Ezra Klein: SiCKO Review

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June 22, 2007

SiCKO Review

whether government-run medicine really kills, or in fact just turns our nurses into a cadre of propagandists in stilettos, is actually a bit beside the point. Contrary to its billing, Sicko is not a movie about health care policy. It does not spend time examining inefficiencies, or incentive structures, or public-private hybrids. It does not offer a methodologically rigorous cross-national comparison of health care systems. (Its portrayal of Cuba is, indeed, absurdly rosy.) That's not its point.

Its point, of course, is to arouse passion, to force debate, and on that, it succeeds. A few hours before, I'd been on Larry Kudlow's TV show, ostensibly to discuss health care and Moore's new movie. "I hate it," barked Kudlow. "Michael Moore's movie Sicko calls for socialized medicine." He hadn't seen it, of course, but felt perfectly comfortable assuming, and judging, its arguments.

The film is more radical, and more troubling, than he'd even imagined. Moore's movie is only superficially about health care. It uses the subject -- and also sick days, and vacations, and child care, and maternal support policies -- as a way to critique unthinking American exceptionalism, to challenge the tautology that states that the way we do things is the best way to do things because … it's the way we do things.

Read the rest.

June 22, 2007 | Permalink

Comments

Yeah, that's kind of what I thought it would be.

Posted by: weboy | Jun 22, 2007 10:42:47 AM

nice review. i was getting a sense of that big picture catching up on amy goodman's coverage of the film the last week or so.

Posted by: dex | Jun 22, 2007 11:27:06 AM

What is 'polemic'?
Is that..accurate? --
However 'inaccurate' may be the polemic itself.

Posted by: has_te | Jun 22, 2007 11:27:42 AM

Yer amazin'..
Read that and never once DID see that 'Katrina' word.

Forbearance, indeed!

Posted by: has_te | Jun 22, 2007 11:37:22 AM

"This is not a movie of arguments, but of examples -- of practices Moore thinks more humane, and more in accordance with his countrymen's preferences."

You mean Canada, right?

Posted by: Alex | Jun 22, 2007 11:39:02 AM

That's the way all his movies are. Bowling for Columbine wasn't an anti gun movie as people claimed- it was a movie about how Americans let our fears control us. I saw that movie, and while on one level I didn't always agree with everything he said, I did agree with his point about the power of fear in America. It's a point that I feel he kind of stole from this book that talked about how American irrational fears have too much of influence on what we do.

Posted by: akaison | Jun 22, 2007 11:43:48 AM

Yakov Smirnov! Heh heh heh.

Posted by: SP | Jun 22, 2007 11:51:46 AM

...barked Kudlow...

One could riff for a good while on how apt this analogy is as a description.

Good review. The movie may do some good on getting folks to think about how much we accept as conventional that is really morally evil.

On the other hand, instead of actually, you know, discussing health care policy as a set of rational choices we could make, we'll likely end up with the media conversation being about whether Moore's movie was 'accurate'.

The Republicans have perfected the art of launching flares from a low-flowing helicopter in a battle zone to distract the heat-seeking missiles. So we'll argue about Moore instead of the uninsured, underinsured, and those financially and medically raped by a profit-directed medical 'system'.

Posted by: JimPortlandOR | Jun 22, 2007 11:58:40 AM

But I don't think any approach will matter with regard to the GOP dog and pony act

Posted by: akaison | Jun 22, 2007 12:38:52 PM

The Republicans have perfected the art of launching flares from a low-flowing helicopter in a battle zone to distract the heat-seeking missiles. So we'll argue about Moore instead of the uninsured, underinsured, and those financially and medically raped by a profit-directed medical 'system'.

Yes but as you indicate, this is SOP for the GOP and its media camp followers. Hence the "Ezra Klein hates free markets" meme. All that can be done is to refuse to play. Ezra has provided a template for how that may be done. He states forthrightly that Moore's vision is a radical one. He defends Moore's right as a creative artist to articulate that vision. He recognizes that what Moore is engaged in is political theater rather than journalism. He uses this position as a springboard to address the substantive issues.

Contrast this with the squealing avoidance exhibited by so many in the face of Rightwing attacks on Farenheit 9/11. How many supposed Liberals and Progressives responded by spewing ritualized denunciations of Moore in order to claim credibility for their own criticisms? Too many.

Such folks don't seem to grasp that by accepting the peculiar notion that they are obligated to appologize for Michael Moore's opinions and theatrics that they are validating the GOP's ad hominem strategy.

Here's a counter meme. Michael Moore has an absolute right to express himself as he chooses and the only one fit to answer for him is ... Michael Moore. If you want to argue the mechanics of his film, get Moore on the horn. If you want to discuss the issues of US health care as raised by the comparisons made in the film, then perhaps we can have a debate.

