Sicko or Wacko?

Michael Moore’s new film, Sicko, which premiered at Cannes last week, is receiving the expected rave reviews. In one particularly interesting review Time Magazine reporter Richard Corliss rejoices that “the upside of this populist documentary is that there are no policy wonks crunching numbers….”

Yes, we wouldn’t want anyone who knows something about health care reform to point out that:

  • Moore frequently refers to the 47 million Americans without health insurance, but fails to point out that most of those are uninsured for only brief periods, or that millions are already eligible for government programs like Medicaid but fail to apply. Moreover, he implies that people without health insurance don’t receive health care. In reality, as Michael Cannon and I have pointed out, most do. Hospitals are legally obligated to provide care regardless of ability to pay, and while physicians do not face the same legal requirements, few are willing to deny treatment because a patient lacks insurance. Treatment for the uninsured may well mean financial hardship, but by and large they do receive care.
  • Moore talks a lot about life expectancy, suggesting that people in Canada, Britain, France, and even Cuba live longer than Americans because of their health care systems. But most experts agree that life expectancies are a poor measure of health care, because they are affected by too many exogenous factors like violent crime, poverty, obesity, tobacco and drug use, and other issues unrelated to a country’s health system. Americans in Utah live longer than Americans in New York City, despite having essentially the same health care.
  • Moore downplays waiting lists in Canada, suggesting they are no more than inconveniences. He interviews apparently healthy Canadians who claim they have no problem getting care. Yet nearly 800,000 Canadians are not so lucky. No less than the Canadian Supreme Court has said that many Canadians waiting for treatment suffer chronic pain and that “patients die while on the waiting list.”
  • Moore shows happy Britons who don’t have to pay for their prescription drugs. But he didn’t talk to any of the 850,000 Britons waiting for admission to National Health Service hospitals. Every year, shortages force the NHS to cancel as many as 50,000 operations. In a Cato Policy Analysis, John Goodman noted that roughly 40 percent of cancer patients never get to see an oncology specialist. Delays in receiving treatment are often so long that nearly 20 percent of colon cancer cases considered treatable when first diagnosed are incurable by the time treatment is finally offered.
  • Moore calls the French system “free,” convieniently ignoring the 13.55 percent payroll tax, a 5.25 percent income tax, and additional taxes on tobacco, alcohol, and pharmaceutical company revenues that fund the system. (Despite the high taxes, the system is running an €11.6 billion annual deficit.) The French system is not even free in terms of what patients pay. Its patients pay high copayments and other out-of-pocket expenses, and physicians are able to bill patients for charges over and above what the government reimburses. As a result, 92 percent of French citizens have private health insurance to complement the government system. Yet there remain shortages of modern health care technology and a lack of access to the most advanced care.

I’ve invited Moore to come to Cato and debate the issue. Of course, he is probably too busy to talk with a mere policy wonk…

Bravo, Sarko

Some more disappointing rhetoric from the mouth of Nicolas Sarkozy, the new French president. Once lauded as the great hope for a new France, he has revealed his protectionist instincts in Brussels.

In an article today in the Financial Times, Sarkozy mounts what the FT calls a “passionate defence of French farmers,” apparently calling for the EU to be even tougher in its defense of European agriculture in world trade talks and to “protect” its citizens from globalization. I wonder how Europe’s citizens feel about being protected from lower prices for food?

In a stunning display of perverse priorities, Sarkozy was quoted as saying, “I’m not going to sell agriculture to get a better opening for services.” But a quick glance in my Economist Pocket World in Figures 2006 suggests that Sarkozy has it all wrong: the contribution to services in the French economy in 2003 was 71.4 percent of GDP, and 74 percent of employment. Agriculture’s contribution? Just 2.8 percent (and 2 percent of employment).

Certainly many services are by definition non-tradeable (ever flown to Paris to catch a taxi?), but according to the World Trade Organization, France was the world’s fourth largest exporter of commercial services in 2004. You’d think Mr Sarkozy would want to do everything in his power to promote their growth, non?

Announcing: Harper’s Law

Mine is a simple — dumb, even — adaptation of Metcalfe’s Law.

“The security and privacy risks increase proportionally to the square of the number of users of the data.”

— First quoted in this eWeek article about the electronic employment verification system included in the current immigration bill.

(I actually suspect that Briscoe’s et al’s refinement of Metcalfe’s law is more accurate, but that’s just so complicated.)

Senate Amendment Guts Immigration Reform

The Senate’s vote yesterday to cut the number of temporary worker visas in half knocks a big hole in the comprehensive immigration reform proposal now being debated in Congress. As I’ve written in a recent Free Trade Bulletin, allowing a sufficient number of foreign-born workers to enter the country legally to meet the obvious demand of our labor market is absolutely necessary if we want to reduce illegal immigration.

Ignoring our policy advice, the Senate voted 74-24 to adopt an amendment by Sen. Jeff Bingaman (D-N.M.) that would cut the number of annual temporary “Y visas” from 400,000 to 200,000. That number is almost certainly too low to provide the workers that our growing economy needs to fill jobs at the lower end the skill ladder for which there simply are not enough Americans available to fill them. The result, if the lower cap stands, will be continued illegal immigration.

The irony is that many of the senators voting to drastically reduce temporary visas are the same senators who warn that we should not repeat the mistake of the 1986 Immigration Reform and Control Act. That bill legalized 2.7 million illegal immigrants but was unable to stop more immigrants from entering the country illegally despite beefed-up enforcement. The real flaw of the 1986 law, however, was its complete lack of any temporary worker program to provide for future, legal workers.

By adopting the Bingaman amendment, a majority of senators have turned the current reform effort into something much more like the failed 1986 law. They have kicked the illegal immigration can down the road, leaving it to a future Congress to find a lasting solution.