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…