Promoted by Steven D (with links modified and emphasis added, using bolded text, for clarity).

by Andrew S. Taylor

Thomas Paine’s Corner

Michael Moore recently went head-to-head with Dr. Sanjay Gupta, CNN’s chief medical correspondent, over a short, pseudo-journalistic hit-piece crafted by the latter in which Moore is charged with “fudging the facts” in Sicko, his new film about the woeful inadequacy of American health care. Their heated debate on Larry King Live provided little illumination, as both quibbled over figures and source citations. Moore did his best, over the course of five minutes, to refute what amounted to a cheap, underhanded assault on his journalistic credibility, but viewers could easily have come away from the exchange with little appreciation for just how sleazy and manipulative Dr. Gupta’s attack on Moore actually was.
What we never got to see was the much-needed debunking of Gupta’s piece, which was essentially a series of astonishing non sequiturs unified only by an emotional arc of patronizing cautionary tones. Judging from the strategy taken in this piece – very much in line with what I’ve seen elsewhere this past week in The New York Times and other publications known for their elitist air of dignified skepticism – the corporate media’s spin-strategy regarding Sicko is going to be to 1) admit that the most damning facts are true, and 2) convince the public that the price of correcting them is more than we as Americans would want to pay.

Let’s observe how Gupta’s short piece, which can be seen here along with the subsequent “debate”, accomplishes this. The film begins with a straight-up admission that the U.S. does indeed rank a low #37 in the World Health Organization’s world-wide survey for quality of health care. He then continues to show France as #1, Italy at #2, Spain at #7, and the U.K. at #18. But then he “reveals” that Cuba rates a #39, two points below the U.S., as if this fact was somehow concealed in Moore’s film (it was, in fact, quite visible on screen). Moore never concealed this fact, nor did he claim that the United States should emulate Cuba except in one noteworthy respect – of “reaching out to our enemies.” But right off the bat, we can see that Dr. Gupta is setting up Moore as someone whose sympathies have blinded his capacity for objectivity.

The debate over dollar expenditures on health care in Cuba and the U.S., in which Dr. Gupta calls Moore to task for being “slightly off” in his numbers, is a remarkably disingenuous tactic. Dr. Gupta, a journalist as well as a doctor, must be fully aware of the fact that side-by-side comparisons of per capita expenditures in dollar amounts between vastly different economies are inadequate measures of the actual cost of health care relative to the country in question. In Cuba, one dollar is many magnitudes more valuable to the individual citizen than it is in the United States. I suspect that Moore only brought up the $251 figure (initially quoted erroneously as $25 in Dr. Gupta’s piece – probably the work of an inexperienced CNN intern) for Cuba’s per capita spending in his film only to illustrate how disparate the two economies are. The point remains completely unchanged if the amount for Cuba is “actually” $229 as Dr. Gupta claimed. The only purpose in bringing these figures up is to attack Moore’s credibility – this, even though there is absolutely no substantive difference relative to the argument at hand. At any rate, Moore’s charge that Dr. Gupta is using “old data” turns out to be entirely correct – the figures of $6096 per year and $229 per year for the U.S. and Cuba respectively are clearly from the WHO website, which gives 2005 as the date. However, Dr. Gupta’s charge is also correct – Moore uses different sources for the U.S. and Cuba figures, and Moore’s figures for Cuba are even older, dating from 2003, while his figure for the U.S. is a recent projection of expenditures in 2007. It is possible that Moore considered the 2003 data on Cuba to be “more recent”, since it was actually used in the UN’s Human Development Report 2006. Moore also explains on his website that “if the Cuban government gave a figure on 2007 projected health spending, we’d have used it” (It is worth pointing out that, in fact, the two Cuba figures appear to show Cuba’s health-care expenses trending downwards – either that, or Cuba’s economy lost some ground relative to the world economy between 2003 and 2005). But what’s truly revealing about Dr. Gupta’s “correction” of Moore’s figures on Cuba is that they are obviously no more accurate than Moore’s, and his attempt to use them as an example of “fudging” on Moore’s part is nothing short of low-down character assassination.

The only thing more remarkable about the $229 figure is that, being $22 lower, it makes the U.S.’s performance that much more embarrassing. Moore’s recent data on the U.S. demonstrates what has been asserted by policy analysts for some time now; namely, that the cost of health care in the U..S. is growing rapidly ahead of inflation and personal income. Meanwhile, Cuba – a country of comparative poverty and a hobbled industrial base, is able to more or less match the U.S. health-wise. This fact alone should be scandalous – so Gupta’s only option in spinning it is to ignore it completely, and distract the viewers (and Moore) with insubstantial quibbles. (In case I hadn’t made it clear, this is like weighing an elephant and a hamster, and arguing about whether their weights have been offset by the presence of a flea or two).

