I came, I saw bootlegged copy, I have observations.
Michael Moore makes very entertaining but one must never lose sight of some realities about him. Moore knows the end point of what he wants to say before he begins the film, and the film is constructed specifically to get there. He only interviews people that support his position. He insures that any alternative views are from shaky prospects. And Moore is very, very much a wild-eyed liberal. Michael always looks through a lens that makes his ideal look far different than objective reality. In “Roger and Me”, he would have General Motors spend billions to stay in Flint and risk insolvency just to support the hapless population of workers. In “Bowling for Columbine”, he pins the blame on poor befuddled Charlton Heston, already showing signs of dementia. In “Fahrenheit 441” he simplifies very complex issues by blaming one individual, GW Bush, (admittedly a doofus, but only a small part of the whole). Having said that, I think this film stands on very firm ground and should be seen by everyone. It effectively explores issues that will figure greatly into the 2008 presidential election.
Moore goes into it dismissing the egregious fact that over 46 million Americans are without health care indemnification. He then goes into great detail to show that many Americans who think they are insured get caught in the “disallowed” trap. Their insurance companies refuse to pay for needed services using one ruse or another. His recurring theme is that insurance companies cut costs be denying reimbursement, especially if it’s pricey and, of course, CEOs and executives pocket the savings. But this is old history. The date for one of his subjects was 1996, and most of this disallowment gambit is way over ten years old. Because of the efficiency of the Information Age, denying care has become much more unfashionable as the light of day shines on it and has been superceded by new evolutions of greed and gluttony. The thrust has changed from conserving wealth to building wealth. Instead of pocketing money diverted from health care provision, CEOs and executives now use entrepreneurial principles to build business empires from health care centers in which they profit by the “bonus” system. They use money to make more money and as the empire grows, their “bonuses” for creating wealth exceed their salaries many fold. They are isolated from actual health care delivery, but their decisions always involve money.
Moore’s thesis is that all that money that CEOs, executives and Big Pharma are taking out of the system should be used to help expand a true universal health care delivery system that’s overdue. As a country, we support obscene salaries of “non-profit” health CEOs and executives by taking money directly out of health care, a zero sum game. The pieces of the pie must always add up to 100% at the end of the slicing. When one piece of the pie gets bigger, the rest get smaller. This thesis simply isn’t contestable. It’s in all the resource management textbooks. So, we, the most affluent country in the world culls out almost 20% or our population from health care indemnification and under-supports the rest so that individuals prosper.
Having digested this film for a while, I truly think Michael Moore’s heart is in the right place. I don’t think he’s one of those Star Trek villains that glows when it’s around discord. I think he truly believes what he portrays in his films, especially this one. But he is a creature of his biases, and a big bias is populism. For example, he is very kind to Hillary Clinton’s attempt to revamp the health care system in 1993, insinuating she failed because “organized” medicine and especially Big Pharma ganged up on her. The reality is her plan failed because it was a conceptual disaster in every way, not even thought out by Hillary, who has never had an original thought in her head. It was her guru de jour Ira Magaziner, and he quickly faded into well-deserved obscurity. Even Moore admits that now Hillary is running second in receiving campaign money from health care corporations and Big Pharma.
Considering all the above, it’s obviously insufficient to open-endedly complain about a bad system. A better alternative has to eventually be put forth. Accordingly, Moore then goes on to extol the virtues of other countries’ health care provision systems. Ever the populist, Moore uses selective interviews to portray them as God’s gift to the citizenry, free, freely available and matchless in every respect. Idyllic Europeans describing getting paid to take three months off after surgery just to get back in a good frame of mind. “Ever get a bill?”. Smiles all around. “Only in America”. Very convincing, at least as far as the interviews go. But all are very vague as to how long they actually wait for services.
Of course there are such systems in the world, but there’s a Catch-22 that Moore doesn’t understand because he’s an interested bystander hung up by his populist biases. The stark reality is that getting access into the system is not the same as actually obtaining services. As access increases at a constant provision level, waiting time waiting for services goes up exponentially. That fact is incontrovertible. It’s in all the resource management textbooks. The National Health Care service in the UK does indeed offer 100% access for citizenry, as do most of the other European Union countries. But access does not necessarily equal efficiency and it isn’t cheap for those funding it. The income tax in most of these countries is considerably higher than ours, many over 50% of gross income, and most have a substantial “value added” tax for everything purchased that dwarfs our “sales tax”. 17.5 % in the UK in addition to income taxes. And the UK is a VERY expensive place to live. But they have unlimited free access to health care. Moore doesn’t seem to see the connection, but Americans soon will.
Better than what we have now? Michael Moore thinks so. Here’s are his final comments at the end of the film verbatim:
“You know, when we see a good idea from another country,
We grab it. If they build a better car, we drive it. If they make
A better wine, we drink it. So if they’ve come up with a better
way to treat the sick…………then what’s our problem. Why
can’t we do that? They live in a world of “we”, not “me”. We’ll
never fix anything until we get that one basic thing right. And
powerful forces hope we never do (Shows photo of Aetna Insurance building) and that we remain the only country in the Western world without free, universal health care”.
There is little doubt that America will have universal health care coverage probably as part of the next presidential term. They have all promised it, and although none show any convincing evidence of ability to deliver, they’ll all try. One thing is clear. We have gotten away with what we have far too long and it’s going to end because it can no longer be sustained. And universal health care will be a very bitter pill for every layer of Americans for a lot of reasons. As terrifying as it seems, Hillary Clinton has a shot at being the next president, and her plan is 1993 HillaryCare revisited. An updated version “managed care” for the new millennium. Few if any of the rest of them have much better plans. The only one of the batch that actually came out and stated that it will be tax based and taxes will rise to whatever level supports it is Edwards. Something the public doesn’t want to hear up front, but will find out after the fact.
Health care delivery will tread the path of the Great Golden Mean. Resource access will be managed by those with an incentive to maintain status quo. A stable normal distribution of care where the majority will eventually get what they need, and those on either end of the curve will get siphoned off……. and all will wait. The price of access and economy will be delay, and Americans aren’t used to waiting. Those wailing to Michael that they cannot obtain access will then be wailing that they have access but no service. Reports of deaths and disability while waiting for services will replace instances of death and disability from inability to pay. Instead of a portion of the population being very satisfied with their service and others unhappy, virtually all will be unhappy with the Great Golden Mean.
CEOs and executives’ bonus millions will dry up, as there will be no utility in building empires for government services. They’ll unfurl their golden parachutes and move on to other areas of more fruitful business endeavor leaving administration to those with an incentive to insure their job security. High priced surgeons delivering superspecialty care for a salary of millions will move onto something else. The same government employees that oversee social welfare programs will administer health care services, and complaining will similarly be met with stone faces. Angry malpractice lawsuits for malpractice will beat themselves to death against the pure essence of attrition. Big Pharma will move to other areas in the world, if they haven’t already.
I heartily recommend everyone see this film when it comes out 6/29. Here’s the URL for a pirated version maybe you can watch standing in line for your iPhone. (Don’t turn me into the Motion Picture of America Association Federales).
We live in interesting times.