The economics and morality of Sicko
‘Sicko’ economics, round 2
David Felix
Bangor Daily News
August 1, 2007
John Goodman summarizes his critique of Michael Moore’s documentary on health care reform as follows: “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.” Bad economics is thus Goodman’s basic charge against “Sicko.”
This charge prompted me, an economist, to see the documentary. My conclusion? Moore is far less guilty of flawed economics and disregard of relevant facts than is Goodman. Moore is also straightforward about his values and ideology, whereas Goodman masks his as scientific economics. This impels me to defend my profession by exposing the falsity of his claims, and some of the salient facts that he ignores.
Goodman rejects single payer universal coverage health systems, which Moore favors, because they require bureaucratic rationing of medical care, and impose longer waiting periods than do private market health systems. The rationing complaint as such is irrelevant; markets also ration, mostly by the purse. What they have been unable to do is provide universal coverage.
The incentive for private health insurance companies is to maximize profits by insuring low-risk clients and rejecting high risk ones. That incentive promotes private bureaucratic rationing of services and intensified screening of applicants. The U.S. public sector and private charities have thus been pressured to finance treatment of some sort for the rapidly rising millions of U.S. uninsured and underinsured. “Sicko” illustrates various aspects of the problem. Goodman gives it no mention whatsoever.
(David Felix then discusses numerous examples of Goodman’s distortion of the economics through major omissions.)
…what economists call deadweight losses, inefficient uses of resources that reduce national welfare. “Sicko” illustrates such losses in the U.S. system; Goodman ignores them.
Which brings us to the moral issue. The major religions advocate egalitarian distribution of social welfare theologically, whereas libertarian ideology prioritizes free markets and individual choice. Each can become enmeshed by policy conflicts between theology and economic reality.
Health reform is an exception. Moore has the easier advocacy task: his single-payer reform is supported by both “scientific” economics and widely held religious principles.
Goodman must show that socializing health insurance, even if it lowers economic costs while improving health, is morally bad. His critique avoids that question, other than hinting at a slippery slope argument. My conclusion: Moore wins over Goodman on economics and morality.
David Felix of Orono is professor emeritus of economics at Washington University in St. Louis.
http://bangordailynews.com/news/t/viewpoints.aspx?articleid=152647&zoneid=35
Comment:
By Don McCanne, MD
The economic benefit of the single payer model is firmly established in the health policy literature. That does not stop the conservative and/or libertarian think tanks from using highly selected data to create the impression that there is a compelling economic argument for rejecting single payer reform. As David Felix’s article suggests, these arguments are made to appear valid by remaining silent on the overwhelming body of information that would refute their deviously crafted premises.
In dismissing the validity of their economic theses, we can then turn to the fundamental dispute: the choice between the egalitarian concept of social insurance and the libertarian ideology of free markets. David Felix is right. This is a moral issue.
Is establishing an efficient, equitably-funded, universal insurance pool that would allow everyone to have affordable access to health care a good thing or a bad thing?
Is keeping the government out by allowing individuals the freedom to use their own personal funds to negotiate their way through insurance markets and the health care delivery system a good thing or a bad thing?
Joining together in a democratic process to be sure that everyone has health care has been considered to be a good thing by all other industrialized nations. Do those who wave the banner of freedom really still believe that they hold the high moral ground when they have emblazoned their banner with a skull and crossbones? I’ll take our banner with its stars and stripes, thank you.