SiCKO, Part Four

Did you know that there's a House bill sitting in Congress right now that creates a universal health care system? H.R. 676 was introduced by John Conyers last January, and was referred to subcommittee in February. What do you want to bet that it never finds its way out of committee for a vote?

I think it was Bill Maher who identified this brilliant Republican strategy of proclaiming that the federal government doesn't work and needs to be smaller, then they fuck it up and say "See?!?" Or something along those lines. Well, it's true, but they're not the only ones destroying government these days. Neither party has a stranglehold on corruption and incompetence. But despite their best efforts, there are some things that the feds do well, do OK, or used to do well. They built the federal highway system, created Social Security, and are good at fighting wars (whether the war is justified, and how the aftermath is managed, is another matter entirely). The administrative costs of existing federal health programs such as Medicare and Medicaid are a fraction of private providers' costs, about eight times less. The EPA and Department of the Interior, even while currently hamstrung by the White House, are still working for a cleaner environment and maintaining public parks and open spaces. U.S. attorneys, despite shaky/criminal leadership at the top, are still going after political corruption and organized crime.

Despite all this, there is still reticence about universal coverage. But what do we have to lose? There's widespread acknowledgment that the system is broken, so how are incremental steps to fixing the flawed privately-managed patchwork of health insurance going to help? Sure, people don't want to be taxed more, but if you can show people the numbers, and that any additional taxes would be less than their current premiums plus deductibles plus co-pays, what else is standing in the way? This idea that government will screw it up doesn't hold water, when comparing the two scenarios.

The existing scenario is privatized health care; a provider is interested primarily in providing a good return on shareholders' investments. There is financial incentive to deny costly procedures, while maintaining a minimum level of satisfaction. Why minimum? Well, since so much health care is employer-sponsored, not many people have a choice of who will insure them. Yes, there is often a choice of plans, but the provider is not negotiable. These companies have a captive audience, so to speak, so the level of service must simply reach a level where the company isn't getting the bad publicity that can be detrimental to earnings. Under the current arrangement, your health and personal finances are in jeopardy, should you be denied a claim or if a medical professional or administrator screws up.

Under a universal care scenario, let's assume you're paying about the same; more in taxes, but no premiums or deductibles, so it's a wash. The doctors stay the same, but they're paid by the government. The government administers the system, which they've already proven - with Medicare and Medicaid - that they can do more efficiently than private insurers. There is no incentive to deny care, there's only incentive to keep people healthy. Like docs in Britain, medical professionals would earn bonuses based on health improvements of their patients (accountability!). Yes, there would be screw-ups, but since the whole system doesn't have co-pays or deductibles, the only mistakes are going to be by the doctors, and those will happen no matter what system you're under. In other words, you can't be bankrupted by paying out-of-pocket for the coverage you need.

OK, time to move on, since a four part post on health care probably decimated my already minuscule readership [I'm guessing that it dropped from 5 people down to 2 or 3].

SiCKO, Part Three

So how is it that we have a health care "system" here in the U.S. that provides such mediocre care, on average, but costs so much more money per capita than other nations' systems? First, there are the problems that are specific to the health care industry; you may have heard some of these before, and some of them are actually true:

• The health insurance bureaucracy eats over 30 percent of all health care costs.
• Blame the lawyers! Medical malpractice insurance stemming from huge lawsuit awards drive up costs. Not really: malpractice premiums are less than 1% of total health care costs, according to the AMA. "Defensive medicine" administered to help guard against malpractice claims is estimated to be 2% of total costs.
• Too many doctors! You've probably heard that the opposite will be the problem as the Baby Boom generation ages, but it may just be that there are too many specialists and not enough primary care physicians.
  

Then there are the institutionalized behaviors and legal/political issues that are at the root of the problem, the breakdowns in how "our" government operates and how our political system works [this is where I start the real opionatin', so feel free to disagree and refute]. One scene in SiCKO that really struck me was of an American in France (in Paris?) commenting that in the U.S., people are afraid of the government, while in France, the government is afraid of the people. Then Moore showed footage of French protesters, footage that would probably elicit a "lazy French" - or worse - response from your average American. But joke all you want about white flags, surrender monkeys and the like, but when was the last time there were huge protests in this country? At least the French are fighting, even if they are sometimes fighting for rights that we might see as extravagances (then again, maybe we're just jealous of all their vacation time).

