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The libertarian response to Sicko

Fingerbite I'm on an email list devoted on iatrogensis—medical problems created by medical treatments—that has a strong libertarian contingent, so I've had a chance to read several right-wing critiques of Michael Moore's new movie, Sicko.

I agree with one popular criticism: Moore should have acknowledged that Cuba is a hell hole. But I've yet to find any serious argument debunking the main point: that American health care is seriously screwed. In fact, the critiques all follow pretty much the same formula. Most cite inconsequential anecdotes of bad health care experiences in Canada, England, and the other countries Moore visited. The more substantial criticisms point out that people in, say, Canada and England may face long waits for medical care, that hospital infection rates are high, and that some people may be denied care if that care is deemed "experimental."

...and so?  I'm still waiting for a problem that's not also common in America. Canada has long waits in emergency rooms? Been to an American E.R. lately? England has high rates of hospital-induced infections? America's private market hasn't solved that problem yet either. (The iatrogensis email list was created to respond to the problem of hospital-borne disease in the US!) Experimental treatments are explicitly excluded from all American health care plans—and the insurers get to decide what counts as "experimental," even if a treatment plan has evidence of past success.

The one thing Canada, England, and the other countries don't have in common with the US is 47 million people who are uninsured. That feat is America's alone. For many of those people, that means no medical care at all. Somehow America has managed to have the worst of both worlds—we have all of the disadvantages of the other healthcare systems without the advantages: 47 million uninsured, relatively low life expectancy, high infant mortality, and low overall health compared to other industrialized nations. (See This New Yorker story.)

The only complaint that makes sense applies only to those Canadians, Europeans, and Cubans who have so much money that they can afford whatever health care they want, when they want it. Okay, you win: if you're super rich, America is the place to be. But Sicko wasn't created for the super rich; it was created for the rest of us.

Posted by carrie on 07/01/2007 | Permalink

Comments

I just saw Sicko a couple of hours ago and I am seriously thinking about becoming an ex-patriot. The movie is one-sided, but it is a side that needs to be heard and is backed up by solid facts. I think few americans can really disagree with micheal moores overall message that the health industry in this country is horrible. Sicko almost made me sick , but I can not afford that luxury because I am one of the uninsured.

Posted by: natron | Jul 1, 2007 9:16:45 PM

Cuba isn't a hell-hole. I wont say it's heaven either (the food is relatively horrible). It's a complicated place, but compared with neighboring islands, mexico, (and maybe even the US) their healthcare and education is statistacally pretty awesome (and free on top of that). Although everyone's home might not be the best, they all have homes. It took me a while to get used to seeing homeless people again in the US after I came back. Anyway, it's a complex place, far from a hell-hole. Texas on the other hand... (kidding!).

Posted by: Steve Lambert | Jul 2, 2007 2:21:01 AM

I had a pretty hard time believing a lot of what I saw in Sicko. Due to low income, my family qualifies for a state medical card, which covers us entirely. At most, I have a co-pay of $2 for a doctor visit (sometimes) and about the same for some of my prescriptions. Most times, I don't have to pay a thing. This took care of broken bones, ongoing asthma treatment, medical equipment, transportation, dental work, eyeglasses, routine checkups, kidney stone surgery during pregnancy, pregnancy itself... hell, a relative of mine had the exact same insurance and had a bone marrow transplant-- the very procedure mentioned in Sicko! This surgery was EXTREMELY expensive, and required a LOT of days in the hospital. I know that a lot of middle class folks don't consider themselves rich, but to me, they are. I saw those people in the movie, and was pretty sure my whole family doesn't make half of what they do-- so I'm finding it rather hard to believe they can't handle some co-pays. My thinking is that they're living beyond their means, and not doing much saving. Considering the state of credit debt in the US, I might not be too far off the mark.

Posted by: anon, ok? | Jul 2, 2007 9:16:21 AM

The poor, illegal immigrants, and the rich are doing ok with the current situation. But if you are apart of the middle class your screwed. That was the main point of the movie. As far as "annon, ok?" I don't get it. The US government is paying your dental? If this is actually true can you please tell me about this amazing program because I've never heard of it.

