Saturday, June 30, 2007

On June 20, I attended a premiere of “Sicko,” Michael Moore’s new documentary. Earlier, I watched a less professional documentary, of my daughter’s college graduation. Both documentaries had something to say about the American health-care system.

The documentary about my daughter’s graduation consists of still photographs from a nondigital camera. It was directed by my wife, who, like Michael Moore, was a star as well as a director in the documentary.

Watching our documentary touched my heart. On one side of me at the graduation sat the director/co-star, a breast cancer survivor. On the other side was my father, whose heart condition and blood pressure threatened to take his life before my daughter was ready to graduate kindergarten, much less college. Finally, there was my daughter herself, who since high school has had a chronic intestinal illness sufficiently contained that she could graduate on schedule.

None of these three stars would have been there without medical treatments that only became available since my daughter was born. New drugs played a significant role in each case. In fact, some pharmaceuticals critical for my daughter only were approved for her condition a few years before she was given them. Drugs in the pipeline are likely to play an important role in her future.

In other countries, would the same state-of-the-art medicines and equipment have been available to my father, my wife and my daughter? Perhaps. But it is a safe bet these technologies were not invented elsewhere.

Much of the medical innovation that the world enjoys comes from America. While as an economist I find much to criticize about our health-care system, America’s role in medical innovation is crucial not just for Americans, but for the entire world.

Michael Moore’s documentary shows case after case of Americans being denied health care. One example struck me in particular. An African-American man was said to have advanced kidney cancer. As soon as his case was described, I thought to myself, “He’s a dead man,” Because I myself was once tested for kidney cancer (I was fine), I became curious enough about it to learn that survival depends on early diagnosis.

According to the Web site WebMD (, the conventional treatments for kidney cancer include surgery, radiation, chemotherapy and stimulating the patient’s immune system to fight the cancer. Apparently, none of these treatments would work for the man in Mr. Moore’s documentary, so some doctors proposed bone marrow transplants. The insurance company argued that the procedure was unproven (“experimental”) and denied coverage. The procedure was not performed, and the man died.

I have three things to say about this case:

(1) It is very sad to see a man cut down before his time by cancer. His wife and child suffered a painful loss.

(2) He very likely would have died even with the bone marrow transplant procedure.

(3) The bone marrow procedure is indeed quite exotic. When I tried searching Google for “kidney cancer bone marrow treatment” I could find no information about it. Even modifying my search to include “clinical trials” produced nothing. I am sure that with more time and effort I could learn something about the bone marrow procedure, but it seems unlikely it has been used widely with success.

I am sympathetic to the argument that it was wrong to deny hope to this man’s family, even if the bone marrow procedure was almost certain to prove futile. However, he would not have had any better luck getting this sort of desperation therapy provided for him living in Canada, Cuba, France or the United Kingdom. My guess is if you want this procedure, your only hope is to participate in a clinical trial — in the United States.

I hope that some day no one will die of kidney cancer. I hope everyone will have experiences closer to those in my wife’s documentary than in Michael Moore’s documentary. Meanwhile, we need to deal with the fact that health care and medicine are complex issues, without easy answers.

Arnold Kling, a Cato Institute adjunct scholar, is the author of “Crisis of Abundance: Re-thinking How We Pay for Health Care,” published by Cato.

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