Sunday, July 01, 2007

FEEL IT IN YOUR BONES

Michael's Moore's Sicko is not a movie. It's an experience. And a shared one at that. For instance, the loud laughter and smirk of every person in the theater directed at President's Bush statement about "Too many OBGYNs cannot practice their...love of women" underlines the humour as well as common understanding of dismal reality that's endemic in many aspects of the running of this country today.

Moore does a really great job in depicting the inadequacies of the health care system in the US. There have been many reviews from diverse quarters about the remarkable accuracy and comprehensiveness of his documentary. Of course, he cherry-picks a little, but who does not? I also have a slight objection about dismissing some of his narrations and examples as anecdotal, because in some cases, even a single story really strikes deep at some outrageous aspects of the US healthcare system, like the story of the man who had to pay 60,000$ for attaching one of his fingers, or like the woman who could not get coverage after she was knocked out in a car accident because the driver of the ambulance carrying her to hospital was not "pre-approved".

The list of qualifiers in insurance company plans is daunting indeed, and more often than not one finds out only after being in a serious accident or having a serious health issue that he or she was not covered. Some aspects of standard insurance plans are galling in the simplest ways; for example, why does my university health insurance plan not cover dental and opthalmological treatments? Aren't these organs an important part of my body? And why should the dentist charge my friend 600$ just for a dental examination? Doesn't this start to feel a little insulting after a while? Sometimes sheer numbers speak a lot, and while one is accomodating about differences in costs, some of the costs for relatively simple treatments in the US are astronomical and unbelievable indeed.

Moore also documents well-known aspects of health care systems in France, Britain, and Canada. While one can debate about advances or sophisticated treatments, it is surely true that simple operations and therapies are cheap or many times free in these countries. Moore also interviews people about other things that should matter in daily lives; like being on extended paid leave when one is sick, or generally having an extended leave period every year, like they have in France. In this context, Bill Maher's superb article about how many Americans have a knee-jerk reflex reaction against everything French comes to mind. As Moore asks, why is there so much instinctive anti-French sentiment in the US? Is it because the government is afraid that Americans may actually like the French?

Another knee-jerk reaction that many Americans, and increasingly people in other parts of the world have, is against everything government. Sometimes the very suggestion that perhaps a service could be handled by the government or that government could put controls on some aspect of private ownership is greeted by denouncing that action- and that person- as "socialist". This is a very dangerous path to tread, because no system is perfect, no matter how good it is. One of the things I loved about the movie was that Moore makes us aware of the many good and essential services that the government already runs in the US, and in the other parts of the world; education, law and order, firefighting, and the postal service to name a few. And privatisation is certainly not necessarily the answer to having these efficient services. Economist Kaushik Basu for example has recounted how, as an answer to private players such as FedEx, the US postal service reinvented and modernised itself to stay efficient and competitive. There is no doubt that these federal US services, without private interference, are some of the best in the world, and nobody ever seems to want to delegate firefighting to the private sector, so that they can first take a look to see if the homeowners whose house is on fire are "pre-approved" to have the fire put out. The point is that government works pretty well in many countries and is essential in some large-scale services, and it is also a truism that specific individuals and administrations have botched up the working of government. Here the people too are to blame, because they just don't demand more transperancy and accountability from the government. To denounce government in a single punch line is to neglect many aspects of current federal systems, and to believe that one system will really solve all our problems. We need to always keep a watch on government to ensure that they don't interefere too much in our lives, but then we also need to keep a watch on private corporations with certain regulatory frameworks, unless of course people are going to again shout "Socalist". In general, both governments and corporations need to be afraid of the people, a scenario seldom seen.

If there is one filmmaker who can make a significant point with the most outrageous technique, it's Moore. This is apparent when he takes a bunch of 9/11 rescure workers first to Guantanomo, where Al-Qaeda operatives are getting fine health-care, and then to Cuba where these workers get actually treated for very low cost. This has been cited again as cherry-picking; I am sure not everyone will always receive the finest health-care in Cuba, but Moore wants to make the general point here about the escalating costs of similar treatments in the US, a point that is right on target.

Part of the problem of course is the lobbying by corporations that goes on in Washington, which Moore recounts. Most prominent are the oil, pharmaceutical, food, and healthcare lobbies (not to separately mention the corn lobby). This is a tricky problem, because not having lobbying also does not help. But the original function of lobbyists was to serve as a mediator of information and understanding between government and corporations. This role largely seems to have been abandoned, and lobbyists are now paid massive amounts by corporations to essentially sell their corporation to the government. The simple lure of fantastic amounts of money is usually sufficent to sway opinions, and bills, orchestrated by powerful forces in the government.