Posted by: natron | Jul 2, 2007 9:57:10 AM

Natron--

It's just the standard state medical card in Illinois... ask any broke person to show you one. All kids in Illinois are also covered now, and this includes dental as well. Check http://www.allkidscovered.com/ for some of the details, and there should be a link to their family care plans as well. Again, not seeing the big deal here.

To me, it just sounds like the middle class are doing a piss-poor job of managing their money.

Posted by: anon, ok? | Jul 4, 2007 9:39:31 AM

Right on, anon. I'm quite middle-class and 180$ a month for health inusrance (directly from Horizon not thru work or anything) isn't fun but it's a necessity. My fiance and I make sure to put it up at the top of our priorities with the rent and groceries. Sure, I may not be able to buy what I want, but if something bad happens, I know I'm covered. For too long the middle class has been irresponsible and now this is what comes of it. Everyone screams for state-run, socialized health care, but someone has to pay for it. And if they don't have the money to pay for individual health insurance, they'd better start saving to soften the blow of the taxes that'll be raised to pay for the gov't-run health care...

Posted by: anon^2 | Jul 4, 2007 9:55:46 PM

i saw this film recently and have been talking a lot about it. One thing i would like to point out, not to take away from the points made in the film, but ok, if people are out there eating all this fast food, all this meat and dairy and refined sugars and getting obese and giving themselves heart disease, diabetes, mental illness, and cancer, it's irresponsible....it's a good idea to have a free universal health care system, i'm just saying that there seems to be another problem in the US with people and taking care of their bodies. The people that work in Big Food industries will go to any length to get the masses to buy and eat stuff that has been shown to lead to disease, and then they go into the loop of needing medical care for all these serious but avoidable ailments.....cheap crummy nutrition-free food is chemical warfare used against the poor who can't afford to buy organic or higher quality foods to stay healthy. In Sicko it's pointed out that no one protests or takes to the street enough in this country, and i think it's cause people are so poisoned and fat and unhealthy and i think this results in a lot of apathy.....anywhere u go, if you look around like 80% of the people at any given event or movie or museum or what have you are overweight....it's not really about being unattractive or something, it's about their health and about being too fat to fight back. Too drugged to resist. It hurts me to see this......these r just my rambling thoughts and generalizations, but i thought i would share them. I enjoyed this film very much, i thought it was superior to all previous michael moore films in that it was less about him and more about the matter at hand.

Posted by: lady jane | Jul 6, 2007 12:59:50 AM

Lady Jane-- I agree. I'm sure it will never happen, but I'd love to see smokers have to waive their right to any sort of state or federal medical insurance for smoking-related ailments. Smoking has absolutely no benefit to anyone, save the taxes it generates from these poor saps who continue to buy cigarettes. I wonder what the insurance situation would look like without this additional burden?

Posted by: anon, ok? | Jul 6, 2007 9:41:47 AM

Insuring America would more or less bankrupt it. Taxes would have be increased to cover the expenses. It's easy to have a universal healthcare plan when your countries population is 33 Million (Canada) or 60 Million (United Kingdom) Compared to 300 Billion (United States).

Posted by: | Jul 9, 2007 9:57:24 PM

This is a response for anon and anon_2:

Having assisted in college English classrooms--not to mention being the editor of a small local publication--I find it difficult to believe that with such immaculate grammar that the two of you are from the "lower classes." I've edited people with Masters degrees who had worse grammar than the two of you!

Also, I don't know what you consider "middle class" income or where "anon_2" is residing where $180 covers two people, but when I tried to apply for medical insurance a couple of years ago through Kaiser Permanente, I was told that I didn't qualify for their low cost plan ($150 or so at that time) because of my MEDICAL HISTORY, and yet, I was only 25 years old at the time and had very few health problems! In fact, they said if I wanted I could reapply for their $250/month plan or something ridiculous, but I figured I'd take my chances. At the time I was living off of student loans!

Personally, I think accusing the middle class of being irresponsible is VERY irresponsible of you. Just because you haven't had to fight with your insurance company yet doesn't mean the day won't come. I've had plenty of things denied by insurance companies for incredibly stupid reasons. Also: I don't have any credit card debt, and I would gladly pay more taxes to know that the money was going to benefit me at some point in the future (unlike now where so much money is spent on national security--a lot of which goes to companies who are contracted in Iraq and NOT to the troops--and A LOT of which makes the rich people in this country A LOT richer: THOSE are our current tax dollars at work!)

