Movies

The New Yorker on Sicko

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In my review of Sicko, I argued that while in the past Michael Moore has had an easy time winning converts in Europe, it's going to be a harder slog with this film. Denouncing the Iraq War and calling Americans, which he clearly doesn't count himself among, stupid ("They are possibly the dumbest people on the planet," he told the Daily Mirror) is easy; convincing Brits that the NHS provides flawless, wait-free medical care—for free!—strains credulity. The New Yorker's David Denby thinks Moore will have difficulty convincing Americans too (Hat tip to Alan Vanneman):

Michael Moore has teased and bullied his way to some brilliant highs in his career as a political entertainer, but he scrapes bottom in his new documentary, "Sicko."

Moore winds up treating the audience the same way that, he says, powerful people treat the weak in America-as dopes easily satisfied with fairy tales and bland reassurances. And since he doesn't interview any of the countless Americans who have been mulling over ways to reform our system, we're supposed to come away from "Sicko" believing that sane thinking on these issues is unknown here. In the actual political world, the major Democratic Presidential candidates have already offered, or will soon offer, plans for reform. A shift to the left, or, at least, to the center, has overtaken Michael Moore, yielding an irony more striking than any he turns up: the changes in political consciousness that Moore himself has helped produce have rendered his latest film almost superfluous.

Speaking with my friend in Dublin today, I inquired about his level of satisfaction with Irish health services. He replied with an anecdote: The last time he required medical attention was for a broken arm, for which he was fitted with a standard plaster cast. After a few days the cast, which was apparently constructed from recycled copies of the Irish Sun, began to fall apart. He returned to the hospital for a replacement but, after waiting in the emergency room for nine hours, decided instead to head home and piece it together with DIY tape. The Irish system, he said, was "a mess."

Andrew Sullivan's Canadian readers chime in here.

There is, of course, much to say in response to Moore's deification of the Cuban system, though I think these pictures, published in the Swedish daily Dagens Nyheter, will suffice for now. They were taken at a nursing home in the Cuban province of Pinar del Río in June 2004:

Healthcare in Cuba

More photos here.

NEXT: Hello, Nurse!

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  1. Horrifying photos. My friend in Dublin was disgnosed (after over a year of disconfort) with throat cancer. The American-trained specialist that he finally saw told him that he really shouldn’t be treated in Ireland–the treatments available there were barbaric, and if he didn’t want to die, he should go to either Germany or US for the targeted therapy needed. He did go to Germany, and is fine now. The health service in Ireland had apparently decided that they didn’t need to spent the money on the new machines for targeted radiotherapy.

  2. Sorry, I stopped reading after the weak-assed insult to Moore’s patriotism.

  3. I found it difficult to believe that even Michael Moore would try to persuade the Brits that the NHS is a success – for God’s the sake, every article the Guardian runs on it is negative, and they’re in favour of socialised medicine. But once again I gave my fellow man too much credit…

  4. Michael Moore Hates America was a decent movie, but had a terrible name (even the director acknowledged, but strangely kept it). The premise of that movie doesn’t have to do with Moore’s patriotism, but with his film style – the ambush interview. Basically, instead of chasing a politico down on the street and trapping them in a lie (wow how hard is that?), you can achieve more by being up front, honest, and sincere. Qualities Moore severely lacks.

    Ironically, though, Moore seems to be using the ambush interview less and less. And of course he’s doing more fact checking this time around. (though his admissions are the worst offenes) Probably because he’s been picked to pieces so much in the past.

  5. The World Health Organization ranks the British healthcare system about 19 places ahead of ours’.

    France is rated #1, I believe.

  6. Joe — I assume you’re referring to this statement:

    “Denouncing the Iraq War and calling Americans, which he clearly doesn’t count himself among, stupid (“They are possibly the dumbest people on the planet,” he told the Daily Mirror) is easy”

    I took that as an attack on his egalitarianism, not his patriotism.

  7. Joe, please point me to the insult of Moore’s patriotism. I mean, I’m sure it isn’t when Moynihan quotes Moore as saying about Americans how dumb THEY are and taking this to indicate that Moore seemingly doesn’t include himself as an American. There must be something else because it would be dumb to think the above is an insult to Moore’s patriotism. And we both know you’re not dumb, Joe.

  8. The photos are terrifying.

  9. Again, for those people who have a hard-on for socialized healthcare, why don’t you try it in your home state so you can show the rest of us how lovely it is?

  10. “The World Health Organization ranks the British healthcare system about 19 places ahead of ours’.”

    On what basis? Cost, which they achieve through rationing?

  11. jp, Jason C,

    “…Americans, which he clearly doesn’t count himself among…”

    The thing speaks for itself.

  12. Anyway, it was nice of Moynihan to provide us with an anecdote about an Irish man’s lack of satisfaction with his free healthcare after taking Moore to task for his use of anecdotal evidence in Sicko.

    In my opinion, such anecdotal examples are of very limited value when assessing national healthcare policy.

  13. On what basis? Cost, which they achieve through rationing?

    I confess that I’m not entirely familar with the WHO’s methodology. No doubt that there is plenty of subjectivity involved.

  14. You’re right, joe. The part you quoted is redundant.

  15. LET THE URKOBOLD SEE IF HE UNDERSTANDS. MOORE SAID THAT AMERICANS ARE IDIOTS. HE MUST INCLUDE HIMSELF IN THAT STATEMENT. THEREFORE, HE IS AN IDIOT AND CAN BE IGNORED.

    EXCELLENT. WE ALL AGREE.

  16. Urkobold? > joe

  17. Gr?nfeld Defence-

    Go lobby in your state legislature. Let us know how it goes if you get single-payer healthcare state wide. But stop trying to put the federal government where it has very little authority to be? K?

  18. Step 1: Find a nit to pick
    Step 2: Pronounce entire article invalid
    Step 3: Declare victory

    O’Reilly, or joe?

  19. I liked Moore through Bowling for Columbine. Not that I agreed with everything he said or did, but I found him amusing, even thought provoking at times. Everything seemed to go downhill from there. Last few years, he’s just been a shrill nut.

    What’s the deal with your sensitivity regarding him, joe?

  20. In my opinion, such anecdotal examples are of very limited value when assessing national healthcare policy

    Which is Sicko appears to be of very limited value.

