Libertarian Watches SiCKO, Remains Libertarian.

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.

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10 Responses to Libertarian Watches SiCKO, Remains Libertarian.

  1. Angie says:

    I read this entire thing. Veeerrry enlightening.

  2. Jay Norris says:

    When I was in business school, “let the free market sort it out” was a mantra of mine. But the health care industry will never be an actual free market. For example, Ford did a cost-benefit analysis of adding an $11 part to the gas tanks of the Pinto and found that it was cheaper to handle lawsuits stemming from burn deaths and injuries than it was to add the part.

    Now take a health insurance company that does a cost-benefit analysis of paying claims according to the specified contract vs. having a talented legal team to take on these clients that don’t have enough money to even hire a lawyer and are now dealing with a major illness on top of everything. It’s a no brainer for the insurance company because. When you have cancer is not the easiest time to fight an insurance company that isn’t living up to their end of the bargain.

    So on the surface it is easy to agree with you. It sounds logical to say that the government needs to just leave these companies alone and lift the mandates. It is also a good argument that health care is not a right in this country, but Michael Moore made it clear that his movie wasn’t about those without insurance – it was about those that had insurance.

    I am helping clients try to deal with health insurance companies every day, but they are just too powerful. There is a lot of profit to be had by doing business they way they do. Even if they wanted to be ethical, all of the other companies do business that way and that is the only way to compete.

  3. autofyrsto says:

    Thanks to Jay Norris for his insight.

    Libertarianism is a very dogmatic creed. The dogma is that people are not entitled to anything that isn’t provided voluntarily. So Libertarians of the Rothbard school, as a rule, dispense with the notion that the American people are entitled, as a matter of natural right, to things like automobiles that meet a certain safety standard and health insurance companies that put general human interests before profit.

    With this understanding, the problems mentioned seem to contractual problems rather than fundamental market failures. The problems may be solvable if only our legislators and courts would reconsider the way these contracts are interpreted. They ought to be interpreted in such a manner that grants a measure of deference to the little Davids who do not have the resources to fight the Goliath insurance companies.

  4. Alex of Walshdom says:

    So, not sure if I’ll see the response, but some points.

    1. Michael Moore is, sadly, not to be trusted when it comes to truthful objective documentation. He manipulates, stages (after the fact performances), omits and uses the techniques of film masterfully to convey his specific point of view in a manner that could be called propaganda. Which is sad, because I agree with him on many topics, but I think he does more harm than good with most of his films. They only succeed in dividing people more on topics.

    2. I think the real concern I have that Sicko addressed is how companies don’t honor the services they say they will provide for a monthly fee. We live in a system where we repeatedly give money to people on the basis that if anything bad ever did happen then they would step in and help. This carries over to car insurance, rental insurance, health insurance, etc. And the trouble is that after years of paying these premiums when something bad does happen a lot of these companies will reneg on providing the support. I like to compare with car insurance, where I’ve given roughly $14,000 to them in my lifetime and never had a claim or a speeding ticket. Yet I fear that if I do get in an accident that they will drag their feet or deny support since I’ve read so many situations of this happening online.

    3. I cannot speak for France or Cuba, but as you may know Vicky lives in England which has NHS. I can tell you that one of her friends has spent years trying to get treatment for something and has repeatedly been delayed by trying to get referrals and meetings scheduled where one mislabeled form can set her back for months. Perhaps their emergency care is free and efficient, but for more long term stuff, well, not so much.

    4. As a libertarian I know you don’t believe in this, but human decency is I think what a lot of people want. If someone is less fortunate financially and does have an injury, then someone with the ability to help them should, well, help them. An extreme example. If you’re driving down the street and see someone in the middle of the road who has flipped their car and is unconscious, with the car slowly catching fire. Do you a) keep driving and blame them for being stupid enough to flip their car or b) pull over, pull out the fire extinguisher in your back seat and put out the small fire (which is of no real risk to you).

    Yeah, that’s an extreme example, and as an analogy it really ignores a lot of the complexity to the health care. But I think people generally want that kind of human decency.

    5. It does exist! I know a guy who had a cat scratch his hand, it got infected and he went to the doctor who said he might lose his hand. He had no money but they put him up in a hospital room for 3 days and took care of it. They said they’d work something out. About a year later he got a call and they’re asking for some money from him, but slowly, and only $5k (which is cheap for a 3 day hospital stay. So that’s an example of human decency.

    Overall, I think it’s a complex issue with some people overly relying (nay, demanding?) on the decency of others and some companies focused too much on the bottom line. I don’t know if Universal healthcare is the solution, but I think some reworking needs to happen.

  5. Jay Norris says:

    I guess I misunderstood Rothbard’s writings. I thought that in Rothbard’s world, everybody would have complete ownership and everything would be privatized – there would be judicial privatization, police, defense, drinking water, etc. So the court you hire might be competing with the court the insurance company hires. They would likely come to different conclusions about the contractual obligations of the insurance company and the two competing police firms could battle it out.

