I’ve given Giuliani’s plan a once over, and I must admit I’m a little disappointed. Given the caliber of free-market folks present at his conference call yesterday, I expected a lot more in the direction of moving health care toward free markets. Alas, never underestimate politicians’ ability to come up short.
I will be giving his plan fuller treatment at AmSpec in a few days, so for the time being here are a few thoughts:
1. Tax Treatment. Giuliani states:
Expand Choice Through Tax Code Reform: America’s tax system penalizes millions of citizens without access to employer health care, including 40 percent of employees at small firms. Americans without employer-based insurance should have tax benefits just as the 175 million Americans with employment-based coverage do. Rudy proposes an income exclusion of up to $15,000 for those without employer coverage to make insurance more affordable.
A standard tax deduction will go a long way toward solving the problems in our health insurance system. Good to see it in Giuliani’s plan. What bothers me is the last sentence in that passage. Does that mean the deduction isn’t available for those who have access to employer-based coverage? The employer-based system is a big impediment to bringing truly competitive markets to health insurance. Under it, insurance companies compete only for the business of employers, not employees. Plus, it restricts consumer choice as most employees are offered only one plan by their employers. So, if an employee with access to employer-based coverage decides he’d rather use the deduction to purchase his own health insurance, will he be able to use the deduction? Inquiring minds want to know.
2. EITC For Health Insurance?
If I’m reading this right, it looks like Giuliani is proposing an earned-income tax credit for the poor to buy health insurance:
Help Low-Income Individuals and Families Secure Health Insurance: Rudy proposes a Health Insurance Credit to low-income Americans that can be coupled with other revenue sources such as Medicaid and employer contributions to make coverage more affordable to millions of the uninsured.
Over at CATO, Michael Cannon disses this idea: “a Health Insurance Credit to low-income Americans…would increase government’s influence and make health care markets less free.”
I’m not sure what Michael’s reasoning is here (he gives no detail), but I’m sure he’ll inform me soon enough. To my way of thinking, such a tax credit is far superior to programs like Medicaid. A tax credit turns low-income workers into health insurance consumers, something that does not happen with Medicaid (unless you live in Florida). Given how lousy Medicaid is, I can see a lot of people using the tax credit to purchase private insurance instead. And having a lot of people abandon Medicaid would make health care markets more free.
3. Making Both Government and Kids Fatter
Here is one thing that makes me want to scream, “NOOOOO!!!!!”:
Infuse Incentives in Insurance Markets That Promote Wellness and Better Outcomes for Chronic Diseases: Health insurance must be redefined to cover wellness as well as sickness. In conjunction with recommendations from doctors and nurses, Rudy will propose new initiatives to promote healthy lifestyles and wellness programs, and tie Medicaid payments to a state’s success in promoting preventative care and tracking obesity for children.
Does Giuliani really want to get the government in the business of promoting healthy lifestyles? If government does that as well as it does other things, then it won’t be long before almost all Americans never exercise, eat a full box of twinkies every day, and smoke a pack too. As for obesity in children, take a look at this graph. You’ll notice that a good portion of the increase came in the 1990s and this decade (although, with the exception of those ages 2-5, the 1980s saw slightly larger increases.) Nevertheless, the 1990s were the years of Medicaid expansion and the establishment of SCHIP. Coincidence? At this point, who knows? But it seems clear that great government involvement in health insurance hasn’t helped matters any.
Dr. Moore, your Canadian colleagues obviously haven’t seen your film. Or maybe they actually know what they are talking about.
Sicko has now dropped to 15th. It’s box office take last weekend was about $1.1 million, a drop of 40%. It’s total box office thus far has been $21.6 million. After the opening week, I wrote:
My rough guess is Sicko will gross about $30 million in the U.S. Impressive for a documentary, but not that great compared to Fahrenheit and given all of the PR Moore has generated for the film.
Sometimes my predictions are not half bad.
One of the main problems with our health care system is that it is filled with academics and activists who think they know better than you and I what type of health insurance and health care you and I need. A good example is Katharine Lyon, quoted in this article on Mental Health Parity:
If parity boosts insurance costs, employers may drop mental health benefits altogether, warned David Hogberg, adjunct scholar at the conservative National Center for Public Policy Research.
That’s unlikely, said Katharine Lyon, vice president of the Florida Council for Community Mental Health. Where there is parity, she said, “they find out there’s less absenteeism, and employees are able to work better.”
The implication, then, is that businesses that do not offer mental health parity as part of their health insurance packages are ignorant of the benefit it has of increasing profits. When employees have mental health benefits on par with other benefits, they skip work less often and are more productive, thereby increasing the amount of revenue taken in by the businesses they work for. And do those added revenues exceed the added cost of including mental health parity in a health insurance plan? Of course, they do! Otherwise, there would be no increase in profits. Thus, if we follow Lyon’s reasoning, there is little reason to worry about forcing businesses to offer mental health parity, because doing so will be good for them.
Here is the question that the likes of Lyon never ask themselves: If mental health parity is so good for the bottom line, why aren’t more businesses already offering it? My experience with the likes of Lyon is that such people have little if any understanding of how markets work — nor do they seem to have any inclination to learn, because doing so would mean they’d have to give up on their “I know what’s best for you” mentality and all of the wonderful feelings of superiority it yields.
But on the off chance such folks are open to a little edification, they should know that markets, thanks to things like profits and market share, are very efficient conveyors of information. If something like mental health parity were so good for the bottom line, it wouldn’t take long for most businesses to figure it out. A few businesses would try it, and if it really worked the way Lyon claims it does, then they would have better performing workers which would lead to higher profits and greater market share. Other businesses that had not implemented mental health parity would wonder why their profits are not increasing and why their market share is declining. It wouldn’t take long for them to figure out that the difference is that they don’t have mental health parity. They would soon include mental health parity in their insurance benefits. Profits are such a great motivator!
The fact that businesses are not doing this almost certainly means that employers have figured out that the benefits of things like decreased absenteeism do not exceed the increased health insurance costs due to adding mental health parity. That’s the market sending us a loud and clear message, but the likes of Lyon seem to have no interest in listening.
Alas, the problem isn’t that businesses are ignorant of the benefits of mental health parity. The problem is that the likes of Lyon are ignorant of how markets work. However, that would be no problem at all if Lyon wasn’t intent on using government to force her ignorance on the rest of us.
The National Review of Medicine highlights the economic illiteracy that permeates Canada’s health care bureaucracy. Last year, the provincial government of New Brunswick decided that physicians with full practices needed an incentive to take on new patients. However, like all bureaucrats trying to outsmart the market, they implemented a program whose unintended consequences outweighed any benefit the incentives may have provided.
[The program] was intended to improve access to family doctors in the province but it also appears to be making it more difficult to find doctors to take over practices from retiring physicians. That’s because the incentive doesn’t apply in these cases.
That’s right. The bureaucrats decided to apply the incentives selectively, somehow concluding that some physicians would respond to incentives while others would not. Here’s how this ill-considered policy is manifesting itself:
Dr Eric Christiansen, 63, of Rothesay, last month hung up his stethoscope. Despite his efforts, the popular MD couldn’t find a doctor to take over his practice, leaving the vast majority of his 2,500 patients without a family physician, in a province in the throes of a physician shortage crisis.
In other words, by selectively applying the incentive, the provincial government made the “orphan patient” situation worse. How could they be so clueless? Brian Ferguson, PhD, of the Atlantic Institute for Market Studies, offers this:
Much confusion and bad policy follows from the inability of many policy analysts to handle the techniques of an elementary economics course.