Meanwhile, back home we're stuck with an inept, corrupt government that few people trust. We have an entrenched two-party political system, strengthened by ridiculous congressional redistricting that protects incumbents. We have spectacularly expensive legislative and presidential campaigns that are almost entirely privately funded by corporations and trade groups. We have a Supreme Court that equates political donations with free speech, which serves to legalize this corruption. We have lobbyists that write legislation. We have ludicrous taxpayer-funded projects. We not only have private health care, but an increasingly privatized military. We have out-of-control educational expenses, expenses that are unheard of in other industrialized countries that provide free higher education to citizens. When that's the government that most Americans see, how could they ever be convinced to let it be in charge of their health? Looks like I am gonna need a Part Four....

SiCKO, Part Two

Michael Moore's website has a nice page that provides references to many of the assertions in SiCKO, it's definitely worth a look. I did take notice of a few of the film's facts that didn't sound quite right, however, that I wanted to check out myself. This also led me to seek out other bits of data:

• France has more productive workers than the U.S.? I could have sworn that the U.S. was at or near the top of the latest OECD statistics in this category, but I could be wrong. Alas, the link on Moore's website that leads to the specific OECD page is broken, so I had to look around a bit. I also kept in mind that whatever OECD numbers Moore was using were 2005 numbers; current stats may tell a different story, but one would think that these types of metrics wouldn't change all that much in a two-year period. I found my way to the OECD database portal, which as productivity data as of October 2006. For some reason the sort function didn't work, so I pulled the numbers offline, but this is what I found:
• surprisingly, the U.S. ranks 18th in hours worked per person - I assumed that this would be higher! We're waaaay behind the #1 country, South Korea, which has us beat by over 600 hours per year (2357 vs. 1708). Good for us! France, by the way, weighs in with 1555 hrs/yr/person, good if you can get it!
• When it comes to GDP per hour worked, we're #6 at $50.4 per, which is well behind leaders Luxembourg and Norway, which are at $72.2 and $71 respectively. Why is Norway's number so high, oil money? Ikea? Wait, that's Sweden. Anyway, France is right behind the U.S. at $49.9. Close enough that it could very well be that it was slightly different in 2005, and France was ahead that year.
  
• Searching for this data led me to what looks to be a pretty neat blog, The Big Picture, that I'm going to check out in greater detail a bit later. The particular entry that popped up as I was searching for productivity stats was this one, which is worth a quick read. It makes some fantastic - and succinct! - points about the future of America's economic might, and how current policies could cause problems for our economic engine going forward. One of my favorite questions also pops up in that post; who would/could sacrifice money-based wealth for time-based wealth? I know where I stand, which is why at some point in this SiCKO informational odyssey, I'll be looking up immigration policies of other countries...just for fun ;)
• Looking up OECD statistics in one's spare time ranks in the top five of most pathetic uses of free time for non-retired persons.
• The most recent United Nations Human Development Report (link to pdf) ranks the U.S. at #12, ahead of #14 U.K. but behind #10 France and well behind #4 Canada (the countries Moore visits in SiCKO). Our high per capita GDP boosts us up the list, while we take a hit for slightly lower life expectancy and eduction stats. Cuba ranks #51, with its low GDP number dragging it down but with life expectancy 0.2 years higher than the U.S. and its education score higher as well. All sorts of neat stats are available in this U.N. report! A few favorites that I picked out:
  
• Our use of coal has remained steady from 1990 to 2005, while it has dropped, sometimes precipitously, in Europe. The U.K. dropped from 29.7% to 16.1%; that's impressive. While in Japan, Israel, and Australia, coal use has actually increased. Yuck.
• Electricity consumption per capita - the U.S. isn't quite as bad as I thought, although when one considers the latitudes of the nations that consume more than us, then the U.S. numbers seem awful. Too bad we're so averse to paying more for efficient, long-lasting appliances.
• Hmmm, I don't think we're nearly as generous, as a nation, as we think we are.
• Finally, a metric that the U.S. leads the world in, health expenditures per capita!
  
