Sicko: a lot healthier than I expected

This evening, I attended a showing of Michael Moore's movie Sicko at the New Albanian...

I wasn't expecting much, so maybe it was easy to exceed my expectations. But I was pleasantly surprised that the movie wasn't far more painful for me to watch. Although certainly not without its flaws, it has something to add. And the movie was well-made, humorous in places, poignant in others-- effective and provocative.

Moore is quite critical of insurance companies and HMO's-- and quite complimentary of the health care systems of France, Cuba, Canada, and England. With that combination, you would expect him to be optimistic about the United States moving toward single-payer health care. But his cynicism toward our government-- in particular, the often-unsavory relationship between politicians and interest groups-- leads him to criticize our system (correctly in many cases) without embracing government as a practical means to his desired end.

Some examples? Early-on, he mentions that Medicare fails to cover a lot of things (although he fails to pile on by talking about the program's extraordinary expense). And he points to the government's selective provision of health care to the heroes of 9/11. He also notes that the government provides awesome health care for the detainees at Guantanamo. (He could have bolstered this with the observation that our troops receive health care that is largely illegal in the states-- since interest groups have restricted competition from competent providers like physicians' assistants and nurse practitioners.) Implicitly, he notes the absurdity of restricting trade in pharmaceuticals, health care services, and health insurance. In a word, he isn't happy with the status quo, but he's not at all optimistic that our government can or will fix the problem.

The problem with health care-- from the point of an economist-- is that government is too heavily involved in health care: in addition to the above examples, we could also list Medicare, Medicaid, and most notably, government's subsidy of health care insurance (as a non-taxed form of compensation).

Because of the subsidy, ironically, those who can afford health care insurance have too much of it. First, by definition, something that is subsidized will be purchased too much (at least in terms of efficiency). Second, imagine how insurance typically operates: it covers rare, catastrophic events. In contrast, health care "insurance" covers everything from allergy shots to cancer. By way of analogy, car insurance of this type would cover everything from door dings and oil changes to severe car accidents. And what would happen to the cost of oil changes, the paperwork associated with oil changes, etc.? We'd have exactly the same sort of mess we have in health care.

With government's current level of involvement-- very far from a market-based system-- one can make an argument that a single-payer plan would be an improvement over the status quo. But of course, one can also argue that a single-payer plan would be even worse. A quick look at our education system and the post office indicate that a government-run monopoly is unlikely to deliver decent quality with any kind of efficiency or without special interest politics. This seems to be Moore's dilemma in the proverbial nutshell.

Sure, there were examples of poor analysis in the movie. For example:
-There was a strange reference to "full employment" in England (when all of Europe struggles with significantly more unemployment than us-- due to various employer mandates Moore seems to appreciate);
-He repeats the common reference to U.S. infant mortality rates (vastly oversold since we treat premies different for the purposes of that statistic);
-He repeats the tired canard that schools just need more money (while they already spend more than $10K per student; how much more money do you want to inject into a government-run entity with tremendous monopoly power?); and
-His analysis of other countries seems to miss the important factor that their populations are smaller and more homogeneous than ours.

And I suppose that other viewers-- perhaps most who would see Moore's film-- could see a call for bringing socialized medicine to the U.S. in Moore's work. But a more nuanced reading of the film points to an idealistic but laudable desire that our health care system would be something better-- without holding out much hope that our politicians will be able to deliver us closer to that outcome.