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.