Reuters

Otis Hart
asap

Michael Moore asks a lot of questions in his new film "Sicko," a documentary on the American health care system.

Why are the sick declined care by health maintenance organizations? Why do patients in other countries have it so easy? How can cases like these happen in America?

Most of the questions are left hanging, almost daring the audience to pursue the answers. Or maybe he's just setting up a sequel. But in any event, we took up Moore on one of the questions he asked a French doctor: Would your system of socialized medicine work in America?

For the record, the doctor smiled slightly and said no.

But we decided to talk to people who knew a little bit more about the ins and outs of health care's role in the American economy: Michael Tanner, director of health and welfare studies for the libertarian Cato Institute, and Dean Baker, co-director of the left-leaning Center for Economic and Policy Research.

SOCIALIZED HEALTH CARE

In "Sicko," the health care systems in Canada, France and the United Kingdom are portrayed as near utopias for the sick. Canadians don't have to wait for months for surgeries, Brits pay about $10 for any prescription they need, French families afford beautiful homes despite paying extra taxes for their publicly financed system. And none of these people seem to pay anything for hospital care.

So what's stopping us? Can we get in on this?

Tanner warned that the U.S. government shouldn't be trusted to handle life and death situations based on the state of a few federal programs.

"If you look at the government systems in this country, the Veterans Administration is a disgrace, no one would consider Medicaid to deliver high-quality, low-cost care, and Medicare does all right in terms of quality, but is $50 trillion in debt," Tanner said. "Not very good recommendations for letting the government run (health care)."

Baker argued that the market should be allowed to decide whether it would work or not.

"The key is having a public plan that's open," Baker said. "What's wrong with giving people a choice?

"So, you think the government are a bunch of stupid idiots, they're bureaucrats, their plan is going to suck. Fine. Then let us stupid people who think the government could actually do something right, let us buy into it. You wouldn't have to force anyone. If they don't like, they don't have to buy it."

PHARMACEUTICAL RESEARCH

U.S. prescription costs are taken to task in "Sicko." In one scene, a 9/11 volunteer finds an inhaler in Cuba for a handful of pesos that costs her over $100 in the states.

There may, of course, be a perfectly good reason for the sky-high costs in the U.S. The argument you often hear has to do with the exorbitant price of researching, discovering and developing new drugs.

While the Pharmaceutical Research and Manufacturers of America declined an interview for this story, it did release a statement by its senior vice president, Ken Johnson.

"It takes, on average, 10-15 years to develop a new medicine from the earliest stages of discovery through FDA approval," the statement said. "And only three of every ten drugs that reach the market ever earn back enough money to match or exceed the average (research and development) cost of getting them to the marketplace."

OK, so it's not pricey to produce drugs, but it's expensive and risky to develop them. Is there a way to have it both ways -- all the research, without the big cost markup?

Presidential candidate John Edwards, for one, suggests buying the patents from the drug companies and using the recipes to make generic drugs at pennies a prescription.

Baker prefers a plan by another candidate, Rep. Dennis Kucinich, which would establish a prize fund for companies that develop essential drugs.

"The Free Market Drug Act, in addition to having the funds going to research -- you'd have a huge pot of prize money which would go to researchers for outstanding research," Baker said.

Tanner says the Kucinich and Edwards plans suffer from backward thinking.

"Pharmaceuticals are a huge, capitally intensive process," Tanner warned. "The cost is a great deal going in and almost nothing coming out. I'm not sure that saying, 'After you come up with all this capital and come up with a product that works we'll reward you,' will be sufficient incentive."

WHAT ABOUT MY TAXES?

In "Sicko," Moore seeks to refute the common perception that the French and Brits pay too much in taxes. But the fact is, taxpayers would fork over more money to the government if America does eventually attempt a national health care system.

Baker, however, makes an interesting argument that many workers' take-home pay might actually go up.

"Health care costs are in effect a tax right now," he said. "Your company is paying you so much money, but right off the bat, 10 to 15 percent is going off to pay your health care. If we could reduce that, it should be a conservative's dream."

Tanner didn't want to wager any guesses about how a plan could affect individual paychecks, saying the numbers vary too much. But he did throw out some rather sizable figures for the Democratic proposals.

"The Kucinich plan would cost $7 trillion over 10 years, Edwards is around $120 billion a year, and Obama doesn't give a figure, but people have estimated $65 billion a year," Tanner said. "So there's going to be substantial new costs, though we can't say how much until we see how comprehensive it would be."

Otis Hart is an asap staff reporter based in New York.