I have mixed feelings about Michael Moore. I envy his capacity to publicize progressive causes, but I am disturbed by a tendency in his films to vilify. Michigan’s deindustrialization owed less to the avarice of Roger Smith than to a multinational corporate order and even the limits of liberal reforms. Vilification may mobilize a base, but it seldom convinces the skeptic. “Sicko” is a positive step for Moore, but it leaves gaps that reformers must address.

“Sicko” questions the logic of profit-driven health care. Markets work for ordinary consumer goods, but the foundations of civilized life are not best left to market competition. Barbara Ehrenreich states the case well: “If there is one area of human endeavor where private enterprise doesn’t work, it’s health care. What ‘innovations’ has it produced? The deductible, the co-pay, and the pre-existing condition are the only ones that leap to mind. The great accomplishment of the private health insurance industry has been to overturn the very meaning of ‘insurance,’ which is risk-sharing: We all put in some money, though only some of us will need to draw on the common pool by using expensive health care. And the insurance companies have overturned it by refusing to insure the people who need care the most – those who are already or are likely to become sick.”

Health insurance, like electrical power, is a natural monopoly. When multiple electric utilities each put up their own polls and wires, their competition increases everyone’s costs. The consequences in health insurance are worse. Ever more Americans cannot afford coverage and are more likely to contract and spread diseases.

“Sicko” correctly portrays the cruelties it documents not as the result of individuals but of a system where corporate survival depends on insuring those less likely to need care or denying coverage to those in need. Callous behavior is a product rather than a cause of private industry’s profit drive. Not surprisingly, every other major industrial democracy has public, universal health care.

But why does Moore evoke criticism? In Maine, we hear that Canadians face long waiting lists for important elective services. Though waiting lists are an undesirable feature of Canadian life, a recent study of the U.S. and five other health systems by the Commonwealth Fund said that four of the five universal health systems do better than the United States, even in wait times. All systems promote better outcomes while spending less than the U.S.

Moore should devote more attention to the issue of wait times. An examination of the attacks on universal health care in social democracies can paradoxically strengthen the case for universal health care. It also can give reformers a clearer idea of the preconditions needed to sustain universal health care.

Privatization experiments within Canada have aggravated problems. A study of cataract surgery in Alberta finds that patients whose eye doctors practice in both private clinics and public hospitals have the longest waiting times. Comparable examples from Australia, Britain and the United States, summarized by the Canadian Center for Policy Alternatives, abound.

And when those with money cut in line, support for the public system erodes. Waiting lists grow, undermining commitment to the public system. By the same token, because care in Canada remains predominantly a good on which all equally depend, public pressure often forces expansion of resources and ways to reduce wait times. Whether the privatizers or the defenders of public health win has consequences not only for Canadians but also for U.S. citizens.

Attacks on universal health care in Canada and Europe are part of broader assaults on social democracy. French conservatives seek to make France more competitive by slashing health care spending and lowering taxes. In Canada, the Chretien government’s late-’90s obsession with budgetary surpluses set the stage for diminished funding of Canadian health care and the exacerbation of shortages.

The task for progressives in our global economy becomes showing that equitable and efficient health care is a long-term competitive advantage, and negotiating transnational health, welfare and immigration rights as conditions of entry to international trade agreements. Universal health care and social democracy are not the cause of economic malaise in Europe, but they could be victims.

The last fallback of the insurance industry, illustrated in a confidential industry memo in “Sicko,” blames U.S. lifestyles for care costs. Lifestyle matters. Yet patients receiving good, timely primary care have less stress and are more likely to make lifestyle changes.

Other nations do have better longevity because of universal health care and the smaller gap between rich and poor. Yet health care in the U.S. is an unindicted co-conspirator. The leading cause of bankruptcy in the United States is health expenses, and insurance CEO salaries are obscene.

John Buell is a political economist who lives in Southwest Harbor. Readers may contact him at jbuell@acadia.net.