Ferguson goes on to point out what should be blindingly obvious to anyone possessing a modicum of economic literacy:
Doctors’ decision-making is affected by financial incentives to a greater extent than many think … physicians respond to market forces, including cash bonuses, the same as any other professionals.
My goodness. Who knew? Apparently not the commissars of New Brunswick.
I have touched previously on the role of piety in the zombie-like consistency with which “progressives” adhere to the cause of socialized medicine, but it occurs to me that there is more to the story. Having considered the matter further, I think social pretension is also an important factor.
If one observes how “the reality-based community,” as they have ironically dubbed themselves, responds to dissenters, much of their verbiage can be distilled down to the following sentiment: Oh dear, how gauche!
Consider the following passage from Matthew Holt. In response to Peter Chowka’s review of SiCKO, he sniffs:
And then into my email box the other day plopped this review from someone called Peter Chowka … I have no idea who you are, Mr Chowka …
Note how important it is for Holt to point out that he doesn’t ”know who” Chowka is (almost certainly a lie, BTW) and to insinuate that the latter’s e-mail constitutes a kind of social blunder.
Another single-payer advocate whose health care positions are apparently contingent on whom he “knows” is Joe Paduda. In a THCB comment regarding Stuart Browning, he says:
Not knowing Mr. Browning, I’m somewhat confused as to his point. It appears he is …
Odd that he must “know” Browning in order to comprehend his point. Then again, the intellectual quality of Paduda’s blog suggests that reaching beyond such considerations would overload his forensic equipment:
Yet another “progressive” health care wonk, Ezra Klein, insinuates that dealing with the socially inept commenters that frequent his blog is a necessary but rather distasteful task:
As of late, we’ve had some commenters hanging around demanding we redefine the word “uninsured,” …
Oh dear, how gauche!
Examples of this sort of thing are numerous enough in the “progressive” blogosphere to suggest that social pretension is nearly as important as moral superiority in forming “progressive” opinions about health care reform.
For these people, deviation from the party line on socialized medicine is not only morally suspect, it’s a kind of faux pas. Advocacy of free market reform is just not the done thing.
The CDC’s report on ER overcrowding is out, and the news isn’t good. ED visits are up 20 percent over the last ten years and the number of EDs actually available to treat these patients has dropped by 9% during the same period. What could be causing this? GruntDoc has a nice, succinct theory:
If you subsidize something, you get more of it.
And who would be stupid enough to subsidize visits to already overcrowded emergency rooms? Why those geniuses in Washington, of course. Patients with Medicaid/SCHIP coverage, for whom such visits are essentially free, are nearly four times more likely to appear in the ED than are patients with private insurance.
And there is, of course, EMTALA. Because this brilliant federal law decrees a “medical screening” for every patient who shows up in the emergency room, regardless of ability to pay, many people with no insurance use the ED as a free clinic. The CDC report indicates that such patients use the ED at twice the rate of privately insured patients.
But take heart! Our masters in Washington are working to “solve” this seemingly intractable problem. This neatly captures the inevitable effect of government intervention in health care. The politicians and bureaucrats meddle with the system, which produces problems. Then, they declare a crisis and meddle some more.
And there are people who actually think we should turn the entire health care system over to these boneheads.
My article yesterday at AmSpec was picked up by the Wall Street Journal today.
There is a great story in last week’s Newsweek about how doctors and scientists are figuring out new ways to keep heart attack victims alive.
One thing that was interesting about the article: Almost all (with one exception) of the researchers are from the United States.
Walter Williams, with his usual clarity, asks a question that every voter should consider when weighing the relative merits of socialized medicine and free market health care:
How would you like the people who run the motor vehicles department, the government education system, foreign intelligence and other government agencies to also run our health care system?
When the question is put so lucidly, without the sanctimonious obfuscations and general humbug so beloved of the socialized medicine crowd, the choice isn’t really very difficult. Williams goes on to point out:
There’s absolutely no mystery why our greatest complaints are in the arena of government-delivered services and the fewest in market-delivered services. In the market, there are the ruthless forces of profit, loss and bankruptcy that make producers accountable to us.
As an example of the low level of quality invariably associated with services controlled by government bureaucrats, Williams points to our increasingly ineffective system of public education:
Government schools can go for decades delivering low-quality services, and what’s the result? The people who manage it earn higher pay. It’s nearly impossible to fire the incompetents. And, taxpayers, who support the service, are given higher tax bills.
There can be little doubt that a government monopoly in health care will produce the same unsatisfactory results. Indeed, those areas of health care already under government control show precisely this pattern. So, here’s how Williams answers his own question:
I’d choose profit-driven people to provide my health care services, people with motives like those who deliver goods to my supermarket, deliver my overnight mail, produce my computer and software programs, assemble my car and produce a host of other goods and services that I use.
John Goodman over at the NCPA has just launched an anti-Moore site. He links to recent essays on Sicko – and our readers here may recognize some writers mentioned there.
I had a piece an “individual mandate” for health insurance in the July/August issue of The New Individualist. As you can probably guess, I wasn’t too big on the idea.
The second one is in AmSpec today. It is only tangentially about health care. Specifically, it looks at one of the funding mechanisms for the proposes SCHIP expansion, the cigar tax.
This week, under the false colors of “health care for the children,” the Democrats in Congress are taking America on a perilous voyage toward the rocky shoals of socialized medicine. The SCHIP bill’s main features are summarized by the WSJ Health Blog, and here are its most pernicious features:
Funding for privatized Medicare plans, known as Medicare Advantage, would be cut back so that the government would pay the same amount for beneficiaries in private plans as for those in traditional Medicare.
Now, why would Medicare changes be included in a bill ostensibly addressing the health care of children? Well, this is the feature that is meant to throttle free market health care reform in the cradle.
The bill would triple federal money for the children’s health insurance program, from the current $5 billion a year to $15 billion a year for the next five years.
More money for children’s health sounds innocuous enough, but the devil is in the details. As discussed here and here, not much of this new money will go to actual kids.
Medicare payments to doctors, set to be cut by 10% next year and 5% the following year, would instead be slightly increased for each of the next two years.
Thus, the collusion of the AMA has been purchased with a gigantic bribe. The irony is that, once the AMA has helped perpetrate this fraud, these cuts will eventually be implemented anyway.
SCHIP is one of the most disingenuous pieces of legislation ever foisted on a patient electorate. Its true purpose is to expand the reach of government-run health care while blocking any movement toward free market reform.
One hopes that President Bush keeps his promise to veto this travesty.
Michael Bliss is one of the most prominent medical historians alive, having penned definitive biographies of Sir William Osler and Dr. Harvey Cushing. He is also a Canadian and a leading critic of that country’s socialized medicine.
In the latest issue of the Canadian Medical Association Journal, he weighs in on the emerging debate north of the 49th parallel.
Somehow, Michael Moore overlooked this:
Canada, once considered the bedrock of national health care systems, is in the beginning stages of change toward free-market health insurance.
For the first time, private health care clinics are proliferating throughout Canada and arguments for allowing private physicians to practice freely are being heard.
“You are seeing the Medicare orthodoxy of the last 30 years being questioned in Canada,” said Dr. David Gratzer, a registered physician in Canada and the U.S., and senior fellow at the Manhattan Institute, a nonprofit public-policy think tank. “Over the last two years, the health care system has dramatically changed to allow more private health care.”
The Supreme Court of Canada, widely viewed as among the most liberal in the world, nearly two years ago allowed a man in Quebec to buy health care on his own – striking down 30 years of precedent and giving advocates for private health care a major victory.
