Monday, June 25, 2007

"Sicko" and the Clinton Health Care Plan

Like Mike (see his post from yesterday), I thought that Michael Moore's new film "Sicko" was a fascinating and important piece of documentary film-making. The film is probably most important because it will almost certainly cause many people to stop limiting their thinking to what seems currently politically possible and to step back and ask Moore's bigger question: "Who are we?" Why have Americans accepted a situation in which not only do 1/6 of us have no health coverage at all but in which the rest of us glumly accept a completely broken system -- especially when that system demonstrably harms many people, and even more shockingly when a vastly better alternative is practiced in almost every modern country in the world?

The fundamental complaint that everyone could level against the movie, no matter one's political viewpoint, is that it is clearly impossible to give all of the issues a decent airing in 2 hours. Everyone, I suspect, will leave the movie thinking, "He should have said more about ____," with some viewers thinking that the missing elements would have strengthened Moore's endorsement of universal single-payer while others will be sure that Moore missed some things that are more important than anything that was included in the film and that would have fatally compromised his argument. I fall into the former category.

That said, there was one aspect of the movie that I thought was more an error of commission than omission. Having described how private health insurance plans had emerged in this country in the 1970's and 80's, Moore then surprised me by depicting the failed Clinton health care initiative of the early 1990's as a good idea that was destroyed by Republicans. This is surprising both because Moore has never seemed to be much of a Clinton fan (given his lefty populism versus the Clintons' "third way" policy centrism) and because the plan that Hillary Clinton's team proposed was a genuinely terrible idea. Moreover, it was terrible for precisely the reasons that the current system is terrible -- it was based on private, for-profit HMO's.

In what became their classic triangulation mode, the Clintons built their health care proposal by first unilaterally disarming, which in this case meant simply ruling out any thought of proposing a single-payer system. Having given away what had to be at least their best negotiating position, they then proposed a system based on what were in essence regional super-HMO's. The logic was, as always in health care debates, based on some seemingly plausible but ultimately misapplied notions about the power of competition to restrain price increases. The plan would have been a give-away to the health insurers in much the same way that the Medicare drug benefit of 2004 (that Moore rightly ridicules in his film) was a transfer of hundreds of billions of dollars to health care interests. While some might still want to defend the Clintons' political calculation, though probably far fewer -- if any -- would want to defend the actual proposal, I never would have imagined that Michael Moore would endorse it after all these years.

That is only a minor error in any otherwise ambitious and important documentary, but it is surprising given that Moore's greatest contribution to this debate is his attempt to jolt us out of our current political constraints. The Clinton health plan, like so much of both Clintons' political strategizing, took for granted the constraints of the political debate, reinforced rather than challenged those constraints, and ultimately made them worse.