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Sicko: Framing the debate

By Andrew S. Taylor  Posted by Jason Miller (about the submitter)     Permalink
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By Andrew S. Taylor

The primary means by which any governing power structure controls its populace is by exerting influence over the individual thought-process, influencing how the populace perceives reality. The main channels of control are therefore systems of education and public discourse (i.e., the media), and the primary methods are censorship of ideas, and censorship of facts. If one can accomplish the latter sufficiently, there is little need for the former. Discourse can proceed in the form of ostensibly oppositional debate, while the most crucial questions and realities are hidden in plain view.

Control over what the public knows can be enough to prevent certain ideas from taking root. This method has two advantages. The first is that it provides the illusion, on the part of those controlled, that they have arrived at “their own conclusions” on a particular matter, since they have been presented with two seemingly opposed viewpoints and have been freely allowed to evaluate both critically. The second advantage is a direct consequence of the first - because the audience has inadvertently engaged in what may be a false premise underlying both propositions, they have also internalized and taken as implicit fact a concept which, if stated directly and in the plain light of day, might have been open to question. It naturally follows that such a method of control is wielded most effectively when the visibly state-fashioned controls are at a minimum, and the “voluntary” controls of social self-censorship are at a maximum. This provides in one fell swoop the greatest amount of passively-generated social control with the least-penetrable subterfuge. The greater the number of individuals who unknowingly participate in and propagate the false premise, the more effective the control. As for those who do see past the subterfuge - as long as they are either the direct and guiltless beneficiaries thereof, or are unable, due to social standing or problems of credibility, to effectively alter the overwhelming public bias, the power structure is safe and control is maintained.

As noted by Herbert Marcuse and others, advanced industrial capitalism provides a highly effective vehicle for such a system of control. Its ever-heightening pyramid of merged corporate and government entities, its ever-thinning and increasingly osmotic membrane of separation between “public” and “private” (both as a point of social conduct, and as a point of fiscal practice and law), and its uncanny ability to rapidly adapt to potentially threatening expressions of social rebellion by absorbing them into the mainstream in the form of a sterilized phenotype, result in an environment of discourse that is openly hostile to the unpleasant and discomforting work of rational thought.

This is something to keep in mind, in the weeks and months to come, as we witness what will inevitably be a full-frontal assault on Michael Moore’s new film, Sicko. It is especially important, because many of the attacks will come not only from industry giants and political operatives whose biases and motivations are transparently obvious (though of course such quarters have already attacked, and will continue to do so), but from well-meaning, intelligent, literate, and dedicated citizens who genuinely (and correctly) fear a government whose “helping hand” so often wears a poison glove. We must not forget that when we speak of an ideal government, or an improved government, that we mean something radically different from the government we actually have - a government that both red-state and blue-state despises with equal fervor, and for largely similar reasons (though this may not at first be apparent).

That being said, there is no greater public service than the destruction of a widely-held myth. This form of pointed demolition transcends any specific ideology, amounting as it does to a fundamental assertion of the right of all individuals to think and know. Moore’s latest film is just such a salvo. Its purpose is to nullify oft-repeated American popular myths about health care as it is practiced in other countries, by providing vivid counter-examples.

What his film does not do, which we should acknowledge up front (because these straw men will surely appear, and Moore will be unfairly blamed for being “deceptive”), is to argue that socialized medicine is a panacea, in which our current problems are magically solved, or that Western Europe enjoys hassle-free health care. Sicko is a demonstration of what is possible, not a comprehensive portrait of what is.

This then is as good a place as any to look at the facts as they stand. We have often heard, from critics and pundits of all stripes, that it is very easy to “lie with statistics.” This point is made so often, that we are sometimes loath to admit that we can also tell the truth with them. It is a question of making reasonable comparisons, falsifiable statements, using consistent standards, and then placing them in their proper context.

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I refer you now, and hasten anyone who wishes to make an informed commentary on this debate, to visit the official website of the World Health Organization, and click on the tab for “countries.” Here is where any admirer or skeptic of Moore’s essential thesis - that the American Health Care Industry is a sham deal and that other countries of comparable wealth are able to provide more effective coverage at a lower cost - can put his claims to the test. This should be the starting point for any debate on the subject: pro and con should first generally agree upon the facts as they stand, and only then proceed to debate an effective strategy for dealing with them. It must also be understood that the truth of Moore’s thesis depends upon the aggregate of the evidence, and is not disproved by a small minority of exceptional examples.

