Thursday, November 13, 2008

Montgomery on Moore's "Sicko"

Colorado blogger Jeff Montgomery has recently written a detailed review of Michael Moore's 2007 movie, "Sicko". Given that "universal health care" has taken on new life in the aftermath of election 2008, I thought it would be good to revisit this topic.

He has graciously given me permission to repost his review here in its entirety:
Comments On Moore's Sicko

For a long time I was not going to watch this movie. I held out for a year, after all. However, I know various people in health care, so I agreed to watch it so I could discuss it with them.

Silly me.

The good news is, especially if you are an Objectivist or other type of classical liberal or advocate of individualism, and you haven't seen it already then you don't need to. Save an hour and 58 minutes of your life for something more valuable. It was a chore.

Before I criticize, I have to say that in a very limited context, Moore succeeded on an emotional level. The limited context is that of evoking sympathy for the people in the film and their situation, and in picking attractive aspects of other countries' medical systems to portray. Who cannot feel sympathy for the medical cases portrayed in the film? And taken out of context, it certainly is a pleasant thought to not have to worry about paying for medical care, isn't it? I'm sure other countries have nice hospitals and nice doctors too. Certain other aspects of the quality of life in France, Canada and Great Britain are also attractive: the long vacations, the good schools... the baked goods. After one such sequence of happy people, Moore cuts back to a scene in the U.S. where a confused hospital patient is intentionally dropped off by an ambulance on the street near a city mission. Ouch.

However, it is precisely that limited context that prevents Sicko from succeeding as documentary or political commentary. You can't comment on a society that you don't investigate. Moore is content to show scenes from everyday life, but never delves into the full context of history or the causal workings of government and the economy. He wishes to suggest that the horror stories he shows are the result of "free market" medicine, but he doesn't investigate causes, so he can't do that. Anecdotal evidence is only as good as the theory it supports, and in the case of Sicko, there is no theory.

Well, there is the usual half-hearted stab at greed, but that falls flat like it always does. He doesn't investigate the nature and extent of government involvement in medicine, or compare countries by that standard, and he doesn't touch on economic theory or even the simplest moral implications of the universal health coverage he pines for.

To Moore, society is a metaphysically divided realm, with helpless citizens on the inside, and the incomprehensible machinations of politics and markets on the outside (the noumenal world of politics?). According to the film, what should matter to the average citizen is what's right in front of us, and nothing more; it is a world without causality, where medical care administered through a slot in a prison door would be identical to medical care in a hospital, because either way it magically shows up. The same inattention to causality regarding the source of care also prevents Moore from seeing the causal relations in the wider phenomenon of health care in society in general. Therefore it fails dismally as real political commentary.

Morally speaking, if your world is made of little more than what appears in front of you, you must advocate altruism, the idea that human beings live to serve one another. That is the only way to keep goods and services magically appearing in front of you without considering where they came from; you must harness others to do it for you. It is not something Moore explicitly explores, it is simply assumed to be true. There is not even one second of reflection in the entire film about whether it is right to use others for such purposes. That is a particularly vicious omission, because it means you, the viewer, have been tried and sentenced to serve, with absolutely no chance to speak in the matter. It is assumed you are to be a slave.

There is one more issue I'd like to mention, and that is the general portrayal of America's health care system. The thesis of the film is that in our country, many are left without important medical care, lives are being ruined, lives are being lost, and we have to just do whatever will fix it, period. I don't doubt that plenty of unpleasant things happen. However, the reason for it is simple: we are neither free enough to provide a wide range of affordable, quality medical services, nor socialist enough to provide care for anyone regardless of their condition or ability to pay. The patients Moore highlights are the ones who drop through that gap in coverage.

However, the solution is not to fully socialize medicine, and Moore has not demonstrated anything of the kind because his narrow focus has prevented such analysis. The solution is to undo the controls on the allegedly free medical and insurance industries so they can provide the best products, just like any industry. As always, the solution is thought, and the freedom to act on it.