• We also kick ass in homicide rate, although plenty of South and Central American and Eastern European countries have us beat. We'll have to work on that....
  
• How do these countries that provide universal health care do it? It's hard to find reliable tax data - the rates tend to be all over the place, depending on which site one visits - plus there are ranges due to tax brackets, and then VAT taxes and local/state taxes also throw wrenches into any objective comparison. But here goes:
• The World Taxpayers Associations indicate that the U.S. has it pretty good when it comes to tax rates.
• Wikipedia's numbers seem to indicate that, when one factors in state taxes and sales taxes, maybe the average U.S. citizen is being taxed like Europe and Canada.
• None of these sites provide a comparison of effective tax rate - how do I know if France gets all the deductions and credits that an America provides? Do they get more deductions? Fewer? This is almost impossible to figure out.
• Back to the OECD - Table 0.2, near the bottom of the page, indicates that the U.S. worker pays less than most other OECD nations in terms of income tax and social security contributions. That's actually quite reassuring - we're not paying too much for all those government services that we don't receive!
  

SiCKO, Part One

We watched SiCKO last night; maybe not the best film to watch during the holiday season, as it doesn't exactly leave one feeling warm and cuddly afterwards, but it was next on the Netflix queue.

How was it? Well, I would definitely give it 4 out of 5 stars, but there are caveats. I happen to be a Michael Moore fan - he's a great entertainer, he's provocative, and for better or worse, he gets people talking about the issues that his films present. No, he's not a journalist, he's not fair and balanced, but that's not his job, he obviously has an agenda and he's not trying to hide it. If you watch one of his movies thinking that you're going to get both sides of the story, you're going to be just as disappointed as if you were to approach Fox News or Salon.com with the same expectations. Not gonna happen. If you're looking for a documentary that presents facts without emotion, again, good luck. One of his most effective tools is giving a human face to the given issue, something that the evening news does all the time, albeit much more subtly and less effectively. One perfectly valid criticism of his past movies is that he's on screen too much, pulling dumb stunts that likely hurt his cause as much as help it. OK, I'll buy that, even if the stunts are usually entertaining. SiCKO, fortunately, moves away from the Fahrenheit 9/11 in-your-face style; Moore doesn't even make an on-screen appearance until the film's half over, and the publicity stunts are limited to a silly trip to Cuba at the end of the film that unfortunately isn't entertaining or effective (you want a good Cuba documentary, try Buena Vista Social Club, awesome movie).

It might be his best movie since Roger and Me in terms of content, but it's also the most frustrating film he's made. I think you would need three or four sequels to do this problem - health care in the U.S. - any justice, but even so there aren't enough Whys being asked in SiCKO. It doesn't take a genius to figure out that health care in the U.S. is fucked up, but why? It's helpful to point out countries such as Canada, Britain, and France where universal government-run care seems to be working, since I'm sure there are plenty of Americans that are ignorant that there are these kinds of systems in place that people are happy with, but how do they make it work? At one point, Moore asks a French doctor whether the national model that's in place in France would work in the U.S. He says "No", then walks away...what, no follow up? Just 'No'?!? I'm not expecting that this doctor would have all the answers, but I was waiting for someone on screen to at least attempt to explain this mess. It's easy to tag Richard Nixon with the blame, as Moore does at one point, but there is no possible way that it's that simple. I have my own theories and suspicions about who and what is to blame, but in the interest of brevity I'll save those for another post. There are also zero suggestions on how to fix the obviously broken American system.

I'll be spending at least one more entry on this topic, picking out scenes and themes from the film, delving into fact vs. fiction, checking some numbers, and searching for any practical ideas for fixing the system. Universal health care is also a great jumping-off point for discussions about the role of government in our lives, so who knows what tangential topics might end up being put in play - taxes, education, infrastructure, libertarians?