The case is known as the Chaoulli decision, after Dr. Jacques Chaoulli, who took action against the system after a patient was forced to wait nearly one year for a hip replacement.
The geniuses who run Great Britain’s system of socialized medicine have proposed using NHS resources to buy iPods and television sets for crackheads, according to the TimesOnline:
Drug addicts are to be offered gift vouchers and prizes on the National Health Service under plans by the government’s medicine watchdog to encourage them to stay clean.
Considering that the same government entity refuses to provide widely-used and effective cancer treatments to its patients, the perversity of this idea is breathtaking. And that point has not been lost on patient advocates:
Katherine Murphy, of the Patients Association, said: “Why should these people with self-inflicted problems be given priority over people who have a genuine illness? Some people with genuine disease are being forced to sell their homes for the medicines they need.”
The answer to Ms. Murphy’s question is obvious. When you allow government apparatchiks to control health care, such warped priorities are inevitable. Even if the bureaucrats are well-meaning and intelligent—not always a given—they simply don’t have enough information to allocate resources efficiently.
Only the market has the ability to allocate resources in a way that provides the most good for the largest number of people. The quantity of information contained in a single price for a single good far exceeds the miniscule amount of data that can be possessed and processed any group of “experts.”
Until health care is returned to the realm of the free market, wacky ideas like giving prizes to crackheads will continue to bubble up from the bureaucratic muck.
Among Michael Moore’s many contemptible characteristics is his willingness to capitalize on the misery of ordinary people. His disgraceful exploitation of Lila Limbscomb in Fahrenheit 9-11 is probably the most egregious example, but his shameless use of three 9-11 responders in SiCKO was nearly as bad.
The one redeeming feature of Moore’s Cuban odyssey was that Regina Cervantes, et al got reasonably decent care. Ironically, it was far better than the care most native Cubans receive in Castro’s dilapidated health care system. Even Reuters, which has consistently abetted Moore in his fraudulent depiction of Cuban health care, has been forced to admit the following:
The hospital where SiCKO’s patients were treated is an exception in Cuba, where patients of many other hospitals complain they have to take their own sheets and food.
Indeed, the hospital in which the three responders were treated is a luxury hotel compared to the hog pens in which most Cubans receive their health care.
The 9/11 responders spent 10 days on the 19th floor of Cuba’s flagship hospital with a view of the Caribbean sea, a sharp contrast to many Cuban hospitals that are crumbling, badly lit, and which lack equipment and medicines.
Predictably, Reuters compensated for this uncharacteristically honest reporting by parroting the usual Lefty canards about the “accomplishments” of Cuban health care, but it was a half-hearted effort. Even those useful idiots can see that a massive fraud has been perpetrated by Moore.
Eric Novack links to yet another nail in the coffin of that bogus bankruptcy study perpetrated by David Himmelstein. He calls Todd Zywicki’s testimony before the House Judiciary Committee a “must read” for the following people:
Those who remember the endless headlines of “50% of All Bankruptcies Due to Medical Debt”, and particularly for those who have based many calls for national, single-payer health care on that paper.
Zywicki’s testimony is indeed illuminating. First, he outlines the two ways that health problems could—in theory—cause serious financial problems for patients:
Reducing the ability to work and thus creating an unanticipated disruption to a family’s income flow, or an unanticipated budget shock to expenses through high uninsured medical bills.
Then he delivers the death blow to claims that such issues are contributing in any significant way to bankruptcies:
There is no evidence that there has been an increase in the frequency or severity of job loss or income interruption as a result of health problems … There is little evidence that medical debt is a major causal factor in bankruptcy filings.
And where does he get the data from which he draws these conclusions?
A recent study of bankruptcy filers by the Department of Justice’s Executive Office of the United States Trustee (USTP) … the most thorough study of the problem to date of those who actually filed bankruptcy.
So, once again, the evangelists of socialized medicine have put forward a phony study to support the ostensible need for the government to take over health care. And, once again, it has been buried beneath the facts.
When are these people going to start playing it straight?
Julia Seymour of the Business and Media Institute has a great piece on the uninsured:
Michael Moore was wrong about health insurance.
So were President Bush, Sens. Barack Obama (D-Ill.) and Hillary Clinton (D-N.Y.), presidential candidates former Sen. John Edwards and Gov. Mike Huckabee and The Washington Post, New York Times, Los Angeles Times, People magazine and Time magazine, as well as CNN, CBS and ABC.
Each of these people and media outlets incorrectly claimed the number of uninsured to be 40 to 50 million Americans. The actual total is open to debate. But there are millions of people who should be excluded from that tally, including: those who aren’t American citizens, people who can afford their own insurance, and people who already qualify for government coverage but haven’t signed up.
*”Uninsured Denier” is an ironic term. To see what it means, go here.
Part 2 by Paul Gessing and yours truly over at AmSpec.
After all the free publicity, sycophantic interviews, obsequious op-ed pieces, and general media acclaim, Michael Moore’s health care schlockumentary is enduring a surprisingly anemic box office:
Sicko is bombing — financially and politically. After three weeks in wide release, it has managed to scrape together just $15.8 million in box office receipts. For most documentaries, that would be a notable take. But given the expectations, this is an enormous failure.
What’s that about?
One possible explanation for SiCKO’s sickly ticket sales is that much of his target audience had already watched it on the web before its official release. If that is indeed the explanation, it constitutes a particularly sweet brand of poetic justice.
But it is also possible to interpret SiCKO’s weak box office as a sign that the general public is not quite as dumb as Moore and his media accomplices think. Maybe the hoi polloi for whom he has such obvious contempt recognize Moore for what he is: a con artist.
Here’s hoping that this is indeed the explanation, and that the electorate is equally suspicious of the various “universal” health care plans touted by various con artists from Washington.
The first of a two-parter by Paul Gessing and yours truly over at AmSpec.
I’m profiled this morning over at Front Page Magazine:
If Moore’s film channels the prevailing left-wing wisdom about the alleged glories of government-run healthcare, Browning’s work represents a much-needed corrective: a skepticism about government’s ability to provide efficient coverage and a confidence that the free-market is a better compass for change than a Hollywood ideologue. “I can’t imagine anything more crucial than the right to make life-or-death decisions, the right to privacy, the right to choose one’s own doctor. And all these things are at stake,” said Browning in a recent interview from his Florida office.
Advocates of expanded SCHIP funding have consistently misrepresented the reauthorization debate as a Manichean struggle between good and evil or, somewhat less stridently, an unfortunate clash of ideologies. In reality, the debate is about preventing the program from being used as a Trojan horse for socialized medicine.
Having learned that government-run health care won’t sell if it is honestly put before the public, its advocates are now using “the children” to implement Hillarycare on the sly. That’s why SCHIP’s latest iteration is designed to cover children who already have health insurance. As the Secretary of HHS puts it:
Most of the children they want to add to SCHIP already have private insurance. So these children would give up the private insurance they have now as they move to government health care.
And this isn’t some bogus statistic worked up by some soulless minion of the “health care industrial complex”:
The CBO recently estimated that as many as half of the children enrolling in SCHIP would drop their private coverage. The independent National Bureau of Economic Research put the crowd-out rate as high as 60 percent.
None of this matters to the evangelists of socialized medicine, of course. Nor are they especially concerned about cost. However, as a comical sop to those worried about the price tag associated with an expanded SCHIP program, they have proposed offsetting costs with a cigar tax.
Let’s hope President Bush has got that veto pen locked, loaded and aimed squarely at this fraudulent legislation.
John Goodman of the NCPA, in the Dallas Morning News.