Of course this will only work if "liberals" and "progressives" cease taking the GOP rhetorical bait out of a misguided lust for "respectability".

Posted by: W.B. Reeves | Jun 22, 2007 12:57:23 PM

Based on Ezra's description, it sounds like Moore is following the standard strategy of health care reformers: Focus on the weaknesses of the U.S. health care system and ignore its strengths. Focus on the strengths of alternative systems and ignore their weaknesses. At least Ezra admits that Moore's portrayal of Cuba is "absurdly rosy." I wonder if, during the sequence showing Brits enjoying their "free" health care, Moore mentioned that they do in fact pay for it through taxes. Or that 850,000 of them are waiting for admission to National Health Service hospitals. Or that delays for colon cancer treatment are so long that 20% of the cases considered curable at the time of diagnosis are incurable by the time of treatment.

Posted by: JasonR | Jun 22, 2007 2:05:23 PM

I see nothing wrong with liberals complaining about the defects of Moore's work as both art and polemic, if the complaints are accurate. If Moore's work calls more attention to him and his methods than to the issues, that may actually be due to defects in his approach rather than to defects in the critics.

Posted by: Sanpete | Jun 22, 2007 2:08:23 PM

If this were isolate to Moore Sanpete- you might have a point because aestheticall you are right. The problem of course is that this tactic of trying to appear like the 'reasonable' liberal isn't limited to Moore's films. It is in the background of most debates in this country. The "crazy loony left." Part of the reason I say some of what I say in diaries and comments here is related to this reality- that we don't even recognize anymore how much of our thinking is built of being defensive.

Posted by: akaison | Jun 22, 2007 2:40:36 PM

Akaison, one of the cheesier tactics used to derail discussion is to ignore the actual arguments made and to subtitute invented, easily rebuted arguments in their place.

For example, no one suggested that it would be "wrong" for liberals to criticize Michael Moore or his films. What was suggested, was that it would be foolish to enable the hijacking of the health care debate in favor of a "debate" over the flaws of Michael Moore and his films. Particularly foolish when such enabling is the product of a vain desire for "respectability" as defined by the opposition.

Liberals and Progressives have no obligation whatever to answer for Michael Moore's opinions or how he expresses them. The sooner they get over playing Pavlov's Dog to the GOP's bell ringers on this score, the better.

Posted by: W.B. Reeves | Jun 22, 2007 3:24:32 PM

The amazing thing to me, as a person who lived during the 50s, is how we've slid down all the major indices from number one to number fifteen or number twenty. Having lots of shiny cars does not mean we're a highly developed society.

Some of this corrects itself naturally, as when we learn that, yes, lots of people come here, but, guess what, a lot of people also go home because here isn't as great as they thought it would be.

But it's absurd, and absurdly expensive, to think our medical system can't be improved. That's money that could be spent on other problems we know we have.

In the post-colonial era we're colonizing ourselves- and attaining third-world status in the process.

Posted by: serial catowner | Jun 22, 2007 3:41:33 PM

To explain for anyone having trouble getting the point, there has been nothing foolish about liberal criticism of Moore's work. Further, there's no good reason to think that the criticism is a response to reaction on the Right, but it doesn't really matter. And though there's no good evidence that this happens much, if a liberal were to criticize Moore in a valid way to build credibility with the Right, that doesn't seem especially foolish either; might help.

As I said, it may be that Moore's methods are the main reason discussions of his work tend to be more about him and his methods than about the ostensible topics of his films. Many liberals give the Right way too much credit for controlling things.

Posted by: Sanpete | Jun 22, 2007 3:53:15 PM

Sanpete considering your thinking is pretty much all defined defensive thinking and posturing in terms of the right- I don't expect you to understand the larger point made by WB.

Posted by: akaison | Jun 22, 2007 3:59:12 PM

Akaison, you don't support the premises of your remark, as usual. Good luck.

Posted by: Sanpete | Jun 22, 2007 4:03:50 PM

WB- I don't see that happening. I regularly read the creator of even this blog argue with extreme rightwinger when most the public supports him on healtcare. Yet, what audience does he write to? What audience were the Democrats responding to when they caved on the Iraqi funding? What audience did they apy attention to on the bankrupty bill? This goes on and on.

Posted by: akaison | Jun 22, 2007 4:04:28 PM

What audience were the Democrats responding to when they caved on the Iraqi funding? What audience did they apy attention to on the bankrupty bill? This goes on and on.

Indeed. What audience are those who complain about Clinton being divisive responding to?

