Michael and Me

Michael Moore doesn’t want me to see “SiCKO,” his pro-socialist, anti-private health care documentary.  If you know anything about health care systems, he doesn’t want you to see it either.  At least, not yet.

So far, the only people allowed to view the film have been reviewers who know nothing about the subject.  The apparent theory is: get it reviewed by people unlikely to spot all the errors and omissions before you open it to more discerning viewers.

As it turns out, though, I have seen the movie.  It is full of errors and omissions, but that is almost beside the point.  Since the whole purpose of the film is to compare the worst features of American health care with the best features of health care in Britain, Canada, France and even Cuba (!), who can complain about a few errors here and there?

The mistake reviewers are making is in thinking this is a movie about health care. It isn’t. There is no attempt to objectively compare the merits and demerits of different health care systems. There are no interviews with any health policy experts. There is not a single, practical proposal any politician could adopt.

So what is the film about? It’s about psychology.  It is a perfect-storm intersection of three phenomena: left-wing politics, health care altruism and Hollywood. Here is what I mean.

The one thing that unites left-wing political movements all over the world, regardless of their differences and idiosyncrasies, is the belief that incentives do not matter. One and all, they believe that people at the top can formulate a plan that will be successfully carried out by people at the bottom, even when it is manifestly not in their self-interest to do so.

In my book, Regulation of Medical Care (Cato Institute, 1980), I described how organized medicine replaced for-profit institutions with nonprofit institutions in first half of the 20th century. First came medical schools, then hospitals, then insurance companies – until the only people left who were making a profit were doctors themselves.  At the time, I implied that the motive behind all this was pecuniary. Since then I have discovered that there are an enormous number of people in the health care community who believe that incentives should not matter.  To them, health care without altruism is a contradiction in terms. 

The prevailing view in Hollywood is that incentives will not matter in a just society, if only people care enough. The song says it best: “All you need is love.”

What is the one thing all three groups have in common?  Rejection of the idea of incentives. Since economics is the science of incentives, this implies the rejection of economics.  (To paraphrase Moore: Incentives are about “I”; the focus instead should be on “we.”)

All three groups are divorced from reality to one degree or another.  That is, when you are around them you are unlikely to hear about any of the principles you learned in Economics 101.  However, Hollywood takes the rejection of reality to a whole new level.

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. For some, this subjective recreation doesn’t cease just because the camera has stopped rolling.  They keep right on going until the world they are living in becomes unrecognizable to the rest of us. (Rosie O’Donnell and Charlie Sheen come to mind.)  I’m not sure if there is a technical term for this disorder. If not, I nominate the term, “Jane Fonda Syndrome.”

For Michael Moore, the real tip-off is the trip to Cuba. Understand: No rational proponent of national health insurance would ever bring up Cuba.  In the very act of bringing it up, he is telling us – in the only way he knows how to tell us – this film is not about health care. It’s about Michael.

Sure there are good doctors in Cuba.  It’s also true that the average Cuban has to bring his own soap and bed sheets when he enters a hospital.  What kind of mind would focus on one fact and ignore the other? A mind that thinks if he recreates the Cuban health care system on film, it will become reality.

But the fantasy doesn’t end there. By implication, Moore is recreating all of Cuban society.  If there is one fact all the rest of us know – indeed, almost everyone else in the whole world knows – it is this: If someone like Michael Moore actually lived in Cuba, he would be in prison in a matter of weeks.  And his biggest problem would not be health care. It would be torture.

So what kind of mind are we talking about here? I don’t think I want to go there.

For a comprehensive look at how the health care systems of Britain, Canada and other countries really work, see Lives at Risk, available at http://www.ncpa.org/pub/lives_risk.htm.

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