Sicko is about America's health care system, and the alternatives. Before I saw Sicko, I believed the common line that, for all its flaws, America's health care system was "the best in the world". After I saw the movie, I did not believe anything of the kind. Sicko opened my eyes to the existence of Britain's National Health Service; after watching the movie, I looked into the NHS, and found that it achieves better results than the U.S. on almost any outcome measure, for far fewer costs. Importantly, it does this using a rational incentive system - doctors are paid for improving the health of their patients, not for recommending large numbers of expensive services.This really highlights the central dilemma facing US medical care. It is really expensive and it has very mediocre outcomes at a population level. It is possible that some people get exceptional medical care beyond that available elsewhere. And it is true that putting a lot of resources into a sector does tend to drive advances in that sector. My own person question is whether this is the best way to drive medical innovation; could targeted research money do more good on innovation than paying more for physician office visits?
I'm not sure, but around the same time that I stopped believing that America had the best health system in the world, I noticed that other people stopped saying it (and in fact started saying the opposite!). Around the same time I started thinking that Britain's NHS is the best alternative, I noticed a lot of policy-wonkish people praising that system in the press. Around the same time I started realizing the insanity of the "fee for service" incentive system, everyone started talking about it. So I wonder if Sicko, rather than just changing my mind, actually changed the whole national conversation
Once again I notice that Canada has very tough drug patent protections (which might do a lot to improve innovation in the drug arena) and still manages to have much lower costs for medical care (as a percentage of GDP). Canadian Healthcare has some major downsides and I would never endorse it as the best possible system (I actually prefer the British NHS for a lot of reasons, that I really need to blog about).
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