In a January 6, 1941 State of the Union address to Congress, President Franklin Roosevelt spelled out American war aims as the nation entered the Second World War. The address is often referred to as the “Four Freedoms” speech, for Roosevelt asserted that everyone in the world ought to enjoy freedom of speech and expression, freedom of worship, freedom from want, and freedom from fear. In these last two categories of want and fear, the President was expanding the traditional natural rights doctrine beyond political liberties to include basic economic rights such as employment and health care. In addition to calling for expanded old age pension coverage and unemployment insurance, Roosevelt insisted, “We should widen the opportunities for adequate medical care.” Yet, over sixty years after Roosevelt’s speech, approximately forty-five to fifty million Americans lack health insurance, while millions of others lack adequate coverage to handle medical emergencies.

It is this crisis which Michael Moore addresses in his most recent documentary, Sicko. In this film focusing upon the American health care system, Moore comes across as less partisan than in Fahrenheit 9/11. In embracing equal health care opportunities for all Americans the controversial filmmaker is championing a concept favored by most Americans and well within Franklin Roosevelt’s expanding vision of freedom. The basic right to adequate health care for all should be a less divisive issue than gun control or criticizing President Bush for his response to 9/11. If this is true then why does the United States not have some form of universal health care? While Moore casts aspersions upon Cold War anticommunism and the American Medical Association, he places most of the blame for the problems of the American health care system upon the health insurance industry’s drive to maximize profits.

After the Second World War, American European allies such as Great Britain introduced national health care programs, and President Harry Truman attempted to incorporate this idea into his Fair Deal. But cries of socialized medicine within the historical and cultural context of the emerging Cold War led Truman to back off his commitment to reform and assume the mantle of a Cold Warrior. Indeed, accusations of communism limited post war reform efforts for labor, women, and civil rights. Moore reminds us of Ronald Reagan’s role as a spokesman for corporate America in the early 1960s, warning suburbanites that expanding government economic programs, such as health care, were paving the way for socialism in America. Such concerns limited Lyndon Johnson’s efforts to expand government health care with Medicare and Medicaid, as well as encouraging Johnson to prove his anticommunism in the jungles of Vietnam.

With the end of the Cold War and collapse of the Soviet Union, we are at last free from the bogeyman of communism; however, we still have no system of national health care. The chief culprit this time appears to be the health insurance industry and their system of managed care. The insurance companies were instrumental in discrediting First Lady Hillary Clinton’s plan with their infamous “Harry and Louise” ads. As a Senator and Presidential candidate, Hillary Clinton, however, receives generous contributions from the insurance companies and advocates complex health reform plans which would retain an important role for the insurance corporations. The other leading Democratic candidates offer similar solutions as many Americans now hold stock in these insurers who seek to maximize dividends for shareholders. Thus, some Americans benefit at the expense of others.

This is not the type of world envisioned by Roosevelt’s “Four Freedoms.” Moore explores health care in Canada, Britain, France, and Cuba to demonstrate that a system of national health care is possible and even desirous. Although Moore is sometimes a little over the top in his praise for these systems, he uses humorous interviews to refute accusations of long lines and poor service with national health care. He converses with an affluent French couple and a British doctor to disprove the idea that national health care costs too much and does not adequately compensate physicians. Moore, however, does tend to avoid more detailed discussion of taxes and the cost of national health care. His idea of taking Americans denied adequate health care to Guantanamo because the military has made such a strong case for how well the detainees are treated is an amusing inversion of Bush administration rhetoric. However, the contentment with the political system in Cuba is a bit too much like the Socialist realism of which Moore pokes fun earlier in his film. Nevertheless, one does not have to endorse the monopoly of Fidel Castro on political power to acknowledge that the Cuban Revolution introduced benefits in education and medical care.

In the final analysis, Moore makes his case for national health care based upon the rhetoric employed by Franklin Roosevelt with his “Four Freedoms.” Equal access to health care is a basic human right and denial of this fundamental freedom creates the fear that some of Moore’s case studies in Sicko well document. Moore argues we accept that the government should provide police and fire protection and public education funded through taxation. Of course, it was not easy for Horace Mann to convince those who had no children in the schools that all would benefit from a more educated citizenry. A similar case may be made for how a healthier population will positively impact the overall economic picture. It is an investment in the future which might allow us to finally lay claim to the vision articulated by Franklin Roosevelt in 1941.