Kurt Loder on ‘Sicko’: Heavily Doctored

I was a bit (pleasantly) surprised to see this article by Kurt Loder. Loder takes a critical look at Moore’s latest film, ‘Sicko’ and finds it lacking in terms of facts.

Michael Moore may see himself as working in the tradition of such crusading muckrakers of the last century as Lincoln Steffens, Ida Tarbell and Upton Sinclair — writers whose dedication to exposing corruption and social injustices played a part in sparking much-needed reforms. In his new movie, “Sicko,” Moore focuses on the U.S. health-care industry — a juicy target — and he casts a shocking light on some of the people it’s failed.

There’s a man who mangled two of his fingers with a power saw and learned that it would cost $12,000 to save one of them, but $60,000 to save the other. He had no health insurance and could only scrape together enough money to salvage the $12,000 finger.

There’s a woman whose husband was prescribed new drugs to combat his cancer, but couldn’t get their insurance company to pay for them because the drugs were experimental. Her husband died.

[…]

Moore does a real service in bringing these stories to light — some of them are horrifying, and then infuriating. One giant health-maintenance organization, Kaiser Permanente, is so persuasively lambasted in the movie that, on the basis of what we’re told, we want to burst into the company’s executive suites and make a mass citizen’s arrest. This is the sort of thing good muckrakers are supposed to do.

Unfortunately, Moore is also a con man of a very brazen sort, and never more so than in this film. His cherry-picked facts, manipulative interviews (with lingering close-ups of distraught people breaking down in tears) and blithe assertions (how does he know 18,000* people will die this year because they have no health insurance?) are so stacked that you can feel his whole argument sliding sideways as the picture unspools. The American health-care system is in urgent need of reform, no question. Some 47 million people are uninsured (although many are only temporarily so, being either in-between jobs or young enough not to feel a pressing need to buy health insurance). There are a number of proposals as to what might be done to correct this situation. Moore has no use for any of them, save one.

As a proud socialist, the director appears to feel that there are few problems in life that can’t be solved by government regulation (that would be the same government that’s already given us the U.S. Postal Service and the Department of Motor Vehicles).

And our current health care system/problems by and large. This may not be very popular, but the U.S. system is somewhat like the French system in that it is a hybrid of both private and public health care. For example, the tax exempt status of health care benefits is a direct result of government policy that increases demand and pushes up prices. The tens of billions of dollars in health care subsidies also increase demand by some of the highest consumers of health care. This also pushes up demand and increases prices. The reduced competition that allows doctors to command higher salaries can’t work unless it has the governments blessing.

The problem with American health care, Moore argues, is that people are charged money to avail themselves of it. In other countries, like Canada, France and Britain, health systems are far superior — and they’re free.

I don’t know if Moore claims these other health care systems are free, but if so that is indeed a blatant lie. Nothing is free. These health care systems are funded via taxes (or in the case of France, taxes and fees consumers pay). This disconnection between the service being utilized and the actual costs is not a good thing to most economists. It creates a whole host of incentive problems if not done well, and even still the bureaucratic costs might outstrip any benefit such a system might provide; for example by expanding covereage and getting away from having those without insurance treated in clinic vs. emergency rooms.

That last statement is even truer than you’d know from watching “Sicko.” In the case of Canada — which Moore, like many other political activists, holds up as a utopian ideal of benevolent health-care regulation — a very different picture is conveyed by a short 2005 documentary called “Dead Meat,” by Stuart Browning and Blaine Greenberg. These two filmmakers talked to a number of Canadians of a kind that Moore’s movie would have you believe don’t exist:

A 52-year-old woman in Calgary recalls being in severe need of joint-replacement surgery after the cartilage in her knee wore out. She was put on a wait list and wound up waiting 16 months for the surgery. Her pain was so excruciating, she says, that she was prescribed large doses of Oxycontin, and soon became addicted. After finally getting her operation, she was put on another wait list — this time for drug rehab.

Whoopsies. Not surprising at all. After all, the problem the woman above faced was probably deemed non-life threatening and off she goes to the back of the que. This highlights another lie often told by those favoring nationalizing health care like in Canada. The 16 months of pain and suffering and the drug addiction that the woman developed are costs…costs that generally aren’t measured in terms of health care expenditures. Was she able to work? Was her family adversely impacted?

And Dr. Brian Day, now the president of the Canadian Medical Association, muses about the bizarre distortions created by a law that prohibits Canadians from paying for even urgently-needed medical treatments, or from obtaining private health insurance. “It’s legal to buy health insurance for your pets,” Day says, “but illegal to buy health insurance for yourself.”

