According to Sicko, almost fifty million Americans are uninsured while the remainder, who are covered, are often victims of insurance company fraud and red tape. Furthermore, Sicko points out that the U.S. health care system is ranked 37 out of 191 by the World Health Organization with certain health measures, such as infant mortality and life expectancy, equal to countries with much less economic wealth.[6] Interviews are conducted with people who thought they had adequate coverage but were denied care. Former employees of insurance companies describe cost-cutting initiatives that give bonuses to insurance company physicians and others to find reasons for the company to avoid meeting the cost of medically necessary treatments for policy holders, and thus increase company profitability.

In Canada, a citizen describes the case of Tommy Douglas, who was voted the greatest Canadian in 2004 for his contributions to the Canadian health system. Moore also interviews a microsurgeon and people waiting in the emergency room of a Canadian public hospital.

Against the backdrop of the history of the American health care debate, opponents of universal health care are set in the context of 1950s-style anti-communist propaganda. A 1950s record distributed by the American Medical Association, narrated by Ronald Reagan, warns that universal health care could lead to lost freedoms and socialism. In response, Moore shows that socialized public services like police, fire service, the United States Postal Service, public education and community libraries have not led to communism in the United States.

The origins of the Health Maintenance Organization Act of 1973 are presented using a taped conversation between John Ehrlichman and President Richard Nixon on February 17, 1971; Ehrlichman is heard telling Nixon that "...the less care they give them, the more money they make," a plan that Nixon remarked "fine" and "not bad." This led to the expansion of the modern health...

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