Saturday, July 7, 2007

Springtime for Michael Moore in Cuba: Review of Sicko

Michael Moore's new movie is fun to watch, but does little to convince. His arguments are weak and his imagery is one sided, which adds to its hilarity but makes it unconvincing. Moore's public relations spin has been that he is trying to moderate his delivery to appeal to conservatives. Having seen the film, I am surprised that Moore believes that he has toned down his rhetoric.

Thus, Anthony Breznican in USA Today writes that Moore

"wants to inspire people of all political stripes to improve a health care system he says is too focused on making profits and not enough on caring for the ill and injured."

Breznican adds that Moore believes that his earlier films were too combative and that Sicko will be more convincing than earlier works like Roger and Me and Fahrenheit 911. I do not think that Moore's aims have been realized, although Sicko is fun to watch. (I wonder if Moore will care that he failed to make his case if the movie does well at the box office and he can, well, afford even more donuts.)

The problem with Sicko is that Moore's ideology is extreme and his fact and research base limited so that he inadvertently succeeds in making a case against nationalized health insurance rather than a well-reasoned case for it. It is hard to believe that Moore was able to blow this, because the United States's current system is dismal, but Moore's argument is perverse enough to increase opposition to national health insurance.

Bismarck introduced the first national health insurance program in late 19th century Germany. As Richard M. Ebeling writes in Freedom Daily:

"State-mandated health insurance began in Germany in 1884, and initially covered workers in factories, mines, foundries, banks, dockyards, railroads and inland shipping. The blanket of coverage was extended over increasing portions of the work force in 1885 and 1892, with family members of workers included after 1892. In 1911, workers in agricultural and forestry occupations were added, and by 1928, practically every trade, occupation and craft in Germany was enveloped in the system.

"Before the First World War, anyone making less than 2,000 marks in the covered occupations was required by law to participate in the insurance scheme. By 1928, all those earning less than 3,600 marks were forced to participate. The insurance funds mandated by the German state were organized on the basis of trades and occupations. But the state continually consolidated them, with the result that, while in 1909 there were 23,000 of such funds, by 1914 they had been reduced to 10,000, and to about 7,400 in 1929."

As well, Goldbug Howard Katz notes:

"...the German Government gave its citizens “free” health care. The second thing that the German Government gave its citizens was “free” old age retirement. For approximately 40 years, Germans went around bragging that their country was the country of love.

"And then there was a transition period. From 1920 to 1930 (or more precisely 1919-1933), called the Weimar period in German history, the country was thrown into turmoil. And what emerged was the country of hate. This country killed 50 million innocent human beings. It enslaved millions of others. It invented a system of mechanized murder (called the Holocaust) which has never been seen in recorded history."

Thus, within 50 years of national health insurance's introduction in Germany, and just a few years after national health insurance was made virtually universal, Hindenburg made Adolf Hitler chancellor. Nazi totalitarianism and World War II followed on the heels of the completion of Germany's national health insurance policy.

Indeed, despite the bloodthirsty nature of their ideology, the Nazis were not content with mere national health insurance, but also advocated wellness policies similar to policies that Moore advocates in Sicko. Thus, the 25 points of Hitler's 1920 Nazi Party Manifesto include point 21:

The State has the duty to help raise the standard of national health by providing maternity welfare centres, by prohibiting juvenile labour, by increasing physical fitness...

Those on the left may argue that claiming that national health insurance is linked to totalitarianism is a post hoc ergo propter hoc fallacy (i.e., Nazism's following national health insurance does not mean that national health insurance caused Nazism). Incredibly, though, Moore uses health care in Cuba, a Nazi-like state, to make the claim that health care is "humane".

Frankly, I was flabbergasted. Is Michael Moore a sociopath, an ignorant fool, or both? Does he really think that presenting us with Potemkin village-like portraits of Castro's victims amounts to a convincing argument for national health insurance?

The Truth Recovery Archive on Cuba estimates that Fidel Castro's regime has murdered 87,073 non-combatants. Humberto Fontova wrote in August 2006:

"The young Fidel Castro was a keen student of Nazi pageantry, often seen around campus with his well-thumbed copy of "Mein Kampf" alongside his pistol. His title of Lider Maximo perfectly mimics the German term Fuhrer". Fontova adds in a Frontpagemag article:

"By 1992 two million Cubans had fled Cuba, most against staggering odds and with only the clothes on their back. By most estimates this is a tiny fraction of those who desired to leave...According to Cuban-American scholar Dr Armando Lago, 83,000 Cubans have died at sea while attempting to leave Cuba...