Posted by: Sanpete | Jun 22, 2007 4:14:40 PM

I find the premise of, "Well, of course what he shows isn't accurate, but that's okay because his heart is in the right place" to be more than a little problematic. It undermines any attempt to hold others accountable to the truth if you openly wink at lies in the service of causes you agree with.

Posted by: Michael B Sullivan | Jun 22, 2007 4:40:05 PM

The amazing thing to me, as a person who lived during the 50s, is how we've slid down all the major indices from number one to number fifteen or number twenty.

Please list these indices, and tell me where I can find this information.

Posted by: JasonR | Jun 22, 2007 4:45:36 PM

From the review:

Intercepting two new parents as they exit an English hospital, he asks, "How much did they charge you for that baby?" "This isn't America," they laughingly reply.

The US healthcare system is the butt of jokes. Holiday-makers learn about it when they're told to carry a minimum of $5m in travel health coverage for that trip to Disney World. When the Tories did their health policy review a few years ago, they sent MPs to lots of countries to see what they could learn from alternative systems. One country was notably missing from their itinerary: perhaps they didn't want to pay the extra £100 or so for the travel policy.

Faux-naifs like JasonR act as if the current system in the US is one that Americans would choose to have, if it were served up as one of a set of options, rather than one they are forced into by the corporate grip on legislators.

So it would be good if JasonR would state his preference explicitly, in words along the lines of 'Given all possible alternatives, I choose a system dominated by coverage that is tied to my employer, that penalises me for pre-existing conditions, and which routinely denies reimbursement as a means of securing profits.'

Posted by: pseudonymous in nc | Jun 22, 2007 5:26:43 PM

It was a beautiful review. Last sentence was poetry. Am convinced there's a whole lot more power in that "reminding America" approach than many give credit.

As for all the grumbling (elsewhere) about the lukewarm Democratic response, I think the critique is tactically misplaced, though I hope it doesn't stop. If this film gets wide viewing, the center shifts. It probably doesn't shift all the way to eliminating the commercial insurance industry, but it make reforming it a heck of a lot easier. If the "far-left" is calling for single payer, and the "moderates" just want to completely revamp the system, implement national insurance reform, eliminate the employer mandate, and offer a guaranteed basic coverage package to all -- well, that is still considerable progress!

The best thing the left can do for an Edwards, Obama, or Hillary health care plan, is to say it doesn't go far enough (whatever "it" happens to be.) If we get to the point where anything short of throwing out the entire system is considered a "moderate" position - we might actually get something done after '08!

Posted by: mdale | Jun 22, 2007 5:36:08 PM

Akaison, Nothing will change unless sufficient pressure is generated to force a change. The new technologies have opened up new possibilities for organizing that kind of pressure but there certainly are no guarantees. The fact is that both of the Parties are elite institutions, far more concerned with directing popular sentiment away from any challenge to the status quo than enabling it.

Under the circumstances, laying the foundation for that sort of challenge has to be the first order of business. Only the fear of a real social/political dislocation is likely to inspire a change of course among the elites. It's the only thing that has ever accomplished such a political sea change.

I don't pretend to have all the answers as to how this can be accomplished. Of this much I'm convinced though. It won't be done without fiercely contending every inch of the terrain in public discourse and debate. The collapse of the Left became a foregone conclusion the moment it gave in to the notion that it could abstain from the existing discourse by retreating into a tidier one of its own design.

Social/political change is never a pristine process. It's messy, disruptive and sometimes quite ugly. However, the alternative is to leave the field entirely to the elite strata and their sycophants with their counsels of complacency and despair.

Those of us who hanker for a vision of the future that isn't held hostage by a relative handful of economic and political power brokers, must, first and foremost, speak at every opportunity and in every forum we can. We must speak clearly, plainly and without apology.

Speaking is not enough of course. To succeed we must build a powerful, articulate and active constituency for change. In this we can expect little to no help from the Democratic Party establishment and the entrenched interest that sign their checks. This because such a movement would, of necessity, exceed the limits of electoral politics.

Can it be done? Not if we don't attempt it. The first step in such an attempt is the continuous articulation of the demand for change. Power has never conceded anything without such a demand. It never has and it never will.

Posted by: W.B. Reeves | Jun 22, 2007 5:48:18 PM

pseudo,

The US healthcare system is the butt of jokes.

So are the Canadian and British health care systems. Not just jokes, but horror stories of people suffering and dying while they're on waiting lists for treatment.

Yes, yes, I've heard it all before. The same old nonsensical story about the downtrodden proletariat and the will of the people being thwarted yet again by corporate overlords. The excuse is getting tired.

