Sicko

[Sicko movie link]

First, however irrelevant it might be, I want to mention that I love the song at the end of the movie "Don't Be Shy" by Cat Stevens. I think one of the reasons it's there is Eddie Veder covered it during the "Vote for Change Tour" back in 2004. Great cover.

Second, and to begin the main point, Michael Moore fairly makes the argument that the health care system in the U.S. really does not seem good enough for a great many people and there are probably many tragic stories illustrating this. I think this is probably the extent of the valid points he makes in the movie.

Before going any further, I want to go around record as saying I would *love* to have excellent access to health care for myself, everyone I know, and everyone I don't know in the hopes that we could maybe all get along better if we just had the care we needed. The problem is, it's just not really clear that this is currently possible, or what actions might take us further from or closer to this dream. Legislation is costly, changes dramatically after it is introduced, and can arguably produce a result that is the opposite of what was hoped for. The Wright brothers accomplished flight on their own, despite the fact that government had invested resources in a failed attempt to do so. More relevant, although the human genome was mapped through a cooperative public effort, it had stiff competition from the private sector.

But getting back to the movie:

HMOs: a common complaint about health care is that HMOs barely work and are costly behemoths. However, as Moore himself correctly points out, HMOs arguably owe much of their existence to legislation signed in the 1970s that incentivized their creation and existence. Although I have no first-hand account of the movement leading up to the legislation, I'm fairly certain it was presented by members of Congress, the President, and many others as a way to improve health care. This is an excellent example of why one might consider exercising skepticism when presented with legislative ideas that "sound good" without good empirical evidence of their likelihood of success.

Social Programs: Surprisingly, Michael Moore points to the "free" library system, "free" education system, and the "cheap" post office. I don't think I really have to say anything more except maybe that yes, even libraries are cutting back on services and turning away patrons because cities just can't handle the expenses.

For-profit insurance companies: another complaint about those pesky insurance companies is that their CEOs suck up all the money in their compensation along with the shareholder and retained profits. However, one would really need to find out how much of the CEO compensation is in the form of exercised stock options versus an actual cash payout, and one would need to consider how much profit is retained by the company in comparison to what they charge consumers, etc. I don't have any figures but as an example, if a company has 20 million enrollees and has $10 billion in profit at the end of the year, the most they could ever possibly give back to enrollees is $500 each! But profit has to go to shareholders and towards company growth so that they don't go out of business.

Medical Reviewers: Sadly, there are probably unethical people in all professions. Medical reviewers are probably no exception. As for the argument that everything should be covered and nobody should ever be denied any coverage, it would be a *really* good idea to have a firm idea of the numbers before attempting anything like that. Also, keep in mind, we already have EMTALA (Emergency Medical Treatment and Active Labor Act) which essentially means that anyone who shows up at an emergency room at almost any hospital must be screened and stabilized without consideration of medical coverage or financial resources. Also, by law, no physician may terminate treatment of a patient for financial reasons without giving adequate notice for the patient to seek care elsewhere.

Lobbying: Yes, it seems horribly unfair but it is everywhere. The "big pharma" argument is really just an argument against lobbying.

Canada: Moore presents some interesting anecdotes but nothing more.

Life Expectancy: If life expectancy is lower in the U.S. it could be for almost any number of reasons: Violence, pollution, dangerous roads, and sedintary lifestyle just to name a few. It's possible that health care is not the cause.

London: Again, nice anecdotes but nothing more.

France: Wow, yes, having someone from the government come to do your laundry after you have a baby does sound really good. It sounds good. But you can't look at these things in a vacuum. You need to consider the effect that having so many programs has on the country. For me, it is intuitively inefficient to have a government program for doing your laundry. The more inefficiency a society has, the more problems it has. -- I also found it interesting that the man who had chemotherapy for his cancer was able to get a doctor's note to get a 3 month paid leave from work which he used, in his words, "...to soak up the sun..." (the irony being that he was paid to go soak up sun after being treated for cancer).

How would *I* "fix" health care?: I think I will write another post on that after we see what happens with this $1 trillion dollar Bill. I can tell you one thing though, if I wanted to bring down the amount being spent on health care I would probably not go out and spend more on it - and certainly not $1 trillion. That is more than a whopping twice the amount of our budget deficit for 2008! I'm pretty sure that would qualify as spending more on health care, not spending less.