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Commentary By David Gratzer

A Prescription for SiCKO

Fourteen years ago, Harry and Louise joined us in our living rooms and told Americans about Hillary Clinton's health-care proposal. To liberals, the insurance industry-sponsored TV spots represented the worst of American politics: the negative tone, the oversimplifications, the dramatic accusations. Robin Toner, writing in the New York Times, suggested that the ads "played on people's fears."

ClintonCare wasn't sunk solely by two fictional characters sitting around a kitchen table. The complicated nature of the plan, coupled with the White House's bungled strategy, did more to damage the cause than advertising executives could ever have fantasized—by the end, even Hillary Clinton's Senate predecessor, Daniel Patrick Moynihan, came out opposed.

But even after Harry and Louise went to TV heaven, joining Morris the Cat and the Glad Man, the ads left a lasting impact on the liberal psyche: lampooned at the Academy Awards, described in countless books, and even earning their own entry on Wikipedia. How, though, have liberals reacted to Michael Moore's documentary, which has much the same bravado? Unsurprisingly, they have been lavish in their praise.

Moore suggests in SiCKO that American health care doesn't simply need a shot of government assistance, it needs radical surgery—of the government takeover kind. Moore sees no role for private insurance, waxes poetic about price controls (particularly for pharmaceuticals), and looks to Cuba as a role model. There are, of course, well-reasoned people who favor some type of government-based health-care solution. Moore's documentary distinguishes itself not because of its argument—goodness, almost every prominent health economist in academia makes a similar case—but by its fast and loose nature.

Moore claims that ERs don't overcrowd in Canada. Yet a recent government study suggested that only about half of patients are treated in a timely manner. Moore suggests that Britain offers quality medical care; meanwhile, one in eight Britons waits more than a year for surgery. France is held up as the promised land, with free health care, doctor home visits, and even laundry service for new moms. Not a word, however, about the heat wave of 2003 that killed 13,000 elderly because the hospital system was unresponsive.

The factual errors are plentiful. Moore claims that HMOs arose from a Nixonian plot, hatched out in secret in the White House. He plays a grainy tape to make his case. Actually, the legal groundwork for this type of managed care was laid by the HMO Act of 1973; co-sponsored, incidentally, by Senator Edward Kennedy. Moore explains that after Nixon embraced HMOs, health care became scarce, leading to shortages (he plays accompanying footage of a hospital ER with 18-hour waits). Moore's hard-luck stories are all unverified. The saddest case involves a young man with renal carcinoma, in need of bone marrow transplant, who has been denied the procedure by his HMO. Actually, there is no evidence that such an intervention would have been helpful; no doctor would advocate this procedure.

Moore's argument would not have survived, in other words, a basic fact-check. Yet, the reviews are sterling. Brilliant, important, enthralling are all words used to describe it.

Liberal columnists have been particularly effuse with their praise. Pulitzer Prize-winning columnist Clarence Page gushes: "He uses the same big-screen pop culture that brings us Paris Hilton and 'American Idol' to summon our eyeballs to something truly valuable: a vision of how much better America's health-care system could be."

Ezra Klein of the American Prospect, who writes often on health reform, offers an absurd explanation of his fondness for the film: It's not actually about health care, rather it's a metaphor for "American exceptionalism." The New Republic's Jon Cohn—arguably one of the smartest voices on the Left in this debate—concedes some "trepidation" at the beginning of his review because "Moore has not always been the most intellectually rigorous storyteller." And in SiCKO, he finds "intellectual dishonesties and arguments without context"—but finds a way to makes peace with the film: "Still, by the time the final credits ran, it was hard to get too worked up about all of that. Because, beyond all the grandstanding and political theater, the movie actually made a compelling, argument about what's wrong with U.S. health care and how to fix it."

Even Canadian columnists forgive Moore for his creative interpretation of facts. In "Moore is Right," Toronto Star columnist Thomas Walkom gushes about the film, but recognizes that the portrayal of Canadian ERs is a stretch—"To any Canadian who has ever been forced to go to emergency, this would seem unbelievable."

How does Moore manage to simplify an argument to the point of absurdity, yet walk away with so many endorsements from people who know better? Perhaps liberals simply cherish the documentary as a day-dream—a fantasy world reshaped by leftist ideas.

And Moore offers a wonderful world. It's not just that the Canadians like their government-run health care; they're so damn magnanimous about it—the Canadian senior doesn't mind paying for his countryman's health care because "he would do it for me." The sharply dressed British doctor maintains that the public sector pays a good salary, rejecting the idea of American-style compensation. He can't own "six homes," but why would he want to? And the French? Not only do they have post-natal laundry service, they are all so pretty and chic!

For 14 years, liberals have wondered about the world that could have been if not for Harry and Louise. Moore wistfully paints that picture.

But if liberals have endured 14 years of regrets, the rest of us have faired pretty well. As it turns out, the disaster scenarios liberals predicted in the early 1990s never came to pass. The percentage of uninsured remained stable; health spending didn't hit 19 percent by 1999, as the Clinton White House forecast; corporate America never collapsed.

Instead, over these years, American health care has enjoyed some modest successes: the rise of consumer-driven health care, first and foremost. And American medicine continues to innovate and excel. Death due to cancer has, adjusting for aging, dropped 1 percent a year, every year, since the early 1990s.

If Americans have fared well over this past decade and a half, people with socialized medicine have not—just as Harry and Louise warned would happen in the U.S. with HillaryCare. Thus, at a time when Americans are celebrating their medical achievements, Moore's beloved French are examining their health care system. In 2004, Health Minister Philippe Douste-Blazy didn't mince his words: "Our health system has gone mad."

That is not to say that reforms aren't needed here. It's just that Michael Moore has nothing to contribute to the debate. Maybe that's because Harry and Louise weren't so wrong after all.