July 2, 2007 – Gin and Tacos

So I took in Michael Moore's latest on Saturday evening. Some of the criticism the movie is receiving is deserved, and some of it is not. Please be warned that the following will contain some "spoilers" inasmuch as that concept applies to a documentary (hint: there is no universal healthcare by the end of the film)

Before I talk about the specifics, it's confession time. For 3.5 years prior to my graduate career, I was a manager at a collection agency that dealt solely with medical accounts. Nothing in Sicko shocked me. A casual viewer might be tempted (especially a casual Rush Limbaugh-loving viewer) to treat Moore's anecdotal evidence as mere anomalies in an otherwise functional system. I cannot stress enough how false that assumption is. We did not deal with uninsured people (neither does Sicko). What we did was simple. Joe has Insurance. Joe gets in a car wreck and needs $18,000 in surgery, ER, and rehab. Insurance investigators locate a technicality that allows them to retroactively void what Joe thought was a legally binding contract. Hospital returns money to Insurer, refers Joe's account to Collectors. Collectors take Joe's assets – liquid or extremely un-liquid (read: house, car, etc) to pay bill.

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As you can imagine, this job did not make me feel particularly good. I graduated college with a lot of debt and I needed to make some money. Real money. It paid very well (as you might imagine, it is hard to get people to do such a job for very long). I do not, as the PI Moore interviews in the film stated, believe that bad-mouthing the system atones for my participation in it. Nor do my excuses excuse it. I'll probably be guilty about some of the things I saw for the rest of my life. Truthfully, I try not to think about a lot of it.

I digress. My point is that the tragedies Moore discusses – even though he certainly cherry-picked the available anecdotal evidence to find shocking and/or ludicrous examples – happen all the damn time. Every day. My personal experience is that the entire health insurance industry would like nothing more than to reject every claim they have ever been asked to pay, and there is no depth to which they will not stoop to avoid paying whatever they can feasibly avoid.

The criticisms of the film are, broadly speaking, as follows:

1. A whitewashed / "overly positive" depiction of other healthcare systems, namely Cuba. There is little doubt that Moore and his crew received better treatment than the average Cuban would get. But isn't that true of anywhere that Michael Moore and a camera would show up? If he went to an American hospital, when the director got a frantic phone call that "Michael Moore is here with a camera crew and some patients" you can bet that they'd get red-carpet treatment. They'd get immediate service from a whole team of doctors.
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And they sure as hell wouldn't be shuttled into a lobby and forced to wait for hours. So the Cuban healthcare system did in fact put on a show for the cameras. That's an unavoidable consequence of recording anything: the mere act of observing something fundamentally changes it.

2. Acceptance/repetition of Cuban government healthcare statistics. Moore should be ashamed of himself on this one. Everything – and I do mean everything – that Castro's government has ever released in the way of statistics is pure fabrication. He learned from the Soviets, after all. Whether it's GDP, population size, economic equality, education, or healthcare, you can rest assured that the Cuban government's self-reported statistics are fantastical bullshit.

3. Moore violated the prohibitions against Americans entering or spending money in Cuba. So do 2 million (Republican) Cubans living in Florida every year, and the government has absolutely no problem turning a blind eye to that. If the Fed even loosely enforced this law, I could see a problem. But Cuban expatriates visiting family via a third country is a well-established, decades-old industry in Florida.

4. British, French, and Canadian systems are presented as flawless when in fact there is massive public dissatisfaction with them. This is the absolute linchpin of anti-Universal Care right-wing alarmism in the US. Nine-month waiting lists, unqualified doctors, crumbling facilities, Creeping Socialism, and so on. Oh, the Horror, the Horror. On the one hand, Moore does downplay things like waiting periods. In Canada, for instance, elective surgery waiting periods are about 4 weeks (as opposed to our Free Market system in which HMOs routinely require 8-12 weeks to see a Gatekeeper, and God help you if you need a specialist). What these alarmist, Red Scare hacks never adequately explain, however, is why these democratic nations continue using these systems if they're just so horrible. They have elections in Canada, right? Britain too? If the systems were horrible communist gulags with year-long waits to receive substandard care, you'd think that some opportunistic political party would suggest a change, no? And they'd win quite a few votes, no?

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I mean the system as described by Gingrich/Frist/et al sounds like something that only slaves and peasants would have to endure. Yet Canadian single-payer and the British NHS both enjoy almost unanimous, thoroughly bipartisan support (Stephen Harper is a supporter, albeit he proposes more provincial discretion). Britain has privatized 50 different industries since the fall of Labor in the 1970s. If people hated the NHS, it would have been the 51st. But Thatcher didn't dare touch it.
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Why not?

5. Moore oversimplifies many issues. It's a goddamn 90-minute movie. Not only is it required to be entertaining but it also must be succinct. It's not a doctoral dissertation. It's a film made by a human being with one eye on marketability and the other eye on getting its message through effectively. Emotional resonance is what they aim for. It's a movie.

6. The Veterans' Administration system proves that government-run healthcare is not viable in the US. The VA scandal proves only that a woefully-underfunded program will provide substandard care. Stunning, really.

The crux of the film, in my opinion, addresses the American psyche moreso than the healthcare system. Why are we the only industrialized nation that lacks universal care? When we see Haves and Have-Nots, why is our reaction "the American dream" of succeeding and making sure we end up as a Have? Why do we accept massive amounts of bureaucratic interdiction in healthcare decisions (HMOs, mandatory pre-approval of services, denial of benefits) so long as those bureaucrats wear Aetna name tags rather than Government ones? Why do we believe that paying for something means we are exercising choice? Why do we bristle at the government telling us which doctor to see but call it a "free market" system when Blue Cross does so?

As I constantly remind my students, the fact that we have elections is not prima facie evidence that we have Democracy and Freedom and all that other happy horseshit. They had elections in the Soviet Union, after all. Likewise, the fact that we as Americans pay out the collective ass for the services of private healthcare providers does not mean that our system is, in even the loosest sense of the term, a "free market" solution.

Isn't that the grand dilemma in post-industrial America? We're so goddamn Free. And with that magnificent freedom – freedom from the government controlling our lives – we've chosen to privatize everything that wasn't bolted to the floor so that a handful of corporations can control our lives. We are a nation-sized insane asylum in which we, the inmates, are ready to fight to the death to protect our right to have a healthcare system we can't afford.

Day: July 2, 2007

SICKO