"500,000 Cubans (young and old, male and female) have passed through Castro's prison camps. At one time during 1961-62, 300,000 Cubans were jailed for political offenses islandwide. This makes Castro's political incarceration rate higher than Stalin and Hitler's."

Fontavo notes that "lunacy" about Castro is nothing new. Yet, if Michael Moore is eager to develop an argument for national health insurance, I'm puzzled how associating it with a Mein Kampf thumping, military-fatigue wearing butcher like Castro does the trick. Perhaps Moore's point is that Castro provided good health care to his political prisoners after he drained them of blood?

As I watched Sicko I began to wonder if the title was meant to apply to Moore's sociopathic indifference to Castro's suppression and murder.

Ultimately, though, Moore's arguments are unconvincing because he lacks factual evidence and data. There are serious problems with the US approach to health care. Costs are too high, about 16 percent of gdp, about 50 percent higher than other industrialized countries'. Also, there is little evidence that medicine here works in its most important applications, i.e., the cure of terminal illness. Modern medicine unquestionably works with respect to traumatic injury, infections, broken arms, and in a number of other areas. But those are probably not where most of the spending goes. We have permitted the medical field to spend in areas where it does not achieve results. This may be true in other countries too, but it is likely true to a more limited degree. Spending in other countries (all other countries have national health insurance or some version of socialized medicine) is limited, more so than here. More people get turned down for exotic operations than they do here. Moore did not interview such people. However, basic health care is more widely available to the needy in other countries than it is here.

For instance, Moore cites a case of a worker who lost two fingers and could not afford $72,000 to reattach both fingers, so he spent $12,000 to reattach one finger and forewent the $60,000 to reattach the second finger. Moore does not ask the Cuban physician whom he interviews whether the Cuban system would have provided for the reattachment of the fingers, or if such procedures are even available at all in Cuba or in England or France. Even if they are, a large proportion of health care in America would certainly not be provided in Europe, Canada or Cuba. In other words, people are denied care in those countries too, but they are denied care in ways that are different from the way that care is denied in the US, where the decisions are made by insurance industry bureaucrats rather than governmental bureaucrats. Moreover, there is greater weight put on ability to pay here than in other countries.

Much like the Bismarckian welfare state, the Nazi Party and Castro's communism, Moore pretends that health and welfare benefits provided by state systems are "free". He repeatedly states that "care is for free" in France and Cuba. This is of course not true. Someone pays for the care, and the care is rationed. When speaking of the Canadian system, one of Moore's interviewees says "someone always complains about anything". Might we not conclude that Moore and his cranky left-wing followers are those ever-complaining people here in the US?

Seventy years ago, the City of New York "nationalized" the New York City subway system. After seventy years of the benefit of public management, the New York subway is dismal. Rats scurry about, and trains skip stations. The entire system is unpredictable, over-crowded and badly run. If one goes to France, Russia or Tokyo, the subways are much nicer. They are clean, well-maintained and run on time. Moore's (and the left's) argument is that the US will adopt a French, Russian, Japanese or Canadian style health care system. But in all areas I have seen, Canada runs public systems much better than we do. Moore and the left are confused. If the United States nationalizes health care, we will have a New York-style health care system, not an Ottawa-style health care system. Perhaps Moore and his left-wing followers should concentrate on the messes that their incompetence has created in other, now less interesting, public sector areas before they move on to new areas for socialization in which they also lack competence. Some examples include education, the subways, the post office and social security.

Indeed, as Moore notes in his movie, the post office and the education system are socialized. Yet, both of these "services" are dismal. The post office is such a bad service that several large firms have sprung up to provide alternative service at many times the cost, yet they are successful. No one knows how much better service would be if competition with the post office were permitted. Moore aims to convince us to adopt nationalized health insurance based on our experience with the post office. Is he on drugs?

As for the public education system, Moore talks through both sides of his mouth. On the one hand he tells us that we can nationalize the health system just like the education system. Then, later in the movie he bemoans the fact that people are afraid to complain about the education system because it is so badly run! The left has taken control of the education system, and standards and literacy have declined. If we nationalize health care, the left will preach its anti-foundationalist philosophy that reality does not matter, it only matters that society construct good health. God save us.

There is considerable unnecessary care in the United States. The way to end such unnnecessary care is to treat spending on health care just like spending on everything else. Introduce competition into the medical profession by ending licensure. Educate consumers about low-cost options overseas. In time, technology will replace current approaches through discovery of new drugs.

We do not need to emulate Fidel Castro.

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