How can you put a price tag on your peace of mind?

Posted by: rachel | Jul 11, 2007 1:25:50 AM

To the unnamed poster... $300 Billion people? You may want to recheck Wikipedia.

Posted by: Charles Star | Jul 11, 2007 2:04:51 PM

Another thing: I re-read "anon, ok?"'s response just now where they accused the middle class of doing a "piss-poor job managing their money," and I find it really offensive. If you really are from the "lower classes," as you claimed to be, then who do you think is paying for your medical card? Meanwhile, the middle classes can't get that card because they "make more money" so they're being taxed to pay for other people's medical care while the care they receive themselves is sub-par...

Also, how you can accuse the middle class of mismanaging their money if you don't have any money yourself? Have you mismanaged your OWN money or have you made decisions or mistakes that have led to your current situation? Should we assume that everyone who DOESN'T have money has wasted their potential and is therefore undeserving of financial help or medical treatment? Your argument makes absolutely no sense to me! Accusing the middle class of not being able to afford health care is like blaming the lower class for their economic situation.

I mean, whatever happened to caring about people?

Plus, let's not forget that your state medical card is a FORM of socialized medicine--it's just not available to everyone...

If we really held congress accountable for how they spend our tax money, they could easily come up with enough for a national health care system. When I think about how much war profiteering is going on right now, it makes me sick! How can they get away with it?

Posted by: rachel | Jul 11, 2007 8:36:04 PM

We spend more in this country on entertainment than on our own medical care. Insurance is affordable for the middle class. The beauty of the free market is that competition keeps rates somewhat in check. There are plenty of high-deductible plans available for low cost. No one needs to go bankrupt. We spend more on movies and eating out than our own health. We need to better prioritize.

Posted by: Middle class man who buys insurance | Jul 13, 2007 1:14:21 PM

This whole argument is missing the point and turning into a bunch of class bashing. "Sicko" shows middle-class Americans who pay good money for insurance but who are then denied coverage from their insurance to pay for needed tests/treatment. How can you say the middle class are wasting their money when they are paying for the insurance that is supposed to keep them from medical debt? The statement "I'm finding it rather hard to believe they can't handle some co-pays" flat out ignores that the point of the film is that (middle-class) people can't get their insurance companies to cover expensive treatments, therefore it's not that the middle-class people can't afford the co-pays for the treatments, it's that they can't afford the entire cost of said expensive treatments. Also addressed in the film is the fact that people who are willing to pay for insurance are denied coverage in the first place. Once again, they have the money to pay monthly insurance fees and co-pays, but they do not have the thousands necessary to pay for ongoing prescriptions and medical care. Willfully ignoring the point of the film and instead bashing middle-class people out of spite helps no one. If lower-class citizens can receive good, state subsidized health care, why can't everyone?

Also, it makes no sense to say that it's easier for smaller countries to have universal health care because they have less people; they also have less citizens to pay taxes. The U.S. has far more citizen, but also far more tax payers. What should be looked at is the ratio of rich to poor, so to speak, not just the number of citizens altogether. Unless the U.S. has a higher percentage of low-income (and therefore non-taxpaying) citizens than countries with universal health care, there is no reason to argue that we cannot afford it as a country.

Posted by: s. | Jul 15, 2007 4:34:24 AM

Rachel- First off, thanks for your comments regarding my spelling, grammar, etc... I am quite poor, but I'm certainly not un-educated. As Moore pointed out, we have these LOVELY things called libraries! I can assure you that I'm not poor due to any sort of "failure" on my part-- I'm just not into the whole money concept.

Secondly, why are you putting lower-class in quotes? I never used those words at all, let alone claimed to be a member. I said I was poor. I fear for your position as an editor, inventing quotes as you do!

I agree that the health care system is in trouble, but I think it is more accurate to say that my concerns with Sicko are that it portrays some sort of "either/or" dichotomy of possible choices that is simply not true. Americans DO make many poor choices regarding diet, money management, credit, and allocation of resources that would certainly ease the burden on any health care system. No doubt a significant amount of money could be found in the defense budget, as has been noted here.