Interestingly, the problem is not with corporations per se, if you want to look at it that way. Corporations' goal is to maximise profit, that's just how they work. One can in fact, in this context, criticise the government for not having enough regulatory controls to make sure that they don't add gratuitous qualifiers for putting someone on their insurance plan. It seems that only in a healthy relationship between government and the private sector can the health care problem be well-addressed. Unlike Moore, I don't think that insurance companies should be completely eliminated as the middle man between doctors and patients; the world has just become too complex a place for that. But it is also ridiculous that a doctor first needs to call insurance company and talk to them to make sure the patient is "pre-approved" for treating even a simple ailment such as a broken bone.

The healthcare situation, and its solution, are maddeningly complex. Wisely, Moore does not suggest solutions, except more government participation. But he still does a very important job, because millions of Americans are confused and distraught about their health care situation and options, and it would bode well to become aware of the acute problem America faces in this respect, which becomes apparent especially when compared to other developed nations. Moore also does a fine job of dispelling the myth that free or cheap healthcare is necessarily of poor quality, and that government doctors have poor lifestyles. Also, the quality of healthcare in the US itself is sometimes overrated, as I myself have heard from relatives and friends.

In the end, the problem is larger. Healthcare is a problem that would very likely be solved by a fruitful alliance of government and the private sector (but admittedly not the Bush government). To perceive such a solution, it is very important to get rid of biases, both in favour of laissez faire capitalism as well as towards massive government involvement. Now is a good time to get rid of catchall catchphrases such as "Government is the problem" or "Government is the solution". It is important, especially in a capitalist country like the US, to teach the beneficial role that government plays, especially in schools. Americans and other people need to stop slapping on labels on policies and individuals. The slightest government controls have to be stopped getting labeled as socialist and inherently detrimental. Making profit by itself is of course not bad (saying that is rightly construed as socialism) but realising that profit-making compels corporations to act a certain way and makes it necessary for all of us- not just government- to make sure that they don't wriggle out of compromises by lobbying and casually paying huge fines, is something essential.

Michael Moore's film can be seen as a comedy. But at the end, perhaps half of the people in the theater had a tear in their eye. Maybe they also were simply asking "Why should I pay five thousand bucks to make sure that me or my child gets good treatment in a simple emergency? Why should I have to suffer a massive financial loss just because some old condition that I had which should not have mattered, suddenly made me ineligible for insurance? Why could I not suffer an injury and simply walk into a hospital and then walk out a few days later with a feeling of actually having been cared for, rather than a feeling of having been financially appraised, evaluated, and summarily asked to pay a large amount of money because I did not read some fine print sometime? In additon to the trauma of my accident, do I deserve this additional mental trauma?". It was likely that every person in the theater had one or more of these questions, either because of their own experience or that of someone close to them.

Whether you believe in government action or more corporate solutions, one thing is for sure; there are fundamental problems with the health care system in the United States. There is a large discrepancy in this situation, and the way that everyone thinks the US is and should be. This issue goes beyond partisan politics. Until it's resolved, I, and many others like me, will believe in God just for hoping that we never fall seriously ill in the US.

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12 Comments:

Anonymous Rohit said...

Ashotosh,

Moore's entire commentary seems to be that medical care should be ''free''. How can anything in the whole wide world be actually free?

Having said that, I will be the first one to acknowledge that serious problems exist in the US health system. Universal coverage, quality of care. under-insured all are issues which need to be tackled. But simply contrasting it with thr so-called ''good''s system in Britain or Cuba is simply meaningless. These systems have their own problems, for example the long waiting lines in Britain. And Cuba is a closed society.

Moore's movie is a nice tear-jerker but it adds nothing to the policy debate.

1:32 PM  
Anonymous Rohit said...

Sorry, Ashutosh.

1:33 PM  
Anonymous Anonymous said...

Actually, Moore's film does add something to the policy debate - energy - in the form of millions and millions of angry, focused people. Policy debates are not just intellectual puzzles, and intellectual contributions to a debate are not best made in filmic form anyhow.

Your little rhetorical flourish of saying "those systems have their problems too" is fallacious as an argument. It combines two fallacies - a part-whole fallacy and a source-rejection fallacy.

The fact that other health care systems have problems does not tell us much about those aspects of the systems we might want to learn from. Perhaps the problems are linked to the positive features, perhaps they aren't. To assume that they are is to dismiss the whole on grounds that apply to a part, or essentially to take the part to be the whole. A rational stance would insist on further analysis before making that judgment, and it would have to be factual analysis - not ideological "logic".

Furthermore, to reject a feature of a system we might learn from because of some other aspect of it is a source-rejection fallacy like an ab hominem or tu quoque fallacy. Just because a system has problems does not mean we can discount it or reject it as a source to learn from. Just because the system that produced the desired feature is flawed does not mean we can ignore the value of that feature. By the same token, just because someone is a fat slob from Michigan who became a millionaire making movies you might hate does not mean that what he is saying is wrong. (That's just illustrative, not a characterization of your position, of course.)