When single-payer health care was proposed to the people of California and Oregon, two of the bluest states in the country, it was defeated by a 2-to-1 margin of the popular vote in both places. When HillaryCare was presented to the country, it crashed and burned from overwhelming public opposition.

Posted by: JasonR | Jun 22, 2007 5:52:02 PM

So are the Canadian and British health care systems. Not just jokes, but horror stories of people suffering and dying while they're on waiting lists for treatment.

How long is the waiting line if you don't have insurance?

Posted by: Phil | Jun 22, 2007 5:54:34 PM

Phil,

It varies.

Posted by: JasonR | Jun 22, 2007 5:57:34 PM

You ignored my last graf, JasonR: state, for the record, that the current insurance model for the US healthcare system is your preferred choice, given a free pick of all alternatives.

Or don't. Either way, we'll laugh at you as well.

Posted by: pseudonymous in nc | Jun 22, 2007 6:01:21 PM

Let me clarify: I'd like you to state your preference for the US system as currently implemented over all alternatives. Not the fantasy healthcare system whose superiority you persist in arguing.

Posted by: pseudonymous in nc | Jun 22, 2007 6:03:53 PM

pseudo,

Describe the alternatives you have in mind and I'll tell you which one I would probably prefer.

Posted by: JasonR | Jun 22, 2007 6:05:49 PM

I find the premise of, "Well, of course what he shows isn't accurate, but that's okay because his heart is in the right place" to be more than a little problematic. It undermines any attempt to hold others accountable to the truth if you openly wink at lies in the service of causes you agree with.

No one but you has suggested this premise.

Posted by: W.B. Reeves | Jun 22, 2007 6:09:32 PM

Describe the alternatives you have in mind and I'll tell you which one I would probably prefer.

all, adj.

Or are you just stalling?

Posted by: pseudonymous in nc | Jun 22, 2007 6:50:43 PM

pseudo,

Sorry, I'm not going to guess at what you mean by "all alternatives." Give me a clear question with a defined set of the alternatives as you seem them, and I'll give you a clear answer as to which, if any, I prefer to our current system. If you keep beating around the bush I'll just ignore you.

Posted by: JasonR | Jun 22, 2007 7:06:33 PM

Ah, you are stalling.

It's quite a simple request: say "I wholeheartedly endorse the US system as it currently exists." Or "I can't think of anything I'd change about the provision of healthcare coverage in the United States as it stands right now." Or whatever endorsement you consider appropriate.

See, I'm defining the choices quite clearly:

1. the US system as it currently exists;
2. something else.

Pick one. If you're just going to filibuster, we'll just have to assume that you're all mouth and trousers.

Posted by: pseudonymous in nc | Jun 22, 2007 7:34:54 PM

Since I think the U.S. system as it currently exists is not the best possible system, I'll go with "2. something else," Meredith. Final answer.

Posted by: JasonR | Jun 22, 2007 7:39:19 PM

Well, that was like extracting teeth. Of course, since you're a bullshit artist, you're not going to spell out what you don't like in the current system, or how you'd change it, are you?

Posted by: pseudonymous in nc | Jun 22, 2007 7:58:36 PM

pseudo,

I stopped reading after "you're a bullshit artist."

Posted by: JasonR | Jun 22, 2007 8:24:23 PM

Well but you are Jason. I mea why does the truth hurt you so much?

Posted by: akaison | Jun 22, 2007 9:52:36 PM

WB- I agree mostly with what you wrote. However it's been my experience that the following is true: beauty is skin deep, but stupid is to the bone. I have begun to lose faith in the American people. I wish I wasn't. But I am. In democracy, or whatever we have now, we get the govt we choose. By our apathy we choose this one.

Posted by: akaison | Jun 22, 2007 9:57:22 PM

Look, I've been writing film criticism since I was in my twenties; I am entirely comfortable critiquing a documentary film, whatever "side" its on if I have problems with it as a film. That, it seems to me is a perfectly valid approach whether we're talking Michael Moore or that Truth About Waco film.

Michael Moore is a documentarian with a particular approach and a particular style. It's not perfect and he's no saint. There's a policy debate that needs to happen in this country about healthcare, and how we pay for it and who gets it. Will Moore's film help that debate? Perhaps; it will certainly bring the conversation forward and move the meter; but I think it's too soon to tell if what is, in all likelihood, flawed and rather polemical film will be the best vehicle for making the necessary points progressives want to see made in the health care debate.

