Sicko: Socialism, Capitalism, Health Care

This review was published originally on cinekklesia on August 25, 2007.

Michael Moore, the documentarian that right-wingers love to hate, recently came out with Sicko (2007), a critique of the U.S. health-care system — and, by extension, a praise of other countries' systems, which he sees as more rational, cost-effective, and humane. It seems that a fair number of conservatives viscerally despise the rotund Michigan native, but they should let the man have his say (and should debate whichever of his points they see as inaccurate or unfair). Regardless of one's views of Sicko, it does serve a useful purpose by proposing an unambiguously socialist position regarding health care, which then serves as a foil against which detractors can stake their own claims. (A libertarian documentary advocating a completely laissez-faire approach to health care would have served the same purpose.)

Sicko alternately moves between health-related tales of woe in the United States and more utopian (from Moore's perspective) situations in Canada, the United Kingdom, France, and Cuba. The U.S. stories are truly heart-wrenching and even infuriating, as people recount tales of insurance companies bending over backwards to deny claims; of medical directors who serve as hired guns for those companies, providing justifications for those denied claims; of people who literally die due to bureaucratic inertia. Of course, Moore has a point to make and chooses his stories carefully in order to propagate that point, and we should remember that insurance companies can (and do) serve a useful purpose. Nevertheless, it does seem that plenty of Americans have had bad experiences with their health care, since that topic consistently shows up as one of the top, if not the top, domestic concern among voters.

The other countries' health-care systems are portrayed in a much more favorable light. Because their systems are taxpayer-funded and government-managed, they are seen as public goods and positive rights — i.e., the citizens of those countries just expect to receive health care because they are, well, citizens. The health-care professionals are government employees, deductibles are non-existent, and pharmaceuticals are dirt cheap. From Moore's perspective, these other countries have it right, and the U.S. has let itself be suckered by various health-related special interests into denying these same benefits to its own citizens.

Moore also anticipates the critiques that would be lodged against his view. He shows various examples of how the other countries' systems are not jammed with long lines of patients waiting to see physicians, how government-employed physicians are not living in squalor (a British doctor he profiles drives an Audi and lives in a nice home — relative to London's astronomical real-estate prices), and how citizens from all sorts of political perspectives have come to rely on—and defend—their government health care. Again, caution is advised, since we are getting only Moore's perspective.

Nevertheless, one should commend Moore for being clear and consistent with his views on health care, for throwing down the socialist gauntlet and implicitly demanding that his detractors come up with a better solution. Within the current political landscape of the United States, establishment Democratic politicians offer a variety of public-policy bandages to "fix" health care, but few are willing to support an outright socialist system.

There are, of course, lots of problems with Moore's analysis. Does not the United States have the most advanced health care in terms of clinical research and technological innovation? Do these benefits not come about due to the profit motive that encourages researchers and their corporate employers to devote countless hours and billions of dollars to improving pharmaceuticals, medical devices, and treatment methods? One could argue that countries like Canada, the U.K., France, and Cuba essentially free ride off the innovations that are produced in the United States; perhaps, in some indirect way, U.S. citizens are subsidizing the rest of the industrialized world's health care.

This is a major gap in Moore's analysis. Like many socialists, he sees economic problems as simply a matter of distribution, rather than production. The other countries in Sicko may have a more equitable system of health-care distribution, but the lack of a clear profit motive—of the possibility of realizing some gain from one's risks—seems to stunt the innovation and production required for further improvements. In other words, socialist economies try to distribute "what is" equitably, whereas capitalist economies try to produce (and distribute) even more (the "what could be").

The other problem with Moore's analysis is the fact that he doesn't address the mixed nature of the U.S. health-care system. The United States is not a medical free market. Far from it. Besides for-profit hospitals and insurance companies, we also have non-profit institutions and government entities like county hospitals, Medicare, and Medicaid. It's a labyrinthine mess that symbolizes our contradictory feelings about health care: we don't know whether we want government involvement or not (and if do, we don't know how much). While Western Europe has opted for a variety of socialist solutions, we haven't made up our minds.

Thus, it would be refreshing if we could hear a voice from the world of mainstream politics advocating a completely laissez-faire health-care system: no government programs, no Food and Drug Administration, no anti-competitive licensure requirements. While few Democrats advocate socialized medicine, few Republicans advocate the libertarian approach. They, too, offer a hodge-podge of public-policy bandages that do little to address fundamental questions about the proper role of government in the lives of everyday citizens. (The Republicans, of course, dropped the small-government cause a long time ago, but that is an issue for another day.)

If we had a more honest debate between the socialists and the libertarians, then we would be forced to deal with the root issues underlying our health-care hand-wringing. We would have to defend the stances we take on the size and scope of government, as well as the responsibility of individuals towards their neighbors (and what that responsibility would look like in real-life, everyday terms). Thus, while I ultimately disagree with Michael Moore's perspective on health care, I applaud him for raising tough issues, taking a clear stand, and challenging his opponents. I just wished that mainstream politicians would do the same.