  21. Joe,

    For real? That was a statement about grammar. Using the word ‘they’ to identify a set necessarily means that you do not consider yourself part of that set. But Moore is of course part of that set. It’s not a statement about patriotism but rather a statement about Moore’s hypocrisy. The merits of that observation may be argued, sure, but that’s what it’s about.

  22. Thank goodness we have a far better system than Britain’s. I only had to schedule a preliminary appointment with a specialist last fall a mere three months in advance. Once the date came around. he spent two whole minutes on my consult!

    After a four-day hospital stay a few years back, my finacee was only on the hook for about $2000 out of pocket after her deductible. True, the main doctor who treated her refused to send a copy of her records to her primary care physician even after several written requests, because he wanted to get a couple of billable office visits out of her. Not bad, considering that our premiums are only about a third more than the total average per-person expenditure in developed countries with single-payer and socialized systems.

  23. Once again, anectdotes (and now pictures!) are trotted out as some sort of defense of our pathetic health care system. That people who favor health-care reform could easily trot out 10,000 anecdotes (and pictures!) of their own is not mentioned.

  24. My wife’s Irish, and a doc, and trained in the Irish system. She loves the Health System more than brown bread, tea, and Sinead O’Conor. Granted, she’s a socialist, but her reasoning isn’t all that loopy. The absolute bottom of Irish health care is higher than America’s lowest level of health care. Over here, the uninsured working poor get socked with the low level stuff. In Ireland, the low level stuff gets spread out a bit more evenly.

    I might add that she doesn’t get much support for her reasoning. Her two formerly canadian colleages are refugees from the Canuck system. They acknowledge the problems confronting the working poor, but think the US system works better for more people.

  25. joe,
    I think this may be your lamest effort ever.

  26. Oh, yeah, about health care:

    Oddly this appears to be one of the few issues that is entirely either/or.
    Either we keep the system as is, or we adopt socialized medicine. If only someone could see a new way…

    Why does the system work the way it does? What are the causes of the inefficiencies? Why won’t anyone take another look at the problems?

    If only…

  27. I didn’t look at all the pictures, but the one in the post may or may not be bad. It depends. Is that chocolate or feces or mud?

  28. has anyone done any real work (i.e. with like, numbers and stuff) on creating incentives for health maintenance and the like? particularly in places with high rates of obesity, etc.

    i was thinking of this in connection with a conversation i had with a friend about the connections of shitty foods, a lack of reasonably priced greenmarkets – or just good produce – in many low income locations across new york city, etc and the difficulty in inducing people to exercise. i would think a good soros-esque project for a foundation would be to put money into studying how to convince people to exercise AND creating something that can work for people across ages and fitness levels, is easy to do, not too time consuming and requires a 5×5 space or less.

  29. Once again, anectdotes (and now pictures!) are trotted out as some sort of defense of our pathetic health care system.

    It’s not a defense of ours – it’s an attack on theirs. But thanks for the helpful blurring of the argument!

  30. Argument by anecdote makes you look bad.

    Moore doesn’t have to sell anything because people want cheaper care and universal coverage.

    Call me five years after the US socializes to contain costs and let me know how the NHS does. The NHS is barely treading water now, and it isn’t paying for a fraction of its true cost. We are.

  31. “The last time he required medical attention was for a broken arm”
    I have several problems with the anectdote about the Irish health care system.
    For a start what relevance does it have to the “Brits that the NHS provides flawless wait-free medical care” system. These are two separate countries and around 50% of people have private insurance in Ireland.
    Secondly, it was nice to see a time period given here, could the news paper his cast was made out of be from the 1970’s? Dublin hospitals most certainly would not have allowed this to occur in the last 15 years.

  32. Day three of the Hit and Run assault on Sicko is in full swing! I’ll be checking in periodically. Thank the gods for joe and Urkobold, the main reasons to read H & R.

  33. Hopefully the NHS can help this d00d, hier

    Truly of URKOBOLDIAN levels!

    (oh my! mercy!)

    (oh – thanks to “jdk” for heads up!)

  34. s.m, to the extent that government is involved in our medical system, there are problems. There are worse problems in Great Britain, such as waiting for even longer periods for essential operations and diagnostic tests. Many people die while waiting. It’s interesting that our politicians are wanting to move more in the direction of socialized medicine, while countries like Great Britain and Canada are moving away from those systems and allowing more privatization in their systems.

  35. I’m shocked, I say, shocked to once again see a discussion on socialized medicine in which the only libertarian writer with direct experience with a socialized medical system is ignored. It’s just a coincidence that he admitted that their (French) system was superior, of course.

    http://www.washingtonmonthly.com/archives/individual/2005_04/006078.php

  36. I have a simple solution to the healthcare “debate”: if you prefer government-administered healthcare, pay for it with your OWN taxes. If you prefer being responsible for your own healthcare, pay for it with tax-exempt wages. Of course, whichever system provides better care will receive more revenue, thus, in turn, being better able to provide such care in the future. Some of you might deride this idea as ‘government-as-insurer,’ but in a socialized state, that is precisely what the government is. Let it compete then, and utilize only those monies that are allocated to it (no ‘borrowing’ from Social Security; no issuing more Treasury bonds; no scapegoating the successful).

  37. Jake,

    It’s argument by anecdote that’s blurring. And frankly, your distinction is one without a difference.

    But, speaking of anecdotes:

    http://ezraklein.typepad.com/blog/2007/06/a-letter-to-blu.html

    I’m not sure how a picture of an old guy in filth refutes that, but I could be missing something.

  38. “Once again, anectdotes (and now pictures!) are trotted out as some sort of defense of our pathetic health care system. That people who favor health-care reform could easily trot out 10,000 anecdotes (and pictures!) of their own is not mentioned.”

    Granted, our system needs improvement, but socialized medicine is not the way to go. We need more competition in the market place to bring down costs. The problems with our system are caused by government intervention into the system. The last thing we need is more government intervention.

  39. highnumber speaks deep truth. This system has the advantages it does because it retains some free market components. On the flip side, we have some significant problems due to the parts that none dare call socialized medicine. Since our system has serious flaws, and the socialized ones have even more serious flaws, how about we try, oh, something with less socialism and more capitalism. There! I said it!

