Sunday, July 08, 2007

Michael and Me

I haven't seen all of Sicko, just enough to make a few comments. Yeah, the production looks good technically but basically, I think the movie should be no more relevant than, say, Hunt for Red October to an intelligent discussion of the issues of health care and health insurance. Why do I say that?

Because the undeniable fact is that insurance is expensive because health care is expensive, not the other way around. Does Moore say that? No he does not. The cost of insurance is rising because the cost of health care is rising. Does Moore say that? No, he does not. The high cost of insurance is a symptom of the deeper problem of health care costs – and if our nation cannot solve the deeper problem, we will never be rid of the symptom. Does Moore say that? No, he does not. He’s pecking around the fringes, not facing the problem itself. Worse he does not clearly articulate the problem as either health care or health insurance. Sorta like some people in Colonial times, he’s stuck a feather in his cap and called it macaroni. Of course what one sees is nonsense on stilts. But it is what it is.

So Moore confuses the difference between health care and health insurance – I think deliberately, since Moore is not a stupid man. Confusing these two hides the real problem. It ends up feeding people’s fears that they cannot afford “health care” because they can’t buy insurance when the truth is that most of us can’t afford health care because HEALTH CARE costs so freakin much!

IMO, what Moore is selling will screw us. And because I think he knows exactly what he is doing, I see him less as an advocate and more as a pimp. By pushing confusion about the deeper problem, Moore in fact is an impediment to understanding. That is why I say, the movie should be irrelevant to an intelligent discussion. Should be. But won’t be. Won’t be irrelevant because the discussion is driven by naivete, ignorance, fear, and cynical politics.

It is a natural human temptation to minimize the importance of facts one doesn’t want to be true, especially when the facts reveal problems that are very difficult to solve. In this case, I believe that the people who are most pleased with Moore’s movie don’t want certain facts to be true. Think about our government's biggest existing health insurance programs - Medicare and Medicaid. Facts are, these programs are rapidly being crushed by the cost of health care (Medicare alone has a $60 Trillion unfunded liability) and are far from effective in meeting the needs of the elderly and poor populations because of fraud, waste, federal budget politics, political corruption, organizational inflexibility, bureaucracy, and the massive amount of law & regulation that governs everything they do. Add to that the health costs driven by our own unhealthy behaviors; we are becoming a population that refuses to take responsibility for our own health except as it can come in a pill-bottle or operation that we demand someone else pay for.

Is there a single reason to suppose that these problems would go away - that our government could do a "better" job with health insurance - if only the government controlled all of it? I think the answer is obvious. No, it could not.

Many of the same people who prefer not to talk about the very real problems in our present government insurance programs, also don’t want to take seriously the problems and occasional failures in other countries’ health insurance schemes. As though if they were to admit there might be a problem elsewhere, the cause of attaining the universal health care in this country would be derailed. Is universal health care such a fragile patient that it cannot stand an honest examination?

IMO, an unwillingness to consider forthrightly the problems that all governmental insurance systems do have is a major obstacle to designing a plan that has a chance of being a “solution”. It is an obstacle because it gets in the way of clear analysis. Instead we hear far too many ad hominem attacks, or appeals to false authority, or fallacious logic, or the old chestnuts “everyone knows” and “this is a no-brainer” not to mention the usual litany of complaints about the cost of insurance, all the while ignoring the cost of health care that is responsible for the high cost of insurance.

BTW, I favor universal health care. I also favor universal health insurance to help pay for health care. There is a lot of work to do because wishing does not make it so. I do not confuse health care with health insurance. I believe that the linkage of group health insurance with one’s employment, while a useful tactic for decades, has outlived its usefulness and it’s time to re-think. At the same time, I believe that any universal insurance scheme whether public or private CANNOT succeed in this country, unless the costs of health care can be reduced and the annual rate of growth in those costs is brought under meaningful control. I favor a substantial role for the private insurance sector in any universal health insurance scheme - as in France, or Germany, or Chile or other countries. IMO, a basic public insurance plan that can be supplemented by private insurance is a reasonable approach and a preferable alternative to the enormous bureaucracy that results within a fully-centralized health care and insurance system such as in the U.K. And, of course, I think that Moore’s movie should be irrelevant to an intelligent discussion of the issues with either health care or health insurance in this country.

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