And as far as the delightful medical card which I so enjoy-- it probably IS available to you-- but you're going to have to give up some of the luxuries you may feel entitled to in order to get it. It helps a lot to remember that although I may be poor in America, compared to much of the world, I'm living quite an amazing life-- eating each day, free to travel, reasonably safe, able to learn, and with a home.

Many Americans just can't seem to grasp this fact for some reason...


Posted by: anon, ok? | Jul 17, 2007 1:51:34 PM

Thank you Rachel for pointing out the obvious regarding anon. I doubted him from the start as well. His so-to-speak experience has not been my experience nor the experience of others I know who belong to either of the "bottom two" classes.

In any event, I just want to add my voice here to the gathering storm calling for "Basic Health Care As A Basic Right". Oh, and if I could call for the guillotining of the well-to-do who use fancy-faulty logic to obsfucate the issue in defense of keeping the system as it is, I would. This is a matter of life and death and it ought to be seen that way.

mnuez

Posted by: mnuez | Jul 19, 2007 8:01:07 AM

Anon...yes the card would be available to middle class folk such as myself, but only if I stopped working enough so that I could meet the low income eligibility requirments. If I and most others were to do that, then there would be no tax money generated to pay for your own "socialized" healthcare.

You are the beneficiary of a "socialized" healthcare program yet would gladly see it denied to everyone else. Why is that? If it works so well for you, why not the rest of us?

also, to whoever pays $150/month..dream on...I am a healthy 27 y.o with no medical issues and I can't get anything worthwhile for under $400....and thats a plan with a high deductible.

Posted by: cdc | Jul 26, 2007 3:47:08 PM

Thanks, Mnuez, for the support. I know this sounds a little paranoid, but there are a lot of vested interests out there right now trying to discredit Moore's film. It wouldn't surprise me if there were some counter-blogging offensives going on--people claiming they get great health care, etc, etc, when there's just no way it can possibly be true! I live in an urban area with access to excellent hospitals, and I still have trouble getting my insurance to cover things sometimes. My parents on the other hand live in the mid-west, and they have even worse problems because there are fewer doctors on their plan, fewer hospitals, etc, etc... Someone posting an anonymous comment that they get great health care in Iowa for incredibly cheap is more than a little suspicious to me...

All this talk about how "the middle class should be able to buy their own health insurance" (and yes, I made up that quotation) is really just a red herring to distract us from the real issue. The point of this discussion is that the people who DO have health insurance get screwed just as much as the people who DON'T. The insurance companies are getting hugely rich off of our money and refusing to cover our medical costs. I mean, can anyone really argue with that? I doubt it!

To further illustrate my point, my doctor-visit copay just went from $20 to $30 per visit this month--that's a 50% increase! Then when the insurance person came in to my office to explain the changes, she said the reason for the increase was to offset the cost of some of the medical expenses they've had to pay in the last year! I.e., even though they paid for some expenses, in the end they raised the cost of our insurance AND the cost of our copays to offset their own costs! It's truly disgusting to me.

Posted by: rachel | Jul 30, 2007 11:41:30 PM

"It's easy to have a universal healthcare plan when your countries population is 33 Million (Canada) or 60 Million (United Kingdom) Compared to 300 Billion (United States)."

I find it astonishing how often this argument is used -- to oppose not only publicly funded health care but also such things as hand-counting paper ballots.

It's almost too irrational and obtuse to construct an argument against. OK, ten times as many people = ten times as many taxpayers, doctors, administrators = pretty much same situation.

Or put more obviously, if this person thinks it's easy with 33 million people, then fine. Just divide the country up and then do it. Oh, I forgot -- it's already divided up into these things called states! How convenient! They could each run their own single-payer system. Just as the provinces do in Canada.

Oh, why bother.

Posted by: citizen-viewer | Aug 7, 2007 5:39:55 PM

I just viewed "SICKO" on TV, Michael Moore your my hero. I just want call attention to some of the facts about our Healthcare Sysyem to think about here in the usa.

First, its no wonder healthcare cost so much in the usa because of all the leaches in the system by far out number the healthcare workers actually giving the people care.

