Sicko is Michael Moore’s best film yet. It brought tears to my eyes and infuriated me at the same time. I saw it last night with my youngest daughter. Ah, let me think here, how am I going to give this an environmental twist? How about using our pathetic health care system as another example of how dysfunctional our political system has become, the same one we are counting on to protect our biosphere and us from peak oil and global warming?
The film documents how Hillary Clinton was beaten into submission when she tried to reform the system and how even she is now beholden to the industry. And who is to blame for this? Would it be the politicians, the lobbyists, or the ignorant, self-deluded American citizens who allow the lobbyists to buy the politicians because they are terrified of losing their jobs, everything they are paying off, and their health care to boot? All of which is covered in the film, by the way.
When Moore asked a retired member of the British Parliament how long they have had free health care for all citizens he was stunned by the reply. They have had it since the end of the Second World War. Imagine that; a country bombed flat and financially exhausted being able to afford universal health care. He explained that before the advent of democracy, only the wealthy could afford education and any semblance of health care. Once it was decided that everyone should have a free education, it wasn’t much of a leap to realize that everyone should have free health care. The free market is an incredibly powerful force, but when a man without insurance has to choose which finger he wants reattached, the $60,000 one or the $12,000 one, you may have found a place where the profit motive does not belong. My brother lost his thumb to an accident two years ago. He was uninsured and no attempt was made to reattach it.
The analogy between our national education system and a national health care system is a pretty strong one. Our public school system is not what you would call perfect. The wealthy still put their children in private schools and those schools are better than the public ones because they are for-profit, free-market enterprises. I know this first-hand. Not only have my children attended both types of schools, but my wife also used to teach math in a private school. But, they are not that much better. In other words, the quality per unit-cost of a private school is actually much worse than a public school. A private high school in Seattle is presently costing about $18,000 a year. This is especially true for higher education, where it costs about $40,000 a year. An engineering degree from a state school holds its value against one from the very best private school.
I am also intimately familiar with our health care system, as any parent who has spent years dealing with a chronically ill child tends to become. I am also caring for my aging and impoverished mother. I know first-hand how incredibly inept our medical system is. I find it difficult to believe that national health care could be worse, and if it is, it sure can’t be much worse. There are four health care lobbyists for every member of Congress. The AMA is one of the most powerful. Its main reason to exist is to trip up the free market by limiting the supply of physicians, thus guaranteeing the perverse wages they receive, and this is just one of the forces controlling our politicians.
When Moore asked a French citizen why his government is so responsive to its citizens’ needs, he replied that it’s because the government fears the people. The French will protest and strike to get what they need. He said that in the States, people fear the government. They fear losing their health care. Riiiight. Wait a minute, when was the last time you attended a protest?
Maybe it’s time to go find one. Make it a family affair if you are too exhausted and strapped for time. May I suggest your local Critical Mass on the last Friday of every month? Improving biking infrastructure and safety not only fights global warming but it also prepares us for peak oil. It is refreshing to rub elbows with hundreds of energetic, naïve, idealistic young people — something we need more of. I will let you know of other protests coming up you can participate in, from biofuels to bike trails.
My only concern about the film is that in its attempt to demonstrate that universal health care does not mean living in squalor, it goes a little overboard and will leave the more naïve with the impression that countries with universal health care are paradise. They aren’t. They just have better health care. They still have their problems.
I want to conclude by attempting to explain why free markets work. I want to do this in a vain attempt to cut off at the knees the coming misinterpretation that socialism trumps a free market. First, no two economists will agree on an exact definition of socialism or a free market. The two terms are, in reality, an attempt to pick a point on a continuum. Picture a horizontal bar marked with units:
Communism-socialism-regulated free markets-unbridled capitalism
Picture also one of the major defining differences between them: taxation. As taxation goes up, you slide to the left of the chart. As taxation approaches 100 percent, where all wages are taken by the government and reallocated evenly via services to all citizens, you have communism and its attendant poverty and misery. In a system without taxation, where all power has concentrated into the hands of the wealthy (a description of much of human history), you have what looks an awful lot like unbridled capitalism, slavery, serfdom, poverty, and misery. You don’t want to be at either end of that spectrum, especially when the system finally implodes.
Now to explain why something in the middle works better. To buy my explanation you have to first buy the theory of evolution and the existence of a genetically bounded human nature. This automatically eliminates about half of the American public. By trial and error, via various modern social experiments with communism, we have discovered how human beings respond when a government attempts to force all people to have the same status. When competition is squelched, innovation and efficiency are also squelched. We are social primates. We need hierarchies to function properly as a group. History has also taught us what happens when the disparity between the wealthy and the poor becomes too great.
I call this a status gradient. Picture a chart with a line that slopes down from the upper left corner. The vertical line on the left shows increasing status (closely correlated with wealth) and the horizontal line shows the number of people at that level of status. You don’t want a “flat line,” but you also don’t want the slope to get too steep. I once read a book called the Status Syndrome. I can’t recommend it because it was one of the driest books I’ve ever read. It described a detailed study of the health of the bureaucrats of White Hall (the employees of Britain’s government bureaucracy). The author controlled for everything you can imagine — age, sex, wealth, diet, exercise — and the only thing he could find to explain health discrepancies was status. His recommendation at the end of the book was to keep the status gradient (my term) from becoming too extreme. He also conceded that that there is probably a limit to how flat you can let the slope (my term again) get before things unravel.
You can stop reading here, assuming you have managed to get this far. My last analogy for free markets, and government’s role in them, is for the mechanically inclined out there. This analogy comes from my observations as a child of the governors that controlled the massively powerful engines that drove my father’s bulldozers. A governor is a small device used to control how much air and fuel is allowed into an engine. It consists of a set of weights on levers. The faster the engine turns, the greater the centripetal force on the weights. This force causes them to close the air intake slightly, thus slowing the engine, which in turn causes the weights to drop, exerting less force, and causing the intake to open again.
Think of this massively powerful engine that can do huge amounts of work as the free market. Think of this small governor that sits on top of it as, well the government. Now picture a massive governor sitting on top of a small engine. The engine uses most of its energy trying to spin the dead weights, which in turn are slow to respond to input. That’s communism. Now picture an engine where someone unbolts the governor and runs off with it while the engine is running. The engine will rev to it maximum PRM until something breaks or it uses up all its resources (fuel). That is unbridled capitalism. What you want instead of these two extremes is a well-designed, functional governor that responds quickly and efficiently to the needs of the engine without drawing too much power from that engine. Throttle an engine too much, and it will stall.
I am old enough to remember the horror stories of my parents growing up in a stalled economy (the Great Depression). I also have first-hand experience of what it is like to be at the bottom of the employment hierarchy during a series of deep recessions. You don’t want to stall an economy any more than you want to stall a bulldozer engine. It takes a tremendous amount of energy and effort to restart them, and no progress can be made until you do.