September 26, 2007

"Sicko"

My review from the July 30, 2007 issue of The American Conservative:

Michael Moore's comic polemical documentaries have done more for his net worth than for his political causes. He attacked greedy CEOs sending American factory jobs abroad in 1989's "Roger & Me," gun sales in 2002's "Bowling for Columbine," and President Bush's war in Iraq in 2004's "Fahrenheit 9/11," leaving him 0-for-3.

In "Sicko," he has his ripest target yet, America's ramshackle health care finance system. Having come down with lymphatic cancer in 1996, I am sympathetic to Moore's bias against for-profit health insurance. I may still be here only because I had the kind of generous insurance that few employers provide these days.

Moore's centerpiece example is a young man battling cancer (at the same age as me) whose request for an expensive bone marrow transplant was denied. He died three weeks later. Moore blames his death on insurance company greed (although that brief interval suggests his condition was hopeless). If I'd needed a bone marrow transplant, I'd have wanted the law to align incentives by requiring my employer to buy both my health and life insurance from the same firm. The insurer would then have had to choose between paying my clinic or paying my widow.

Strangely, "Sicko" misses much of our expensive but stressful system's black comedy, such as medical providers mailing out heart-attack inducing bills demanding we pay their zany list prices, apparently in the hope that an occasional senile patient might dutifully ante up rather than forward it to his insurer. For instance, after a two night hospital stay costing $2,000 (according to the rate my insurance company had already negotiated), the hospital billed me for $34,000.

Unfortunately, Moore's self-promotion, disingenuousness, and leftist ideology leave his event movies being more about Moore than about their ostensible subjects. "Sicko's" underlying goal appears to be to use our absurd health payment system to persuade us that socialism in general is superior to capitalism, that innately evil tumor on humanity. That's not a debate he's going to win, so he's distracting from the reality that medical insurance is a big exception to the rule that the profit motive works best.

Moreover, Moore's faux populism gives him an excuse to dumb down "Sicko" and not bother to explain why the competitive enterprise system that's good at providing us with, say, life insurance is bad at medical insurance.

In truth, our dysfunctional tradition of employer-provided health insurance isn't a result of the free market. Instead, it emerged during WWII as companies slid past wage-price controls by offering free fringe benefits to attract workers. In other words, it began as corporate liberality evading government-mandated stinginess. Of course, you won't learn that from "Sicko."

The documentary's lack of economic sophistication could be tolerated if his audience really was as uneducated as Moore implies. Yet, despite his trademark obesity and bad clothes, Moore's blue-collar Joe shtick is just an act, as he showed in his gun control movie "Bowling for Dollars." Moore's fans -- urban white liberals -- want gun control to disarm the minority criminals who threaten them, but they aren't going to admit that, so Moore concocted a fantasy for them about how dangerous those heavily armed rural rednecks are.

Similarly, Moore lovingly shows us in "Sicko" that the French upper middle class live more stylishly than us American slobs. And he seems most at home chatting with another pseudo-prole, the grand old man of English leftism, Tony Benn, who used to be Anthony Wedgwood Benn, the 2nd Viscount Stansgate.

When Moore ventures abroad to tells us about the wonderfulness of the government-paid systems in Canada, Britain, France, and, yes, Cuba, his satirical eye deserts him as he descends into complete credulity: It's free! Unlimited care, free!

Sadly, nothing can be unlimited. When I had cancer, I made my insurance pay for second, third, and fourth opinions. I hired an oncologist as my consultant to help me evaluate the clinical trials offered by three top lymphoma specialists. With his aid, I became the first patient with intermediate-grade non-Hodgkins lymphoma to be treated with a radical new monoclonal antibody that has since become a multi-billion dollar per year drug. I've been fine for the decade since.

Today, I suspect, few HMO's -- or, contra Moore, governments -- would pay for such a lavish (but effective) plan of attack.

Still, despite Moore's miscues, health insurance is the best domestic issue the Democrats possess. Why let them have it?

Rated PG-13 for brief strong language.

My published articles are archived at iSteve.com -- Steve Sailer

18 comments:

dearieme said...

The National Health Service works very well for Members of Parliament and the like. They get private-treatment standards without having to pay for them. The life of privilege is sweet.