    [Cue maniacal laughter]

    By the way, dare I suggest that the United States’ system is pretty much the engine of medical advance that other healthcare systems depend upon? Is that because we have socialized medicine? Heck, if the FDA weren’t becoming a brick wall to the introduction of new medicines and techniques, we’d probably all have bionics now. B-b-b-bastards!

    My anecdote is about an ex-girlfriend who moved to Vancouver to teach at a university in BC. Pretty much every professor with means there had some sort of access to U.S. medical services. No idea why. Oh, and this woman was quite liberal and quite pro-socialized healthcare before going to Canada. Which she loved, otherwise, except for their weak, weak dollar and their lack of a national cuisine.

  40. Sorry, I stopped reading after the weak-assed insult to Moore’s patriotism.

    Let’s try for more robust attacks next time, shall we?

  41. I’ll take the number of system related deaths in our current system on my own head as a defender of it being less bad than alternatives.

    Will advocates of single payer take on their heads deaths due to the destruction of innovative incentive in a socialized system? If we don’t do it and nobody else does either, I’m talking about a lot of sick and dying people.

    If Moore and his cohort get what they want, and they do this without very careful consideration to innovation, they will be responsible for hundreds of thousands of suffering people. No hyperbole. No soapbox. Future dead and suffering people that could have been saved by maintaining an incentive to invest.

  42. Check out:
    http://www.manhattan-institute.org/html/herzlinger.htm

    She uses the swiss for examples of a “third way.”

  43. From Shocked’s article:

    “I said “Look, if we made twice as much money, we’d probably prefer American health care for a severe crisis. But we don’t, so we don’t.””

    Consider the implications. So, nobody pays for that severe crisis stuff. Doesn’t that mean it doesn’t exist? Wasn’t everything currently covered under the French system at one time really expensive cutting edge stuff?

  44. “Oddly this appears to be one of the few issues that is entirely either/or.
    Either we keep the system as is, or we adopt socialized medicine. If only someone could see a new way…”

    There are free market alternatives. It doesn’t have to be either/or. There are several books out there that present various alternatives.

    “Why does the system work the way it does? What are the causes of the inefficiencies? Why won’t anyone take another look at the problems?”

    These problems have been dealt with. Big insurance companies and Medicare and Medicaid are driving up costs. A one payer system would drive up costs more if it wasn’t for its policy of rationing services.

  45. And frankly, your distinction is one without a difference.

    Really? Take a look at these two statements:

    1) “It is not the case that socialized health care systems are efficient.”

    2) “America’s health care system is the best imaginable.”

    Do you not see any difference at all?

  46. Abdul
    Umm . . . where I live the “uninsured poor” get free health care, for emergencies and meds anyway.

    Xanthippas
    Moore is the one favorably comparing the Cuban system to our own.

    “people who favor health-care reform could easily trot out 10,000 anecdotes”

    Yet, strangely they don’t.

  47. One can argue that socialized medicine is immoral without even questioning whether or not it is effective.

    Socialized medicine cannot succeed without rationing, period.

    So, in blunt terms, socialized medicine means that those with the resources (cash or insurance) to purchases whatever medical treatment they want or need to ensure should be denied the right to make those purchase so that less fortunate people get medical attention that they cannot afford.

    I even got Dan T to admit that was accurate and necessary one day.

  48. highnumber,

    It’s not a sensitivity towards Moore, so much as an annoyance at the dishonest propaganda of Mr. Moynihan. I’d have been equally irritated regardless of the target of such a cheap smear.

    Josh,

    I haven’t opined about the article. As I said, I didn’t read it. Other than that, your observation that I declared the article invalid is quite incisive.

    kohlrabi,

    It’s a statement about grammer made for the purpose of insulting Moore’s patriotism.

    Political spin doctor’s get paid good money to manipulate people into ignoring what’s in front of their eyes. There is no reason to so exert yourself doing their work for them.

  49. carrick,

    That’s why very few people actually support “socialized medicine,” as you’re using the term.

    Most of what health care reformers discuss is a combination of socialized insurance, aid for the poor and children, or the Massachusetts mandate thingy.

  50. Matthew,

    “”people who favor health-care reform could easily trot out 10,000 anecdotes”

    Yet, strangely they don’t.”

    Huh-wuzza? Say, Matthew, I heard about this Michael Moore film you may find interesting…

  51. M.C. Moynihan,

    Did we really need another Michael Moore jeremiad?

    D.A. Ridgely,

    Sometimes ignoring is the best policy.

  52. Ultimately, I think the US may end up adopting Barack Obama’s plan. Hopefully, someone will eventually have the balls to change the stupid tax code.

  53. Most of what health care reformers discuss is a combination of socialized insurance, aid for the poor and children, or the Massachusetts mandate thingy.

    Yes that is true, but in his film, Mr. Moore has focussed attention on single-payer systems which are essentially socialized medicine and not on the the plans of these reformers.

  54. Umm . . . where I live the “uninsured poor” get free health care, for emergencies and meds anyway.

    Precisely why the only viable solution is to mandate that any insurer in the US insure based on the average risk of the average american, thus everyone pays the same. We already pay for the uninsured poor, but at e-room prices. By doing it this way, and mandating that one must offer individual insurance, the force of the market will be brought to bear against the medical overhead which does nothing but increase costs. Yes, some people’s lifestyle choices will cost more, but they’ll probably die earlier so the true life cycle cost will get a bit better.

    Would be much better than a socialist system, and keep the govt out of things. Since you’d be free to leave at any time (since, regardless of your med risk you have to be insured at the rate of an average american and individual insurance couldn’t be denied), the current state of the insurance company trying to subdivide and exclude would go away, as would the problem of people unable to be insured due to their employer insurance.

    Perhaps not so libertarian, but this is one place where I see the inequity of the current system as needing something.

  55. I like Moore like I like John Stewart.

    But neither one has a fucking clue how to actually fix things.

    Also, it is hard to take anything Moore says about healthcare seriously…I mean he is a walking double knee-replacement, angioplasty and diabetes candidate if there ever was one.

  56. Precisely why the only viable solution is to mandate that any insurer in the US insure based on the average risk of the average american, . . .

    While were at it, why don’t we make people in Iowa subsidize car owners in California so they don’t have to pay outrageous premiums for car insurance. We can let people in North Dakota subsidize home owners in Florida so they don’t have to deal with the consequences of living in a hurricane zone. Boy, this idea has lots of cool applications.