The term “universal health care” is destined to take its place beside “collateral damage” as a modern masterpiece of euphemism. Just as the latter can be deployed without conjuring images of dead babies and demolished neighborhoods, the former can be used without evoking the specters of purgatorial waiting lists and obsolete technology.
As Peter Chowka points out today in the American Thinker, this euphemism is now de rigueur among evangelists of government-run health care. And they become very touchy when free market types decline to use it in the prescribed manner. Those of us with the temerity to conflate “universal health care” with socialized medicine are regularly upbraided for our effrontery.
A typical example of this can be found at Movin Meat, where the reprimand is couched as a “plea for clarity.” But “clarity” is precisely what the advocates of government-run health care don’t want. They want to keep the true face of socialized medicine behind a gauzy veil of euphemism until the American public has been successfully coaxed down the aisle.
Make no mistake about it. When the veil is finally pulled back, “universal health care” will possess all the warts that we associate with socialized medicine: bureaucratic mismanagement, substandard care, rationing, etc. Such blemishes disfigure all government-run health care systems—all of them.
Rather than quibbling with Michael Moore’s omission of Cuba’s position relative to the U.S. on a World Health Organization (WHO) international health care system ranking report, CNN should have called into question the use of that biased report itself.
The WHO report doesn’t just rank health care systems according to how well they cure you when you’re sick. Indeed, 25% of the WHO report’s scoring is based on the “fairness” of a country’s health care financing as measured by how redistributionist – socialist – it is.
The result is an absurd report that ranks the medical system of Morocco as superior to that the U.S. But it’s good enough for Michael Moore!
Sicko took in about $2.65 million this weekend. That’s down 26% from last weekend, even though it appeared in an additional 54 theaters.
I particularly liked this part:
As for Stuart Browning, he’s a Miami-based man of great wealth who, judging from his cool attire and lack of socks, believes he’s the reincarnation of Sonny Crockett, Don Johnson’s Miami Vice persona.
Stuart, are you on the payroll of Michael Mann? Inquiring minds want to know.
Last night I appeared on the FOX News channel show “Hannity’s America” discussing my films, Michael Moore’s Sicko and the threat of collectivized medicine.
The only video to show up on the web so far is from an anti-FOX wingnut site who have edited the video with some inane commentary at the end – as well as this little jewel on their web site:
As for Stuart Browning … According to one website, he has connections to some conservative (and possibly CIA or governmental) sources of money …
For the advocates of government-run medicine who actually believe the United Nation’s claim that the U.S. health care system is inferior to that of Morocco(!), it’s not a big leap to assume that the CIA funds filmmakers like me to debunk socialized medicine.
Ahh well… here’s the video:
A new study shows that the Emergency Medical Treatment and Active Labor Act (EMTALA), in addition to being a huge financial burden on hospitals and physicians, has dramatically increased wait times in America’s emergency rooms:
EMTALA is another example of federal legislation that hurts the very people that it was meant to protect: low-income patients in need of emergency medical services.
How did that happen?
Under EMTALA, hospital ERs are forbidden to turn away any patient, even when it is blindingly obvious that there is no emergency condition present. And many ER patients aren’t especially sick:
In a study that questioned patients waiting to be seen in the ER, one-third of patients considered their problems of no or only minor seriousness.
But, once a patient appears in the ER, EMTALA mandates that she receive a medical evaluation, regardless of condition or ability to pay. Thus, hospitals and doctors are forced to provide an enormous amount of free care to patients whose maladies are not urgent.
The excess demand resulting from this idiotic mandate has produced overcrowding in 68% of urban emergency rooms, where most low-income patients are treated. That means long wait times:
In ERs that are at or over capacity, the wait times for patients to be seen are roughly twice the wait times in ERs that are not at capacity.
So, low-income patients in serious need of emergency care find themselves languishing in ER waiting rooms overcrowded with people who aren’t very ill.
Such wonderful things happen when Washington apparatchiks decide to “improve” health care.
Michael Tanner of CATO notes that James W. Holsinger, President Bush’s nominee for Surgeon General, testified to Congress that he supports:
1. Universal health insurance;
2. Banning pharmaceutical advertising;
3. Banning the advertising of sugary cereals and other “junk food” on television;
4. Federal regulation of vending machines in schools; and
5. Increasing tobacco taxes as part of a campaign to “make America a tobacco-free nation.”
Couldn’t the Bush Administration have found someone who was a bit more dedicated to individual liberty?
Yesterday, I posted an entry suggesting that the advocates of socialized medicine behave very much like members of a UFO cult. That is, they respond to contrary evidence by clinging even more tightly to their absurd belief system.
A friend sent me a link to a Cinema Blend piece that confirms this. These people are apparently incapable of critical thinking. The glaring inaccuracies and transparent dishonesty of SiCKO have no meaning for them. Here’s how this phenomenon manifests itself in the mind of Josh Tyler:
I have never ever seen any movie have this kind of unifying effect on people. It was like I was standing there, at the birth of a new political movement … If Sicko truly has this sort of power, then Michael Moore has done something beyond amazing … Sicko isn’t just a great movie, seeing it may be one of the most important things you do all year.
One hopes that the majority of Americans are not this impervious to objective data. If they are, they will have to learn the truth about socialized medicine through bitter experience.
Here are images of non-Potemkin health care facilities in Cuba.
After Michael Moore threw his hissy fit on CNN the other day, he posted a response to CNN on his website under the unintentionally ironic heading “Sicko Truth Squad.” So let’s take a look at how the Sicko Truth Squad distorts the truth. Starting with the quote from the CNN report:
DR. SANJAY GUPTA, CNN: “(Moore says) the United States slipped to number 37 in the world’s health care systems. It’s true. … Moore brings a group of patients, including 9/11 workers, to Cuba and marvels at their free treatment and quality of care. But hold on – that WHO list puts Cuba’s health care system even lower than the United States, coming in at #39.”
Minor point: “Slipped” indicates that at one time the U.S. was ranked higher than 37 on a previous World Health Organization report. But there was no previous WHO report—the report Moore refers to was the first one the WHO ever conducted that ranked the health systems of the world.
Major point: The implicit assumption here is that the paper the WHO report (PDF) is printed on is worth anything more than the paper one uses after a bowel movement. One of the factors that the WHO report attempts to measure is health outcomes. Included in that factors are life expectancy and infant mortality, which tells us next to nothing about the effectiveness of a health care system (more on that in the next post). It uses data on illnesses like cancer, most of which comes from the OECD. But OECD data is notoriously unreliable. Indeed, the OECD, in conjunction with the Commonwealth Fund, concedes that that in most cases its data is not “internationally comparable” because “there is a lack of international agreement on the most promising indicators and many definitions of each indicator that could be adopted.”
What further makes the report, in the immortal word of Michael Moore on CNN, “crap” is that it uses factors that have nothing to do with how well a health-care system treats illness. One such factor is “fairness in financing.” As I wrote in the American Spectator over a year ago:
It is this factor that largely explains the U.S.’s low ranking on overall performance. On fairness in financing (see page 188 of the WHO report), the U.S. ranks 55th, behind “fairer” countries like Bangladesh, Tanzania, and Cuba.
The standards (PDF) that go into the fairness in financing measure include progressivity — i.e., whether the rich pay more into the health-care system (fair); whether some households incur catastrophic payments (unfair); and whether equivalent households make unequal health-care payments (unfair). Yet it’s questionable if such standards are really fair. For example, is it fair for two households with equivalent incomes to make equal payments if one household consumes more medical services?
