Moore’s “Sicko” Could Put Lives at Risk

John C. Goodman

In interviews and publicity stunts to promote the movie, Moore is making a general call for instituting a socialized, single-payer health care system.  For example, Moore attended a rally at the California state capitol the other day with hundreds of nurses.  Most were wearing red "SiCKO" promotional shirts and enthusiastically chanting, "Hey ho, hey ho, private healthcare is sick-o," and "What do we want? Single payer! When do we want it? Now!"

Moore recently told ABC's Good Morning America that in Britain and Canada people "have a basic core belief that if you get sick, you have a human right to see a doctor and not have to worry about paying for it."  By contrast, according to Moore, "people are dying in this country as a result of the decisions that get made by [private] health insurance companies."

I suppose this is plausible if you have never been to Britain or Canada.  People who actually live there know they have no right to any particular health care service.  A Canadian, for example, has no "right" to an MRI scan or heart surgery.  There is not even a right to a place in line.  If you are the 100^th person waiting for heart surgery, you are not entitled to the 100^th operation.  Other people can, and do, jump the queue.  Far from enjoying a "right to health care," people in other countries often wait for needed care.  For example:

• In Britain, about 1 million are waiting to be admitted to hospitals at any one time.
• In Canada, more than 876,000 are waiting for treatment of all types.
• In New Zealand, the number of people on waiting lists for surgery and other treatments is more than 90,000. 

Patients who wait are often waiting in pain.  Many are risking their lives.  One investigation of colon cancer treatment delays in Britain found that 20 percent of the cases considered curable at time of diagnosis had become incurable by the time of treatment.  Another study of coronary bypass surgery delays in Ontario found that 121 patients were permanently removed from the waiting list because they had become so sick that they could no longer undergo surgery with a reasonable risk of survival. 

One reason people are waiting for care is a conscious decision by the government to limit health care resources.  Whereas Americans can plop down cash for an MRI scan at a local shopping mall, in Canada private purchase is illegal.  Moreover, Canada has only one-third the number of MRI scanners and the wait for a "free" government-provided scan is about three months.

The United States has about 1,000 PET scanners (which can detect metabolic cancer a year earlier than an MRI scan).   The Canadian Medicare system has only three.  To believe the quality of care is the same in the two countries, you basically have to argue that PET scanners don't matter.

Ironically, Britain was the inventor of the CT scanner and in the 1980s exported about half the scanners used in the world.  Yet the British government purchased very few of the devices for the National Health Service (NHS) and even discouraged private gifts of CT scanners to the NHS.  Britain also was the co-developer (with the United States) of kidney dialysis, but it consistently has had one of the lowest dialysis rates in Europe. 

Patients in single-payer systems often lack access to lifesaving prescription drugs many Americans take for granted.  For example, Taxol, a drug that is widely prescribed in the United States for the treatment of breast cancer, and Gemzar, a drug used to treat pancreatic cancer, are unavailable in some regions of the U.K.  Less than one-third of British patients who suffer a heart attack receive beta-blockers (used by 75 percent of patients in the United States), despite the fact that post-heart attack use of the drug reduces death by 20 percent.  And according to the World Health Organization (WHO), as many as 25,000 people in Britain die of cancer each year because they cannot obtain the latest cancer treatments.

Perhaps as a result of not receiving the care they need, people with curable diseases often do not survive.  In the United States, only one in four of those diagnosed with breast cancer dies of the disease, compared to one in three in Germany and France, and almost 1 in 2 in New Zealand.  In the United States, only one in five prostate cancer patients dies of the disease, compared to 1 in 4 in Canada and 1 in 2 in France. And in the United Kingdom, more than half of all prostate cancer patients die from the disease.

When Moore boldly asserts that Britons "wouldn't trade their NHS cards for his Blue Cross card," he could not be more wrong. In fact, people in other countries often have to pay out-of-pocket for care that has been denied them by the government:

• In Britain, about 7 million people have private insurance for services the government theoretically provides for free.
• In New Zealand, more than one-third of the population has private health insurance to cover services theoretically provided free of charge by the state.
• Canadians spend $1 billion a year in the United States on health care services not available in Canada.

Why, then, is national health insurance in other countries as popular as it appears to be?  One reason is that people do not realize how much they pay for it in taxes.  Even mediocre care looks good if you think it is free.  A second reason is that doctors in other countries often don't tell their patients their care is being rationed.  Instead, they say, "there's nothing more we can do."  A third reason is that most people are healthy.

Relative to U.S. levels of provision, countries with national health insurance routinely under-provide to the seriously ill and over-provide to patients with minor ailments.  This is a direct result of the political nature of national health insurance.  In a typical U.S. private health care plan, 4 percent of the enrollees spend more than half the money.  In a political system, politicians cannot afford to spend half of the budget on 4 percent of the voters, many of whom are probably too sick to vote anyway.  The temptation is always to take from the few who are sick and spend instead on the many.

So what are we to make of Moore and his "documentary?"  Economists, like other scientists, study reality in order to adapt to it.  Artists, by contrast, selectively focus on some facts and ignore others in order to recreate reality.  For some, this subjective recreation doesn't cease just because the camera has stopped rolling.

For Michael Moore, the real tip-off is the trip to Cuba.  Understand: No rational proponent of national health insurance would ever bring up Cuba.  In the very act of bringing it up, he is telling us - in the only way he knows how to tell us - this film is not about health care.  It's about Michael.

Sure there are good doctors in Cuba.  It's also true that the average Cuban has to bring his own soap and bed sheets when he enters a hospital.  What kind of mind would focus on the one fact and ignore the other?  A mind that thinks if he recreates the Cuban health care system on film, it will become a reality.

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John C. Goodman is president of the National Center for Policy Analysis and co-author of Lives at Risk: Single-Payer National Health Insurance Around the World (Rowman & Littlefield, 2004).