  57. One thing few people ever notice is that the primary reason that health care is so “expensive” here relative to other industrialized countries is that we pay our health care professionals substantially more than anyone else. Anyone who has ever run a business (hospital, doctor’s office, or dog kennel, for that matter) knows that labor is a tremendous part of the total bill…usually the vast majority. Any switch to a “European-style” system would require to slash the pay of doctors, nurses, aides, and technicians by 30% or more. I doubt any politician is going to use that as a slogan.

    Delving into this a bit further, part of the reason that these countries can get away with paying such piss-poor salaries is that in general, they subsidize the education of health-care professionals more heavily than we do. So France, for example, might spend an extra two billion dollars a year training its doctors, but then pay them two billion dollars less – a wash (assuming we ignore interest and all that jazz for the sake of a hypothetical). France then uses this to claim that it is both more generous because is spends MORE on education, and smarter because it spends LESS on health care…when in fact, all it has done is some accounting tricks.

  58. carrick,

    I’ve seen “single payer” refer both to systems that ban private-sector medical care, and to systems that do not.

  59. While were at it, why don’t we make people in Iowa subsidize car owners in California so they don’t have to pay outrageous premiums for car insurance.

    Ooh! Ooh! Mr. Carrick! Pick me! Pick me! Ooh! Ooh!

  60. I’ve seen “single payer” refer both to systems that ban private-sector medical care, and to systems that do not.

    That’s a big problem with the whole debate…defining the language of the debate.

    Which Moore’s stream of anecdotes does nothing to contribute to. It only further obfuscates the debate, which is the most frustrating part of any propaganda.

  61. 2 things – photos of a shithole nursing home as an indictment of their health care system work no better than photos of a shithole nursing home in Appalachia as an indictment of our system.

    2nd – Catastrophic care! Huzzah! Get it while you’re young for 45 bucks a month, and you’re good until you need the prescription discounts for Cialis in your golden years. What’s this health care crisis I’ve heard so much about?

  62. To solve the healthcare crisis, three things need to happen:

    1) An 200% increase in the number of medical schools in the United States.
    2) An end to the tax exemption/deduction of group health insurance costs.
    3) A 50% decrease in the “length” of the drug pipeline.

    These three changes solve all the problems with the US healthcare system: Limited supply, third-party payment and insulation from market forces.

  63. EE,
    Also, the high barrier to entry into the health care field. As this hier story shows us, the AMA is just like any other trade union, fighting tooth and nail against competition. Why do we need to see a $200,000 worth of education MD for a sore throat or common cold when PAs or RNs could provide the same service with referral options for much less?

  64. Dagens Nyheter is a Swedish Liberal magazine btw.

  65. Don’t see how pointing out that the Euro’s solution sucks too is an endorsement of our fercockta system.

  66. joe,

    Are you seriously claiming that a native English speaker saying “they” instead of “we” is a simple grammatical mistake? We’re not talking about possessive of a gerund, or some obscure grammar rule here; we’re talking basic pronouns that are used in every other sentence.

    While I don’t think Mr Moore would actually explicitly say that he’s not an American, the fact that he (possibly unconciously) tries to disocciate himself from Americans speaks volumes.

  67. Far be it from me to defend socialized (or semi-socialized) health care medicine: and I won’t even try. I must say that my experiences with the Irish health care system have been quite good.

    My first son was born in Dublin by C-section and the wife was in the hospital for 5 days: total cost, 1,500 euro. Said son later broke his arm. I was imagining untold hours in the A&E and a huge bill. We got there and the receptionist asked if we had medical insurance. I ruefully said no and she replied “well that will cost you 40 euro before we can see him”. That 40 euro was the entire cost for consultation, x-rays, cast, and 2 follow up visits.

    Just don’t ask about the taxes we paid on everything else while we lived there. As for serious illnesses I can’t say, but routine medical care was cheap and efficient. One caveat: if you show up at the A&E at 4:00 on Saturday morning you can expect a long and unpleasant wait, and I’m not telling THAT story.

  68. Recently when talking about how voters are ignorant of economics several H&Rers remarked on the stupidity of their fellow Americans. I guess they are anti-patriotic? I agree with Joe, this Moynihan (where did this guy and his talk radio-talking points come from, National Review?) seems to specialize in un-thoughtful hatchet man posts (against the liberal bogey-man of the day, Gore or now Moore).
    “I argued that while in the past Michael Moore has had an easy time winning converts in Europe, it’s going to be a harder slog with this film.” I think the opposite. I think Moynihan (or more likely his pay-masters) is worried a lot of people will agree with Moore. I myself think Moore is quite the flawed filmmaker, so why are they so relentless in hacking away at his movie? Answer: the American public, despite being cajoled, manipulated and distracted by millions of dollars of lobbying money to believe otherwise, have just had one too many crappy experiences with our crappy system.
    Moynihan marshals some impressive evidence, eh? A buddy in Irreland told him a story, he read some stories on Andy Sullivan’s page, and even has PICTURES of a gross place in Cuba. Amateur hour at the Apollo…

  69. Ken,

    There’s been an awful lot of support for “universal” health care in this country, for a long time. It’s not like this issue just suddenly came out of nowhere (remember HillaryCare?). I don’t think a Michael Moore film is going to matter one way or the other.

    I don’t think that the support is due so much to people being stupid, as to people thinking that “universal” health care = something for nothing. Those who don’t study the issue don’t realize that there are an awful lot of negative side effects to such a system.

  70. Yet, strangely they don’t.

    What blogosphere are you referring to? Perhaps it is the one where liberal bloggers are not constantly referring to failures of the present health care system?

  71. Crimethink-Could it be that they just find their own healthcare to be crappy? That’s not a possibility?
    The fact that there are, like, 50 first world nations and we are just about the only ones with a system like ours might have some of their eyebrows raising as well…

  72. matthew,

    The “uninsured” are insured by medicaid. . . . medicare. . . whatever. The uninsured are fucked. Hospitals will inflate their bills. To get decent healthcare in the US, you have to be rich or poor. Working poor are screwed.

  73. I’ve seen “single payer” refer both to systems that ban private-sector medical care, and to systems that do not.

    On the off chance that joe is still hanging around . . .