Welcome to the world of unintended consequences. The reason why you can’t let people buy private health insurance is that then the government would only be left with those who don’t meet the criteria for private health insurance. Further, most of the people who do would resent having their taxes so high and having to pay for other people’s health care. You might see a backlash sort of like we saw here in the U.S. for welfare.

What’s the problem with government health systems? Moore’s movie doesn’t ask that question, although it does unintentionally provide an answer. When governments attempt to regulate the balance between a limited supply of health care and an unlimited demand for it they’re inevitably forced to ration treatment.

As any economist would say, “No duh.” This is obvious, after all that is what prices do. Prices ration resources (goods and services). By having government run health care you’d no longer use prices to ration health care, but another mechanism…government mechanisms. Long lines, mandantory wait times, simply prohibiting certain aspects of procedures/treatment or even outright banning of the procedure/treatment itself (e.g. vertility treatments–in Canada the selling of eggs for fertility treatments is illegal). Either way the resource will be rationed. Either it will be rationed based on political agendas or via the market and prices. Not surprising that Moore wouldn’t touch on this point.

This is certainly the situation in Britain. Writing in the Chicago Tribune this week, Helen Evans, a 20-year veteran of the country’s National Health Service and now the director of a London-based group called Nurses for Reform, said that nearly 1 million Britons are currently on waiting lists for medical care — and another 200,000 are waiting to get on waiting lists. Evans also says the NHS cancels about 100,000 operations each year because of shortages of various sorts.

I’m from the government and I’m here to help.

And just to reiterate a point Loder (and I myself) made earlier: The U.S. health care system is a mess. It is on a growth path that is completely unsustainable. Still, this doesn’t mean that we should embrace the nationalized health care that we see in England and Canada. Those systems are financial black holes as well and face very serious problems. The French system while better is also facing long terms sustainability problems like the U.S. just with a longer horizon until disaster. To the extent that Moore points out the problems and ugly aspects of the U.S. system it is a good thing. That Moore hides or ignores the problems with the health care systems in other countries and extols only the good aspects of these health care systems transforms his movie from a documentary into propaganda.

FILED UNDER: Economics and Business, Government, Health, US Politics, , , , , , , , , ,
Steve Verdon
About Steve Verdon
Steve has a B.A. in Economics from the University of California, Los Angeles and attended graduate school at The George Washington University, leaving school shortly before staring work on his dissertation when his first child was born. He works in the energy industry and prior to that worked at the Bureau of Labor Statistics in the Division of Price Index and Number Research. He joined the staff at OTB in November 2004.

Comments

  1. C.Wagener says:

    Many good points. For what it’s worth, my former business partner’s wife described her experiences with European health care. She is a dual Croatian/American citizen. She also has lived in Germany and France. She’s currently living in Dubrovnik.

    The “free” health care is available between 8 a.m. and noon. You show up to a windowless waiting room (i.e. no receptionist or nurse). The people keep track of who came first and wait for a nurse to open a door and call you in. Depending on who you are you may be called out of order. The care in general is primitive.

    The essentially government sanctioned “black” market takes place after noon, at which time you can actually schedule an appointment. You pay cash. The government has this arraignment so they can say they “provide free health care” when in reality they don’t have the resources to do so.

    Her view of Germany and France is that the systems are much like Croatia in that the government provided health care could not possibly take care of the population, so a private (first, last and everything in between dollar system) exists along side. In all three systems connections to government official could allow certain individuals to get the “free” system to treat them in the same way as the market system.

    I think the primary problem with the U.S. system is that it detaches first dollar money from patients decisions. If people have a boo boo and want 30 Vicadin, then they should bear all the cost. They might find that they could get by with 5 or 10.

  2. Steve Plunk says:

    No matter what is wrong with our health care system and no matter how bad I really doubt Moore and his “documentary” film will help.

    Pointing out extremes in a country as large as ours could probably fill a hundred more films like this one but what about the successes of our system? I’m sure they are too boring to be worthy of a mention.

    Movies like this are no way to formulate public policy.

  3. Tano says:

    A few minor points about the quoted passages:

    “As a proud socialist, the director appears to feel that there are few problems in life that can’t be solved by government regulation”

    Of course, “socialists” do not aspire to government regulation, but governmental ownership.

    “(that would be the same government that’s already given us the U.S. Postal Service and the Department of Motor Vehicles). ”

    Talk about cherry-picking. The DMV is the classic whipping-boy in these types of discussions, but I must say that the last few interactions I have had with my DMV have been infinitly more positive than the last few interactions I have had with some private companies, like my cable company, or my phone company. I would suggest that the public has had far more problems with their private insurance companies than with, e.g. the Social Security Administration.

    The old saw about government bureaucracy being bad, and private buraucracy being good just doesnt accord well with experience.

