Sicko - A Looming Smash Hit

A lot of people I trust have seen it and said it will be a smash:

I went in expecting to hate it. But I was wowed. His technical abilities have developed amazingly from Roger & Me to this. This might actually be the best film of this sort I've ever seen. He's brilliant at exposing problems in the system. Well, give him credit for that. The problem is that the alternative vision he gives us is laughable - literally.  But there are horrendous inefficiencies with the US system, they need to be bulldogged, and at present nothing's happening.  Bringing attention to focus on that is a great service.

Another reader writes in defense of government medicine:

You have your own very negative personal experience with Britain's system. But I feel that the situation as it currently exists in the US requires solutions that, even for a conservative, have to go beyond the hardened orthodoxy of "government = less for more", "private enterprise = more for less". I am no economist; in my own experience, however, this equation just doesn't cut it. I have little direct experience of government work, but both my parents have worked in state and local government (in a state energy office and a city welfare program) and I saw them working hard, being frugal in their work, making a lot happen with a little, accounting for every expense.

My own brief experience in consulting was, by contrast, one of huge amounts of waste: high-priced plane tickets bought at the last minute for no reason other than laziness, luxury hotel rooms, excessive quantities of staff, lavishly paid for by giant corporations and all to give them messages they wouldn't act on, but needed to have hired in to check a box or cover their asses.

I don't want the people involved in those transactions deciding who gets what medical procedure, but they're exactly the type of person deciding it now. (This also makes me despair at the thought of ever reining in the great damage we're doing to the environment - corporate culture is just too wasteful and entrenched for individuals on their own to make much difference.) My own experience in university and nonprofit worlds is somewhere in between - in the university I find pockets of extreme frugality and pockets of great inefficiency and waste.

All this suggests to me that much of the difference between efficiency and inefficiency, or smart and dumb decisions, in any given sector is cultural, dependent on local group and individual choices, on access and accountability, rather than a necessary structural effect of the profit status of the enterprise. I think of the $300 wrist splint which cost pennies to make and which I was able to get for $30 because I had insurance. The hospital makes a lot of money, the insurance company passes on the cost to my employer, which has chosen the group health care plan and takes part of the cost out of my paycheck; I have little choice in the matter. It's one way to manage collectivity (one which, in this case, certainly allows for inefficiency and stupid choices); government is another. I have lots more opinions on this, but I'll stop here because I really don't know the economics.

Dammit. I'll have to see the bloody thing.