I don't think it's useful, or fair, to lump every lefty critique of Moore into "doing the right's bidding" - there are plenty of reasonable objections to be made about the way Moore tackles his subjects and the films he's produced - as films, at the very least, as well as part of larger discussions on issues of the day. The health care debate does not start or end with him or with Sicko. And it's as dangerous to lay that weight on the film, as it is to brand every critic as somehow a traitor to the left. Let the film rise or fall on its merits, and let the health care debate proceed with Moore's contribution serving as one piece in a much larger mosaic. Let's not substitute one for the other.

Posted by: weboy | Jun 22, 2007 10:05:46 PM

So are the Canadian and British health care systems. Not just jokes, but horror stories of people suffering and dying while they're on waiting lists for treatment.

Most of which are either anecdotal friend-of-a-friend stories, or which are easily explained through simple underfunding. Plus, you get more than enough American "the insurance company wouldn't pay for treatment X/decided I had a pre-existing condition and left me holding the bag" stories to more than equal those.

And again, nobody points to the Canadian or British systems as being ideal public health systems. You want to look at Germany, France or Japan for those. The Canadian and British systems are just public health systems that happen to be somewhat better than the American system is.

Posted by: mightygodking | Jun 23, 2007 12:01:53 AM

Most of which are either anecdotal friend-of-a-friend stories,

As are "jokes" about the U.S. health care system. Perhaps we can agree that anecdotes and stories are not a good basis for rational policy-making.

or which are easily explained through simple underfunding.

You say that like it doesn't really matter. Yes, the waiting lists and shortages in publicly-funded health care systems are often the result of underfunding. Publicly-funded systems tend to be underfunded because governments are not as good as markets at reconciling supply with demand. That's a good reason to prefer private funding to public funding, at least for the bulk of health care services.

And again, nobody points to the Canadian or British systems as being ideal public health systems. You want to look at Germany, France or Japan for those. The Canadian and British systems are just public health systems that happen to be somewhat better than the American system is.

Good luck showing that any of those health care systems, most especially the Canadian and British ones, are better than the American system. Where's your data?

Posted by: JasonR | Jun 23, 2007 12:25:44 AM

Where's your data?

And round in his merry circle our bullshit artist goes. Because once we cite (again) the data, he'll say it doesn't apply, but that his faith-based certainty in the puissance of this particular system, a model of emulation for no-one, does, for all sorts of abstract reasons.

Would you like a healthcare system that doesn't routinely deny coverage and fight over reimbursement as a matter of policy? Or is that just a mild social side-effect that we should be willing to pay in order to ensure that billionaires get the best healthcare on the planet?

Because that's Moore's point. There's an honesty, at least, in other countries towards the structural weaknesses of their particular systems. I'd just like JasonR to come out and say that some people having to choose between bleeding now and bankruptcy later is for the greater good.

Posted by: pseudonymous in nc | Jun 23, 2007 2:15:11 AM

And again, nobody points to the Canadian or British systems as being ideal public health systems. You want to look at Germany, France or Japan for those.

I don't think this is right.

Every time Ezra and others mention the VA system as a model, they are espousing a UK NHS-style model.

Single-payer advocates, which are many on this board, structurally are most close to the Canadian system of those listed above.

Are Germany, France the best models out there existing today? Probably so. But as I've said before, I'd suggest that on the spectrum of health care systems, they are closer to our existing system than single payer-- i.e. tight regulation of insurance providers (in France's case the government involvement is somewhat greater) with public input on basic coverage elements.

Perhaps more importantly, if you want the JasonR's of the world to support health care reform, we need to focus on the similarities between our system and the German/French-- and focus on the key reforms necessary to take us to the next level. Stating our system is worse, is both self-defeating and isn't necessarily true, depending on which metrics you choose. For many on the right, being the world's driver of innovation, along with the best medical care at a hospital/physician level (e.g. there's a reason the world's true global elite come to the US to go to select health centers) trumps the macro-level health indicators that are rife with confounding variables are messy data sets.

Posted by: wisewon | Jun 23, 2007 9:27:06 AM

weboy- I do film criticism now too- and yes, it is fair in a political discussion to ask why the knee jerk reaction. These people for the most part aren't film critiques. Most of the people here reacting to aren't either. I am not saying they need to be- I am simply saying call a duck a fucking duck. Stop adding the extra layer of what ifs in there just because it's possible they have other reasons. Yes, anything is possible, but as I often say to Sanpete- what's likely?

Posted by: akaison | Jun 23, 2007 10:14:15 AM

And it's as dangerous to lay that weight on the film, as it is to brand every critic as somehow a traitor to the left.

Or as dangerous as putting words into other people's mouths? The only person making the "traitor" characterization is yourself.

