Michael Tanner

Michael Moore's new movie Sicko is both funny and poignant. Some of the stories he tells of Americans who have been caught up in the bureaucracy of the American health care system are truly heart-wrenching. The insurance company bureaucrats he exposes are cruel and capricious. There is no doubt that Michael Moore is a skilled filmmaker and an effective propagandist.

However, serious advocates of health care reform would be advised against relying too heavily on Moore's view. Moore ignores the positive side of American health care altogether. Moore cites a 2000 World Health Organization (WHO) study that ranks the US health care system as 37th in the world, "slightly better than Slovenia." However, this study bases its conclusions on such highly subjective measures as "fairness" and other criteria that are not strictly related to a country's health care system such as "tobacco control."

For example, the study marks down the United States for not having a sufficiently progressive tax system, for not providing all citizens with health insurance, and for a general paucity of social welfare programs. The United States is actually penalized for adopting health savings accounts and because patients are paying what the WHO considers too much out of pocket. Such judgments clearly reflect a particular political point of view, not a neutral measurement of health care quality.

The real world shows that the United States still offers the world's best health care. It is notable that when former Italian Prime Minister Silvio Berlusconi needed heart surgery last year, he didn't go to France, Canada, Cuba, or even an Italian hospital—he went to the Cleveland Clinic in Ohio. Berlusconi was following in the footsteps of tens of thousands of patients from around the world who come to the United States for treatment every year.

One US hospital alone, the Mayo Clinic, treats roughly 7,200 foreigners every year. Johns Hopkins University Medical Center treats more than 6,000. One out of every seven Canadian physicians sends a patient to America for treatment every year, and those patients or the Canadian government spend more than $1 billion annually on health care in this country.

When you compare the outcome for specific diseases like cancer and heart disease, the United States clearly outperforms the rest of the world. For example, women in the United States are four times more likely than women in Europe to be diagnosed before a tumor has spread, and are therefore far more likely to survive cancer. Fewer than 25% of US women with breast cancer die, but 28% of Canadian women, 35% of French women, 31% of German women, and fully 46% of British women do. Nearly half of Americans with leukemia will survive at least 5 years. In Europe, the 5-year survival rate is just 35%. Similar results can be seen with prostate cancer, colon cancer, and other diseases.

Moreover, the United States drives much of the innovation and research worldwide. Seventeen of the last 25 winners of the Nobel Prize in Medicine either are US citizens or work here. US companies have developed half of all the major new medicines introduced worldwide over the past 20 years. Most types of advanced medical technology are far more available in the United States than in nearly any other country.

The same is true for prescription drugs. For example, 44% of Americans who could benefit from taking statins, lipid-lowering medication that reduces cholesterol and protects against heart disease, take the drug—which seems low until you realize that just 26% of Germans, 23% of Britons, and 17% of Italians get it. Interestingly, even the WHO report ranks the United States number one for responsiveness to patients' needs, for choice of provider, dignity, autonomy, timely care, and confidentiality.

Moore points out that too many Americans lack health insurance, but ignores the fact that most are uninsured for only brief periods. Nor does he mention that nearly 10 million of the 47 million uninsured are actually eligible for Medicaid, but fail to apply. And, of course, Moore makes no mention of the government regulation that drives up the cost of insurance—especially for young people.

Moore highlights the stories of several Americans who were denied reimbursement for experimental treatments. Some of the results are tragic. But does Moore really believe that national health care systems would cover such treatments? Indeed, Moore generally overlooks the flaws of other national health care systems.

For instance, he downplays waiting lists in Canada, suggesting they are no more than inconveniences. He interviews apparently healthy Canadians who claim they have no problem getting care. Somehow, he could not find any of the nearly 800,000 Canadians who are currently on waiting lists for treatment. Nor, apparently, did he have time to interview Canadian Supreme Court Chief Justice Beverly McLachlin, who wrote a 2005 decision striking down part of Canada's universal care law that said many Canadians waiting for treatment suffer chronic pain and "patients die while on the waiting list."

The American health care system clearly needs reform. However, it would be a shame if Moore's latest piece of propaganda stampedes Americans into sacrificing the quality, choice, and freedom that our health care system provides today.

Michael Tanner is director of health and welfare studies at the Cato Institute, Washington, DC. Cato is a nonprofit public policy research foundation named for Cato's Letters, a series of libertarian pamphlets that helped lay the foundation for the American Revolution.