Kurt Loder on SiCKO
Nick Gillespie | July 2, 2007, 6:38pm
If Michael Moore's new doc about health care is a dud, part of the explanation is that it's really not convincing in offering either a diagnosis or a prescription for the American system.
Here's Kurt Loder at MTV giving Sicko a big thumbs down:
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. 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. Last March, the BBC reported on the results of a Healthcare Commission poll of 128,000 NHS workers: two thirds of them said they "would not be happy" to be patients in their own hospitals. James Christopher, the film critic of the Times of London, thinks he knows why. After marveling at Moore's rosy view of the British health care system in "Sicko," Christopher wrote, "What he hasn't done is lie in a corridor all night at the Royal Free [Hospital] watching his severed toe disintegrate in a plastic cup of melted ice. I have." Last month, the Associated Press reported that Gordon Brown - just installed this week as Britain's new prime minister - had promised to inaugurate "sweeping domestic reforms" to, among other things, "improve health care."...
In 2004, French Health Minister Philippe Douste-Blazy told a government commission, "Our health system has gone mad. Profound reforms are urgent." Agence France-Presse recently reported that the French health-care system is running a deficit of $2.7 billion. And in the French presidential election in May, voters in surprising numbers rejected the Socialist candidate, Ségolène Royal, who had promised actually to raise some health benefits, and elected instead the center-right politician Nicolas Sarkozy, who, according to Agence France-Presse again, "plans to move fast to overhaul the economy, with the deficit-ridden health care system a primary target." Possibly Sarkozy should first consult with Michael Moore. After all, the tax-stoked French health care system may be expensive, but at least it's "free."
And that's all before Loder gets around to Moore's strange depiction of Castro's Cuba as tropical paradise. Read the whole review here.
And check out Reason's review online here.
MattXIV | July 2, 2007, 9:35pm | #
Loder actually makes one of the points that is so often missing from healtcare debates since it doesn't fit neatly into anybody's political world view, namely that every single first-world healtcare system is/has/will experience problematic increases in costs/rationing, regardless of how it is structured.
This seems to be the consequence of three trends. First, all these populations are getting older. Even before retiring, older people still need more medical care and are more likely to experience complications, so as a population ages, you'll see higher costs at lower outcomes. Second, the cost of "standard of care" medicine grows at a faster rate than GDP because medical technology options grow very quickly and the newest technologies are typically more expensive that the older ones (there are some exceptions - laproscopic surgery probably saves money - but most new interventions increase both outcomes and costs). Third, increasing wealth has made it possible for people to induldge in unhealthy but pleasurable lifestyles at higher rates than before - obesity rates and all that jazz. There is pretty much nothing that can be done about the first and the last two are actually side effects of overall positive developments, so there really aren't any politically feasable, let alone actually advisable, policy changes that would address them.
Regarding the US outcomes and money vs other countries, the US definitely gets less per avg dollar spent. But this is totally non-suprising. Mostly privately funded healthcare (the US system) will be funded based on the marginal benefit to outcomes vs cost of the last dollar for each individual, which is rarely the lowest in society, whereas a well-ran single payer system will spend its marginal dollars at the highest marginal benefit overall. These low-marginal return dollars from the relatively wealthy are why the US generally does better at getting newer equipment quicker and treating trauma. Of course you could take the same amount of money and redistribute it and get better outcomes statistics, but it would be the redistibution to people with better marginal outcomes opportunities that does it, not any efficiency of single-payer systems. (Aside: The US gov't-provided safety net healthcare systems are notorious for not making good allocations on the margin, resulting in the poor going to ERs to get routine care, expensive operations being covered but cheap preventative meds not, etc.) One doesn't even need to redistribute with healthcare in mind to achieve this effect.
But outcomes statistics are not ends themselves. What actually happens to individual people will primarily be redistribution, and consequently ones views on gov't-provided universal health care should be shaped by attitudes towards redistribution, not by chasing after efficiencies that are most likely illusory.
Aresen | July 3, 2007, 12:56am | #
John
As can be seen above, I am no ardent defender of the Canadian system, but I think you exaggerate its failings.
There are long wait lists and people do die while waiting for treatment, but the people in the system are compassionate and to their best with the limited resources available to them. Granted, they do some "triage" and try to concentrate there efforts where they will do the most good.
A friend of mine had a "mild" heart attack [if one can define any heart attack as "mild"] five days ago and received prompt and efficient treatment from the moment he arrived at the hospital. His wife, who died several years ago from cancer, received the very best treatment and, when it became hopeless, palliative care throughout her illness.
OTOH, my uncle in California, was essentially allowed to die by Kaiser, who didn't want to spring for the expensive treatments that might have extended his life.
This is anecdotal, of course, and proves nothing.
The major benefit of the US system is that it is continuously produces innovations and advances as the lure of profits drives medical providers to seek new and better ways of treating people. While I am not indifferent to the suffering of those unable to afford the best care, I recognize that such care would not exist were it not for the profit motive that is so despised by supporters of the single payer system here in Canada.
Which brings me to the major problem here in Canada:
By Law, I am prohibited from providing for myself by seeking alternative insurance and medical systems.
My worst fear is that, should you in the US adopt our 'single payer' system, the much-despised [by liberals] profit motive that drives medical innovation will cease to function.
Given the unlimited demand for medical services, no system will ever be "perfect" in the sense of providing the maximum possible treatment to all who seek it. There are not enough resources in the world to do that.
However, given the choice between medical care rationed by price and any other system of rationing the resources, I choose the former,
for the simple reason that the former will produce more innovation and more benefits for all in the long run. 