Crazy enough, I never saw SiCKO, Michael Moore's documentary on the American health care system from almost three years ago, until just this weekend. What a difference three years make.
While fully acknowledging how easy it is to criticize the effectiveness of a persuasive documentary several years after it was produced, and how difficult it is to evaluate the effectiveness of something that became an integral part of the public discourse on this topic, there was something that was definitely missing from SiCKO: villains.
Instead, Moore opted to rely again and again on moralism, making the American people themselves seem like the ones at fault: 50 millions Americans are uninsured, and there are a lot of sad victims everywhere, so is this who we want to be as a country?
Personally, I share Bob Somberby's frustration with universal health care proponents' inability to discuss the price of health care in effective ways. After Moore went to Canada to compare health care systems, I wanted him to say how much Canadians pay for their obviously more effective system (they paid US$3,678 in 2006, BTW, while we were paying $7,071). He keeps on saying it's "free," but everyone knows nothing is free and when he says that most people unfamiliar with how we're getting looted every day in the US will just assume that they pay an equal or greater amount for their health care system, but just in taxes.
Then he goes to the UK. They don't ask for money at the hospital, and sometimes they give people money for transport! Great stuff, but how much do they pay for that? ($2,723 on an average year, if you wanted to know.) France, the same, and he shows an engineer living well with lots of extra cash on hand. How much do the French pay for their health care system? It's $3,374 on average, one of the more expensive systems out there, but you'd never know from the documentary.
It's only until he gets to Cuba does he compare prices, in passing, in one quickly uttered sentence, and it's easy to write off the cheapness of the Cuban system as a result of larger economic differences.
Why is this so important? Americans fundamentally don't care about morality; they care about evil-doers. Those value voters that were so famous in 2004? They cared more about punishing women for having sex and gay people for existing than they did about actually enforcing a system of moral values. And the failure of health care proponents to hand the American public a villian in the health care debate this past year is only part of why people aren't getting riled up for the public option they generally support.
Moore's morality argument, while completely valid, is just too abstract for some people. Sure, it'd be nice for the government to provide everyone with health care, but after work and kids and all the other obligations working people take on, it isn't a priority. Who can blame people who are themselves being crushed under the high cost of health care if they can't bring themselves to agitate for others' access to the health care system? Especially when most think they'll have to tighten their budgets:
The poll found 48% of respondents in favor, and 49% against, the health care proposals current being developed by Congress and the Obama administration. In addition, opponents were more intense, with 39% strongly against and 10% only somewhat against, compared to 30% strongly in favor and 18% somewhat in favor.
In addition, 52% expect their own personal health care costs to increase if the bill is passed, and 56% expect the country's overall costs to increase.
It's hard to ask people to pay money for something they don't think will benefit them personally:
Just 19 percent of Americans think the changes would actually help them personally. That figure has remained unchanged since August. As many as 34 percent think the proposals would actually hurt them, while 41 percent say they would have no effect.
A better argument, one that speaks to people's self-interest, is to talk about the money that they're throwing away each year because they're getting ripped off. A nation of people who clip coupons to save 50 cents on canned corn will care about the fact that they're paying around $3000 more each year than they should be paying for their health care system. Find a working family and I'm sure you'll find people who could do a lot with the extra thousands of dollars that should be available to them at the end of each year.
And then show them where that money's going, which is to the mansions and helicopters and yachts of the uber-wealthy. I grew up in Carmel, Indiana, home to Eli Lilly, America's second largest pharmaceutical company. Trust me, those folks aren't starving. They don't need to charge Americans several times the cost it took to produce a drug so that they can keep on "innovating." They want to charge Americans that much money because they can get away with it, since most people aren't willing to die to save a few bucks. Unlike other products, people won't comparison shop, find a substitute, or just not indulge if their product is too expensive. Rather, they do whatever they can to get it; it's "Your money or your life" on a 300 million person scale.
And the money that these folks spend on their tenth huge television or the most exclusive private school is the money that could have paid for a working asthmatic's inhaler. The message, presented that way, will get through. Especially with Americans. Living abroad for several years has shown me that if there's one thing Americans hate more than anything else, it's getting grifted. It's a reflection on ourselves if we pay even a few cents more than something's worth for it. "Fool me once, shame on you," the American says while thinking But Jesus Christ I'm stupid and lazy not to have seen that one coming. We have a complex emotional relationship with money that's hard to shake even if we're not struggling.
