Sicko and the liberal narrative

220px-Sickoposter

220px-Sickoposter

My wife had an assignment to watch the Michael Moore documentary Sicko for her writing class. I watched it with her so that we could discuss it and generate writing ideas. Sicko's message is simple: The healthcare system in America is bad. The healthcare systems in Canada, England, and Cuba are good. America should be more like them.

As a liberal, Michael Moore looks at the world through the lens of an oppressed vs. oppressor narrative. Outcomes in an economy are the result of someone's insincere intentions. It is because of this narrative that Moore believes that the American Healthcare system is worse than other countries. Moore finds stories and statistics that fit this narrative. I will argue that Moore misinterprets the facts. I think that facts can be interpretted to show (1) that the healthcare system in America is not as bad as Moore claims, (2) that government-run healthcare systems are not as good as Moore claims, and (3) that the negative aspects of the American healthcare system are caused by the well-meaning government policies that Moore recommends.

Stories
 
The first way that Moore's movie tries to make America's healthcare system look bad is by showing personal stories of Americans who had a negative experiences with the healthcare system. These stories were truly touching. I felt bad for the people who had to make difficult choices when it came to paying for healthcare. One couple had to move in with their grown up children. Another 79-year old man had to go back to work to pay for his medications. Anyone could sympathize with these stories. Concerning the content of the stories, there was nothing to disagree with.

Disagreement does arise however when Moore tries to use these stories as evidence of his oppressor vs. oppressed narrative. According to Moore's narrative, the people in these stories are oppressed by health insurance companies and politicians who support free markets. The only way to help these oppressed people is to provide a government-run healthcare system.

In response, oppression usually involves the use of force and coercion. Free markets by definition are free from coercion. For example, businesses cannot force people to buy their services. They can only attract customers by offering some mutually beneficial product or service. I suppose I am extreme, but I believe that government coercion is only justified when to adjudicate contracts. Second, real oppression is often caused by government-run healthcare. Since government-run healthcare systems must ration care, they often deny care to elderly patients or make patients wait. On stort from Canada, Sally Pipes' mother died prematurely because she was denied a colonoscopy for being too old. A 31-year old man in Sault St. Marie, Canada was told he had to wait five years for an appointment to get a physical. In America, young people are oppressed when state laws in New Jersey and Massachusetts price young people out of the market by forcing insurance companies to cover more than young people reasonably need or want. These laws raise prices by forcing insurance companies to treat every customer roughly the same..

Statistics
Michael Moore uses several statistics to tell his "America...bad, government-run healthcare...good" narrative. For instance, Moore cites the Census Bureau statistic that 50 million Americans do not have health insurance. I want to address this statistic because I heard Obama repeatedly use this statistic when he was promoting the Obamacare. This statistic comes from the U.S. Census Bureau that reported in 2007 that 45.7 million Americans do not have health insurance.  Who are these uninsured people and why don't they have health insurance?  Do these people fit into Moore's oppressed vs. oppressor narrative?

According to the Harvard economist, Greg Mankiw, this statistic is very misleading:

To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had national health insurance, they would probably not be covered.

The number also fails to take full account of Medicaid, the government’s health program for the poor. For instance, it counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always apply if they ever needed significant medical care. They are uninsured in name only.

The 47 million also includes many who could buy insurance but haven’t. The Census Bureau reports that 18 million of the uninsured have annual household income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.

Of course, millions of Americans have trouble getting health insurance. But they number far less than 47 million, and they make up only a few percent of the population of 300 million.

Any reform should carefully focus on this group to avoid disrupting the vast majority for whom the system is working. We do not nationalize an industry simply because a small percentage of the work force is unemployed. Similarly, we should be wary of sweeping reforms of our health system if they are motivated by the fact that a small percentage of the population is uninsured.

Another statistic that Michael Moore uses to support his narrative is that America's life expectancy is lower than countries that have government-run healthcare systems. While it appears to be true that Americans have a lower life expectancy than several developed countries, it would be an error to use this statistic as evidence of a poor healthcare system. For example, a country could have the best medical system in the world, but its citizens could have a lower life expectancy because they might make poor health choices, or they might have a high homicide rate, or unusually high automobile accident rates.

If you want to accurately compare the healthcare systems of countries, you can't use homicide rates, and automobile accidents, or even obesity statistics as evidence against the healthcare system. Unfortunately, it turns out that America does have unusually high homicide rates, automobile accident rates, and high obesity. According to ABC news correspondent John Stossel, “our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.” In the book, The Business of Healthcare, American's live longer than people in every other western country once you factor out people who die from car accidents and homicides. As Harvard economist Greg Mankiw has noted, “Maybe these differences have lessons for traffic laws and gun control, but they teach us nothing about our system of health care.” On his blog Greg Mankiw also suggests, "Given how overweight we Americans are compared with citizens of other countries, it is amazing that we live as long as we do. If we further standardized life expectancy by body-mass index, the U.S. lead in health outcomes would likely grow even larger." Again, the American healthcare system is not as bad as Moore makes it seem in his Documentary.