Anonymous said...

If the drug you used is a multi-billion a year profit maker, lots of insurance companies and individuals do pay for it. Not so much governments, I would guess.

In France a heat wave gave the medical system 14,800 plus deaths. Central direction and bureaucratic control are primative means of administration, similar to the switched telephone network which failed during 9/11 and the Kennedy assassination. Capitalism is an advanced self organizing means of administration which is similar to the Internet which got people to Instapundit and secondary news sources during 9/11.

Evil Sandmich said...

Healthcare is where the free market meets up with people's infinate demand for life.

Can't say as I blame them, being a 'people' myself; but it's the tragedy of the human condition that there are not infinate resources to meet any infinate demand; for anything good at least.

Luke said...

Nice piece. You are in the groove.

Anonymous said...

How ironic that Moore chose a cancer patient as his index case. The US has the best cancer survival rates in the world, not just for the insured, but for everyone. For example, the survival rate for American women with breast cancer is 30% better than for French women. And Americans measure their waiting times for elective procedures in days, not months. Acknowledging that their are big problems with the US health delivery system, do we really thank that the VA, the Indian health service, Walter Reed, Medicare and Medicaid are good models for improvement?

Shouting Thomas said...

My wife received first rate, compassionate care as she was dying. The bill was paid by an employer sponsored health plan.

I think you're missing something here, Steve. My wife's last two weeks of life must have been outrageously expensive, although I never saw the bill.

Health care is enormously expensive. Nobody wants to die. Everybody wants every remedy tried when they are sick. My mother, who is an LPN, works in nursing homes where 80 and 90 year old living in a vegetative state are revived when they suffer a heart attack. And, as Ann Coulter recently pointed out, trial lawyers make a fortune out of raking doctors over the coals.

I think that this is a problem without an easy solution. Coulter suggests that placing limitations on ambulance chasing lawyers might help. I'm inclined to agree.

My experience with the health care system has been, generally, good. Isn't it a little idealistic to think that there is always a solution for all people all the time?

In some way, I think that the real problem is that we refuse to accept that life is sometimes tragic. We seem to feel that there is always somebody to blame, and that the tragic element would disappear if only all the villains would do right.

Floccina said...

"I am sympathetic to Moore's bias against for-profit health insurance."

Isn't Blue Cross a not for profit?

floccina said...

Isn't Blue Cross a not for profit?

beowulf said...

Anonymous,

You realize that the government (Federal and state combined) spends more per capita on health care than the UK government does (and the British has had universal coverage for 60 years)? So, the government (or rather, the taxpayers) do pay for profit making drugs.

No doubt the French hospital system was overwhelmed by the heat wave. But that wasn't a health insurance issue, it was due to the lack of air conditioning in many homes and the fact that the entire nation of France (including doctors and nurses) takes the month of August off for holiday. A flu pandemic over the Christmas holidays here wouldn't look much prettier.

Finally, as to your example of the internet as a "self organizing means of administration", I will only point out the Internet was invented by the US Department of Defense, the World Wide Web was invented by the Conseil Européen pour la Recherche Nucléaire (CERN). And if I'm not mistaken, Instapundit is an employee of the Tennessee state government.

Anonymous said...

"Having come down with lymphatic cancer in 1996, I am sympathetic to Moore's bias against for-profit health insurance."

This is pathetic, not to mention illogical.

Why would your own medical situation cause you to by "sympathetic" with Moore's attack on our "for-profit" health care system? Because you think you (or other people) should be able to obtain more medical care than you (or they) can afford? Pray tell, what is the justification for this? Should your fellow citizens also be taxed to pay for bigger homes or nicer cars or fancier schools or [fill-in-the-blank]? Why not?

Health care is not an indivisible collective good like national security or most infrastructure. It's a consumer good, no different in principle from food or clothing or housing or education, etc. Should the government pay for all of these things too? Of course, the "government" doesn't pay for anything, but uses its monopoly on force to require citizens to give their hard-earned money to politicians and bureaucrats, who then redistribute the money according to *their* needs and interests.

The main reason we have the world's most advanced medical industry is because it still is (mostly) private. What we need is less government -- fewer mandates, regulations, and subsidies -- not more. A smart guy like you should know this.