I hate to keep repeating myself but it seems it's necessary. Once more, I have no objection to people making honest critiques of either Moore or his films in a context where that is the topic of discussion. I do object to people behaving as stooges in Right wing attempts to substitute such topics for the substantive issues of the health care debate. I made this point in response to JimPortlandOR's expressed concern that such a hijack of the discourse was likely.

Weboy, you're a film critic. In that role you are obligated to critique Moore's film as a film. Fine and dandy. But policy debate and politics are not film criticism. Ultimately, the pros and cons of Sicko as a film are irrelevant to those areas of discussion. As are Michael Moore's personal habits, sense of style and weight.

Whatever else Sicko may be, I'm relatively certain that it is not a programatic desiderata or a position paper. Neither is Michael Moore a policy wonk, office holder or any sort of political leader. Attempts by the opposition to pretend otherwise in order to derail substantive debate should not be abetted.

Posted by: W.B. Reeves | Jun 23, 2007 12:42:13 PM

"Perhaps more importantly, if you want the JasonR's of the world to support health care reform, we need to focus on the similarities between our system and the German/French-- and focus on the key reforms necessary to take us to the next level."

Not sure we'll ever bring the JasonR's on board, but you're right, we might bring someone. Lumping all of the foreign systems together as "national health insurance" probably is a political mistake, because they all then become "socialized medicine". That moniker only fairly applies to the British system. Seeing as how the three democratic front-runners have proposed plans that are not really as ambitious even than the German and French model, I would say that you are right that there is much less risk of the left bolting because the plan isn't single payer than of the right bolting because they believe it is.
But there is a huge electoral middle that will support reform primarily based on the resonance of the criticisms of the current system with their own experiences and anecdotes. If this film had been made by Moore circa 1992, when he was perceived as a simple advocate for blue collar economic issues, rather than a polarizing figure who propounded every liberal cultural issue, it would have been politically perfect.

Posted by: RW | Jun 23, 2007 1:44:53 PM

Every time Ezra and others mention the VA system as a model, they are espousing a UK NHS-style model. Single-payer advocates, which are many on this board, structurally are most close to the Canadian system of those listed above.

Exactly. One minute they're saying "Oh, we're not proposing a British- or Canadian-style system" and the next they're touting a single-payer system based on Medicare ("Medicare for All") or something based on the current VA system, which are structurally equivalent to the Canadian and British systems. This bait-and-switch is getting tedious.

Posted by: JasonR | Jun 23, 2007 1:59:44 PM

Because once we cite (again) the data,

You haven't cited any data, so you can't cite it "again." If you seriously think you have data showing that the U.S. health care system is inferior to those of Britain, Canada or any other country, produce it. Put up or shut up.

Would you like a healthcare system that doesn't routinely deny coverage and fight over reimbursement as a matter of policy?

We already have a system that doesn't routinely deny coverage and fight over reimbursement. Denial of coverage and reimbursement fights are the exceptions. The vast majority of people obtain coverage with little or no difficulty, and the vast majority of claims are processed without any serious dispute.

I'd just like JasonR to come out and say that some people having to choose between bleeding now and bankruptcy later is for the greater good.

The potential for having to choose between "bleeding now and bankruptcy later" exists under all health care systems. No system has unlimited resources. No system will pay for every treatment that might benefit a patient. Everyone faces the potential for bankruptcy caused by illness and medical bills.

Posted by: JasonR | Jun 23, 2007 2:16:36 PM

As I understand it, the national health care system that HillaryCare most closely resembled is Germany's.

But HillaryCare would apparently be unacceptable to most of the reform proponents here, because it would preserve many features of the current system that they keep insisting are fundamental flaws. It's not single payer. It would both fund and deliver health care services primarily through private, for-profit businesses. It would keep the existing private health insurance industry largely intact. And it would preserve a multi-tiered health care system in which the quantity and quality of health care services available to a person would depend substantially on how much private wealth he has.

Posted by: JasonR | Jun 23, 2007 2:34:55 PM

"You say that like it doesn't really matter. Yes, the waiting lists and shortages in publicly-funded health care systems are often the result of underfunding. Publicly-funded systems tend to be underfunded because governments are not as good as markets at reconciling supply with demand. That's a good reason to prefer private funding to public funding, at least for the bulk of health care services."

Right, because we all know there is no agency problem with the disconnect between insurance premiums and charges incurred when going to the doctor. And we also know that there's tremendous elasticity in demand for medical services. I mean everybody shops for a doctor based on price, right? And if that valve replacement is too expensive, why I think I'll just pass on it. Yes, just like the market for any other commodity...

Posted by: Lewis Carroll | Jun 23, 2007 3:19:50 PM

Right, because we all know there is no agency problem with the disconnect between insurance premiums and charges incurred when going to the doctor.