And with any grift, there's always a grifter. When we're paying around $3000 more a year than we should be each year for health care and have to pass up on other essentials and basic pleasures to pay for it, that money is going towards someone's helicopter or yacht trip around the world or just into a bank account to become their "money to play with." These people aren't nice and what they're doing - denying coverage that they owe people as well as controlling access to doctors and treatment in order to make a bigger profit - is terrible enough that people can respond, with their emotions and energy as well as their intellects and be completely justified.
The irony of the fact that there's such a clear villain in this situation is that Moore is usually so adept of finding someone to blame and confront for the problems he profiles in his films. Roger and Me was all about confronting a villian, and Bowling for Columbine constructed one out of Charlton Heston and then confronted him. Sure, it was funny watching Moore and the 9/11 heroes get turned away at Gitmo, but there wasn't anyone there who was either the cause of the broken health care system in the US nor did he really talk to anyone.
This all relates back to how the fight for affordable universal health care eventually became the fight for plain old universal health care this past year. Instead of talking about decreasing the amount of money each person pays for health care, it's become a battle to show that everyone will be paying the same afterwards. Forget the fact that we're paying far too much now - the goal is to show that we have a duty to cover the poor and that fulfilling that duty won't put too much burden on the working class.
We thought we could win this argument with one arm tied behind our back. Turns out we didn't!
Also turns out plain old universal health care doesn't work out so bad for insurers. Sure, they'll be told they can't deny people coverage (although they'll keep on going with their tricks to keep from paying for treatments), but they'll get subsidies and an individual mandate out of the deal. Not so bad.
Affordability, though, is an attack on their bottom line. It means that they would have to reduce their own profits. No corporation wants to do that, and so magically the debate on health care moved to the right and liberals let it happen because a nice morality debate on how we should be covering the poor is a lot cleaner and a lot easier to understand (and a lot more fun since you get to look down on anyone who disagrees with you!) than getting in the mud and talking about how much people are paying and how much they should be paying.
And while those topics are all covered tangentially by Moore, with several examples of people paying too much and not getting good coverage, he didn't do much to make it seem like the looting was institutional. Sure, there were some people who didn't get treatments paid for, which is heart-wrenching, but most Americans don't think that could happen to them. He, and far too many health care proponents, should be taking the time to explain how people who don't even need their coverage in a given year are being cheated.
Because then he ends up sounding like that terrible stereotype of the moralizing, snooty liberal, telling Americans they're not generous people for not having a universal health care system. Maybe it's just me, but there were parts when he was talking about how British people think about "we" instead of "me" more than Americans (people who've gotten to know British people can take a laugh break now), or how French people take care of the worst among them because they're more enlightened (whoa boy), it's mis-placing the blame and comes off as Euro-centric arrogance.
The reason we don't have a single-payer system already in the US isn't because the American people aren't generous. To the contrary, they don't know how generous they're being, just to the wrong people.
The issue is a lack of information and tons of misinformation, which is a result of both the right, which does their thing and tries to confuse and scare people, and the left, which likes to every now and then sit and judge the rest of the country, laughing about how the tea-baggers are stupid, all the while the policy debate gets so warped most Americans don't even know why they should care about health care reform. We laugh at the tea-baggers, but most Americans don't know why it's a good idea to support the closest thing to single payer we got offered in 2009 that'll save them thousands if they can get in.
The more pressing issue is the out-sized health care industry that has too much influence in politics and doesn't want the looting to stop, and I hope Moore will do a follow-up specifically because of that. The fact that I can write this post now, I'll fully acknowledge, is because we got to experience the national health care debate first hand this past year, every day for months. And we saw the distractions thrown at the press and Americans, like the tea-baggers, and we saw how moneyed interests bought off Congress, and we saw how Americans ended up mired in misinformation about their own health care system and what even the results would be if they improved it.
So none of this is to say that SiCKO is a terrible movie or an awful way to go about getting the message out. On the contrary, who knows how much the moral argument for universal health care was made banal by this film. But I did want to discuss the difference these past few years have made in our understanding of the problem, even though they haven't made much of a change to the problem itself.