By Ira Stamm

(Stamm is a Topeka psychologist and health-reform advocate)

Michael Moore's movie "Sicko" offers a graphic and thought-provoking view of health care in America. It also gives glimpses of health care in Canada, Great Britain, France, and Cuba.

It begins with the all-too familiar problems encountered by those with and without insurance. In one dramatic scene, a homeless person is treated in the emergency room then taken by taxi and dumped from her wheelchair into the street in front of a rescue mission.

Moore takes us to the land of insurance not known to most consumers. One former insurance employee tells how it was his task to go through approved insurance applications after the patient had filed an expensive claim to see if the patient had not listed on the application a symptom that might have been evidence of a pre-existing condition. For example, if a person had a persistent cough that they had not taken to a doctor for evaluation, and they later developed a disease for which the cough was an early symptom, then the patient"s claim for that illness would be denied on the basis that he or she had not listed this pre-existing illness on the insurance application.

Some insurance companies, it turns out, award bonuses to their medical directors based on the amount of money their denials of care save the company.

Moore also spotlights the amount spent by the pharmaceutical industry lobbying for passage of a version of Medicare Part D, the prescription drug part of Medicare, that is highly favorable to the industry. At the urging of the industry, Congress did not include a provision for Medicare to negotiate drug prices with pharmaceutical companies. By contrast, the Veteran"s Administration is allowed to negotiate prices. As a result, Veterans who purchase medication through the VA system pay 46 percent less for exactly the same medication purchased by seniors under Medicare Part D.

The most novel and informational part of Moore"s film is the journeys he takes to Canada, Britain, France, and Cuba to learn about their universal health, single-payer systems. In Canada, he attempts to debunk the myth there are long lines to see a specialist or have elective surgery. In Britain, he examines the myth that under a single-payer system doctors are paid poorly.

France turns out to have the most interesting system of all. In addition to free health care, French citizens are given time off from work for their health care and recovery from medical procedures. Following the birth of a child, an aide comes to the home to help the mother tend the child and wash diapers. Professional day care is provided at a cost of $1 per hour.

The French also get six weeks of paid vacation a year. Critics of the French model of care note that it comes at a high cost. The French pay high taxes and because of this there has been an exodus of affluent French from the country.

Moore plays the role of narrator and actor in this gripping and fast-paced movie. To the extent that Mr. Moore has his detractors, his presence in the movie may cause others simply to brush the movie aside. Yet, without Mr. Moore in the movie

Sicko would lose some of its very human and caring nature.

Moore appears to favor a universal, single payer plan similar to what he observed in Canada, Britain, France, and Cuba. My own observation is that the quest for universal health coverage should not automatically be linked to a single-payer plan or any other funding mechanism. America as a nation needs first and foremost to commit itself to providing universal coverage and from this commitment then proceed to figure out the best model for funding such a plan. A familiar campaign ploy of some current presidential candidates is to equate universal health care with socialized medicine, which is erroneous.

"Sicko" is must viewing for anyone concerned about or involved with health-care reform no matter what view or position one takes about the topic. Through "Sicko," Moore gives a clear and strong voice to the millions of silent Americans who have had no voice in the debate about health-care reform.