. It seemed like an amalgam between private and public.

SECOND EMAIL: Increasingly an amalgam.

The welfare state here was created in two main periods. Initial steps under the Liberals in the 1890s and first few years of the 1900s, but mainly under the first Labour government (1935-1949). This was the main period for the growth of free public health.

After 1984 the public health system began to be dismantled – Labour gave it and Labour started to take it away 50 years later.

The public health system partly props up the private sector – or the private health sector leeches off the public sector.

These days if you have some urgent operation you might end up waiting several years on the public health, so if you can afford it you go private.

A couple years ago the public health system almost let my old man die. The idea was that since he was about 75, there was no point in attempting a potentially risky operation. We just happened to be very lucky to have a close family friend in that particular public hospital who fought for my old man’s operation.

In each major population area in NZ there are *thousands* of people on the waiting lists for operations in the public hospitals. Recently the local health boards have taken to bumping thousands of people off the waiting lists.

I can understand that an American film-maker might hold up the system in (basically the old white Commonwealth) social democracies as an argument for public health in the US, but the systems in Britain, NZ and Australia are woefully inadequate and ever since the postwar boom ended in the early 1970s we have had a worsening situation in the public health sector. In Britain, a lot of the NHS is in a pretty bad situation and also is leeched off by the private sector.

The other thing is the commodification of chunks of the public health system. What has happened in NZ is that a whole lot of stuff that used to be free – because the law of value was taken out of the public sector – is no longer free because chunks of the public sector are expected to break even and other chunks are expected to make profits.

One of the odd things about the US is that American capitalists are often less sophisticated than their other Western counterparts – it’s still a mystery to me how a ruling class so lacking in intelligence got to be international top dog! – and they don’t see that some kind of serious public health service is actually in their interests.

For instance, far from undermining private health – because the reality is that no social democratic government is going to wipe out the private sector – it provides the opportunity for all kinds of no-risk leeching by the private health sector, pharmaceutical companies and so on.

And a fit workforce at a minimum cost is in the interests of capital too.



  1. This is a fine addition to the original review, a new and valid change of perspective that doesn’t refute anything in the original. And since it’s coming from someone who’s experienced a national health program, it doesnt sound like the querulous left criticism here at home.

    Comment by plato's cave — August 30, 2007 @ 12:52 am

  2. It was easily moore’s best movie.

    It was focused, so either you liked it all or hated it all. I thought Fahrenheit was so anti-Bush, it accepted any argument right or wrong, and see what sticks.

    In the US, universal healthcare, single payer is aa actual transitional demand.

    Comment by Renegade Eye — August 30, 2007 @ 3:37 am

  3. It was easily moore’s best movie.

    It was focused, so either you liked it all or hated it all. I thought Fahrenheit was so anti-Bush, it accepted any argument right or wrong, and see what sticks.

    In the US, universal healthcare, single payer is aa actual transitional demand.

    Comment by Renegade Eye — August 30, 2007 @ 3:39 am

  4. I’ll definitely check out the moore’s movie cos of the good reviews up there. It’d be interesting to study health care system, here where i live the govt is saying we need a medical reform too, promoting universal self financed insurance system so on. Think it’s a gloabl issue and we might learn from other country;s expeeiences. always good to go comparisons.

    Comment by crashahelmet — May 15, 2008 @ 9:09 pm

  5. I study documentaries (have started just 2months ago) in university. Moore’s movie are heavily political and change the whole concept that documentaries don’t sell and can only seldomly make to the big screens-he changed them all. I’ll go see Sicko this summer.

    Comment by Pat — May 18, 2008 @ 10:16 pm

  6. I remember watching this. I did like it but for some reason the way Moore explains his points in his films seems so one sided that it kind of turns me away from them. I do remember though that this film was actually a little less one sided than previous films of his but still very agenda driven. I understand reasons for doing this but it doesn’t make it feel much like a documentary and more like an opinion infomercial.

    Comment by Fitness Strength Training — June 4, 2009 @ 8:36 am

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