The Reality is More Complex

Everyday Economist links to Michal Moynihan’s review of Michael Moore's Sicko in Reason Magazine. (I could do four prepositional phrases in a sentence, but it's Sunday.) "Watching 'Sicko' so you don't have to."

I may have to. It's my issue, so to speak, and I want to credibly rebut it. I also just learned that a freind-of-a-freind's parents are the objects of the opening segment. Pardon my name dropping. It is so crazy a premise, however, it seems an unfair world that would actually call one to reasonably rebut.

Viewers are taken to London's Hammersmith Hospital, held up as a shining example of socialized care, where doctors are well-paid and patients well looked after. Moore ambles through the corridors interviewing patients that acclaim the NHS's ‘free care,' and express horror at the barbarism of the American system. Indeed, the facility's "cashier" exists to give money to patients—for travel reimbursements—rather than taking it from them. But as is often the case with Moore's films, the reality is more complex.

In 2005, London's Evening Standard reported that Hammersmith Hospital would slash hundreds of jobs; the hospital, the most debt-ridden in Britain, was hemorrhaging money and desperately needed to cut costs. And while the hospital was "downsizing", Hammersmith's CEO—yes, even the NHS has an executive class—collected a year-end bonus of close to $20,000. Small beer by American standards, but enough to provoke tabloid headlines in Britain.

At least Britain and Ireland allow private care. This provides much more of a two-tiered system than Americans would tolerate. Part of me likes the Irish model: government provides a base level to all citizens but any sane human purchases private insurance to get better care. Not sure you could sell that to either side around here.

Worse is the Swedish system, which provides good care but proscribes purchasing better care. Which glass would you rather drink from?

But Dillner's truculent insurance provider was not Aetna or Kaiser, but the notoriously generous Swedish welfare state, where health care is "free." And because there is no private clinic in Sweden that could perform the operation, Elias will sit in a queue, hoping, in lieu of privatization, for prioritization. Swedish legislator Robert Uitto said that the Dillner case was unfortunate, but "People shouldn't, on principle, be allowed to purchase care in the public system."

Sicko also introduces us to Diane, whose brain tumor operation was initially denied by Horizon BlueCross because it didn't consider her condition "life threatening." She eventually received treatment, but "not without battling the insurance companies," Moore says.

Jack Szmyt found himself in a similar situation. After waiting two months for his initial diagnosis—he too had a brain tumor—Szmyt was told that it would be another month until doctors could start the necessary treatment. Rather than wait in a queue, he borrowed $30,000 from a friend, and flew to a private clinic in Germany. Had he not sought private treatment abroad, his German doctor said, he would likely have died. When contacted by the media, his insurer, again the Swedish government, said it didn't consider the assigned waiting period "unreasonable."

This is where HillaryCare really blew up, if I remember correctly. Somebody found $1,000 fines and jail time on repeat offenses for Doctors who took money to work outside the system. People -- rightly -- recoiled at that. It will be interesting to see the Democratic proposals and measure them on this yardstick: will they allow better care for the rich ("The Rich would live and the poor would die" I can hear Peter, Paul & Mary singing...), or would they forbid private care which is quickly shown as both un-American and something most people would not want to face if their child were sick.

From the review and Moore's history, I think it's safe to say that level of nuance is not explored. Maybe if Arnold Kling made a film version of "Crisis of Abundance..."

Pharmaceuticals Posted by John Kranz at June 24, 2007 2:03 PM