    But if somebody can’t afford a lawyer in today’s system or if they were desperate enough to go bargain shopping for their health insurance from a scam company like MEGA, they probably made some sacrifices and cut police protection and judicial service from their budget… especially since Coca-Cola just raised the price of their drinking water by 20%.

  6. Nik Varrone says:

    Good blog post Tim! You make me blush when you call me a “Libertarian Guru.” I’m going to have to get politically involved now to live up to that title.

    I like your take on the situation because the contracts are complicated and use language that most people do not really understand. I, like Alex, have been paying for insurance for many years now and can only imagine how much I’ve actually spent trying to protect myself from emergencies. It affronts my sense of justice to think that after all that investment in these groups that I, or anyone, could be denied coverage when I’d need it most.

    I like your libertarian solutions to the problems as well and would offer a further solution to what you’ve suggested. I’ve been reading about non-profit health care companies which seem to present a logical alternative to for-profit companies. I think that the co-op or non-profit could in the long run provide better care and return better service to the consumer. After all isn’t national health care suggest a government controlled non-profit health care system? I would prefer to be able to take my business elsewhere with a company be it for-profit or non-profit rather than be forced to petition my government for “a redress of grievances” which often feels like pissing in the wind. If anyone thinks it’s next to impossible to take on health care companies ask the countless citizens who’ve been wronged by our governments war on drugs how easy it is to change our federal system.

    The nation can argue as much as it wants about whether it’s best to adopt a national health care system or not but I’m sure that we can agree that our system does afford more choice. I must concede that, at present, these choices are more available to the wealthy but I feel strongly that choosing to create and patronize non-profit health care companies will in the long run see us through this problem.

    To learn more about non-profit health care visit
    http://www.nonprofithealthcare.org/

  7. autofyrsto says:

    TO JAY: You’ve understood Rothbard’s world correctly. What happens is that when I dream wistfully about Libertarian wonderlands, I usually think of Rothbard’s. That’s what influences my thought processes. When I then try to think up actual to solutions to current problems in this country, however, I usually presuppose a uniform judicial system not unlike the one we have, where “equal justice under the law” is theoretically possible. I probably make the “unconditioned jump” quite frequently without warning my readers! 🙂

    I’m familiar with Rothbard’s idea of a privatized judicial system, but have not read deeply enough into to it to have been convinced that that’s really workable. I need to study more…

    ——————

    TO ALEX: Dude! Thanks for your input. Especially on point 3: the apocryphal unsatisfied customer!

    Regarding point 4: –“I know you don’t believe in this, but human decency is I think what a lot of people want.”– I DO believe that that’s what a lot of people want. I just don’t believe that that’s what a lot of people are entitled to. I want $1,000,000, but there is nothing that says I should be entitled to such a thing.

    Missing from your list of options was option c), an option that many people would undoubtedly opt for, which is to get the government to pass some law MANDATING all passersby to stop and investigate motor vehicle accidents under pain of fine or imprisonment. –To pass some law transferring responsibility from those who caused the accident to the public at large. –Some law that would give anyone who causes an accident a cause of action against anyone who passes the accident scene without stopping to help. This is essentially what a universal health care system would do: it would force the public at large, i.e. taxpayers, to share responsibility for problems frequently caused by the careless few. Of course it would be great if everybody chipped in out of the kindness of their hearts, but I, and Libertarians in general, would not impose some sort of mandate that they should do this.

    Moore attempts to convince us that the taxes are not too much of a burden by giving us a tour of the palace-like, “typical” middle-class French home, but that is not convincing to me. To me there is something fundamentally wrong with that mandated transfer of responsibility.

    —————————–

    TO NIK: That’s a great example of the free market in action. Here you have people who are willing to forgo some extra profit in order to reduce their overhead and serve more customers. I would love to know what sorts of regulations they have to deal with, and whether many of these companies have trouble staying afloat because of them.

  8. libertariangirl says:

    I strongly disagree with Alex’s idea that libertarians don’t believe in decency. I believe in decency, I’m just not going to force anyone to be decent, and in the end everyone will be better off anyway.

    Jay Norris mentions the Pinto and the $11 part. Well, when Ford started getting all sorts of lawsuits related to the Pinto catching on fire, they certainly rethought that and after that, carmakers also changed their own designs to make them safer. In the end, Ford’s decision to save $137 million a year by not using the newer part cost them years of bad publicity and litigation; their cost-benefit analysis was therefore lacking and not correct in the first place.

    If you’re worried about profit-seeking, there are many non-profits that could be involved in a private insurance marketplace.

  9. autofyrsto says:

    “Only gov’t could create a system so cruel, you lose your health insurance the very moment you lose your job.” – Michael Cannon, via Twitter.

  10. […] masquerading as a ‘private’ one.”  —- An idea I played with a while ago, after having watched Michael Moore’s SiCKO during the summer of 2008 (“SiCKO has opened me to the possibility that a [sic] socialized […]

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