It’s pretty clear that such standards were designed to bias an outcome in favor of government-run health-care systems. The WHO report states that in health care, “government remains the prime mover,” and its “key role is one of oversight and trusteeship — to follow the advice of ‘row less and steer more.’” We further learn that markets ration health care
by price, which means that who gets what goods and services depends not only on how much those goods and services are valued by people, but on who has the means to buy them. Priorities are not set by anyone but emerge from the play of the market. As indicated, this is almost the worst possible way to determine who gets which health services.
The WHO report was written based on socialist assumptions. Is it any wonder then that the U.S. health-care system, one of the least socialist among the developed world, does not fare so well in the WHO rankings?
By omitting any discussion of the assumptions of the report, Moore leaves his audience with the belief that the report is from an unbiased, objective government agency. Such a tactic is what is known as “appeal to authority.” That’s amusing, since Moore clearly fancies himself an iconoclast always challenging the powers that be.
Michael Moore isn’t the only advocate of government-run medicine to use deception and lies to further the cause. Paul Krugman at the New York Times, in a column earlier this week, defends the Canadian system with all the deceit he can muster:
Yes, Canadians wait longer than insured Americans for elective surgery. But over all, the average Canadian’s access to health care is as good as that of the average insured American …
Krugman wants his readers to think that by “elective”, he means things like hip replacements and cataract operations – when, in fact, “elective” surgery in Canada includes all cancer surgery and coronary artery bypass surgeries.
Hundreds of reviewers, representing every political persuasion, agree that SiCKO presents a simplistic and distorted picture of American health care. Moreover, writers as diverse in their world views as Kurt Loder and Larry Elder have decried its absurdly flattering depiction of the Cuban, Canadian, and British health care systems.
The only thing more execrable than the monumental dishonesty of SiCKO has been the behavior if its creator. Michael Moore’s recent antics on CNN, ably deconstructed in this piece by Peter Chowka, apparently added racism to his standard repertoire of dissembling and humbug.
Despite all of this, SiCKO’s basic premise—that our current health care system should be replaced with socialized medicine—has apparently not lost a single devotee. In fact, the advocates of government-run health care have increasingly exhibited a species of cognitive dissonance.
Emulating the members of that famous UFO cult described by Leon Festinger, the evangelists of socialized medicine have responded to the adipose auteur’s crumbling credibility by clinging ever more tightly to their preposterous beliefs.
One can see why these people describe themselves as “reality-based.”
Peter Chowka at the American Thinker wonders if Michael Moore didn’t purposely throw a temper tantrum on CNN yesterday to boost Sicko’s lagging box office receipts:
It does not seem unreasonable to think that Moore’s performance with Blitzer on CNN was, in large part, calculated to generate controversy about and rekindle interest in the lagging Sicko box office. Several times, Moore promoted his Web site where he said he would “correct” CNN: “I’m going to put the real facts up there on my Web site so people can see what he [Gupta] said was wrong.” In fact, before the night was over, almost the entire home page of michaelmoore.com was devoted to the CNN-Moore brouhaha, with video of Moore’s appearance and links to new content including screeds like “CNN vs. THE FACTS” and “Demand an apology from CNN.” At 1 pm EDT on July 10, Moore’s Web site was temporarily not available-possibly due to high demand whipped up by bloggers and media outlets inspired by Moore’s extreme and ultimately self-serving antics on CNN. Moore’s schtick was like throwing red meat to his large core fan base that already thinks that CNN is right of center, too soft on (if not in cahoots with) the Bush-Cheney administration, and complicit in the selling of the Iraq war to the American people.
Read it all.
In his latest post about the Anti-Universal Coverage Club, of which I’m a proud member, Michael Cannon quotes Grace-Marie Turner on her reluctance to join:
It’s perception. If people think we’re against having everyone have health insurance coverage, what kind of statement is that?
I’m an admirer of Turner, but her delicacy about “perceptions” is misguided. Indeed, it plays into the hands of the socialized medicine crowd, whose strategy for winning the health care debate includes creating the impression that a government-run, “universal” health care system would be more “caring” than a system based on the free market.
It is the evangelists of government-run health care who should be worried about perceptions. In the end, that is their only weapon. Advocates of free market reform possess a much more powerful weapon: the facts. And the facts clearly indicate that “universal health care” is anything but humane.
The battle over health care reform cannot be won by making nice. The advocates of socialized medicine are perfectly willing to get out the brass knuckles in order to prevail. The good guys (that would be us) will lose this battle if we try to fight it according to the Queensberry Rules.
My latest, in National Review Online.
Here’s a story about a 60-year-old man in France:
Conversation at lunch revealed that the neighbor, who had a history of heart trouble, suffered severe chest pains a few weeks ago. He wisely went to the hospital seeking treatment. He was told that there was no space available for him. He was advised to go home and call back later to see if a room might have become available. He did so, but was told repeatedly that the hospital remained full to capacity. Several days later this man died at home, never having received hospital treatment.
This incident, while true, is also an anecdote. It doesn’t prove anything about the merits or demerits of France’s universal-health-care system compared to those of the (still somewhat) private system in the U.S. But this sad event does reveal that merely declaring, statutorily, that every citizen has a right to health care, or that health care is “free” to every citizen, does not make health care available to all or “free.”
Yes, it is just an anecdote. Then again, at one point stories about waiting lists in the U.K. and Canada were probably just anecdotes too.
Columnist Mark Steyn weighs in on “British bomb plot and Michael Moore-style health care.”
Dr. Sanjay Gupta, neurosurgeon and CNN reporter, made a 4-minute “Reality Check” of Sicko, concluding that “[Moore] did fudge the facts.”
Asked to respond on “Situation Room”, Moore says it’s “crap.” And then he proceeds to abuse Wolf Blitzer for 4 minutes. Watch Dr. Gupta and Moore here.
Step 1: When Challenged, Throw A Tantrum.
Michael Moore demonstrates that tactic here. The idea here is that if you can generate enough righteous indignation, you’ll appeal to people’s emotions, and those same people will overlook the facts that are at issue and think that you must be morally superior to your opponents.
Step 2: Accuse Your Opponents Of Being Paid Off.
After CNN showed a report challenging Moore, Moore whined, “That report was so biased, I can’t imagine what pharmaceutical company’s ads are coming up right after our break here.”
This tactic suggests that your position is so eminently reasonable that the only person who would disagree is either nuts or a paid stooge. Another great way of not dealing with the facts at issue.
This is how the far left argues. Here are two other great examples of these tactics, the first an email from Rick Pullem sent to Stuart Browning:
How Capitalism can save American health care. Any idea when this dream might happen? Whose pockets are you in? Doctors in this country make how much compared to docs in other countries? You are just another corporate pundit. How about fixing the current crisis instead of bashing those that have legitimate ideas? Keep playing the ‘I gotta get mine’ game and screw the everyone else. Guess you don’t believe in a just GOD. Yep, Micheal Moore is a hobbible person not trying to help the common person like you. Keep up the great work, your family should be proud.
And here is one from the blog “Citizen Alert”:
Now, let’s look at their agenda. Go and Google Stuart Browning and you will find he is a film maker and an advocate of free market health care. His partner in promoting free market healthcare is physician David Gratzer. Then, Google David Gratzer, and you will find that one of his buddies is none other than Milton FREAKING Friedman. If the neo cons every replaced God with anyone sometime down the road it would be Milton FREAKING Friedman. Milt wrote the foreword to Gratzer’s book The Cure: How Capitalism Can Save American Health Care. Nice title. It was put out by
Encounter Books. Google that. This took me all of 60 seconds to find out all this by the way. Google Encounter and you find:
Encounter Books is an American conservative book publisher. It is an activity of Encounter for Culture and Education, Inc.