    I have never heard or read any commentary that uses the phrase “single-payer system” to mean anything other than the government pays the bills. In fact, it seems to be the most common way to hide the fact that commentator wants the government to pay the bills.

    I doesn’t help the situation in any way if it has become common practice for “single-payer” to mean something else as well.

    I will acknowledge that I have seen single-payer to mean the government pays doctors in private practice as well as meaning the government employs the doctors directly. However, I see little practical impact in that the government will still set the terms for all coverage of all treatments for all medical conditions.

  74. Geez, stop worrying. The American medical profession will never allow Americans to have a rational, affordable healthcare system. You free-market fanatics are safe, so let it go.

  75. Sorry, I stopped reading after the weak-assed insult to Moore’s patriotism.

    Now there’s a surprise from Joe.

  76. I actually wouldn’t give you a nickel for a whole bag full of Michael Moore DVD’s.

  77. The World Health Organization ranks the British healthcare system about 19 places ahead of ours’. France is rated #1, I believe.

    That might explain why George Harrison left London and it’s stellar free health care to have his lung cancer treated in LA.

    So far in my life the only crappy health care I’ve had was courtesy of the US Navy, which offers a fully socialized, single payer health care program.

  78. Are you seriously claiming that a native English speaker saying “they” instead of “we” is a simple grammatical mistake?

    All right, a two-front war! I get to argue with people who think it’s absurd that Moynihan was taking a shot at Moore’s patriotism, and with people who think that Moynihan’s shot at Moore’s patriotism was so plainly deserved as to be irreproachable.

    crimethink, I think people switch around “we” and “they” when discussing the general public all the time, especially when they are making a humorous point. I don’t even think it’s a grammatical mistake.

  79. regarding the debate about taking a cheap shot at Moore’s patriotism: ignoring whether they were talking about a grammatical error or not, I think Moore was out of line. I realize saying that bothers the ‘joes’ of the world who are polarized against the talking heads who deplore the ‘hate america first croud’. I don’t think there is anything wrong with criticizing the US or any of our policies, i encourage it even, but a broad statement like Moore’s does insult me. Where does he get off saying we are some of the dumbest people on earth? That’s not about patriotism, that insults ME not my country.

    Regarding the other debate. I have a few unnecessary anecdotes of my own.
    1. my sister lives in canada and is a liberal who fully supports socialized medicine. ironically, She just traveled to Arizona to have her baby because she was at high risk for complications.
    2. All my health care experience (which is quite a bit, I snowboard a lot and I’ve broken bones on 5 occasions) has been very pleasant, speedy, and professional. Granted, I have excellent coverage because I can afford it. But why is that unfair since I earned my money? Unfair would be taking the money I earned, and using it to pay for leechers.

  80. sorry for the run-on sentences, hope you could follow that rant.

  81. He returned to the hospital for a replacement but, after waiting in the emergency room for nine hours, decided instead to head home and piece it together with DIY tape.

    What magical fairy land of hospitals do yall go to? I’ve waited for 5 or more hours in American hospitals. It seems my wait times are as long as Euros, so I’m more than happy to trade the state picking up my costs in exchange for you bastards waiting as long as I usually do.

  82. hings – photos of a shithole nursing home as an indictment of their health care system work no better than photos of a shithole nursing home in Appalachia as an indictment of our system. -Randolph Carter

    Yeah, but it is nice to show those A**holes wearing the Che Guevara t-shirts.

  83. Edward, sweetie,

    The American Medical Association, founded explicitly for the purpose of keeping doctor’s wages high, has passed a series of laws that limits the number of students graduated by medical schools and the numebr of people who can become doctors.

    They even got the Federal Government to call a projection of 245 doctors per 100,00 population a glut, and a problem to be solved by ordering medical schools to graduate fewer doctors.

    In other words, much of the high cost of medical care is the result of the government limiting competition in the medical field. This is a well-known phenomenon called “rent seeking”. You might want to read up on it, and stop embarassing yourself by confusing managed trade with a free market.

  84. Anytime individual cases are presented
    as if to represent a whole system
    then you can assume bias is upon you.

    Measure the means of the care delivery.
    There are ___ x-ray machines per capitia.
    ther are ___ CAT scan…
    There are ____ MRIs…
    ___ doctors, ____ ERs, ____ heli-ports/choppers,
    how many, kidney, heart, lung transplants,
    how many pharmacies, hospitals, and how close
    and so on.

    If there isn’t the means for modern medicine
    then there can’t be the delivery of it.

  85. My Irish anecdote–this winter my 97 year old great aunt passed away. My sister from Boston, who works as a child psychologist in Mass General, was very disappointed in the Irish hospital, North of Dublin in Co. Louth.
    My aunt was in the “women’s ward”, which she said was just a very large room full of beds. No semi private or private rooms.
    Intensive Care was just a room with a bed. No heart monitoring machines, etc.
    Worst of all, the nurses seemed to lack basic hygienic training. They were very, very careless with how they utilized their sanitary rubber gloves.
    That’s her report.

  86. he American Medical Association, founded explicitly for the purpose of keeping doctor’s wages high, has passed a series of laws that limits the number of students graduated by medical schools and the numebr of people who can become doctors.-tarran
    Does anyone remember a few years ago how Columbia University was found to be accepting government grants NOT to train doctors?

  87. Michael C. Moynihan,

    Not to defend Moore, but one could probably find equally disturbing videos and pictures in healthcare facilities in the U.S. In other words, while anecdotes can be a powerful form of argumentation, they are the least persuasive sort of evidence.

  88. Not to defend Moore, but one could probably find equally disturbing videos and pictures in healthcare facilities in the U.S.

    Walter Reed comes to mind.

  89. Recall that Communist Romania’s health care system was similarly praised by some observers as the “one good thing” in the otherwise deplorable Ceausescu regime. Only when he kicked the bucket and the outside world saw images of feces encrusted, malnourished orphans chained to their beds did that perception change.
    I predict we will see something similar in Cuba when Raul dies.

  90. Michael Moore was great in “Team America”. Bring it all down!

  91. Deus,

    I don’t doubt that Cuba’s system of healthcare is screwed up.

  92. I’ve waited for 5 or more hours in American hospitals.

    That’s because there are beds full of non-paying drug seekers. Or Canadian patients sent down here because their healthcare system is tanking faster than a thing which tanks very fast.

