This is part one in a series where I challange Michael Moore's Prescription for Health Care. Mr. Moore's first proposal is that every American must have full, uninterrupted health care coverage for life.
What determines American? Is it American citizen? What about a visitor who is accidently ill? What about illegal immigrants? Should we deny them coverage? Let's suppose we are generous and say everyone who inhabits our borders is American and should have full, uninterrupted health care. Illegal immigrants do not pay taxes. Is it fair for them to receive health care paid for by some else's tax dollars? Should they get it for free?
"must have full"
Who determines full? If the full health care, Mr. Moore is imagining, was possibly available, there would be no economic system of health care. There would be no need to determine how to allocate a scarce resource. Let's suppose we want to allow full health care available. Let's even suppose government had the funds to deliever that to "every American". How would the distribution be determined? Who could fairly distribute this resource? Health care providers who are experts in their field already dispute regarding the choices of therapy regimens.
"uninterrupted for life"
How would uninterrupted be determined? For example, how would hospital discharge (a big cost saver in health care) be determined? If capped reimbursement incentivized hospitals to decrease hospital stay, how much more would a single government provider?
The urge to implement comprehensive health coverage stems from a belief that the market failures of health care are due to a lack of government regulation. Kirzner writes in The Perils of Regulation, "the urge to regulate, to control, to alter these outcomes must presume not only that these undesirable conditions are attributable to the absence of regulation, but also that the speedy removal of such conditions cannot be expected from the future course of unregulated market events."
I believe the market failures Sicko addresses are not due to a failed government system but to an epidemic of unhealthy lifestyles that cannot be supported economically. Preventable illness comprises 80% of the burden of illness and 90% of all healthcare costs. Preventable illnesses account for eight of the nine leading categories of death. No medicine, surgery or treatment can reverse the damage caused by a lifetime of smoking, poor eating and lack of exercise. By simply increasing treatment that buys time, ignores the inevitable need to align patient's economic incentives toward healthy living. This is the innovation needed in the economic system of health care, not just more health care.