Encounter Books publishes serious non-fiction books, with a scholarly leaning, in the areas of history, religion, biography, education, public policy, current affairs, social sciences, and politics.
Ah, the Conservative infrastructure is alive and well. See what I mean? Everyone slants.
Hmm…I never knew that Friedman’s middle name was FREAKING!
More over at Health Hog.
Then get government to shut them down. Qliance is a chain of medical clinics in Washington State trying to bring boutique medical care to people of lower income. Sounds like a good thing, no? Well, not if you are one of the clinics competing with them:
But to Group Health’s [Stephen] Tarnoff, Qliance represents more of a threat than other boutique firms because it has scaled back perks that are typical of higher-end outfits. It is nothing more, he believes, than a “basic primary care” service, but one for which patients have to pay out of pocket. “People who are going to get this are going to have to pay twice,” predicts Tarnoff, once for their monthly primary care fee and once for the insurance they will still need for specialist visits and catastrophic care. If this model catches on, he says, many insurance companies might eventually stop covering primary care altogether.
Tarnoff seems to know what tune to sing to get the ear of the State Insurance Commissioner:
In fact, Qliance’s founders say they would welcome such a change. They compare primary care insurance to car insurance that would cover such routine work as an oil change. State Insurance Commissioner Mike Kreidler, among others, disagrees. “If we see a scenario in which primary care is abandoned by health insurers, then we would start to have second thoughts about what this is doing to the whole system,” says Kreidler. “There are a lot of uncertainties as to what the effect of this is.”
A few years ago, Kreidler cast doubt on the operation of boutique practices by telling them they were acting as insurance companies—by accepting prepaid money in exchange for medical services—without following regulations required of such companies. Yet a bill he supported, which passed this past legislative session, allows “direct patient-provider primary care practices” to run free of regulations on insurance companies. But the new law also imposes some safeguards. One that is crucial: Such practices cannot turn someone away on the basis of their health.
Yes, there are uncertainties! That’s called a free market. It cuts through the uncertainty by figuring out what businesses work and which don’t. If these types of clinics work well and fewer and fewer insurance companies cover primary care, that means that people prefer the clinics to having insurance cover primary care.
But, alas, Kreidler believes that only elites like himself are qualified to make decisions about our health care. About two years ago, he testified against a bill in Congress that would let people buy insurance out of state. According to Kreidler:
Unlike group insurance consumers, individuals shopping for coverage do not have the sophistication of an employer when making coverage decisions. Consumers in the individual market need the protections afforded by State regulation.
Yep, you are too stupid to know how to buy insurance, and you are certainly too stupid to decide if you want insurance that covers primary care.
All I can suggest to the owners of Qliance is to keep an eye on how cozy their competitors get with Kreidler. If the relationship gets too cozy, they might consider moving to a state that is friendlier to market innovations.
Ezra Klein has a piece in the Washington Monthly in which he predicts failure for state-initiated “universal health care” reform:
The history of state health reform initiatives (and there’s quite a history) is a tale of false hopes and great disappointments … Universal care advocates must be realistic about that, and think hard about how to convert the energy in the states into a national solution before the current crop of novel experiments fail—because fail they almost certainly will.
For once, Klein is right. Typically, however, he misses the point. Rather than drawing the obvious conclusion that socialized medicine, like socialism in general, contains intrinsic flaws that render its eventual failure inevitable, he sees the probable collapse of these state programs in purely tactical terms:
If high-profile efforts like those in Massachusetts and California can’t be properly implemented, or are launched and then collapse, they’ll become powerful weapons in the hands of protectors of the status quo.
And how would these fiendish “protectors of the status quo” use their “powerful” weapon?
After the demise of Washington State’s plan, for instance, the Heritage Foundation published an article stating that the program “gave state legislators around the country an experimental taste of how a Clinton-style health care plan would work—or fail to work. The result was higher costs, burgeoning bureaucracy, and micromanagement.”
In other words, these soulless minons of the “health care industrial complex” would tell the truth. Have they no shame?!
If Klein and other advocates of socialized medicine would spend less time avoiding the obvious realities of government-run health care and more time exploring workable solutions to the problems bedeviling American medicine, they might actually make a useful contribution to health care reform.
Some politicians and intellectually lazy policy wonks would have us believe that electronic medical records possess magical powers. If the United States will just adopt EMR wholesale, they tell us, many of the problems plaguing American health care will evaporate.
If your instincts tell you that this is just a little too easy, you should listen. An analysis published in the Archives of Internal Medicine indicates that the glib evangelists of EMR are … well … full of BS. In actual practice, EMR turns out to have no significant effect on quality of care:
For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use.
Reuters reports on that this outcome was something of surprise to the researchers themselves:
“We did expect practices (with electronic medical records) would have better quality of care,” said Dr. Randall Stafford of Stanford University. “They really performed about the same,” he said in a telephone interview.
These findings, combined with the EMR concerns discussed here, suggest that policy makers and health care wonks should quit proposing magic bullets and get down to the serious work of health reform.
My latest column at the American Spectator.
Yep, that’s Medicare for you. Even though colonoscopies had been proven quite effective by the early 1990s, Medicare didn’t fully cover the procedure until 2001.
A standard feature of government-run health care is the dilatory adoption of new medicines and technologies. In Great Britain, for example, patients often have to go outside the NHS to access cutting edge treatments.
Sadly, as the NYT reports, the segment of American health care controlled by Washington suffers from the same bureaucratic inertia. The procedure discussed in the article is “catheter-based ablation,” which is used to treat atrial fibrillation.
Advocates of the procedure say it is less invasive than open-heart surgery — the only proven method for curing many patients — and in the long run more cost-effective than drugs, which generally offer temporary relief.
But many retired Americans are unable to benefit from this procedure because Medicare won’t pay for it. Why?
Federal regulators … have not approved as safe and effective any of the devices used. So hospitals and doctors are finding it difficult to be fully reimbursed for the procedure’s cost.
So, what’s the problem? Is this some dangerous experimental procedure? Nope. It’s just that the bureaucrats are behind the curve:
This is one of those areas where the practice of medicine has moved faster than the approval process,” said Daniel G. Schultz, head of the Center for Devices and Radiological Health at the Food and Drug Administration.
And who is hurt by the government’s glacial approval process? The patient. While the apparatchiks try to catch up, people will very likely die.
Government-run health care—coming to a hospital near you.
Congratulations, Stuart, for the discussion of Dead Meat in the New York Times. Very cool.
And to New York Times readers who have found their way here, welcome.
Playing grainy audiotape from the Nixon White House, Michael Moore claims that HMOs were part of a plot by the then-President to push managed care on the population.
As I write in The Cure, Nixon certainly was a prime mover for popularizing HMOs – but there was no plot, and “recently discovered” audiotape is hardly necessary in understanding the issue.
The HMO Act of 1973 was passed by a bipartisan majority in Congress. Senator Edward Kennedy was a co-sponsor, by the way.
(This post is part of a series that examines key aspects of SiCKO.)
Again, from the land Down Under, looks like a crippled woman who is caring for her invalid husband has a bit of a wait:
Jennifer Haffenden, 65, says she is barely able to care for herself because of an excruciating arthritic ankle.
She thought help was in sight, until she looked more closely at her appointment card for the orthopaedic specialist at Maroondah Hospital.
“I thought it was for this year and I nearly turned up before I realised it was June 2008,” she said.
By that time, the Croydon pensioner will have been waiting 14 months.
