U.S. CARE OF CITIZENS IS 'SICKO'.

Byline: ROSE ANN DEMORO

MICHAEL Moore's riveting new film provides a valuable lesson that we can solve the health care crisis without dumping more resources into a too-often heartless, private, insurance-based system.

Lack of insurance is not the trouble in America. The insurance industry itself is the problem.

A Zogby/UPI poll in February found that 42 percent of Americans said their insurer had refused to pay a medical bill. A USA Today/ABC poll in March found one in four Americans had trouble paying for medical care in 2006, although two-thirds of those were insured.

"Sicko" puts human faces on those numbers. Like Donna and Larry Smith, who had to sell their home and move into a cramped room in their daughter's house when their medical bills became unpayable. Or Laura, the young woman sent a huge bill for her post-accident ambulance trip because it wasn't "pre-approved."

Neither story is an aberration. Moore unearths 1971 White House tapes in which President Nixon and John Ehrlichman discussed the pending bill to promote managed care. Ehrlichman reassures Nixon that "all the incentives are toward less medical care ... because the less care they give 'em, the more money they make."

Three decades later, Moore shows the inevitable evolution of this scheme, partly through two industry whistle-blowers who agonize over their role in denying care. "You're not slipping through the cracks. They made the crack and are sweeping you toward it," one says.

In an intimate final screening in New York that the California Nurses Association was invited to attend with the real-life stars of "Sicko," Moore made clear his view on whether the bandages and sealing wax that some politicians and presidential candidates favor can fix this callous system. "We have to eliminate the private insurance companies. They have to go," Moore said.

Such sentiments may not be widely popular on Capitol Hill. After all, "Sicko" notes, the insurance industry's "biggest accomplishment might be buying our U.S. Congress." But beyond Washington, it gets a different reception.

A New York Times/CBS poll this year found that 64 percent said the government should guarantee coverage for all, and 55 percent identified it as the top domestic priority for Congress and the president.

Can it really be done? Moore shows us four ways how -- Canada, Britain, France and even Cuba. He could have added every other industrialized country where care "doesn't depend on your premiums; it depends on your needs."

Amid the four other countries Moore visited, the U.S. is last or next to last in one health care indicator after another, such as life expectancy, adult mortality and infant-mortality rates, to name three, according to World Health Organization statistics. Only when it comes to per-capita spending are we number one.

Where does the money go? From one-fourth to one-third is siphoned off the top for paperwork and profits for the private insurers, compared with less than 5 percent for Canada or our own Medicare, a publicly run program.

Forcing everyone to buy insurance, as Gov. Arnold Schwarzenegger proposes, or providing tax credits or shifting more government money to the HMOs won't solve the crisis; it will just reward the insurers for their system of preventing care and make them wealthier.

Put that money back into delivery of care. Set up a system in which everyone is covered, for life, with quality medical care, comprehensive benefits and cost controls.

Sound impossible? Most of those featured in "Sicko" would not have been helped at all by the majority of the limited reforms proposed in Congress or by most of the presidential candidates to date. But we can accomplish that here in California with Sheila Kuehl's Senate Bill 840 or nationally with House Rule 676 in Congress, both of which would guarantee comprehensive health care for all without relying on the insurance industry.

"Sicko" profiles three Sept. 11, 2001, rescue heroes who have since struggled to obtain needed care. Moore tries to bring them to one place where the U.S. does guarantee universal care: the military base at Guantanamo.

Only when they're turned away do they go next door to Cuba. "They just wanted some medical attention, the same kind (our government) provides to al-Qaida," Moore says. For the rescue heroes or the rest of us, is that too much to expect?