NOTE: This spoiler was sent in by EEM who says..."Michael Moore plays a lot to his audience as always, but still manages to make an intriguing and thoughtful film."

The movie starts off with a famous Bush gaffe (“Too many OBGYNS can’t practice their love with women”). We see home video of a man named Adam doing his own stitches on his knee because he doesn’t have insurance. We’re given the number of insured Americans at about 50 million. We also meet Rick, who accidentally cut the tops off his left middle and ring finger. Due to the fact he had no insurance; the hospitals gave him the option of his middle finger ($60,000) or his ring finger ($12,000). He made the cheaper and more romantic choice of his ring finger. Moore tells us this movie isn’t about the 18,000 a year who die because they have no insurance, but rather about the insurance the rest of Americans have.

We next meet an older couple (Donna and Larry smith) who are using their two cars to move. They arrive at their new home in Denver…in their daughter’s storage room. We now review a bit of their story. Donna was a newspaper editor, and Larry was a machinist. They have six children. Unfortunately down the road, Larry had three heart attacks and Donna got cancer. The bills became too much, despite their insurance. After becoming bankrupt, they’re forced to move in with their daughter. Their daughter’s husband (Paul) leaves town the same day. He’s a contractor, but due to lack of work, he’s forced to go out of town…way out of town (Iraq).

We next meet Frank (age 79), a janitor at Pathmark. He’s covered by Medicare, but it fails to cover all the medication he and his wife needs ($213 for painkillers). Next we meet Laura who was in a 45 mph head on collision that knocked her out. Her insurance company later sends her a letter stating the ambulance ride would not be paid for because it wasn’t pre-approved. She wonders how one goes ahead to pre-approve an ambulance ride when unconscious.

Moore then tells of how he reached out for insurance horror stories. Within a day he receives over 3,000 responses and gets 25,000 in a week.

We meet Doug with his daughter Annette (9 months). Sadly she’s going deaf. They’re covered by Cigna. They approve an implant for only one of her ears, stating it would be experimental for her to be able to hear in two ears. He hears about Moore’s request for stories. He writes a letter to Cigna (without prompt by Moore) and angrily tells them he plans on letting his story be heard. We next hear a call on his machine from Cigna HQ: They now plan on approving the second implant.

Moore not only receives mail from angry patients, but Health Care workers themselves. Meet Becky. She’s a health insurance salesperson (one of the top). She talks about how long the list is for conditions that would be met with a denial. She talks about how she has to put a cold façade on the phone, since she gets so heartbroken by some of the denial stories.

We now meet more insurance stories:

Maria (Blue of California) – Brain Tumor
Dianne (Horizon Blue Cross of New Jersey) – Brain tumor
Laurel (BCS) - Cancer
Amy (Mega) – Breast Cancer

Amy is denied mandatory IV drugs. BCS tries to say Laurel’s cancer was a pre-existing condition. Maria’s surgery is “not medically necessary”. Dianne is told her tumor is “not life threatening”…she’s dead now.

Laurel’s cancer has spread throughout her body. Amy’s cancer reached her brain…she dead now. Maria got an MRI in Japan, while vacationing. She was told she had a brain tumor. Blue Shield repeatedly denies she has a tumor, so she’s suing.

Dr. Linda Peno (former medical reviewer for Humana) describes a good performance of her job as being one that “saves money for the company”. The goal is to deny whenever possible. The doctor with the highest percentage of denials would get a bonus.

Tarsha Harris wasn’t denied her treatment and had an approved operation. However, the company looks into her past and discovers a past yeast infection that was long gone (before being insured). They take the money back and tell the hospital to send Tarsha the bill.

We meet Lee, whose job was to find anything that can be used against patients so coverage can be denied. We get the basic story that this is how HMOs work. You pay rates, the company makes money. The company tries their best to keep as much money as possible by creating cracks in the system that put the patient at fault.

Julie Pierce’s husband, Tracy, suffers from Kidney Cancer.  She works at an ICU in St. Josephs (Kansas City, MO). After being denied by their HMO several times, they turn to a possible bone marrow treatment. Tracy’s younger brother ends up being a perfect match. It’s denied as well. They demand a meeting with the board of trustee that work at the hospital. They offer only “sympathy” and he later dies.

We see U.S. Congress testimony by a devastated Dr. Peno. She admits her part in denying an operation which would have saved a man. She also admits she will not be accountable because she saved her company $500,000.

We find out the birth of HMO. February 17th, 1971. The Nixon Tapes:

Nixon: You know, I’m not too keen on any of these medical programs

Ehrlichman: This is a private enterprise one.

Nixon: Well, that appeals to me.

Ehrlichman: Edgar Kaiser is running his Permanente deal for profit…And the reason he can do it…All of the incentives are toward less medical care…Because the less care they give them, the more money they make…and the incentives run the right way.

Nixon: Not bad.

We see Nixon on TV the next day announcing the plan. Even stating he wants every American to have the best care, when they need it.

We next see Bill Clinton creating a task force to tackle health reform chaired by then first lady, Hillary Clinton. We see Republicans try and tackle her abilities by basically twisting universal health care as more government control, and less control by the people. This of course leads to the big scare word, SOCIALISM.