SKT said...

I'm currently a medical student. One of the surgeon's who I worked with last year said, "I haven't operated on an insurance card in a long time." Another said, "the difference between America and England is that in England some people get the Chevrolet or no perhaps no car at all, while in America everyone gets the Cadillac whether they can pay for it or not", implying of course that the U.S. healthcare system is even more heavily socialized than Europe!

What people don't realize is in America people get treated with unlimited resources and heroic interventions as soon as they set foot inside the hospital door, regardless of their ability to pay. They have social workers who always find some way for the patients to get healthcare and drugs once they leave. And no one goes to jail for not paying their hospital bills (in fact no one pays their hospital bills in full).

There is no rationing in America. In England, they don't put people with kidney failure on dialysis, unless they meet some strict criteria, basically made to rule most people out. In America, everyone gets put on dialysis, even the Mexican illegal, at limitless cost to society.

SFG said...

"Capitalism is an advanced self organizing means of administration which is similar to the Internet which got people to Instapundit and secondary news sources during 9/11."

The problem is that it turns into an oligopoly or monopoly left to its own devices. Look at the crappy operating systems Microsoft turns out--always crashing, prone to viruses and very insecure. The problem with competition is that someone wins.

tommy said...

From a piece that appeared in City Journal recently:

One often hears variations on Krugman’s argument—that America lags behind other countries in crude health outcomes. But such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use, and cultural values. It pains me as a doctor to say this, but health care is just one factor in health. Americans live 75.3 years on average, fewer than Canadians (77.3) or the French (76.6) or the citizens of any Western European nation save Portugal. Health care influences life expectancy, of course. But a life can end because of a murder, a fall, or a car accident. Such factors aren’t academic—homicide rates in the United States are much higher than in other countries (eight times higher than in France, for instance). In The Business of Health, Robert Ohsfeldt and John Schneider factor out intentional and unintentional injuries from life-expectancy statistics and find that Americans who don’t die in car crashes or homicides outlive people in any other Western country.

And if we measure a health-care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50 percent; the European rate is just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England—a striking variation.

Anonymous said...

Yes, some Blue Cross plans are non-profit mutual insurance companies, where the "stockholders" are the policyholders. Any surplus in excess of what is needed for reserves to pay future claims is given back to the policyholders, although not necessarily in the form of a dividend check.

I don't see a crisis in health care. The problem is everybody has gotten used to health care being "free." People aren't consumers of health care, because insurance companies have typically offered very extensive coverage for almost everything, and a lot of people never even explicitly paid a premium.

Instead of individuals making buying decisions, the government and insurance companies have had to bargain with providers to get good deals. HMOs came about to provide some way to combat individuals demanding all the care they could (because the insurance company would pay for it) and providers supplying it so they could charge even more.

Unlike Steve Sailer, I don't see this as more than a political football that the media has drummed up (with the help of Moore and Clinton). The 47 million Americans without insurance have chosen to forgo it. Poor people have access to medicaid. Sick people otherwise uninsurable have access to state high risk pools (at a premium). Mostly though, young healthy people have other priorities other than buying health insurance.

Anonymous said...

"The problem with competition is that someone wins."

Karl Marx never said it better.

Anonymous said...

"Karl Marx never said it better."
I knew it was only a matter of time before somebody mentioned that guy! Well, looks like you've one the argument. I obviously can't say anything to that beautiful gem of logic that you just spit out.

Anonymous said...

sfg - quote --
The problem is that it turns into an oligopoly or monopoly left to its own devices. Look at the crappy operating systems Microsoft turns out--always crashing, prone to viruses and very insecure. The problem with competition is that someone wins.
---------------

You convinced me. the Feds should outlaw Windows, the Mac OS, Unix, linux,etc and just start a Department of Computers and write us a great OS. I can't wait to get V.1.0

Svigor said...

Karl Marx never said it better.

Sfg has a point. The real trouble with capitalism is the -ism. Capitalism is fine as a tool, but as a governing system? As a governing system it's parents selling their children, husbands pimping out their wives, creditors enslaving their debtors...people selling the rope to hang themselves.