My friend and Libertarian guru Nik encouraged me to watch Michael Moore’s SiCKO last month. He said it struck a chord with him, and that after seeing what Big Pharm and the Health Industry puts people through, he is now considering looking into some sort of national health program. Universal health care is anathema to most Libertarians. The only one I’m aware of who every embraced the idea of a universal health care program is Mike Gravel, and for this he has been accused of “drinking the Liberal Kool-Aid” on the issue.
At the outset, I’d like to say that I have remarkably little experience with health care. I’ve never gone out of my way to deal with health care. I’ve never gone out of my way to study health care. Nonetheless, many Libertarian principles are universal, and seem to apply just as readily to health care as to any other political issue. Still, much of what I will have to say will sound downright bone-headed to those who have more experience with health care than I do. Those who have more knowledge than I do on this topic should feel free to school me in the comments section. I will receive your polite constructive criticism well.
I’m a pretty big Michael Moore fan. I regard Roger & Me as a modern classic. His wit and courage never cease to amaze me. But his work, like all attempts to persuade, should be approached with a critical mind. It isn’t enough to be witty and courageous. You also have to be right. So I’ll start my critique with a maxim originally conceived by Professor Judith Thomson and quoted by Murray Rothbard in 1982’s The Ethics of Liberty:
In some views, having a right to life includes having a right to be given at least the bare minimum one needs for continued life. But suppose that what in fact is the bare minimum a man needs for continued life is something he has no right at all to be given? If I am sick unto death, and the only thing that will save my life is the touch of Henry Fonda’s cool hand on my fevered brow, then all the same, I have no right to be given the touch of Henry Fonda’s cool hand on my fevered brow. It would be frightfully nice of him to fly in from the West Coast to provide it. . . . But I have no right at all against anybody that he should do this for me.
Whenever I’m called upon determine a person’s “rights” in a given situation, this is where I begin. Within the context of SiCKO, it translates simply to this: health care is not a human right. To recognize a right to heath care for some would impose an obligation to provide health care on others. Because Libertarians decline to do the latter, they also decline to do the former. A corollary to this rule is that it is generally within one’s right to decline to provide health care to another for any reason or for no reason at all.
In the film’s introduction, we are treated to the story of Rick, who cut off the tops of two of his fingers while using a table saw. Because he was uninsured, the hospital charged $60,000 to reattach his middle finger and $12,000 to reattach his ring finger. Because he could not afford both, Rick chose to reattach the ring finger only. Moore goes on to allege that “18,000 [people] will die this year simply because they are uninsured.” This is pure bollocks. (The technical term for it is argumentum ad misericordiam). I’ve never heard of a single case of death by simple uninsuredness. If you look hard enough, you will find in each case that some other factor contributed to the death–usually either an illness or an accident. Yet, barring prior agreements to the contrary, health care professionals are (or at least should be) under no obligation to cure any illness or remedy any accident. If they choose to get involved, it should be on terms agreeable to both parties. In Rick’s case, there was a offer, a negotiation, and an acceptance. What else should there have been?
Some people in the film lament the “awful” feeling of trying “to put a value on your body”. Others have less of a problem with this, and opine that the proper value for a body ought to be $0.00 (i.e., that health care should be free on demand). I really don’t understand this mentality. It must be awful for these people to live day to day trapped in such worthless bodies. I’m pleased to acknowledge that my body is of great value–so much so that in some situations, I may not be able to afford to pay somebody to repair or replace it. Therefore, I had better take good care of it, and not cut any parts of it off with power tools.
SiCKO‘s main theme follows its introduction: What happens when you contract with a health care provider to provide you with health care, and health care goes unprovided when needed? At various points in the film, a variety of people accuse the health insurance industry of “killing” people. In reality, the health insurance industry neither kills people nor accidentally saws off their appendages. Illnesses and accidents (and the occasional medical malpractice) do the killing and maiming. At worst, health insurance companies breach their contracts by failing to pay for health care that they have ostensibly agreed to pay for. This is where SiCKO is at its most instructive.
