Rejecting Moore's prescription on healthcare could alienate liberal activists, who will play a big role in choosing the party's next standard-bearer. However, his proposal -- wiping out private health insurance and replacing it with a massive federal program -- could be political poison with the larger electorate.
"Sicko": An article in Friday's Section A on Democratic presidential candidates' attitudes toward Michael Moore's film about healthcare said former Sen. John Edwards was from South Carolina. He is from North Carolina.
At a special screening in Washington this week, politicians, lobbyists, media pooh-bahs and policy junkies flocked to see Moore's film. And its slashing demand for action on an issue that voters care deeply about, and Democrats hope to capitalize on, generated plenty of buzz. Moore hopes that, after its general release June 29, "Sicko" will exert significant influence on the presidential campaign.
Instead of greeting the film with hosannas or challenging it head-on, however, the leading Democratic presidential candidates have sidestepped direct comment on Moore's proposals.
Sens. Hillary Rodham Clinton of New York and Barack Obama of Illinois and former Sen. John Edwards of South Carolina all have staked out positions sharply at odds with Moore's approach. But none of them is eager to have that fact dragged into the spotlight.
If Moore's fire-breathing proposal catches on among party activists, who tend to be suspicious of the private sector and supportive of direct government action, the candidates' pragmatic, consensus-seeking ideas could look like weak-kneed temporizing -- much the way their rejection of an immediate pullout from Iraq has drawn heated criticism from antiwar activists.
In "Sicko," the filmmaker calls for abolishing the insurance industry, putting a tight regulatory collar on pharmaceutical companies and embracing a Canadian-style government-run system.
Advocacy groups are already planning to use the film to pressure the Democratic hopefuls.
"The candidates haven't sensed the political fever in this country that fundamental change is called for in the healthcare system," said Rose Ann DeMoro, executive director of the California Nurses Assn. "What we are going to do is call on the candidates to reconsider their positions."
Stoking the passions of rank-and-file Democrats for a government takeover of the healthcare system amounts to political folly, respond some liberal veterans of Washington's healthcare battles.
"To presume that the private sector is going to sit idly by to see the destruction of private coverage I think is a misreading of reality," said Ron Pollack of the advocacy group Families USA. "I think the presidential candidates understand that if healthcare reform is going to have a chance of success, it will require bipartisanship and a balance of public and private coverage. It cannot be the triumph of one ideology over the other."
Such a blending increasingly seems to be taking place in major federal and state programs, including Medicaid, the State Children's Health Insurance Program and Medicare. As employer-sponsored health insurance shrinks, insurance companies have reinvented themselves as managers and middlemen for government programs, said UC Berkeley health economist James Robinson.
For example, more than 60% of Americans enrolled in Medicaid, the federal-state program for the poor, are now in some form of managed care, compared with fewer than 25% in the mid-1990s. In California, Medicaid is known as Medi-Cal.
"Whatever mix of private and public sources will increase the number of people with coverage, the insurance companies would like it to be managed by them," Robinson said in a recent interview. "They can work with Medicare, they can work with Medicaid, they can work with employers, they can work with whomever."
There's little room for such nuanced partnerships in "Sicko." If there's a villain in the movie, "the villain is called the health insurance industry of America," Moore told a Capitol Hill rally Wednesday. To laughter and applause, Moore said he hoped the film would turn into a "going-away present" for industry lobbyists.
"Sicko" uses the wrenching stories of individual Americans to compare some of the worst failings of this country's system with a rosy perspective on healthcare in Canada, Britain, France and even Cuba -- a country that offers healthcare for all but also imprisoned a doctor in the late 1990s for speaking out against government failure to respond to an epidemic of a mosquito-borne virus.
Moore investigates the dumping of hospital patients on skid row in Los Angeles. He tells the story of a middle-class couple from Colorado who lost their home and had to move in with their adult children because of medical bills, even though they had insurance. A particularly sobering episode involves a Missouri family in which the father is denied a medical procedure that might have saved him from cancer.
Filmgoers also meet an uninsured American who accidentally sawed off two of his fingertips and had to choose which one to have reattached, because he couldn't afford to do both. Moore juxtaposes that story with that of a young man in Canada who lost five fingers in an accident and had them all reattached -- without having to pay.
"It's quite effective, [but] it's not a documentary," Robert D. Reischauer, one of Washington's leading health policy experts and a supporter of coverage for all, said after viewing the movie.
"Policy propaganda," he called it.
For most Democratic presidential candidates (Rep. Dennis J. Kucinich of Ohio advocates a government single-payer program), it's more like a headache.