Almost every doctor must hire one or two employees who does nothing but constantly on the phone to the insurance companies to see if various things are covered and they are constantly fighting and trying to find ways of avoid paying for various procedures. It seems like the insurance companies are constantly trying to avoid payment one way or another.

Let me give you an example: I'm very lucky guy because I'm a retired united auto worker and the American company I retired from has always payed for all of my dental work and also all of my medical procedures for years.

But, in the last couple of years they have been trying to avoid every payment they can worm out of. My Dentist did a surgical operation on my Jaw bone, they refused payment to the dentist because they said it medical surgery and not a dental procedure and there was no dental procedure number to cover this procedure. OK, so i said pay him under the medical insurance plan and they say oh no we can't do that because he's a Dentist. This is so dam stupid it makes me sick. HaHa

Every Where you look all you find is leaches in the system, look at all the insurance, hospital, drugs companies, attorneys, employees that don't help anyone. Then you got all these same Employers making a profit for doing nothing. Then these same enployers also fill the deep pockets of most of U.S. Congress and the President too. And the list goes on and on, with no end in sight.

This is the exact same thing that is happening in IRAQ too. Our government is paying huge amounts of money to all these cronie contracters who are politican friends to do services in IRAQ. In a lot of the cases the services are not even performed.

I'd say if we went to a Universal Healthcare System like they have in Canada, everyone would be covered for free of charge and usa would save a lot of money too.

Also, you have no idea how much this one thing would help the American Automobile Manufacters. Example TOYOTA is eating the lunch of both FORD and GENERAL MOTORS because they have this HUGE Employee Healthcare expense that TOYOTA does not have in Japan.

Wouldn't it be something to see EVERYONE on the payroll in the American Healthcare System working to actually help the american people for a CHANGE. That would really be something NEW to behold.

Let me tell you another way the AMA have found to increase the Doctors income (like they really need it). The American Doctors (AMA) have been telling all the American Medical Schools for years to hold down college enrollments because there wasn't any shortage of doctors in the USA.

Well, I want a point out to you that the BABY BOOMERS will be eligible to receive MEDICARE in about 2011 and USA will need Medical Doctors Really BIG TIME. Well, everyone knows it takes 10 years to generate a new doctor, so the AMA has this plan to up grade (with afew months extra education) as many RNs as needed to "Assistant Doctors" working under the supervision of the present Medical Doctors.

This way the people will get a Registered Nurse for a Medical Doctor with half the education and we will be charged the same Medical Doctors fee as before and of course the Doctors will get a big chunk of the Fees.

THANK YOU Michael Moore, Keep up the GOOD WORK, your my hero..

Posted by: Harry Dingey | Aug 27, 2007 5:46:10 PM

It goes without saying that Americans need protection from being bullied by insurance companies trying to avoid legitimate claims, but there is a BIG problem with socialized medicine that no one is addressing...

Let me give you an analogy, suppose I decided that it wasn't fair that some people can eat prime rib while others can only afford canned tuna. And to give people fair access to delicious food I instilled a policy that all food would be subsidized and to purchase food in the grocery store you just had to show your state food card and everything would be paid for by the government. I then determine the average food bill per capita and that is my budget for this program. Well, the grocery store would be selling a TON of expensive food and a lot more food in general and my budget wouldn't cover even half of the bill (not to mention the administrative cost of running the program). SO taxes would go up...WAY UP. And the average family would now be paying at least half their income to pay their food tax (where before their food cost was about 1/4 to 1/6 of their income.

Point is, when it's free, consumption goes up. And the same will happen with medical services. So finding a happy medium where people get the coverage they need but still have money to eat and put a roof over their head is damn hard. Before we jump into a universal health coverage plan, we better make sure there will not be the unintended consequence of financially breaking the American bank. We are already steaming full speed towards disaster with escalating national debt. Our officials have a long history of buying votes by giving us what we want, without the guts to say that in the long run it will be bad for America and that future generations will be enslaved under a mountain of debt for services they didn't receive.

BTW, I had an $8000 disability reimbursement denied because of a technicality in the filling out of the paperwork and am almost bankrupt for being out of work due to medical illness. But, I still wouldn't want to pass a bad program that will eventually be so costly that we suffer more from trying to pay for it than we benefit from having it.

