Thursday, June 28, 2007

The Surprises in Sicko

When audiences nationwide go to see Michael Moore’s new movie Sicko tomorrow, quite a few things in the movie are likely to surprise people.

The movie shows where the United States ranks in the world of medical care. Many Americans have come to think of the United States as having a sort of unassailable superiority in medicine and medical science. Perhaps it did at one time, but no one ever rushed forward to tell the American public that things had changed. To see a Cuban hospital that is more clean, modern, and efficient than most American hospitals, or to learn that the United States ranks alongside Costa Rica in a key measure of medical performance, may come as a shock. After the U.S. news media’s portrayal of the Canadian health care system, Americans must be forgiven if they are surprised to see Canadians having such an easy time going to see their doctors compared to what Americans go through.

I would hope everyone knows that the United States has the most expensive medical care in the world, but people may still be astonished to see how much Americans pay.

The single-payer system that the rest of the western world uses for medicine, and that Michael Moore advocates in Sicko, might be politically unavailable in the United States at this point, but we could still find ways to move closer to the efficiency of that approach by closing up some of the bigger loopholes in the current system. The biggest gap in health insurance in the United States is caused by insurance companies trying to evade the whole concept of insurance by deciding after the fact what their insurance policies cover and don’t cover. A good way to start would be to revoke the insurance licenses of health insurance companies that show a pattern of declining legitimate claims by policyholders — and perhaps prosecuting the executives for fraud in some of the more egregious cases. No new laws would be needed for this course of action. All it would take is for state insurance regulators and attorney generals to start taking seriously the laws that already govern the insurance industry.

To make sure that we aren’t giving insurance companies any discretion when it comes to living up to their contractual commitments, I think it makes sense to take away insurance companies’ legal ability to create documents. There is no need for insurance companies to write insurance policies, claim forms, and the other documents they use. If insurers were forced to use standardized government-mandated policy documents in which they could merely check off the things that were covered and those that were not covered by an insurance policy, they would not have the wiggle room they currently use to lead customers to think they’re covered, then tell them later that they’re not.

Another issue Sicko raises is only tangentially related to medical treatment, but it may be just as important. Compared to some European countries, the United States loads an enormous economic burden on its youngest adult workers, while providing equally enormous economic benefits to those who are a generation or two older. It almost doesn’t seem fair that a 50-year-old with a near-average income can live a life of luxury in the United States, while a 22-year-old with the same income may be living in poverty and on the edge of bankruptcy — never mind the fact that as a rule, at least among college graduates, 22-year-olds earn much less than 50-year-olds. The country, you think, could do a little more to help people get started in life, perhaps by making education a little less expensive or by making sure that every town has housing that doesn’t cost a fortune.

In the end, these are all political issues. What would happen if the ordinary person could be healthy, out of debt, and facing a multitude of choices in life? Politics is divided between those who would like to see the day when this happens and those who want to make sure that day never comes.