But Dr. Gupta’s piece only goes from bad to worse on the subject of patient wait- times. Dr. Gupta mentions “non-emergency elective surgery,” in which “a study” reveals that Americans have the next-to-least wait time after Germany. He gives no comparative figures (i.e. what is the difference between best and worst – a wide spread or a marginal one?) and also fails to explain why Germany’s universal coverage bests the U.S. “That’s not something you’ll see in Sicko,” Dr. Gupta admonishes, referring America’s alleged wait-time superiority, “as Americans talk about their lack of coverage, and suffocating red tape.” This is truly a dirty tactic. The phrase “non-emergency elective surgery” goes by in a rush, and, juxtaposed as it is against the phrase “That’s not something you’ll see…” it implies again that Moore has left a crucial flaw in the universal health care systems of other countries out of the picture altogether.

But who did this study, and which countries were involved? The study was done by Commonwealth Fund in 2005, and only six countries were involved. This is exactly the same study Dr. Gupta references a few moments later on, only he doesn’t mention until that point that only six countries were involved. In fact, he leaves the viewer with the impression that he’s referencing the study for the first time at that later moment – most likely because he wants to imply that the U.S. is second best in the world on non-emergency elective wait-times, not just second best out of the six countries surveyed (here, incidentally, are the six countries involved in the study: United States, Canada, Australia, New Zealand, United Kingdom, and Germany).

There are some other interesting facts mentioned in the study, which can be found here, that somehow didn’t make it into Dr. Gupta’s noble fact-finding mission (all text in italics that follows is directly copied from the study):

It singles out the United States for having problems significantly in excess of any of the other five countries.

-“While sicker patients in all countries reported safety risks, poor care coordination, and inadequate chronic care treatment, with no country deemed best or worst overall, the United States stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs resulting in forgone care.”

Patients in the United States report the highest number of medical errors.

One-third (34%) of U.S. respondents reported at least one of four types of errors: they believed they experienced a medical mistake in treatment or care, were given the wrong medication or dose, were given incorrect test results, or experienced delays in receiving abnormal test results. Three of 10 (30%) Canadian respondents reported at least one of these errors, as did one-fifth or more of patients in Australia (27%), New Zealand (25%), Germany (23%), and the U.K. (22%).

Patients in the United States spend the most, and get the least access for their money.

As was found in past surveys, the U.S. is an outlier in terms of financial burdens placed on patients. One-half of adults with health problems in the U.S. said they did not see a doctor when sick, did not get recommended treatment, or did not fill a prescription because of cost. Despite these high rates of forgone care, one-third of U.S. patients spent more than $1,000 out-of-pocket in the past year. In contrast, just 13 percent of U.K. adults reported not getting needed care because of costs, and two-thirds had no out-of-pocket costs.

But here comes the ultimate humdinger; a trick of editing that is downright diabolical. Dr. Gupta intones: “But in Canada, you can be waiting for a long time. A survey of six industrialized nations found that only Canada was worse than the U.S. when it came to waiting for a doctors appointment for a medical problem.”

Let’s hit the pause button..the big, evil edit is only seconds away. What has Dr. Gupta just said? Let’s paraphrase (and remember also that Dr. Gupta has only just now explained that the study only covered six countries, and creates the false impression that this moment is the first time in his report in which the study is cited). Out of 6 industrialized countries, the U.S. ranks number five for waiting periods, and Canada ranks 6th. In other words, the other four countries (Dr. Gupta, incidentally, never tells us who those four contries are, lest we learn that it’s those crazy socialists somehow besting us again) have less of a waiting time than the U.S.

A perusal of the PDF file available for download at the link above – remember, this is the same study Dr. Gupta used – reveals the following:

-Roughly one-half of patients in the top four countries featured in the study are able to get same-day appointments when sick, compared to only 30% of U..S. patients and 23% of Canadian patients. In other words, the degree by which the U.S. bests Canada in this figure is much smaller than the degree by which it falls behind any of the other four.

-U.S. patients had the highest rate of difficulty in getting care on holidays and weekends without going to an emergency room. Not surprisingly, the U.S. also had the highest rate of emergency-room use for conditions that could have been treated by a regular doctor.

-While the U.S. and Germany were the only two countries in which more than half of all patients could see a specialist within one month, Australia was a close 3rd at 48%. In four of the six countries, 80% or more of all patients were able to see a specialist within 4 months.

-The U.S has the largest percentage of people (16%) without a regular doctor. The next-highest percentage was only 8%, shared by Canada and Australia.