Moore provides us with a number of case studies that call into question the good faith of many of our favorite heath care providers. In one instance, an insurance provider declines to cover a woman’s ambulance trip because she and the company had failed to “pre-approve” it. In another instance an insurance company’s approval of a woman’s $7,000 operation is revoked because the woman had failed to disclose a minor yeast infection on her application. Now I’m a Libertarian law student. As I watched these stories, some questions came to mind:
First: were the contracts between these insurers and their clients valid? If one could show the contracts to be unconscionable or fraudulent, or that the insurance companies somehow breached them, a court could require the companies to pay up. A way to solve some of these problems could be to reconsider, and to reform, if necessary, the manner in which courts interpret some of these contracts. This way, consumers and consumer groups could be the watchdogs that keep the insurance companies honest.
Second: if all of these insurance companies suck so bad, why doesn’t a good insurance company come around and take away all their business? One of the tenets of Libertarian philosophy is that free market competition inevitably brings about the highest quality goods and services. If this is true, then something out there is preventing it from happening. What is it? I haven’t even begun to study the regulatory labyrinth in which our health care industry is ensnared. To get a tiny taste of it, you may find these three blog postings to be illuminating. Perhaps a way to improve health insurance is to remove some of these market restrictions and allow competition to do the work for us.
SiCKO skips right over these questions, however, and goes right for question three: Why doesn’t the national government just take over the health care system the way it has in every other first-world country? (The technical term for this is argumentum ad populum). It’s an interesting question, especially because Moore chooses Richard Nixon’s back-room wheeling-and-dealing with the heathcare industry as the wellspring of America’s health care woes. Moore goes on to bemoan the health care industry’s biggest accomplishment: “buying Congress” with the intent of passing prescription drug legislation. Since the misuse of government power seems to have been the problem with health care all along, its seems counter-intuitive to me that the solution to the problem would be to give the government more power over health care. But Moore goes on to provide some case studies to help guide us to the conclusion that the solution is just that.
SiCKO presents the Universal health-care systems of Canada, England, France and Cuba in a one-sided manner that invites skepticism. France and Cuba especially are presented as sort of candy mountains of health care–lands of sweets and joy and joyness where there is no unhappiness and certainly no unsatisfied customers. It may be true. I don’t know. But there is definitely a “yeah right” factor that demands further investigation. For example, I missed the segment on the 2005 riots in the Paris suburbs. What was that all about? Not health care, I presume. And Cuba. If Cuba’s health care system is so great, why do Cubans keep cramming themselves into ramshackle dinghies and floating over to Miami, where they have to deal with our horrid health care system? A recent episode of All Things Considered actually reflected rather poorly on the Cuban system:
“The life of a professional who works in this country is pure invention in order to live,” says one Havana doctor, who spoke on the condition that his name not be used, saying he could lose his job or even go to jail for criticizing the current system.
Asked if his salary is enough to feed his family, he laughs. “It’s impossible,” he says. “With that, you can’t feed anyone.”
This doctor is now in his 60s. He earns 525 Cuban pesos each month, which is just a little more than $20. His wife earns the equivalent of about $15 a month.
Like all Cubans, they get a ration card allowing them to buy staple foods at subsidized prices.
In Cuba, people get paid in the Cuban peso. But there’s another currency — the convertible peso, or CUC — which is for tourists and luxury items such as shampoo. The doctor says it’s true that education for his children is free, but he still has to buy them school supplies.
“You have to buy backpacks,” he says. “You have to buy dinner, notebooks. And all of this you have to buy in CUC.”
But he’s not allowed to earn CUC, and this poses one of the central conundrums of modern life for millions of Cuban workers: Some of the necessities are only available in a currency you’re not allowed to earn.
Again, I think I missed this part of the film. Maybe it was in the director’s cut, or the deleted scenes, but I missed it. In any event, this doesn’t seem to me to be a particularly high standard for government-run health care system to live up to, and certainly not one that I would advocate in this country.
All that aside, I think SiCKO ends up making a pretty good point. Socialized health care need not fare worse than any of the other socialized services that we take for granted in the country, such as schools, libraries, and security (police). SiCKO has opened me to the possibility that a socialized health care may even be better for us than the congressional-industrial complex that apparently controls health care in this country today. But although this is the only solution that SiCKO explores, it is not the only possible solution.
Why not explore a return to the days prior to Nixon’s derided meddling with the system? Why not explore more Liberty as a possible solution to the problems that Moore agrees are rooted in our regulatory state? It will take a separate documentary to make the case.
Maybe one is posted on Google Video. I’ll have to find it.