The greatest crime of the pseudo-intellectual is to come to conclusions, as if this was an easy or honest thing to do, without having done all of the gruntwork of challenging and supporting claims based on something more than the self-evident consensus of a rejectionist in-group.

5:13 PM  
Anonymous Rohit said...

anony,

I have never been a fan of the fallacy debate, so excuse my lack of interest in it. Two points,

First, if the millions of angry Americans want to be part of the policy debate, then they would have to educate themselves--look at the boring charts and graphs. Sicko is a not a a Hollywood movie, it styles itself as a documentary, and hence must answer to higher standards of objectivity.

Second, when I say Cuba is a closed society, it's a fact. What the government can command in Cuba is not something a democratic and free society can do. So I am very skeptical of claims of learning from Cuba.
I mentioned problems in the British system is to emphasize that no system is perfect, oece you adopt a different one--you are simply faced with a different set of problems.

Finally, when people talk of government in medical care in USA, they pretend as if the system is entirely privatized, it is not! The government in USA pays roughly 46% of total medical costs--Medicare/Medicaid have a budget of over 200 billion$ which is of course financed by tax dollars.

So we are already looking at a quasi-government medical system. Does it require more government investment? Maybe. But that requires a policy debate and not Moore style theatrics.

6:37 PM  
Blogger Ashutosh said...

Rohit: Free? It's of course not free...the cost comes out of taxpayers' pockets. He is not demanding free health care of course, he is saying that taxes should actually be used for healthcare. What are taxes spent in the US instead on? The Iraq War of course, and other shenanigans. Also, Medicare is a good service, but doesn't it also have qualifications and is limited to folks above 65? I agree with Anon that just because other systems have their own problems, that does not mean the US cannot borrow from them. And this whole myth of less waiting time in the US also seems to be partly a myth...one of the things Moore says is that women can have to wait for months to get a mammogram, which could mean the difference between life and death. Of course, rich people in the US get royal treatment, and even then not perfect. But it's the majority who are middle class who have to suffer. This is not just some socialism-minded feeling for people, but something that a developed country should implement. I am sure even Saudi Arabia can take care of its richest people, but we don't call it a developed country.
On the other hand, your point about Cuba is taken. I don't think the picture is so rosy.

8:30 AM  
Anonymous Rohit said...

Ashutosh,

If Americans want a government which cuts down on defense budget, and redirects the money to health care, then should elect such a president. None of the democratic candidates save one, has talked about cutting down America's gigantic defense budget.

The point I wast rying to emphasize was that if you want universal care, then be ready to accept limits on care too. You cannot have EVERYTHING!. That should answer your point about your lack of dentist care. Much of the rising cost in health care (a study showed something like 60% or so) is due to technology which Americans so love).

As far as waiting time is concerned, anecdotal evidence doesn't tell the story. It is less in America simply because there is no rationing.

8:58 AM  
Blogger Ashutosh said...

You are right, and one of the big problems is that the healthcare system problem is tied up with other big problems, such as the lack of a good president. I am not saying that they should have everything, but excluding teeth from standard treatment just seems wrong by elementary standards. And while accepting limits is very reasonable, the context of the limits should change their nature; a waiting time limit is unacceptable for emergencies, but a ridiculously high charge and much dillydallying should also be unacceptable for simple operations.
My general point is that one simply cannot argue that the American healthcare system is overarchingly better by any means. Other systems have their problems too, but Moore has done a great job of eliciting awareness about the problems and identifying their specifics in the first place. I think that there are many especially outside the US who think that US healthcare is a godsend and the best you can possibly get, and it's important to dispel this illusion. The excessive love of technology is something quite true.

9:05 AM  
Anonymous Anonymous said...

As an American I want to apologize for Michael Moore.

"Sicko", could aptly describe what he is for he really seems mentally ill.

Given the "Hollywood scene" he is probably on some "recreational drugs" (illegal drugs like cocaine or something like that) as well.

People are starting to call Hollywood "Hollyweird" because of the behavior of the actors and actresses coming out of there.

Please understand there are a great deal of people in America who Hate what Hollyweird is reflecting so don't think they represent all of America.

2:16 PM  
Anonymous Max said...

Health Care has also increased due to lawsuits but the socialist Democrats refuse to pass comprehensive litigation reform.

Suing Doctors is how Demoncrat Presidential contender John Edwards made his millions. He often sued when the reality was that the promblem was a birth defect but Edwards got a jury to blame doctors for it.

9:17 PM  
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1:49 AM  
Blogger Krishna said...

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2:32 PM  
Anonymous Howard said...

Moore made great points about health care, but health care - like most issues in America - is linked to some more central issues. I wish he'd take on those central issues more directly. I talk about it in the post I linked to with my name. Let me know what you think.

1:35 AM  

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