Incomprehensible.

And we also know that there's tremendous elasticity in demand for medical services.

There is at least as much elasticity in the demand for medical services as there is the demand for other goods and services that we provide through private markets, including such obvious necessities as food, housing and clothing. So whatever point you think you're making, you're not.

I mean everybody shops for a doctor based on price, right?

No, of course not. Some people do, but most people do not buy the services of doctors through a direct fee-for-service arrangement. They buy health insurance instead, and the insurer pays most or all of the doctor's fee. The insurer shops for doctors based on, among other things, price.

And if that valve replacement is too expensive, why I think I'll just pass on it.

You could, yes. Obviously, so could the government, if your health care is publicly funded. He could deny you valve replacement surgery altogether, on the grounds that it is too expensive, or he could put you on a waiting list so long that you die while you're waiting for the operation. That's the kind of thing that happens in government-funded health care systems.

Posted by: JasonR | Jun 23, 2007 4:40:57 PM

I thought after Fred was banned we wouldn't have any more ape shit psychos around. thanks for providing me needed entertainment JasonR.

Posted by: akaison | Jun 23, 2007 5:28:20 PM

"But HillaryCare would apparently be unacceptable to most of the reform proponents here, because it would preserve many features of the current system that they keep insisting are fundamental flaws. It's not single payer. "

But you wouldn't support that either, right?

Most of the democratic proposals are not close to as ambitious as the managaed competition plan Hillary proposed.

Posted by: RW | Jun 23, 2007 5:45:26 PM

We already have a system that doesn't routinely deny coverage and fight over reimbursement.

And, once more, JasonR retreats into his fantasy hypothetical healthcare system, as opposed to the one that actually exists. There's really no point arguing with someone who plays such blatant switcheroo.

The JasonR fantasy healthcare system is a friction-free world where pre-existing conditions don't matter, where promises of coverage are never ever revoked, where waiting lists don't exist, and where all current alternatives offer the equivalent of Moscow bread queue. Unfortunately, Americans don't live inside JasonR's head.

Everyone faces the potential for bankruptcy caused by illness and medical bills.

Er, no. Unless by 'potential' you mean the same potential of winning the lottery, which is just more specious bullshit.

Posted by: pseudonymous in nc | Jun 23, 2007 5:51:28 PM

But you wouldn't support that either, right?

I'm not sure. I might. But since it's not single-payer, does not eliminate the profit motive from either funding or delivery of health care, maintains the private health insurance industry, and preserves the link between health insurance and employment, it must be completely unacceptable to all those who insist that those features are fundamental flaws of the current U.S. health care system.

Most of the democratic proposals are not close to as ambitious as the managaed competition plan Hillary proposed.

Right. Even HillaryCare, a much more modest and less disruptive kind of reform than single-payer, is too radical for any of the Democratic candidates.

Posted by: JasonR | Jun 23, 2007 6:43:41 PM

pseudo,

Do please show me your evidence that people are routinely (yes, that's the word you used, routinely) denied coverage under the current U.S. health care system.

Of course, you have no evidence. Because this claim is nonsense, like most everything else you write.

Unless by 'potential' you mean the same potential of winning the lottery, which is just more specious bullshit.

No, I mean a risk much greater than that. Most medically-related bankruptcies are not caused by medical bills, but by other expenses. In the typical case, a person whose financial situation is already precarious becomes seriously ill and has to take time off work, losing income. He then goes into debt to cover ordinary living expenses and eventually has to declare bankruptcy. Medical bills can contribute to the insolvency, but are rarely the primary factor.

Posted by: JasonR | Jun 23, 2007 6:54:02 PM

and around and around we go trying to argue with crazy Jason

Posted by: akaison | Jun 23, 2007 6:57:19 PM

"I'm not sure. I might"

What more would you need to know to decide whether you would support it?

Posted by: RW | Jun 23, 2007 7:16:12 PM

I'd have to see the actual proposal.

Posted by: JasonR | Jun 23, 2007 7:45:49 PM

and around and around- good luck getting an straight answer

Posted by: akaison | Jun 23, 2007 9:49:10 PM

Jason, I'm afraid you do obviously inhabit a fantasy world.

Your first mistake is in believing that there actually is a *market* in healthcare. There's no such thing, unless you count the person on the street with no health insurance coverage who pays 'retail' for services. (A person who, when they do receive treatment, often can't pay for it anyway, and their inability to pay increases what you and I pay, via higher premiums, for the same services.) If there really was a true market, neither insurance companies nor the government would be an intermediary in the payment for product/commodity/service process. That would imply no *insurance* at all. Does that sound hard to understand, Jason?