Conclusion
Moore seems to believe that economic outcomes are caused by some oppressive agent and that government can make things better by stopping oppressive forces within an economy. It is very natural and intuitive to explain various phenomena by appealing to some purposeful activity. Cavemen made the error of believing that some volitional spirit caused the movement of leaves fluttering in the wind. I think that creationists likewise make the mistake of assuming that the biological order that we observe must come from a purposeful being. According to evolutionary psychology, these intuitions may have provided some evolutionary advantage by making organisms more alert when they heard noises in the bushes at night. I believe that the Sicko is in error partly because it depends somewhat on these intuitions.

So what is the right way of interpreting stories and statistics regarding economic issues such as healthcare? Instead of assuming that outcomes in an economy are the result of volitional activity, one could view outcomes as the result of non-volitional market forces. These non-random forces transmit information in the form of prices which provide feedback to businesses and consumers who change their behavior according to changing circumstances. This way of looking at the world is less intuitive and more difficult to understand than the oppressed vs. oppressor narrative. The purpose of this paragraph was not to justify this way of thinking, but simply to provide a contrasting narrative by which to interpret stories and statistics.

Is it rational to vote for third-party candidates?

The purpose of this post is to answer the question: "Is it rational to vote for third party candidates?" Let me first define the words I am using. By "rational" I simply mean choosing the wisely among alternatives. A rational person weighs the various options (calculates ratios) and chooses the option the he/she thinks will do the most good. A rational person aligns their actions with their goals. By "third-party candidate" I am simply referring to a candidate that is not one of the major two parties in the United States—namely Democrat and Republican.

I want to go through a series of thought experiments to try to answer the question of this post.

Scenario 1
 
Let's say that Barack Obama and Mitt Romney are the only 2 candidates on the ballot. Let's say that between the two candidates, a Romney presidency is 100% aligned with my goals and an Obama presidency is 0% aligned with my goals. (Saying that Romney is 100% aligned with my goals is the same thing as saying that I agree with everything that he says.) In this scenario, it is rational to vote for Romney.

rational-choice-is-romney

rational-choice-is-romney

Scenario 2
Now let's say that Romney is 1% aligned with my goals and Obama is 2% aligned. Since Obama is more aligned with my goals, it would now be rational to vote for Obama.

rational-choice-is-obama

rational-choice-is-obama

Scenario 3
 
Now let's add a third-party candidate. The candidates are Romney, Obama, and Jesus (insert perfect candidate of your choice here). Let's say Jesus is 100% aligned with my goals, Romney-50, Obama 49. Let's also stipulate that they all have an equal chance of winning. In this case it is rational to vote for Jesus.

rational-choice-is-jesus

rational-choice-is-jesus

Scenario 4
 
Now lets take the same example—Jesus-100, Romney-50, Obama-49. But Jesus happens to have no reasonable chance of winning an election. But, Romney and Obama have fairly equal chances of winning. What is the rational thing to do? As I defined in the beginning "rational" means choosing the best option among alternatives. Because Jesus has no chance of winning, I believe that it is rational to vote for Romney over Jesus. Why? Because although Jesus would do the most good, the good that Jesus would do if he were elected doesn't matter. It is simply not part of reality. A vote for Romney in this case would do more good in the world than a vote for Jesus.

rational-choice-is-romney-2

rational-choice-is-romney-2

Conclusion If scenario 3 was representative of the situations that we find ourselves in, then it would be rational to vote for a third party candidate. However, in my lifetime there has never been a third party candidate that has had a chance of winning. Every election that I can remember resembles scenario 4 and there is no evidence that we will depart from scenario 4 anytime soon. Therefore, under normal circumstance, I believe it is irrational to vote for third-party candidates, because that decision will not be aligned with the goals of the voter. Voting for the most electable candidate that you agree with is the best way to influence politics in a direction that you one think is best.

ANTICIPATING OBJECTIONS

The "Vote on Principle" Objection
 
Some object by saying that one should vote "on principle" or similarly people should vote "their conscience". I am not really sure what this means, but I think it means that everyone should vote for the person with whom they agree the most whether or not they have a chance for winning. If we apply this principle consistently, then it means that since everyone agrees with themselves the most, they should write in their own names and vote for themselves. This is absurd so perhaps the "vote on principle" advocates mean something like vote for whoever you agree with the most that is a running candidate. But this approach assumes that one can do more good if they vote for someone that is a running candidate even if they agree with that candidate less than they agree with themselves. If that really is the assumption, then it only seems logical to apply it more broadly as I have to vote for someone that will do more good by being elected.

In my opinion, I am voting on principle. The principle I am using is rationality. I want to do the most good among the alternatives available. My conscience leads me to try to do the most good possible.

The "Lesser of 2 Evils" Objection
Some object that I am just settling for the "lesser evil". I might agree with this argument if we were voting between Hitler and Pol Pot, but I don't think that picture matches reality. I think that framing the issue this way is categorical. Anyone judging the candidates to be evil presumes the omniscience of God. The decision making process is not categorical, but incremental—meaning that there are costs and benefits that need to be examined and weighed for each candidate. In other words, the choice between candidates is a choice between 'more good or less good' given the trade-offs inherent in the voting process. In other words, it is pointless to argue what should happen in a perfect world. Instead, we should focus on what can be done in the world that we find ourselves in. If we compare our current situation with the perfect world, then everything will seem evil to us. To get a clear picture, we must compare where we are now, with where we have been.

