In SiCKOness and in Health - Sometime over Father's Day weekend, Michael Moore's latest film was available for viewing in its entirety on YouTube. (Apparently, a copy of the film that Moore stashed away in Canada was leaked.) I was fully prepared to watch the movie on my iMac without benefit of overpriced snacks, artery-clogging hot dogs or running commentary from moviegoers behind me. Of course, by the time I went to look for SiCKO online the next day, a phalanx of lawyers induced YouTube to remove the movie, and last night I was forced to pony up $9.75 to see Moore's latest offering. The supreme irony is that I had to pay to see a film that advocates "free" single-payer health care. (How about some free "movie care" Mike?)

No one will confuse me with a film critic; by my lights, it is tough to compare Moore's work with most other films, or with other documentaries for that matter. With that said, SiCKO did not disappoint. As with every one of Michael Moore's movies, SiCKO is the same stew of wholly one-sided polemic combined with half-hearted attempts to amuse or tug at his viewer's emotions, all of which are completely undercut by his grating smugness. And as is always the case, the images and footage serve Moore in the same fashion as a magician's comely assistant, in that they distract rather than inform.

But my main problem with SiCKO has nothing to do with any of the foregoing, but lies entirely with his refusal to acknowledge that a single-payer system would have its flaws. (This is not unlike his refusal to acknowledge that antebellum Iraq was less than idyllic in Fahrenheit 9/11.) To be sure, any health care system - or more correctly, any health care resource distribution system - would have its requisite trade offs. Canadians, Europeans and Cubans "pay" for their health care not only by way of confiscatory tax rates, but also by way of sclerotic economies, non-existent job creation and intrusive government.

For his part, Moore will not admit that anything will need to change. He intimates that Americans will enjoy the same level of choice of providers and access to care as they do presently, with the only adjustment being the mechanism by which health care providers are paid. Of course "the pay's the thing", as it is the payment mechanism that drives how health care resources are allocated. We have arrived at our patchwork quilt of diverse payment schemes and conflicting incentives entirely by way of government encroachment. Indeed, as government has gotten more involved in providing and paying for health care, the cost of care for both private and public beneficiaries has only increased.

Moore and other pleaders for single-payer health care also seem ignorant (or resentful) of the idea that America's health care system is at least in part a product of our individualist cultural ethic. Because of this cultural idiosyncrasy, we have been able to lead the world in both economic growth and medical innovation. It goes without saying that the world reaps the benefit of medical and pharmaceutical treatments that have been underwritten and subsidized by the U.S.

But beyond the effects of culture on the provision of health care, we would do well to examine the effect of universal health care and the other components of the welfare state on the culture. What we know of such impacts is not encouraging, as discussed elsewhere.

As distinct from charity that is a product of one's own choice, the coercive and confiscatory traits of the welfare state have a soul-corroding effect on both the "donor" and the receiver. Because the central element of volition is removed from supposedly charitable behaviors under the welfare-state model, the habits of charity, empathy and compassion are not practiced. Both our ability and willingness to donate to others atrophy from lack of use, and the moral component of our humanity is diminished as a consequence.

This phenomenon is evidenced by the fact that in contrast to most of the socialist states of Europe, rates of charitable giving are extremely high the United States, particularly international aid. A new report from the Charities Aid Foundation concludes that the U.S. "is the most generous in donating an average of 1.7 percent [of GDP] each year," with Britain averaging 0.7 percent and Germany and France contributing 0.22 percent and 0.14 percent respectively. And according to the Hudson Institute’s 2006 Index of Global Philanthropy, in 2004, Americans gave a combined total of $71 billion in non-governmental charitable assistance to the developing world. This private aid was over and above the $19.7 billion provided by the U.S. government that same year.

Using Europe as an anecdotal example, it does appear that there is something specific to life in a welfare state that diminishes a person's generosity of spirit. Similarly, previous expansions of the American welfare state by way of the Cloward-Piven strategy facilitated a cultural cannibalism in which counterculturalists of the 1960s sought to destroy American culture in order to remake it in a form more to their liking, as discussed here.

The damage done during this period of American history, and the carelessness with which this program was engaged, cannot be overlooked or overstated. Here you had a pair of privileged white elites whose only concern was to create economic havoc for the federal government in order to encourage some form of guaranteed income for all Americans. And in order to achieve this end, they were willing to use millions of faceless and ultimately powerless blacks as implements. As one reads A Strategy to End Poverty, two things become apparent. First, one is struck by [Richard] Cloward and [Frances Fox] Piven's temerity in that they would presume to be able to single-handedly eradicate poverty in America. But secondly, it becomes clear that Cloward and Piven gave no thought to the long term effects of their scheme.

Theirs was not a plan designed to improve the educational, political of social standing of the poor. To Cloward and Piven, inner city blacks were just another one of the "elements in the big-city Democratic coalition." By putting their plan into effect, Richard Cloward, Frances Fox Piven, George Wiley and the entire [National Welfare Rights Organization] organization expanded the reach and impact of the welfare system into the lives of impoverished blacks. And by widening the scope of a program that "hunted after-hours for a man in the house," the Cloward-Piven experiment contributed terribly to the breakup of untold millions of poor and minority families by depriving them of the benefits of a consistent male presence.

In so doing, Cloward and Piven's experiment did seemingly irreparable damage to the body politic of America. It effectively brought about the end of the civil rights movement as a force for moral excellence, and brought about the advent of the "civil wrongs" movement. Whereas the civil rights struggle was about equality and empowerment, the civil wrongs movement has everything to do with avoidance of responsibility and a sense of entitlement, the results of which are evident in many benighted communities yet today.

To be sure, the liberal critique of America's health care system has little if anything to do with its cost, its inefficiency or its inability to provide relief or cure for cancer, AIDS or heart disease, as changing the payer would have no positive impact on any of these circumstances. The Left despises our system of health care entirely because it is insufficiently "universal" (read equal, at least by liberal standards.) But the unwillingness of the Left to consider the negative consequences of single-payer health care that have already manifested themselves in Canada and elsewhere - coupled with their inability to recognize the detrimental sequela of previous welfare state expansions in the U.S. - robs their argument of persuasive power and applicability to the real world. My sense is that this suits them just fine, as liberalism works best in two dimensional situations, be it on the printed page or the movie screen.