American health care reform has a tradition of political factions making outrageous and irresponsible claims. In the 1960s, the American Medical Association desperately tried to kill Medicare legislation, arguing that doctors and patients would become cogs in a socialist machine. They even enlisted help from the tobacco lobby. Newt Gingrich and his Republican revolutionaries used similar sloganeering against the Clinton reforms. Their scare tactics, such as the famous "Harry and Louise" ads, helped the GOP capture Congress in 1994.

Michael Moore’s Sicko continues the tradition, this time from the left. In his tidy universe, there’s nothing wrong with health care that can’t be fixed by throwing out greedy HMO and pharmaceutical execs, and replacing them with a government-run, single-payer system of universal care. No one need face any hard choices, such as how much to spend on end-of-life care, or worry about excess costs. Just go ahead and order that MRI.

Let’s stipulate that we must, and I think will, achieve universal health insurance coverage. Massachusetts and California are already making progress. Let’s also stipulate that without universal coverage, many insurance plans have perverse financial incentives to enroll healthy people and deny coverage to sick ones.

But what about perverse political incentives?

In fact, we do have a universal care program run by the government for our senior citizens. And as the boomers retire, Medicare will become an ever-larger share of the overall health system. So why, as I pointed out, do Medicare quality and cost of care vary so wildly even among cities of the same state?

In most places, the government still pays doctors and hospitals for doing more stuff, regardless of whether it’s needed. By and large, a cabal of politically selected physicians from various specialties determine the rates. Without competition, these docs have little incentive to lower prices for any procedure—and none to eliminate the need for a procedure through better preventative or chronic care. (Primary care is also slighted.)

So should Moore have made a film about greedy doctors instead? No. Most doctors try to do the right thing—like a lot of HMO executives. Entrenched Interests aside, getting the incentives right in a system as complex and varied as health care has taxed some of the brightest minds in America, Berkeley included. And as "Beyond the Silver Bullet" reported there are encouraging signs, even amid the gloom of rising costs and rising numbers of the uninsured.

We desperately need smart political leadership. That must include a willingness to level with the public about hard choices, such as what we’re willing to pay and what it should buy, to bring about real reform. Instead, Sicko serves up platitudes. Moore’s movie perpetuates the lie that simply turning health care over to the government—or moving to Cuba—is a magical cure. And he’s handed entrenched interests a straw man. Expect privatizing fundamentalists to push the opposite patter: Take this marketplace magic and call me in the morning.

Several recent commentators, such as Atul Gawande of the New Yorker, believe that despite Sicko’s central dishonesty—that there’s a simple cure for all that ails us—the film performs a useful public service by energizing the call for universal coverage. I disagree. If history is any guide, Sicko’s slick lie will only lead to more of the same.