She is then likely to be put on another waiting list for surgery, for up to 18 months.
But the Australian Government isn’t just rationing surgery. It’s also rationing medical providers:
Ben Kennedy resigned from the Royal Brisbane Children’s Hospital last month because working for Queensland Health left him “burnt out” and unable to work safely.
Speaking for the first time since resigning, the 35-year-old said patients were waiting too long for scans, and radiographers were suffering from working long hours with constant on-call commitments.
He said he was forced to work on-call for up to eight weeks at a time, sometimes finishing at 2am and starting again at 7am.
“It’s the equivalent of being drunk at work,” said Mr Kennedy, who starts a new job tomorrow at a private radiology clinic.
But, Mr. Kennedy is probably exaggerating:
A Government spokesman denied radiographers were overworked or that there was a staff shortage.
“Radiography staffing levels are determined on the basis of patient demand and the need to deliver safe, timely services,” he said.
Hat tip: Socialized Medicine.
In one of his posts that I linked to yesterday, Ezra Klein tries to refute the notion of consumers making their own health care decisions by pointing to a study conducted by the U.S. Department of Education showing lackluster adult literacy in this country:
So forget, for a moment, whether individuals have the interest or time to take charge of their treatment regimens. If 43 percent of Americans are reading at a fifth-grade level of lower, how many even have the capability? And how much damage will be done — as in the article’s example of a women who sought to save face and accidentally consented to a hysterectomy — if we don’t take these educational inequities seriously?
Let’s assume that 43% of adults read at a fifth-grade level or lower. Where do you suppose they received their education? It’s a safe bet most, if not all, received it through the public (i.e., “government”) school system.
So if government achieves such abysmal results on something like teaching people to read, why on earth would we want to put it in charge of something more complex like health care?
That would seem to be a pretty obvious question, but never underestimate the power to leftists like Klein to ignore the obvious in pursuit of their social schemes.
Sally Pipes appears in Michael Moore’s health care schlockumentary and she takes exception to its flattering portrayal of Canadian health care:
Moore put me, fleetingly, into “Sicko” as an example of an American who doesn’t understand the Canadian health care system. He couldn’t be more wrong. I’ve personally endured the creeping disaster of Canadian health care.
Pipes’ personal experience involved negotiating the bureaucratic shoals of Canada’s health care system on behalf of her mother:
She was too old, and too sick, to merit the highest quality care in the government’s eyes – I can honestly say that Moore’s preferred health care system is something I wouldn’t wish on him.
But there isn’t any danger of Moore experiencing such a system. He has the financial resources to avoid state-run health care. But, if he has his way, the rest of us will face what Pipes’ mother experienced:
A dehumanizing system of triage, where the weak and the elderly are hastened to their fates by actuarial calculation.
Think about this the next time someone tells you that we need a health care system like the one endured by our neighbors to the north.
In response to Michael Cannon’s column on using his HSA to treat his torn ACL, Ezra Klein writes:
That’s all for the good, when it’s all for the good. On the other hand, that’s just a hop, skip, and a jump away from “She had shortness of breath, but no radiating arm pain, so she decided to wait through the weekend because she couldn’t afford the ambulance ride. She died.”
Cannon calls that type of thinking “lazy.” I call it patently stupid. Why would she wait through the weekend because she couldn’t afford the ride? Surely someone in that situation would go to a Minute Clinic (which is very affordable). The docs their would surely refer the patient immediately to a hospital assuming the condition was serious.
Does Klein really think that people are so inept that they are unable to make good decisions on how to spend their health care dollars? Actually, that’s a rhetorical question.
*Klein is uninKleined to make “snese” too.
One of Don Luskin’s readers had an exchange with Paul Krugman over what drives health care costs in this country. The reader summed up the exchanged thusly:
As you can see Mr. Krugman made a misstatement about insurance company overhead costs (easily fact checked from financial statements) and failed to address the true drivers of healthcare cost inflation and he mistakenly believes that controlling the main drivers of healthcare cost inflation means rationing care. These kinds of fatuous statements by politically motivated economists need to be countered wherever they appear. I found CAHI’s paper, “Medicare’s Hidden Administrative Costs”, to be a partial rebuttal of Krugman’s statements. On examination of public company health insurer’s financial statements I found their overhead costs falling as a percentage of medical costs (benefit payments). If they were “the fastest growing component of costs” as Mr. Krugman states they would be increasing on a percentage basis with respect to benefit payments. This is really sad.
Ken Blackwell makes an interesting observation about the recently thwarted terror plot across the pond:
An ongoing physician shortage brought on by the inherit shortcomings of their government-run health care system … allowed Al Qaeda operatives to legally enter the country and quickly become trusted members of its National Health Service.
But isn’t that something of a stretch? Well, no. Because physician remuneration in the NHS is so inadequate, the best and brightest Brits are going into other lines of work. Thus, in order for NHS to fill the gap:
Foreign doctors are given top priority and almost immediate entrance into Great Britain.
Obviously, the vast majority of foreign doctors are high quality professionals with no ideological ax to grind. But in its desperation to fill physician slots, the British government apparently created short cuts that were exploited by terrorists.
So, in addition to providing lousy service and poor outcomes, government-run health care now presents a security threat as well. It seems to me that it would be easier (and less dangerous) to allow physician wages to rise to their natural market-determined level.
Grace-Marie Turner has an op-ed in the Baltimore Sun on Sicko that ends with this great line:
If Michael Moore’s waistline ever puts him in the hospital for heart surgery, it will be interesting to see where he goes for medical care – the Mayo Clinic, or Cuba?
As I have written here and here, the only thing more disingenuous than SiCKO is the coverage it has received from the establishment media. A particularly egregious case in point is CNN’s faux analysis of Moore’s schlockumentary:
Our team investigated some of the claims put forth in his film. We found that his numbers were mostly right … we found surprisingly few inaccuracies in the film.
Among the assertions found to be “mostly right” by CNN’s crack “team” is Moore’s claim that “fifty million” Americans are uninsured:
For the most part, that’s true. The latest numbers from the Centers for Disease Control and Prevention say 43.6 million … uninsured in 2006.
In addition to overlooking the obvious fact that Moore’s figure is 12% higher than the CDC number, CNN missed this study showing that the “uninsured crisis” is a chimera. David Gratzer explores the implications of the study here.
Also certified by CNN’s “investigators” is Moore’s claim that Americans pay too much for a substandard health system:
Like Moore, we also found that more money does not equal better care. Both the French and Canadian systems rank in the Top 10 of the world’s best health-care systems, according to the World Health Organization. The United States comes in at No. 37.
CNN’s “experts” evidently don’t understand that the W.H.O. rankings are partially based on a dubious criterion called “fairness financing” that heavily favors government-run health care systems. David Hogberg provides more detail on that issue here.
Yet another dubious datum swallowed whole by CNN is Moore’s claim that thousands of people die every year because they lack health insurance:
According to the Institute of Medicine, 18,000 people do die each year mainly because they are less likely to receive screening and preventive care for chronic diseases.
But if the point is to save lives, CNN has overlooked important research that shows a much better way to do so is to reduce government regulation. According to this 2004 study, our current regulatory burden kills 23% more patients than are allegedly done in by the lack of coverage.
4,000 more Americans die every year from costs associated with health services regulation (22,000) than from lack of health insurance (18,000).
And so it goes. CNN has not “investigated” SiCKO’s disingenuous claims. It has, instead, perpetuated them by recycling debunked talking points routinely deployed by the evangelists of government-run health care.
Which leaves me again wondering: When will the establishment “news” media start doing their job?