It will be interesting to see how often this data is mentioned in mainstream debates about Sicko. I seriously doubt that any reputable scientist would actually refute all or most of the WHO data. However, it is quite likely that few major outlets will engage with it directly at all - they will instead complain that Moore’s examples of abused and neglected patients in the Unites States are not “representative.” This is the most common of straw men - Moore does not in fact claim that they are representative, but rather bemoans the fact that they could happen at all - especially as a natural outcome of the system as it operates normally, as opposed to an aberration in a system that is operating abnormally. They are included here not as representative examples but inevitable examples. He is demonstrating that the system, when operating normally, produces a significant minority of such cases. (This is a very important distinction to remember, whenever someone throws up a catastrophic example of health-care negligence from, say, Canada, in an effort to degrade the debate so that it appears to amount to little more than mutual “cherry-picking”).

Such strategies of attack against Moore are also in keeping with the almost surreal stubbornness of American mainstream media in its imposition of a kind of statistical isolationism upon policy discussions of any kind (in essence, a pathological unwillingness to measure our prospects for social problem-solving against similar problems faced in other countries, as well as the possible merits of the solutions proposed for them). This is a dangerously disingenuous tactic for a society so firmly committed to imposing its own social models upon the world beyond its borders. While it occasionally leaks through that European and Asian countries far surpass America in terms of the quality of public education and environmental policy (and now, thanks to Moore, in health care), it is apparently still impermissible to ask, in any public forum, “how do they do it?”. And any suggestion through mainstream channels that we might try to emulate them amounts to public political suicide. It seems that the illusion of American superiority in all things is an illusion still too cherished to be widely challenged. This is perhaps Sicko’s most valuable contribution: it dares to suggest that we, as a society, might benefit from a little more humility.

But let’s return to that WHO data. If you have IE7, you can easily use the “tabs” feature to do side-by-side comparisons of the United States to any other country listed on the WHO website. Let’s look at Moore’s most impressive claims. Do Canadians live 3 years longer? Click along with me…yes, they do. Is their child mortality rate lower? It is. Do they spend less on health care - hold on, we must be careful with this question. We cannot necessarily use dollars, even with the “international $” which lists the per-capita expenditures of each country on health care, because it will not actually provide us the answer to what we are looking for. We want to know how much it costs one country relative to itself to pay for their health-care system. The better figure to use is “% of GDP”. So…do Canadians pay less? Hell yes.

Do the French live longer? Less child mortality? Less a % of GDP? Yes, yes, and yes. The British? Yes, cubed. We are not talking about statistically negligible differences, either, but about longer lives of two or three years. We are taking about 10 to 30% reductions in child mortality (given in numbers-per-thousand). We are noting that while the U.S. spends %15.4 of its GDP on health care, the next-highest expenditure is around 10%, and it goes down from there. At this point it seems as though, since we’re willing to spend so much on health-care, we could easily blast the rest of the world out of the water by spending it correctly, should we chose to do so.

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But, does it hold true elsewhere? Indulge me as I do some more tab-clicking. Here goes the backwards-alphabet challenge: Switzerland? Yes. Sweden? Yes. Spain? Yes. Switzerland spends 11.5% of its GDP - quite a bit above the others but still well below the U.S. In all three countries, I’m seeing life-span gains of 3 or 4 years, and child mortality rates that nearly halve the U.S.’s. Sweden does halve them, while spending only 9.1% of its GDP.

Perhaps the S’s are lucky. I continue. Poland? Worse, at a third of the cost. Norway? Yes - better and cheaper. Ditto Netherlands. And Luxembourg. Italy, too, similarly leaves us in the dust. Also Ireland. Iceland, as well, kicks our ass. Hungary, however, does worse, if that makes anyone feel better. Greece - much poorer than the U.S. - does better. Germany does better. This is getting a bit boring….but I press on. Finland is better. Denmark has the same life-expectancy, but far fewer dead children and half the cost. Czech Republic does worse than the U.S. Belgium is better and cheaper.

In almost every case since the S’s, we are looking at drastically reduced rates of child mortality (30-60% lower), longer life-spans by at least 2 years (and more often 3 or 4 years, with the difference especially noteworthy among women), and GDP figures that almost never peak 10%, and are usually about half of what we spend in the United States.

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