Better not to get sick at all

June 23rd, 2007
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There’s been no shortage of articles in print and the blogosphere taking on Sicko, Michael Moore’s latest effort to convince his countrymen and the world that whatever America is doing on any subject, it must be bad. Critiques have generally zeroed in on Moore’s presentation of Cuba’s health care system as not only functional, but superior to that in the U.S.

Several able writers have exposed this as simply false. Not only is sophisticated care in short supply or absent for the vast majority of Cubans, but the basic health care infrastructure is decrepit and barely functional. Patients must bring their own sheets and food when they go to hospital, for example. Aspirin is a sought-after scarcity. Examples continue almost without end.

Given the stark reality that high-quality care is available only in a few selected clinics to those with connections or foreign currency, it’s hard to see how Moore could have been fooled about Cuba, and so his claims can be seen as propaganda. The why remains a bit of a mystery. Surely he doesn’t actually want a Cuban-style system for his country? Is it as simple as anything that can be used in the service of making the U.S. look bad is OK by him?

Given the gulf between claims and reality, attacking Sicko for its praise of Cuba is perhaps the easier route. In this recent article in Reason Online, Mike Moynihan takes the harder one. The film also visits France, Sweden and the U.K. seeking examples of superior health care, and Moynihan engages the debate, offering counter-examples of structurally poor care under socialized medicine in advanced states. Like this one:

Take the case of four-year-old Elias Dillner. In 2004, Dillner’s parents were told by doctors that their son too would benefit from cochlear implants. After being fitted with the first implant, Dillner’s insurance provider said the second operation could not be “prioritized.” The family would have to wait. “We will do anything,” Elias’s mother told reporters, “even if it means that we have to take out a loan for the operation.” Without insurance, the second procedure would likely cost $40,000.

But Dillner’s truculent insurance provider was not [U.S. private insurers] Aetna or Kaiser, but the notoriously generous Swedish welfare state, where health care is “free.” And because there is no private clinic in Sweden that could perform the operation, Elias will sit in a queue, hoping, in lieu of privatization, for prioritization. Swedish legislator Robert Uitto said that the Dillner case was unfortunate, but “People shouldn’t, on principle, be allowed to purchase care in the public system.”

Cuba provides “free” and “universal” health care in the same way that totalitarian regimes through the decades have showered their comrades with every imaginable freedom in their constitutions and have guaranteed everyone a job and enough to eat. The gulf between lie and reality could hardly be greater – and for these regimes, perhaps that’s part of the point.

But in the West, most conservatives accept at least the sincerity of the attempt to create universal health care. Few if any of us accuse the founders of devising a gigantic lie: we just think it hasn’t worked out as envisioned. We’re arguing over whether it’s effective.

Many people, not least in Canada, instinctively believe that government is better at delivering certain services, or at least operates with purer motives. And so they have a far harder time seeing evidence of failure as innately structural rather than outlying abnormalities that can be repaired (generally through devotion of greater resources). Millions continue to regard the system as effective and superior to any alternative.

Having a close relative who for the second time within three years was forced to avail himself of the U.S. system makes me beg to differ. In Canada, he spent four months in excruciating pain repeatedly encountering rationing and outright denial of service, dehumanizing bureaucracy and even contempt from increasingly young, ill-trained and surly system employees. In the U.S., he received literally overnight service, delivered with a smile and personal attention, and at a bearable price. These diagnostics will be followed by surgery at one of Canada’s few private clinics, again for cash.

Dr. J. and I told the story of “Uncle Jack” in this Calgary Herald article.

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