Received the following comment regarding my recent post, “More Single Payer Glories”:
The key word there is elective surgery. People don’t die from conditions requiring elective surgery. They could also have had treatment sooner if they had health insurance.
Some definitions of elective surgery do suggest that it is surgery for a condition that is not life-threatening. But governments that have waiting lists for elective surgery appear to be operating from the definition that elective surgery is surgery that is “subject to choice.” It “is beneficial to the patient but does not need be done at a particular time.” In other words, it is surgery that is “non-emergency” surgery.
But that doesn’t mean that such surgery isn’t vital to preserving life. Heart bypass surgery and cancer treatment are surely necessary to survival, but are often classified at elective.
Thus, people can, and do, die while on a waiting list for elective surgery.
The Canadian and British health care systems have received a lot of bad press for their purgatorial waiting lists, and for good reason. But long wait times are not unique to these two countries. They are, in fact, a standard feature of all government-run health care systems.
As David Hogberg points out, patients “Down Under” often die while languishing on the waiting lists that plague the Australian health care system. This article, in the Herald Sun, describes a patient whose experience is all too common:
A pensioner who cares for her invalid husband while hobbling around on crutches faces a three-year wait for ankle surgery.
So, like many trapped in government-run health care systems, the patient decided to look into the private health care market:
The specialist told her she could operate within two weeks. But with the bill expected to hit $4000, Mrs Haffenden was forced to go on the 14-month waiting list to see the same specialist as a public patient.
Even worse, it is quite likely that another 18-month delay is in store for this patient after she endures the initial 14 months. And what sort of response did the Herald Sun get when it attempted to find out what was being done about such outrages?
A government spokesman said significant commitments had been made to reduce waiting lists and speed up service delivery.
Sound familiar? It should. That’s what the apparatchiks of the Canadian and British health care systems have been saying for years. Indeed, they have been saying such things for almost as long as their patients have been waiting for basic medical care.
How did Sicko do in its opening weekend? A look at that question over at my own blog, Health Hog.
Here’s left-wing healthcare pundit Ezra Klein in an email message to me concerning my movies on Canadian health care:
Ah, argument by anecdote, the last refuge of the scoundrel. […] America has no shortage of terrible tales of maltreatment, deprivation, and wrongful death, but I’m not going to dip into that pond as I try to not enlist other’s misfortunes as pawns in my argument.
And here he is commenting about the anecdotal stories in Michael Moore’s Sicko:
Every story, every tale, every vignette asks the same question: “Who are we?” Who are we that our fellow citizens have to decide which fingers they’ll pay to get reattached? Who are we that our hospitals push the ill and indigent into cabs, and drop them off, disoriented and clad in a paper-thin gown, on skid row?
A stunning piece by Kurt Loder of MTV:
Unfortunately, Moore is also a con man of a very brazen sort, and never more so than in this film. His cherry-picked facts, manipulative interviews (with lingering close-ups of distraught people breaking down in tears) and blithe assertions (how does he know 18,000* people will die this year because they have no health insurance?) are so stacked that you can feel his whole argument sliding sideways as the picture unspools. The American health-care system is in urgent need of reform, no question. Some 47 million people are uninsured (although many are only temporarily so, being either in-between jobs or young enough not to feel a pressing need to buy health insurance). There are a number of proposals as to what might be done to correct this situation. Moore has no use for any of them, save one.
And, it appears that Loder has familiarized himself with our good friend Stuart:
That last statement is even truer than you’d know from watching “Sicko.” In the case of Canada — which Moore, like many other political activists, holds up as a utopian ideal of benevolent health-care regulation — a very different picture is conveyed by a short 2005 documentary called “Dead Meat,” by Stuart Browning and Blaine Greenberg. These two filmmakers talked to a number of Canadians of a kind that Moore’s movie would have you believe don’t exist.
Read it all.
The Times reviewer seems less enamored with Michael Moore than many American reviewers. Perhaps his personal experience with the British NHS has colored his view:
“What [Moore] hasn’t done is lie in a corridor all night at the Royal Free watching his severed toe disintegrate in a plastic cup of melted ice. I have. I’ve spent more hours than I care to remember in NHS hospitals vainly waiting for stitches or praying for the arrival of a midwife. There are no such traumas in Moore’s rose-tinted vision of our glorious NHS.”
David (Catron): I’m getting some of that too. A letter-to-the-editor to the American Spectator regarding an article I wrote about a Moore press conference came with the title “Hogberg’s Health Money Hog blog,” pretty clearly implying that I must be paid off. The letter came from Marilyn Clement, National Coordinator of Healthcare-Now. She started her letter thusly:
I’m so excited by your blog. I’ve been waiting to see who would come to the rescue of the insurance companies.
I found that amusing because (1) I did not defend insurance companies in my article on Moore’s press conference — I defended profit in the health care system; and (2) while I’m sure I’ve said a nice thing or two about insurance companies somewhere, generally speaking I’m not a huge fan of them because they often stand in the way of free-market reforms that I favor.
But, alas, what do you expect from those given to hysteria? And believe me, Ms. Clement can be quite hysterical. I got into an email exchange with her, and in response to my question regarding her claim that there were waiting lists in the U.S., she replied:
More than 50 million people –- those totally uninsured and those who think they are insured (until they get sick) — wait and wait –- often until they die. Among those who wait are the 18 million or more who die every year (according to the Institute of Medicine) simply because they have no health insurance. Multiply that by the number of years the Bush administration has been in place –- and compare that to the increase in profits by the insurance companies and HMO’s.
18 million? Well, let me do the math. Over six years of the Bush Administration, that would be 108 million who died due to lack of health insurance. That’s quite a shocking number! But here’s something I don’t understand. According to the CDC in 2004, the latest year available, the U.S. had only 2.4 million deaths total. Assuming that number is about the same for all six years of the Bush Administration, then the “official” tally is only 14.4 million deaths. So where did the Bush Administration hide the other 93.6 million bodies?
Ms. Clement replied that she had meant to write “thousand” not “million.”
Who knows? Maybe math wasn’t her strongest subject.
It would appear that I’m a soulless minion of the “health care industrial complex.” That is, at any rate, the thrust of various comments I have received in response to my posts on Michael Moore and his new schlockumentary, SiCKO. The following question from “Jed” is typical:
Hey! I’m wondering, if I make a website like yours, how much can I make each month for being a health insurance lobbyist?
Jed’s highly entertaining query echoes a trope popular among “progressives” with no substantive defense against criticism of Moore and his film: all such criticism is bought and paid for by “Big Pharmadocinsurancehosp.”
The use of this trope isn’t limited to obscure denizens of the blogosphere. It is increasingly deployed by establishment media types. This piece at MSNBC, for example, avers that:
Those with vested interests in preserving the current status quo in health care have already activated their lobbyists, media flacks, think-tank mouthpieces and trade organizations to go after Moore and his movie.
And this article in Newsweek echoes the theme:
Why do we put up with a broken, bloated, bureaucratic and increasingly barbaric health system? Because your politicians are in the thrall of the people who profit from it … the drug companies, the hospital industry, the bought-and-paid-for politicians and the health-insurance companies.
Thus, serious criticism of Moore and his accomplices can be summarily dismissed without the necessity of showing that it is factually flawed. One can see why this is such a popular trope. Its use requires infinitely less intellectual exertion than the application of critical reasoning to the problems besetting American health care.
But a more pressing issue is this: If I’m a bought-and-paid-for stooge of the “health care industrial complex,” where’s my check?
+ May 2009
+ May 2008
+ May 2007