Friday, April 4, 2008

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.


At April 4, 2008 at 10:24 AM , Blogger Bryce Raley said...


Have you read economist Paul Zane Pilzers books on economics in regards to health care, the wellness industry, the food industry, the pharm industry and the insurance industry? He paints a good picture of all these in several of his books. I have read The Next Trillion and the The New Health Insurance Solutions .

At April 5, 2008 at 10:49 AM , Blogger Eric Schansberg said...

Nope...I'll check it out. Thanks!

At April 5, 2008 at 3:12 PM , Blogger Darrell said...


Isn't the state, biblically speaking, a coercive entity (see Rom. 13)? So if the function of the state is to punish injustice, what more sense does it make for the state to regulate doctors than to regulate clergy?

We have almost gotten to the point of attaching unlimited liability to the doctor, and to the state. In pagan cultures the witch doctor was conferred with divine status, and much like those ancient pagans, we expect to be cured of all diseases or discomfort. The doctor is to be a practitioner of magic.

Likewise, sin is imputed to Big Pharma, Big Insurance, etc. as the scapegoat to be pushed out of the proverbial camp.

The health care problem isn't primarily economic, it is moral, and grounded in anti-Christian notions about man.

At April 5, 2008 at 3:29 PM , Blogger Eric Schansberg said...

Sure, it makes no sense for the State to regulate doctors-- aside from whatever direct and significant harm they do to others.

What interested and surprised me most about Moore's movie was that he didn't just scapegoat big business...

At July 16, 2009 at 10:35 AM , Blogger Unknown said...

Thanks for the review and the comment over at Hillbilly Report.


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