The Barbarian Invasions is an impressive Canadian film. (Yes, we do make them). The movie won two awards at the 2003 Cannes Film Festival: Best Screenplay and Best Actress, and is currently playing in a number of US cities. It is the story of a man dying of a terminal disease who renews his relationships with his friends and family, especially his adult son. Much of the action takes place in a hospital in Montreal, Quebec, where director and screenwriter Denys Arcand dissects the Canadian health care system.
(I write this review as the province of Quebec recovers from a streak of violence by health workers’ unions. The Quebec government recently announced policies to increase the contracting out of some services to private providers, which obviously attacks those unions’ interests. Rioters vandalized a children’s hospital where the Premier made a speech, and invaded politicians’ offices, hurling pig manure.)
The film opens with a nun struggling down the corridor of a crowded ward to administer Holy Communion: patients, health professionals, even electricians, are tripping over each other, packed into an environment of general confusion. And yet, there is another floor of the hospital that is completely closed. Why? We learn from the manager that this is due to a government directive. (Although I’m in another province on the other side of the country from Montreal, I know the feeling: our Vancouver General Hospital has an entire cancer pavilion that sat empty for a decade!)
The dying man’s son is a successful investment banker in London. He’s the kind of guy who can awriggle around anything. (He reminded me of Komarovsky, the character played by Rod Steiger in Doctor Zhivago: a wealthy businessman in Tsarist Russia with only contempt for the revolutionaries, he winds up a commissar after the dust settles.)
First, he wrangles his way into the hospital’s management offices without a pass and corners the manager, who is completely isolated from the chaos outside. He offers her a bribe to get his father moved out of the zoo and into a private space on the empty floor. She quietly takes the bribe, but points out that she can do nothing without the hospital employees’ union. The son pays off the union boss to prepare a private room on the empty floor. Painters, carpenters, and other workers quickly make it up.
Then, because there is virtually no access to PET scans in Canada, the son takes his father to Vermont to get one. One of the son’s friends in Baltimore (one of many Canadian doctors who have emigrated to the US) examines the scan and informs him that his father will have a much better chance in Baltimore than Montreal. Remarkably, the father wants nothing to do with it: "I voted for socialized health care, and I’m prepared to suffer the consequences!" he proclaims.
With this line, the father speaks for too many Canadians, who often wrap their national identity up in nationalized health care. For this reason, Canadian politicians have not had the courage to give Canadians more health freedom. However, the pain and inhumanity caused by the Canadian health care system are starting to make even the most nationalistic of us reconsider the amount of control over health services that we’ve ceded to our governments.
This movie tells us a lot about the consequences of government monopoly health care. The hospitals are poorly managed, the doctors and nurses confused, the unions who really run the show thuggish, the patients all but ignored. The film is sparking a debate in Canada about the role of the state in health care. Any American who thinks that health care in the United States would be improved by implementing a single-payer system would learn much from it too.