Michael Moore's new movie, Sicko, premieres at the Uptown Theater in Washington today and can be expected to generate a frenzy of media excitement. With presidential candidates already falling all over themselves to offer proposals for universal health care, Moore's powerful indictment of the American health care system will almost certainly add to the debate.
But serious advocates of health care reform would be advised against relying too heavily on Moore's view.
Moore ignores the positive side altogether. For all its problems, the United States still provides the highest-quality health care in the world. 18 of the last 25 winners of the Nobel Prize in Medicine either are U.S. citizens or work here. With no price controls, free-market U.S. medicine provides the incentives that lead to innovation breakthroughs in new drugs and other medical technologies.
U.S. companies have developed half of all the major new medicines introduced worldwide over the past 20 years, and according to a survey by the president's Council of Economic Advisors, Americans have played a key role in 80 percent of the most important medical advances of the past 30 years.
Instead, Moore focuses on 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. When you compare the outcome for specific diseases such as cancer or heart disease, the United States clearly outperforms the rest of the world.
Take prostate cancer, for example. Though American men are more likely to be diagnosed with prostate cancer than men in other countries, we are less likely to die of it. Fewer than one in five American men with prostate cancer will die from it, but a quarter of Canadian men will, and even more ominously, 57 percent of British men and nearly half of French and German men will.
Similar results can be found for other cancers, AIDS and heart disease. When former Italian Prime Minister Silvio Berlusconi needed heart surgery last year, he didn't go to France, Canada, Cuba or even an Italian hospital — he went to the Cleveland Clinic.
As one would expect, Moore refers frequently 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 but fail to apply. Moreover, he implies that people without health insurance don't receive health care.
In reality, 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 it.
And Moore overlooks the flaws of national health care systems. He 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. Somehow, he couldn't find any of the nearly 800,000 Canadians who are not so lucky.
Nor apparently did he have time to interview Canadian Supreme Court Chief Justice Beverly McLachlin, who wrote in a 2005 decision striking down part of Canada's universal care law that many Canadians waiting for treatment suffer chronic pain and "patients die while on the waiting list."
Similarly, in a truly funny sequence, Moore struggles to find the payment window at a British hospital. But it might not have been so funny if he talked to any of the 850,000 Britons waiting for admission to those hospitals.
Every year, shortages force the British National Health Service to cancel as many as 50,000 operations. 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.
The American health care system clearly needs reform. But it would be a shame if Moore's latest piece of propaganda stampedes Americans into sacrificing the quality, choice and freedom that our health care system provides today.