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Monday, July 09, 2007


"Fact-checking" Michael Moore, single-payer, and more

In the post below this one, Michael Moore goes up against not just Wolf Blitzer, but Dr. Sanjay Gupta "fact-checking" him as well. Gupta says quite straightforwardly that "[Moore] did fudge some facts," but the evidence for that is rather lacking. The one I want to focus on here is his claim that "Sicko" says the U.S. spends $7000 per person on health care, and Cuba $25, whereas the "real" numbers are $6096 and $229, respectively. Moore defends his numbers in the clips, but I'd like to ask a broader question (to which I don't know the answer).

What are those numbers? What are the "health care costs per person"? Were the numbers taken from the same year? Perhaps the most recent data were from 2004, and Moore applied an inflation adjustment, and Gupta didn't.

Or perhaps they're from different studies with different assumptions and include different things. Do they include, just to pick something at random, the costs of eyeglasses? Personally, I can no more function without glasses than some people can function without medicine. If glasses are included, do we count only the times you really "need" new glasses when you get a new prescription? What if I were (note the subjunctive, please) to buy expensive designer prescription sunglasses? Are they included?

When it comes to a comparison with Cuba, what exchange rate was used? An "official" one? A "real" one, whatever that might be? And even if they agree on the exchange rate, do they take into account that Cuban medical personnel are paid less than American personnel, because their living expenses are much lower? Perhaps Gupta adjusted for that, and Moore didn't. Who knows. Moore says he'll be posting a defense of his numbers on his website, so perhaps we'll learn the answers.

Or let's ask more serious questions, in conjunction with my title question of "single payer." "Single payer" is a common phrase here, but in Cuba (and to a lesser extent in other countries with a National Health Service), they don't just have "single payer," they have "single receiver." If you look at the Cuban budget, I can imagine they're a top line item labeled "health care," and under that is not just the cost of medical personnel and medicine and bandages and so on, but also the cost of building hospitals, running medical schools, and everything else having to do with medical care. Are those things included in the U.S. numbers? I doubt it, frankly.

In the last year or two, two huge new medical facilities (one Blue Cross/Blue Shield, one Kaiser) opened within a few miles of my home. If BCBS and Kaiser borrowed money to put those buildings up, as I suspect they did, is that money found in those health care expenditures? And whether it is or not, were those two facilities the highest priority need for health care? Both of them are spiffy new places. I haven't been in either one, but I'm guessing they have nice art on the walls, fancy atria, and all sorts of nice attractive aspects. But perhaps the country would have been better served had they been just a little less fancy, and with the money that was saved, a new clinic built in a small town in the rural South which has none. Of course, that couldn't happen, because that's not BCBS of California or Kaiser's responsibility or concern. Or perhaps they shouldn't have been built at all, and instead the money used to construct and run a new medical school. Again, not their problem. Cuba just graduated 2200 new health professionals from Cuba and 24 other countries (including the United States), while the U.S. (and many Western countries) have chronic shortages of doctors, precisely because it is not something that can really be addressed on a national level. Nor will it be if "single payer" is just that, and not "single receiver" as well.

Postscript: By the way, that shortage of native-born doctors, which has suddenly become the focus of attention in Britain for the wrong reasons, is not a recent development. Forty years ago I had a summer job in a hospital, and I remember that even then, many of the doctors were foreign, because then as now, there simply weren't enough places in American medical schools to fill the need. Not that I have anything against foreign-born, foreign-trained doctors; I've certainly been treated by enough of them over the years. But I do think that it behooves any country to train enough doctors to meet its needs, and on the other side of the coin, the brains that are being drained from those other countries are undoubtedly contributing to worse medical care there.

Update: Moore's fact-checking demolishes Gupta's claims.

Further update: Cuba is actually building 20 new hospitals this year...in Bolivia!

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