    As to Steve’s comments about what is “free”. I think most people understand perfectly well that there isn’t anything that is “free”. The term is used to mean free at the point of service, and that is a very good thing, for it allows health care to be accessible when needed, irresepctive of the transitory ability to pay.

    And I think that most people also understand the notion of rationing – and how prices ration in a market system. If health care is a limited service, then I think most people would value a rationing based on need, and immediacy of need. Price rationing means simply that one recieves health care in direct relationship to ones wealth, and many of us find that inherintly immoral.

  4. bonesaw says:

    All i can say is ask my sister what she thinks of the “free” health care system in England. She is working on a military base for the US Government but is eligible for “free” health care as she holds residence in England. She tells me that the care and the facilities are in shambles. She recently gave birth to my niece and needed to stay in the “free” hospital for a week before she checked her self out because of the shoddy care and facilities. For example she had to share a room with 3 other new mothers in which they slept in 25 year old standard single beds. When she asked if she could pay for a hospital bed with some support after her c-section she was told that she could not. That is just one example. Free health care is for loser countries. Get a job that pays for a large portion of your health care and pay the rest yourself.

  5. Steve Verdon says:

    The old saw about government bureaucracy being bad, and private buraucracy being good just doesnt accord well with experience.

    Actually you need to read up on Gammon’s Law. That law applies pretty much to government run/protected bureaucracies. It isn’t your personal experience that is relevant, but how much in the way of resources go into administration vs. actually providing the service in question.

    As to Steve’s comments about what is “free”. I think most people understand perfectly well that there isn’t anything that is “free”. The term is used to mean free at the point of service, and that is a very good thing, for it allows health care to be accessible when needed, irresepctive of the transitory ability to pay.

    It isn’t even free at the point of service. All those services have costs and they are paid for one way or the other. It isn’t free to certain individuals either since it could mean a variety of secondary and tertiary effects such as higher prices for other goods, longer wait times, etc.

    And I think that most people also understand the notion of rationing – and how prices ration in a market system. If health care is a limited service, then I think most people would value a rationing based on need, and immediacy of need. Price rationing means simply that one recieves health care in direct relationship to ones wealth, and many of us find that inherintly immoral.

    Let me put it this way, if you are going to make rationing of health care a political issue, do you really want somebody like Bush and Cheney makes those decisions? Once again, we see the flaw in Tano’s world view: so long as we get somebody who makes decisions he likes government is great, when this isn’t so, why it is bad.

  6. Tano says:

    Steve,

    Maybe you should read up on Gammon and his “law”.

    “It isn’t your personal experience that is relevant, but how much in the way of resources go into administration vs. actually providing the service in question.”

    E.g. Gammon distinguishes betwen administration and bureaucracy, a distinction you seem not aware of. I actually am not all that impressed with the distinction, since it amounts to describing “good bureaucracy vs bad bureaucracy”, and by giving the good a different name, it allows for a clean, simplistic assualt on bureacracy.

    The “law” also doesn’t seem very impressive. It amounts to an ideological bumber sticker rather than any serious description of a regularity in the administration of large organizations. It was based on one study, and, after reading Gammon’s own desciption of the study, seems very focused on extracting the conclusions that he probably supported to begin with.

    I know it is a “dismal” science, but that doesnt mean it need be done in a dismal manner. “Laws”, in the sciences, are regularities that always hold, not ideological nostrums that can be extracted from single studies and then applied whenever and wherever one wants to make a political point.

    Nor do I see how it is specific to government bureaucracies, and not private ones – which was my basic point.

    As to the meaning of “free at the point of service” I dont understand what kind of convulted point you are trying to make. “Free at the point of service” does not mean “free” (why do I have to repeat this?) – so it doesnt preclude secondary or tertiary costs or anything else,,,,obviously. It means that if you are sick or injured, you get treated, period – and your ability to pay, at the moment, is simply not an issue.

    “if you are going to make rationing of health care a political issue, do you really want somebody like Bush and Cheney makes those decisions?”

    Of course not. They would probably support a system in which rationing is tied to one’s wealth.

  7. Grewgills says:

    I’ve been living in Western Europe for the past two years. Neither I or my wife have any complaints about the care we receive. I have heard very few complaints about the medical care and we know people that have had strokes, and others with cancer. We do have to pay a monthly fee for the service that amounts to about 145 euro a month. If we were wealthier and had kids we might have to pay as much as 400, if that were not covered by our employer. But what it really boils down to is, what do we pay and what are our outcomes. By that standard the US system is doing a much poorer job. The US pays the most by quite a lot and is in the mid-30 in outcomes. Even if you try to argue that the US isn’t really at 37 or 35, do you really think it is near #1?

    For those of you who argue how much more efficient the management of public vs private care is or would be, my understanding is that management costs/total budget of Medicare is less than that of Kaiser.