Posted by: David | Sep 8, 2008 3:45:11 PM

It goes without saying that Americans need protection from being bullied by insurance companies trying to avoid legitimate claims, but there is a BIG problem with socialized medicine that no one is addressing...

Let me give you an analogy, suppose I decided that it wasn't fair that some people can eat prime rib while others can only afford canned tuna. And to give people fair access to delicious food I instilled a policy that all food would be subsidized and to purchase food in the grocery store you just had to show your state food card and everything would be paid for by the government. I then determine the average food bill per capita and that is my budget for this program. Well, the grocery store would be selling a TON of expensive food and a lot more food in general and my budget wouldn't cover even half of the bill (not to mention the administrative cost of running the program). SO taxes would go up...WAY UP. And the average family would now be paying at least half their income to pay their food tax (where before their food cost was about 1/4 to 1/6 of their income.

Point is, when it's free, consumption goes up. And the same will happen with medical services. So finding a happy medium where people get the coverage they need but still have money to eat and put a roof over their head is damn hard. Before we jump into a universal health coverage plan, we better make sure there will not be the unintended consequence of financially breaking the American bank. We are already steaming full speed towards disaster with escalating national debt. Our officials have a long history of buying votes by giving us what we want, without the guts to say that in the long run it will be bad for America and that future generations will be enslaved under a mountain of debt for services they didn't receive.

BTW, I had an $8000 disability reimbursement denied because of a technicality in the filling out of the paperwork and am almost bankrupt for being out of work due to medical illness. But, I still wouldn't want to pass a bad program that will eventually be so costly that we suffer more from trying to pay for it than we benefit from having it.

Posted by: David | Sep 8, 2008 3:45:30 PM

I always hear the same reason for not having an affordable government service; not enough money. It is surprising to me that a nation that has the greatest gross domestic product (13.8 trillion compared to the world's 54.3 trillion -CIA World Fact Book 2007) in the world doesn't have an affordable and reliable medical care system. Yes, I understand that a nation such as that of America has expenditures which far outweigh most of the world, but I still cannot get this sick feeling inside that American citizens are being given the short end of the stick. I am not a genius with finances and I never wish to imply that I am, but after looking at expenditures for healthcare for 2005~2007, (also much greater than any other country) I am beginning to think that much of it is misappropriated. Shouldn't the public who paid good money to the country so that it may take care of them be able to actually feel their taxes in effect?

How about cutting back on the other things such as government subsidies/bailout payments to large corporations that are failing due to bad management? Companies which eventually go defunct anyway or end up owing larger debts. Many people are put under extreme scrutiny as to determine their cost efficiency by insurance companies and given "solutions" which are "appropriate" to them. Shouldn't companies suffering from poor management be "analyzed" too as to determine the cost efficiency? Sometimes I wonder if these bailout packages are temporary solutions to avoid increasing unemployment (as would happen if a company goes under) because many times you still see the same people who made the same mistakes still in control of the company.

How about the military budget (not to insult any soldiers serving)? I know that America is caught in a tight spot in several places around the world and need to pay the soldiers and such, but having a defense budget (which I believe has been continually increasing at a more faster rate ever since Iraq) that rivals that of the rest of the world, may be digging into funds which could be used elsewhere. I know the scale in which the American military operates on is far greater than any other country in the world by far, yet I get the thought, "couldn’t the country afford to not have that extra B-2 bomber to allow for possible government funded programs? ($2 billion per unit if I am not mistaken, when considering the initial cost of the aircraft and maintenance over the plane's total years in service)

Yes there are many flaws to my way of thinking but it feels wrong to have to pay taxes and not to see the money not work for them. It's been said, "..Ask not what your country can do for you - ask what you can do for your country (J.F. Kennedy)." I agree that it is good for people to aspire to build themselves a strong nation and to serve when the country calls. Yet, I also believe that a nation must also answer the call of the people for which it was founded. Nations have risen when people had come together to work towards a common goal, either it be for freedom, prosperity, or independence, nations were formed for people not the other way around.

Posted by: John Lee | Sep 19, 2008 4:53:33 PM

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