  93. “They are possibly the dumbest people on the planet,”

    Even if you replaced “they” with “we”, I fail to see how calling your fellow countrymen possibly the dumbest people on the planet is anything but unpatriotic, hateful, and bigoted. In fact, I might just consider it a weak-assed insult that prevents me from ever listening to what Michael Moore has to say.

  94. joe,

    If you read what Moynihan wrote, all he’s doing is repeating what Moore said, and noting that he used the pronoun which refers to groups one does not belong to, to refer to Americans.

    Do you dispute either of those things?

    Considering that the use of pronouns is a pretty basic skill for a native English speaker, it’s hard to believe that Moore just made an obscure grammatical mistake; it’s more likely that he’s trying to disocciate himself from Americans. But, that’s my analysis, not Moynihan’s.

  95. crimethink, I think people switch around “we” and “they” when discussing the general public all the time, especially when they are making a humorous point. I don’t even think it’s a grammatical mistake.

    I’m not crimethink, but here goes:

    1) They are idiots.
    vs.
    2) We are idiots.

    The word “they” seems to indicate that the speaker is referring to a group that differs from himself in some capacity. The word “we” seems to be inclusive, as if the speaker is including himself in the statement he is making.

    Well, I’m sure you’ll argue with that, joe, but I thought I’d try.

  96. MJ,

    A lot of the blame for liberals going ape-shit whenever someone’s patriotism is called into doubt has to be laid at the feet of the right-wing zealots who claim that anyone who disagrees with them is anti-American.

    There are times when it’s totally appropriate to question someone’s patriotism, for instance, when they call their countrymen the stupidest people on the planet. But unfortunately the Coulters and Hannitys of the world have given the liberals an excuse to dismiss criticism of some of their, well, unpatriotic comrades.

  97. Anyone have a link to the Daily Mirror article? That would seemingly solve the issue righ there.

  98. Did Moore profile Spanish or French healthcare, BTW?

  99. ++tarran

    Rent-seeking is a definite problem in nearly every industry. Allowing nurses to perform more roles would also alleviate a lot of the cost of medicine in the US. As 21st Century “nurses” are probably better-trained and more able than most 19th Century doctors. You just have to drop the magic word “doctor.”

    However, I still maintain (as detailed in this thread ) that the increasing accuracy with which we can predict medical problems, coupled with other issues like adverse selection and asymmetrical information, means that the cost of “insurance” for certain people will gradually approach what the cost of their outright care would have been in the first place– or at least increase until it becomes unaffordable. One market “solution” to this is to provide funny money insurance which somehow covers nothing and is prone to being retroactively cancelled. I think Moore’s movie does a service in pointing out this kind of bogus coverage. Unlike him, I don’t blame greed or bad guys– I think the result is simply the inevitable working out of economic forces. But it’s there nonetheless.

    We’re not talking about market failure in toothpaste here. Insurance is a weird-o financial instrument and I don’t see how it can ever be profitable to supply cheap medical insurance to the sickly, cancer-prone and poor.

    The market is happy to provide insurance on a leaky boat. It does so at the cost of one boat.

  100. Not in the Mirror’s online archives. They don’t seem to go back that far.

  101. http://www.who.int/inf-pr-2000/en/pr2000-life.html

    “The position of the United States is one of the major surprises of the new rating system,” says Christopher Murray, M.D., Ph.D., Director of WHO’s Global Programme on Evidence for Health Policy. “Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries.”

    The WHO cites various causes for why the United States ranks relatively low among wealthy nations. These reasons include:

    In the United States, some groups, such as Native Americans, rural African Americans and the inner city poor, have extremely poor health, more characteristic of a poor developing country rather than a rich industrialized one.
    The HIV epidemic causes a higher proportion of death and disability to U.S. young and middle-aged than in most other advanced countries. HIV-AIDS cut three months from the healthy life expectancy of male American babies born in 1999, and one month from female lives;
    The U.S. is one of the leading countries for cancers relating to tobacco, especially lung cancer Tobacco use also causes chronic lung disease.
    A high coronary heart disease rate, which has dropped in recent years but remains high;
    Fairly high levels of violence, especially of homicides, when compared to other industrial countries.

  102. highnumber,

    Yeah, I could never find anything but a second-hand account of the Mirror article. Anyway, I simply wondered whether he was referring to Americans as a whole or a group of Americans.

  103. tarran, honey

    Thanks for the link to the Wikipedia article on rent seeking. How do you propose to deal with rent seeking? Have the state outlaw it? Ah, but that would be government intervention, wouldn’t it?

  104. Um, Edward. Rent-seeking *is* government intervention.

  105. I would never question a person’s patriotism, but its a known fact Libertarians are slightly more patriotic than Democrats and Republicans.

  106. jhn,

    Not necessarily.

  107. Grotius– you’re right if all you mean is that tradesmen are always free to band together to voluntarily limit supply.

    But government action is needed to prevent third parties from entering the market. The tradesmen might be able to sell their goods (“I’m an AMA doctor!”) to the public as being superior to non-cartel goods, but their market control cannot reach the point of actually preventing competition through legal means without some government involvement.

  108. Is this the same World Health Organization that ranks Cuba as a good country for health care?
    As far as Moore’s patriotism, it is not possible to attack what does not exist.
    Moore has made a large fortune selling bs to American suckers for years. If he is finally called for doing so, well schills generally do wake up to a con.

  109. I think when you really get down to it, the problem with the US system is that it makes disease profitable, and thus desirable. For a healthcare company to prevent a sickness is to rob itself of the profits that can be made by treating it.

    And if there are no real diseases going around, you make some up: “depression”, “ADD”, “erectile disfunction”, etc.

  110. As far as Moore’s patriotism, it is not possible to attack what does not exist.

    If patriotism is the last refuge of a scoundrel, so is attacking someone else’s patriotism. Seems odd that a man who hates his country would spend so much of his own time and money trying to change it for what he thinks is the better. Speaking of which…

    I would never question a person’s patriotism, but its a known fact Libertarians are slightly more patriotic than Democrats and Republicans.

    A “known fact” eh? I’d like to see a citation for that. Wishing for police to leave you alone and for big corporations to run free across the land, does not necessarily a patriot make.