We see clips (retro and current) that try and scare the people into thinking that socialized medicine will lead to a domino effect ending with the fall of freedom. The health care industry spends over $100 million to defeat her plan.

The United States slips to #37 on the ranking of world health care systems.

We next see clips of the HMOs doing just fine economically. Next are the lobbyists buying off politicians, including Hillary ($854,462 in 2005-6). We also see price tags put on many politicians, including President George W. Bush ($891,208). We see rhetoric from both sides about congressional bills that will allow Americans to receive more help, when really control is being handed over to drug companies.

The man appointed to help such bills was Congressman Billy Tauzin. We see several funny clips of him spouting his love for his mother. Bush then signs a Medicare provision that actually makes it possible for the elderly to pay even more for their medicine. Afterwards, 14 congressional aides would leave their jobs to take positions in the health care industry…as well as one congressman…Billy Tauzin (now CEO of PhRMA). He makes $2 million a year now.

Meet Adrian Campbell. A single mother with cervical cancer. She’s 22 and denied since she’s “too young to have cervical cancer”. She gets her treatment in Canada. She’s able to do this by claiming to be her Canadian friend’s (Kyle) common in law. We’re next told of Canada’s health care system. A lot of scare reports are shown on TV about how Canada’s health care system is horrible. Moore interviews a couple of his Canadian relatives who are terrified to go to the states without insurance. He interviews another Canadian who talks of socialized medicine and taking care of everyone…and he’s in the conservative party.

Moore interviews another Canadian man whose fingers were cut off by a machine. His story differs greatly from that of Rick at the start of the movie.

Moore now goes to England. Only working people who can afford it have to pay the very minimal fee for their medications. Everyone else gets it for free. Moore humorously looks for a billing department in hospitals.

Moore then wonders about all the free things Americans have (such as public schools, libraries, police and fire departments). He wonders why medical care shouldn’t be the same. We also see stats on how the health of the English is far better than those in the states. We also meet some doctors, who aren’t suffering despite the fact they’re not in a private sector.

Kaiser Permanente is the largest HMO in the country. Donna Keys was fully insured by them. Her 18 moth old caught a fever of over 104. She called 911, and the ambulance took her to the closest hospital. The hospital contacted Kaiser, which declined to cover the tests or drugs needed. She would need to go to a Kaiser Network hospital. Donna begged the hospital to treat her anyway, since time seemed so short. She was escorted out. Her child had a seizure and went into cardiac arrest. Shortly after getting to Kaiser, she passed away.

Meet Corrine and her daughter Zoë. Zoë came down with a fever and she stopped breathing. Corrine was naturally terrified. The hospital gave her free medicine for a throat infection. She stayed for three days, which was completely covered. A happy ending…she lives in France.

Moore goes through some happy stories in that country. Including day care, extended sick leave, extended vacation time, and even a government paid nanny to do laundry with maternity leave.

Moore goes back to the states. We see security video of a cab that pulls up to a curb. We see a woman named Carol. She’s confused, disoriented and wearing just a hospital gown. Kaiser Permanente had put her in a cab and told the driver to drop her off. We hear more stories of hospitals dumping patients off at shelters and clinics.

We now meet 9/11 rescue workers who are having medical problems (mostly respiratory). Many who were not on payroll for their heroism are denied coverage since they weren’t technically “at work”. Others are psychologically damaged by the things they saw at Ground Zero, but are refused care.

We next see the medical services offered at none other than Guantanamo Bay, Cuba. Moore takes a few 9/11 rescue workers as well as other uninsured Americans to Miami. They take a boat but we aren’t allowed to see their journey due to homeland security laws. They arrive in Cuba, but are outside of the base. No one from the guard tower responds to their calls for help. Moore then examines the Cuban health care system, where we find out they have free universal health care (not to mention the cheap costs of medicine), provide care to other third world countries during disasters, have a lower infant mortality rate compared to the U.S., and have a longer average lifespan than us.

The sick Americans receive care at the Havana Hospital and are astounded and furious by the fact they can receive their care in a third world country but not their own. We even hear commentary from Dr. Aleida Guevara, a pediatrician and daughter of Ernesto “Che” Guevara. The firefighters in Havana hear about the visit, and invite the workers to their station. They honor the workers, claiming all firefighters are family. Moore marvels at the fact that supposed enemies can reach out to each other. It inspires him to do something.

He learns that the head of one of the biggest anti Michael Moore sites is shutting down. His wife is sick and the bills are starting to pile up. Moore decides to write them a check (anonymously at the time). His wife got better and his website remains intact.

Moore wonders about how when Americans see countries build a better car, they drive it. When they make a better wine, they drink it. Yet, when other countries have a better way to treat their sick, we stay with the same system.

The film ends with Moore humorously walking up the capitol steps with his laundry (a reference to France’s government paid nannies).

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Moore examines our health care system compared to others around the world. Although they pay a lot more in taxes, their benefits far outweigh ours.

He also goes into many sad stories about HMOs holding back money, leaving millions in debt or dead. Meanwhile, lobbyists help corrupt politicians (Republicans and Democrats) into giving more control to HMOs and drug companies.

Moore takes several sick Americans to Havana, where they are treated for free.

He concludes that since Americans aren’t afraid to accept foreign products (cars, electronics, etc.), they shouldn’t be scared to change the way they treat their sick.