The "Send a message" objection
 
Some say that you should vote for the candidate you agree with most to send a message. I admit that in some rare circumstances this may be a rational strategy. For instance, let's say that there are only 2 candidates, Romney and Obama. I agree more with Romney, but he has no chance of winning. In that case I would still vote for Romney because sending a message is the best I can do in that situation.

rational-to-send-a-message

rational-to-send-a-message

But most of the time when people say they are sending a message, I think they are really just treating elections as an occasion to vent their emotions, rather than as a process to pick someone into whose hands to place the fate of the nation.

The "They are all the same anyway" objection
 
Some claim that the major party candidates are all the same and therefore they should vote for some third-party. This claim strikes me as very ignorant. Anyone who is aware of the voting patterns between Democrats and Republicans know that they very rarely vote similarly on any piece of legislation. Perhaps more important, the president has the power to select supreme court justices that can serve for several decades. With very few exceptions, the type of judge that a democrat will select is much different than the type of judge that a republican will select. Saying that one does not like either candidate is not equivalent to saying that they are all the same. We must do our homework and select which electable candidate will do the most good.

The "people will wake up" objection
Some argue that we should let the worst candidate win so that "people will wake up". The problem with this argument is that people don't "wake up". The worst candidate ends up electing judges that sit on the bench for decades that make matters even worse over the long run.

Stereotypes

A stereotype is a conceptual categorization often in reference to a group of people. Examples of stereotypes are: Jews are wealthier than white anglo-saxton protestants, blacks are more likely to be on welfare than whites, students in business are more conservative than students in the arts, men are stronger than women, homosexuals are effeminate etc.

The most important question regarding stereotypes is this: Is it more often the case that stereotypes reflect reality or more often the case that they affect reality?

Those who assume that reality is mostly socially constructed tend to reject the idea that stereotypes reflect reality. Those who believe in an objective reality that exists independently of beliefs and opinions are more likely to be suspicious of the effect of stereotypes on reality. I find myself in this latter group for the following reasons:

First, the human mind forms concepts based on differences and similarities between objects, events, and people. Our ancestors in our evolutionary past had a stake in forming correct concepts about their world. Those ancestors who took the time to see if every large feline they met was dangerous would not have survived long enough to pass on their genes while those who were able to make quick judgements in order to react would have more likely survived. In other words, concept formation is useful because it helps us understand the world our around us without having to engage in the impossible task of treating every experience as completely new and wholly uncertain. I suspect that most people would find this uncontroversial except when it comes to concept formation (i.e., stereotyping) about people. 

The second and more convincing reason is this: the claim that human concept formation is merely socially constructed is self-refuting. An argument is self-refuting when it must assume the thing it is arguing against. The act of stating that something is true or false, or valid or invalid necessarily assumes the validity of concept creation. Therefore, rejecting the idea that stereotypes (in the sense of conceptual categorizations) in general reflect reality is also self-refuting. I qualify the previous sense with "in general" because I am not saying that all stereotypes are accurate. (That would be a false stereotype).

People don't hold stereotypes forever. As people live and engage with reality, people are often quite willing to change adjust their stereotypes. For example, my grandfather was a LA Firefighter during the Watts riots of 1965. Because of his harrowing experiences, my grandfather had formed some discriminatory feelings against blacks. However he also had many close associations with black co-workers for whom he had no negative feelings at all.

According to the cognitive scientist, Steven Pinker in his Pulitzer finalist book The Blank Slate,

"People's stereotypes are consistent with the statistics, and in many cases their bias is to underestimate the real differences between sexes or ethnic groups. This does not mean that stereotyped traits are unchangeable, of course, or that people think they are unchangeable, only that people perceive the traits fairly accurately at the time. Moreover, even when people believe that ethnic groups have characteristic traits, they are never mindless stereotypers who literally believe that each and every member of the group possesses those traits. People may think that Germans are, on average, more efficient than non-Germans, but no one believes that every last German is more efficient than every non-German. And people have no trouble overriding a stereotype when they have good information about an individual. Contrary to a common accusation, teachers’ impressions of their individual pupils are not contaminated by their stereotypes of race, gender, or socioeconomic status. The teachers’ impressions accurately reflect the pupil's performance as measured by objective tests."

As stated previously, accepting the general validity of stereotypes does not mean that all stereotypes are accurate. False stereotypes are likely to persist if there is no consequence for them persisting. And of course, stereotypes do not justify racism or sexism, though it does justify discrimination which is not a categorical evil. Stereotypes are not "simply human inventions that have done more harm than good." In fact it would be harmful to deny the realities reflected by stereotypes if our goal is to elevate cultures that disproportionately tend toward socially harmful behavior.

Check the comments for a good treatment of stereotypes in Steven Pinker's book The Blank Slate: The Modern Denial of Human Nature .