  111. Joe,

    Please. That you see claims of anti-patriotism there doesn’t mean it exists. What’s plainly in front of my eyes is exactly what I’ve said in my previous post. It’s you who is manufacturing some other meaning. Comparing me to a political spin doctor does little to hide that.

  112. I think when you really get down to it, the problem with the US system is that it makes disease profitable, and thus desirable. For a healthcare company to prevent a sickness is to rob itself of the profits that can be made by treating it.

    Whereas, a govt bureaucracy or govt contractor never has any incentive to make work for itself? For our public school system, low test scores and student ignorance are good news, since these things never fail to bring calls for more money for the schools. For the military-industrial complex, overseas threats are good for business, which is one reason they want us to be messing around in as many troubled regions of the world as possible, making as many enemies as possible.

    And if there are no real diseases going around, you make some up: “depression”, “ADD”, “erectile disfunction”, etc.

    ADD is indeed debateable, but clinical depression and ED are well documented phenomena.

    Now, I would agree that there are a lot of people who aren’t really sick who get treated for these problems, but that doesn’t mean that the problems don’t exist for any of them.

  113. If patriotism is the last refuge of a scoundrel, so is attacking someone else’s patriotism. Seems odd that a man who hates his country would spend so much of his own time and money trying to change it for what he thinks is the better.

    Yeah, Michael Moore is a true bastion of self-sacrifice. Even after all his valiant, tireless efforts to change America for the better, he hasn’t gotten a single dime, or an extra minute of media attention in return.

    Sarcasm aside, I have no reason to doubt someone’s patriotism because of their good-faith efforts to make our country better. Criticisms of US govt policy, or even trends in our society, are the lifeblood of our freedom and vibrancy. However, to lump all Americans together and flat-out insult us, while implicitly excluding oneself from that insult, is not the mark of a patriot.

  114. “and for big corporations to run free across the land”

    tweet!

    foul!

    overextension. That’s the “corportarian” position.

  115. Well, crimethink and MJ, since Moynihan didn’t think it necessary to provide any context for Moore’s statement, I guess we’ll never know what point, or joke, he was making.

    kohlrabi,

    Please. That you see claims of anti-patriotism there doesn’t mean it exists.

    In case you haven’t noticed, pretty much everyone else on the thread sees the rather obvious smear of Moore’s patriotism, too. Most of them are endorsing it.

    I guess there are none so blind as those who will not see.

  116. Whereas, a govt bureaucracy or govt contractor never has any incentive to make work for itself? For our public school system, low test scores and student ignorance are good news, since these things never fail to bring calls for more money for the schools.

    A valid point, but we know that legally a corporation serves one purpose – to make money for its shareholders. I don’t think that a government entity exists for the stated purpose of making work for its employees, even if it sometimes happens.

    I mean, it’s really doubtful that school system employees intentionally try to lower test scores of their students. But there’s no doubt that HMO’s intentionally try to make as much profit as possible.

  117. It is true that nurses are better educated with higher skill levels than ever before, and could probably pick up a lot of the work that we currently see doctors for. However, it’s also true that there is an ongoing shortage of nurses that is likely to get worse because of the current demographic shift — the population is getting older and requiring more health care, but baby boomer nurses are themselves getting older and retiring. Not to mention there are regional shortages of other types of healthcare professionals such as physical therapists, and nurses are often tapped to do their work.

    Of course, physical therapists have struggled and won the fight to make a PhD entry level for their field — having the barrier to entry raised so high it’s no surprise we’re getting shortages there as well.

    There will always be struggles over scope of practice boundaries between healthcare professions. Doctors don’t want nurses doing their work, and neither do physical therapists. Dentists don’t want hygeinists doing their work. Never mind that dental care is among the most difficult for poor and rural people to access. It seems that dentists just don’t want to live in the hinterlands and don’t want to accept medicare and medicaid.

  118. Dan T,

    Are you saying HMOs profit from disease? Their best customer is one who never has to see his or her doctor. You might want to think about that again.

  119. carrick,

    I am familiar with the use of the term “single payer” to refer to the government taking over the role of health insurance providers.

    Whether people pay out of pocket for services above and beyond what the Single Payer would cover differs from plan to plan.

  120. Walter Reed comes to mind.

    And let us recall who owns and runs Walter Reed. Why it’s none other than the government. The same government that all the lefties want to administer all of our health care.

  121. Joe,

    “In case you haven’t noticed, pretty much everyone else on the thread sees the rather obvious smear of Moore’s patriotism, too. Most of them are endorsing it.”

    That’s entirely irrelevant. FWIW, I think they’re wrong as well, but that’s beside the point. I will stand by my first statement until I see compelling evidence to the contrary. The original comment was a slam against Michael Moore for claiming all people in a given set are stupid when he in fact belongs to that set. Whether the set is American or Male or what-have-you means nothing to me. MM is the one who identified it. Quoting Proverbs has as much value as comparing me to a spin doctor.

    This is all very tiresome. Simply, your claim that Moynihan’s article was bogus because of a weak slam on Moore’s patriotism holds no weight given what Moynihan actually said. That you and 96% of commenters supply addition meaning and context doesn’t change that. Ad Hominim attacks don’t change that. Quoting Proverbs doesn’t change that.

    Consider:

    “and calling Caucasian Men, which he clearly doesn’t count himself among, stupid (“They are possibly the dumbest people on the planet,” he told the Daily Mirror)”

    “and calling Michiganders, which he clearly doesn’t count himself among, stupid (“They are possibly the dumbest people on the planet,” he told the Daily Mirror”

    “and calling Adults, which he clearly doesn’t count himself among, stupid (“They are possibly the dumbest people on the planet,” he told the Daily Mirror)”

    Moynihan’s statement has essentially the same meaning.

  122. I’m going to run by Moore’s house on the 4th of July and see if he’s flying Old Glory.

  123. The thing speaks for itself: saying that someone “doesn’t even consider himself an American” is not only obviously a shot at his patriotism, it is so obviously a shot at his patriotism that it could appear in a reference book as an example of an attack on someone’s patriotism.

    All you’ve done is tease out the language behind this shot at Moore’s patriotism.

    This is the type of thing that you have to try really hard not to understand.