As a participant in the health insurance field I can attest that the failures others have taken pains to point out to you here do exist. The name of the game is cost shifting, delaying and denying payment etc. So those waits you talk about in your fevered railing against those nefarious socialized or single-payer systems are rife in our system as well. I deal with them every day.

So yes, maybe a single payer system would result in a denial of coverage or delaying or rationing or something of the sort. But the point is we already have those things, with little or no consistent rationale or accountability for them. If it was run by the government, at least we could make some rational decisions as a group of consumers/insureds for what should be covered, on a cost/benefit basis, rather than a maximization of private profits basis. At least for things not serious and life-threatening.

I make much $$$ off the system right now, but I realize that the financing system for health care in this country sucks. And though I offer only anectodal evidence (although 80-100 groups' worth), my personal experience as a broker is consistent with well known surveys indicating miserable satisfaction levels for private health insurance in this country. Both intra-national (Medicare and VA) and international (Germany, UK, Canada) comparisons show far greater satisfaction with OTHER systems, and yet you manage to somehow argue for the sytem we currently have?

Posted by: Lewis Carroll | Jun 23, 2007 9:51:26 PM

Correction, the last sentence in second to last paragraph should be "At least for things serious and life-threatening". And BTW, I would not be in favor of PROHIBITING individuals from paying personally for things which were not covered because they were not serious or life-threatening or have a really shitty cost/benefit ratio.

Posted by: Lewis Carroll | Jun 23, 2007 9:54:51 PM

and around and around. A new person trying to convince Jason that he is wrong. Will he do it ? Who is willing to take bets?

Posted by: akaison | Jun 23, 2007 10:31:26 PM

Just a quick search, btw, shows that Table 1 in this report backs up what I've heard about relative value and satisfaction in the US system vs. others:

http://dll.umaine.edu/ble/U.S.%20HCweb.pdf

Posted by: Lewis Carroll | Jun 23, 2007 10:34:19 PM

Lewis,

If it was run by the government, at least we could make some rational decisions as a group of consumers/insureds for what should be covered, on a cost/benefit basis

I think you've got the right objective, but the wrong solution (i.e.single-payer).

This is the key issue at the end of the day for health care reform. As I've said in other threads, my concern is the lack of competition on methods of cost-control that would exist in a single-payer system. There are a lot of different ideas on how best to control costs-- the reality is no one knows which is most effective, fair and/or equitable. We need a system that allows for experimentation of cost control methods, consumer choice (i.e. some may be willing to pay more upfront for less restrictions and vice-versa) and different options on levels of covered procedures (e.g. on the spectrum of standard-of-care versus experimental). Preserving competition over these elements is fundamental to the long-term success of our health care system, which by definition cannot exist in a single-payer.

Posted by: wisewon | Jun 24, 2007 9:11:58 AM

ww,

I do think a single-payer system could easily control costs. The problem is that the way it could definitely do it - price controls - is anathema in my mind. I do suspect though that it would immediately result in across the board savings of 20+%, given that is the difference in overhead between private and state funded systems. That savings could be reinvested elsewhere in the health care system (such as generous preventive medicine).

But I agree that, short of price controls, single payer wouldn't necessarily do anything to slow the RATE OF GROWTH of health care costs. This seems to me a more intractable problem.

Posted by: Lewis Carroll | Jun 24, 2007 10:16:39 AM

Lewis,

I would suggest that if you look at projected growth rates in health spend over the next 20 to 30 years, you would see that the growth rate problem is much more significant that the targeted 20% you wrote about above. In other words, while the 20% translates into approximately $200 billion today, the growth rate issue will lead to several trillion in additional health care costs.

My point above is that single-payer is not a good solution for addressing the growth of health care costs. Competition over ideas on constraining costs should be our objective, something that doesn't and can't happen in a single-payer system.

Posted by: wisewon | Jun 24, 2007 10:31:20 AM

Focus on the weaknesses of the U.S. health care system and ignore its strengths.

You know, ignoring a problem in hopes it will go away really doesn't work when it comes to health care.

Posted by: Amanda Marcotte | Jun 24, 2007 11:20:05 AM

I find the premise of, "Well, of course what he shows isn't accurate, but that's okay because his heart is in the right place" to be more than a little problematic.

Oh, thank god no one said that or you'd have a point.

Posted by: Amanda Marcotte | Jun 24, 2007 11:21:52 AM

Completely unrelated to anything in your post:

I just saw your pic at the bottom of that article.

HOLY CATS you're cute! *blush*

Posted by: Grace | Jun 24, 2007 3:20:12 PM

Moore on youtube

http://www.youtube.com/watch?v=WpYqpOG7NJg

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