Commentary

Moore’s Sick Rx

Michael Moore’s new film Sicko, a critique of the U.S. health-care system and paean to socialized medicine around the world, premiered amid great fanfare at Cannes last month. Time magazine reviewer Richard Corliss rejoiced, “The upside of this populist documentary is that there are no policy wonks crunching numbers.”

Wouldn’t want anyone messing up Moore’s fantasy with … facts.

The American health-care system undeniably has serious problems, and Moore effectively dramatizes the suffering of people caught up in them. Yet he often exaggerates those problems. For example, he frequently refers to the 47 million Americans without health insurance, but fails to point out that most are uninsured for only brief periods, or that millions are eligible for programs like Medicaid but fail to apply.

Moreover, he implies that people without insurance don’t get health care. In fact, most do. Hospitals are legally obliged to provide care regardless of ability to pay, and while physicians don’t face the same 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 get 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 other 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 those in New York City, despite having essentially the same health care.

And when you compare the outcome for specific diseases, like cancer or heart disease, the United States clearly outperforms the rest of the world. When former Italian Prime Minister Silvio Berlusconi needed heart surgery last year, he didn’t go to an Italian hospital or to France, Canada or Cuba. He came to the Cleveland Clinic.

While overly critical of U.S. health care, Moore overlooks the flaws of national health-care systems. He suggests, for example, that Canada’s waiting lists are mere inconveniences, interviewing apparently healthy Canadians who claim they have no problem getting care. Yet nearly 800,000 Canadians aren’t so lucky. The Canadian Supreme Court has pointed out that many Canadians waiting for treatment suffer chronic pain and, “Patients die while on the waiting list.”

Similarly, 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. Roughly 40 percent of cancer patients never get to see an oncology specialist. Delays in getting 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. Perhaps Moore could have talked to some of these folks?

Visiting France, Moore waxes ecstatic about the government’s willingness to pay for nannies to help care for newborns. He apparently doesn’t notice that the taxes necessary to pay for such a system have given France one of the lowest rates of economic growth in Europe or that many of the country’s best and brightest are fleeing.

Moore also slides over the facts when he implies that the French system is “free.” It’s funded through a 13.55 percent payroll tax, a 5.25 percent income tax and other taxes on tobacco, alcohol and drug-company revenues. And the system is still running a $15.6 billion deficit.

And French patients still have to pay high copayments and other out-of-pocket expenses, and physicians can 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.

America needs to have a serious debate about how to fix our health-care system. But Moore’s demagoguery and refusal to address the numbers will do little to contribute to that debate. Maybe he could’ve used a few policy wonks after all.

Michael D. Tanner is director of health and welfare studies at the Cato Institute.