  124. Crimethink,

    ADD is indeed debateable

    Not really. To say so would require ignorance of how behaviorally based disease categories are defined and diagnosed.

    It may be a diagnosis that is difficult to make and over used, but the actual disease is quite real.

  125. I was going to go off on this post, but I see that Grotius has covered things nicely. I have been quite impressed with Mr. Moynihan’s ability to lower the level of discourse on Reason.

    I am surprised he is allowed to post/write here. And it is not like Reason has the highest quality standards around.

  126. Joe, for fuck’s sake, drop the patriotism bit.

    It’s annoying and brings nothing to a discussion about American health care.

  127. And let us recall who owns and runs Walter Reed. Why it’s none other than the government. The same government that all the lefties want to administer all of our health care.

    Yes, but that’s the evil, right-wing, gay-hatin’ armed-to-the-teeth, racist government. Not the warm, fuzzy, loves-you-for-who-you-are government.

  128. Joe,

    Again with the assertions. I’m afraid this is going nowhere as I believe my prior post makes my case and I don’t want to repeat it since there is nothing new to address.

    “This is the type of thing that you have to try really hard not to understand.”

    Couldn’t have said it better myself.

  129. No, mediageek, it’s the underfunded, unprepared, cost-cutting, “privatized” government.

    The operations that Walter Reed hase been carrying out for decades – the in-patient serives provided in the main buildings – have been and continue to be excellent.

    The scandal has been in the new out-patient facilities…

    Wait, are all of these details boring you? OK, yes mediageek, government bad. Bad bad bad. Government government government.

  130. joe,

    You’re correct that Walter Reed is technically run by a private organization. However, a private company with the govt as its only customer will suffer from all the same lack-of-competition problems that plague govt agencies, and it typically performs at least as badly, and quite possibly worse than, an agency of the govt itself.

    So, I don’t see the Walter Reed situation being relevant for either side of the arg.

  131. Evidence is important in this discussion.
    There is not a lot of good evidence out to support either side of the debate. The World Health Organization provides the best attempt at providing that evidence.

    It is the best place to start.
    http://www.who.int/whr/2006/en/index.html

    http://www.who.int/whr/2006/annex/06_annex3_en.pdf
    expenditures

    http://www.who.int/whr/2006/annex/06_annex1_en.pdf
    basic outcomes

    http://www.who.int/hrh/documents/whr06_background_papers/en/index.html
    More detailed analysis

    http://www.who.int/hrh/documents/inequality_access_measurement_issues.pdf
    A look at the difficulties measuring inequality of access

    I do not think health care is a federal problem, but one for the states. But that is just my opinion. 50 single payer systems competing for outcomes make more sense than a Canadian style system, but tracking outcomes will be an important role the feds can provide.

  132. crimethink,

    I agree, Walter Reed is not relevant. Nobody is proposing nationalization of medical care.

  133. Dan T,

    Are you saying HMOs profit from disease? Their best customer is one who never has to see his or her doctor. You might want to think about that again.

    You are correct, for whatever reason I stuck “HMO” in there when I was kind of talking about the healthcare industry as a whole.

  134. I think that showing that photo of the man in Cuba only serves to futher illustrate the point that that our healthcare system is worse than that…maybe not on the same level…but on the level that not everyone is afforded access to it.

  135. In my opinion, such anecdotal examples are of very limited value when assessing national healthcare policy.

    Moore:
    A story about someone from Ireland with a problem with the Irish healthcare system = irrelevant anecdote.
    A story about someone from the U.S. with a problem with the U.S. healthcare system = science.

    I liked Moore through Bowling for Columbine.

    It’s interesting that how brilliant Moore is is inversely proportional to how much the viewer knows about the subject.

  136. highnumber | June 26, 2007, 4:23pm | #
    I liked Moore through Bowling for Columbine. Not that I agreed with everything he said or did, but I found him amusing, even thought provoking at times. Everything seemed to go downhill from there. Last few years, he’s just been a shrill nut.

    How does anything Highnumber says contribute to that opinion?

  137. crimethink: From what I see most of the time liberals whine about insults to their patriotism, what actually was being criticized was their wisdom and judgement. Nothing puts a legitimite critic off his game like fake self-righteous indignation.

    joe: A fuller version of Moore’s quote renders the they/we thing moot:

    “They are the dumbest people on the face of the earth…in thrall to conniving, thieving, smug pricks…We Americans suffer from an enforced ignorance. We don’t know about anything that’s happening outside our country. Our stupidity is embarrassing.”

    On the other hand, I think it makes even more hateful. I mean, yes, the American political class sucks, but I don’t think they are any appreciably worse than any other Western country.

    What I really don’t understand joe is how you think Moynihan’s writing about what Moore said is beyond the pale of civil discourse, but Moore’s comment is defensible.

  138. Hell, maybe I’m naive but anecdotal or not, those pictures of the Cuban nursing home are severely beyond the pale. I’m sure there are abusive and neglectful nursing homes in the U.S., but I find it hard to believe there are any as bad as those. The conditions in that nursing home are beyond unsanitary. They are positively squalid.

  139. Vanessa,

    I would say not maybe… you are naive.

    4 pictures does not tell much of a story about a nursing home, let alone an entire health care system. I am sure someone could come up with equally horrific pictures somewhere in the US. The facility would be in a nicer building, of course.

  140. If I were trying to make a comprehensive argument about the quality of a healthcare system, and if the quality of my argument might actually have material consequences for said system, I would not rely on a few photographs. So certainly, I would not base a comparison of two healthcare systems on a few photographs.

    But I think that 4 pictures as horrific as these tell a big story about that particular nursing home. But if you’re so committed to keeping an unbiased stance…well good for you I guess.

    As for what these photos have to say about Michael Moore and his praise of the Cuban system relative to ours, to say the least, they are suggestive that he did not do an adequate job of attempting to disconfirm his argument that Cuba’s system is better. If he attempted it at all, that is.

    Anyhow, as is common for me I bothered to comment when a thread is effectively dead.

  141. Experts have talked about this before. How many times have you read about the importance of ‘adding value’ for your audience? How many times have you read about ‘building trust’ with your readers/prospects?
    Many, many times. You know it well. Every marketing guru has spoken about this topic. I’m sick of hearing it. But it STILL bears repeating.

    http://www.onlineuniversalwork.com

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