-The U.S. had the highest number of “coordination problems” with doctors – including duplicate tests and test data unavailable at the time it was needed.

None of this makes in into Dr. Gupta’s fair and balanced “fact-check”, of course – only the victory-dance about being number two to Germany, and the out-of-context comparison to Canadian wait-times (which, while it may speak ill of Canada’s system, clearly does not refute the success of socialized medicine in general).

Now cut to the whopper – testimony from pro-Bush minion Dr. Paul Keckley to the following effect. This is truly mind-blowing:

“That’s the reality of those systems. There are quotas, there are planned wait times, the concept is that care is free in France and Canada and Cuba, and it’s not. Those citizens pay for health services out of taxes, and as a proportion of their household income, it’s a significant number.”

Let’s review and reflect. Even though Dr. Gupta is fully aware – because he read the report – that the U.S. lags behind the other five countries in this study in just about every conceivable aspect of patient access, and even though he came right out and said himself that the U.S. is behind these other four countries which have universal coverage (though, importantly, he doesn’t say just how far behind), he still puts up this stink pile of a quote from a Bush-ite corporate lackey, for his “expert” testimony that patients in these other countries suffer under the unpleasant burdens of quotas and planned wait times. Dr. Gupta has performed the ultimate spin trick – one that is used in the mainstream media every day, so we should know how to spot it – of telling a little piece of the truth and then deliberately negating it from the viewers’ memory by following it with a contradictory statement that appears to not contradict it. It’s a kind of sequential elision. This trick been studied by psychologists and practiced by propagandists for decades, and it exploits a well-known weakness in human short-term memory. Observe this sequence:

Canada has a longer wait-time than the U.S…Canada has socialized medicine…socialized medicine involves quotas and wait-periods….obvious implication: socialized medicine will increase your wait-time. The fact that four other countries with socialized medicine bested the U.S. – which Dr. Gupta deliberately refrains from stating to make this tactic more effective (the viewer must infer it on the spot from the statement “only Canada was worse than the U.S.”) is now completely erased from the narrative.

And now onto the dreaded high taxes.

Immediately following Dr. Keckley’s testimony, we resume with Dr. Gupta’s narration:

“It’s true that the French pay higher taxes, and so does nearly every country ahead of the U.S. on that list. But even higher taxes don’t give all the coverage everyone wants.”

And return to Keckley:

“15 to 20% of the population will purchase services outside of the system of care run by the government.”

Here is where the rising arc of bullshit reaches its third-act denouement. You can’t begin a report with this magnitude of obfuscation, you have to build up to it, by winning the viewer’s trust and hypnotizing him with statistical half-truths. TV journalists know very well that the human brain, when presented with a mixture of information and image, will naturally default to the image for the narrative string, rather than the information. They will follow an easy linear progression as opposed to a non-linear inference. And these journalists also know that there is no better way to lie than by telling a half-truth.

Yes, they pay higher taxes overall, but they spend less money on health care, which means that there the cost to the individual of staying healthy is less, not more, regardless of whether or not they are paying higher taxes for free university education, cleaner air and so on.

The frightening beauty of the half-truth, the reason it is such an effective tool for propagating falsehoods, is that it allows the viewer to make – on their own, thereby implicating them in the thought-process and creating the much-needed illusion that they have come to their own conclusion – an incorrect inference based on an established truth. The viewer is shown something he knows to be true (those countries pay higher taxes), and then reaches “his own” unsubstantiated judgment (I will have less money if the United States adopts a system of universal, free health care). What better subterfuge for the conveyance of falsehood is there?

And, finally, we have these words of wisdom from Dr. Gupta.

“So, there’s no perfect system anywhere. But no matter how much Moore fudged facts – and he did fudge some facts – there’s one everyone agree on: the system here should be far better.”

So, Dr. Gupta tells us he is on our side after all. He sympathizes. Only he wants us to give up on the only solution to our problem that has been demonstrably effective. Bereft of any other expert suggestions, the viewer is once again implicitly re-directed (as always) to some mythical “third way” of health-care which never seems to arrive.

“And he did fudge some facts….” Indeed.

(I must correct a statement made in my previous essay on Sicko, in which I claimed that Moore “appears to be wrong” that Cubans live longer, on average, than Americans. The WHO data which I used gave Americans an average life-span of about six months longer than Cubans, as of 2005. Moore’s website, however, references data which puts Cubans ever-so-slightly ahead of American – 77.6 vs. 77.5 years respectively. What this tells me is that, in the aggregate, the U.S. and Cuba are in a statistical dead head for longevity, with minor variations each year in which one country moves just slightly ahead of the other. For all intents and purposes, they can be considered equals.)

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