July 2007


I ran into this fascinating map while researching election results. It’s a cartogram of the 2004 presidential election, coloring each county by its proportion of blue (Dem) or red (Bush) votes, and sizing each county by population

The map comes from Michael Gastner, Cosma Shalizi, and Mark Newman of the University of Michigan.

Compare to this map of the 2006 House election. But this map shows even more spectacularly where exactly the blue and red are: blue in the big cities, red in the rural areas, purple in the suburbs.

What it highlights even more is how much of the population is urban and suburban. You can see all our mid-size cities as purple islands floating in a net of red , and of course our biggest cities as honking big blue areas.

Also worth a look: Newman’s cartograms of some basic world data.

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Last week my wife dragged me to see Sicko. I’d never seen a Michael Moore film, and I didn’t have high expectations. But in fact it’s a remarkable film and you ought to see it. Even you half-dozen conservatives or libertarians who read this site.

Moore’s case is almost entirely anecdotal, and that has pluses and minuses. On the plus side, anecdotal stories are pretty much undeniable as individual cases. The people who tell their stories to Moore have been screwed over by the health industry.

‘Anecdotal’ is almost a swear word for academics, because individual cases don’t prove a trend. But they can suggest one; the question is, are Moore’s cases isolated? The fact that he received tens of thousands of cases when he asked for them suggests that they’re not. The wider test is whether Moore’s stories will resonate with the public. I think it will. It certainly does with me; I’m not spectacularly unhappy with my health plan, but it’s expensive, and an enormous worry in periods between jobs. I’d switch in a minute to the universal plans Moore highlights.

Moore plays a little dumb in his interviews, affecting astonishment that there’s no hospital bills in France and Britain. This may hide the fact that he actually does respond to the obvious counter-attacks: the film points out that our life expectancy is lower than in countries with universal health care; that national health doctors don’t live in poverty; that health bureaucracy is worse in the US than with universal care; that the higher taxes don’t prevent a comfortable middle class lifestyle, and even facilitate it, by eliminating major classes of expenses. Compared with France, the US in effect taxes the young, burdening young couples with university loan repayments, child care, and health care costs.

There’s an interesting clip in which Richard Nixon approves the “incentives” in the original HMOs— that is, HMOs are supposed to combat people’s apparently irresistible urge to go to the doctor all day long, and we’ll save on health care. If that’s the idea, it fails, since we pay more than countries with universal care. But if you’re talking incentives, let’s look at the perverse incentives in our own system. As Moore points out, people are paid bonuses in our system to prevent people from getting health care. Insurance companies see it as their mission to collect money and not pay it out. Someday we’ll be smart enough to see this and make them reform or disappear.

Health is unlike other sectors of the economy in that costs have little relation to individual choices and values. Health is pretty much a lottery: you don’t choose to get cancer, or break your leg, or lose your hearing. That makes it singularly unsuitable for market forces. The rational approach to this sort of expense is not to make the sick pay the most; it’s to spread the risk out as broadly as possible.

(Aren’t some health costs subject to our control? Sure: stop smoking and eat less. Again, Moore’s film suggest that this sort of thing is handled better, not worse, under national health plans— they can concentrate more on preventive medicine.)

Politics, they say, is the art of the possible. Universal care hasn’t seemed possible in this country for years. Moore has done a great service, I think, by making it seem possible. He’s not asking for a utopian dream; he’s asking for something other countries have had for decades.

What he hasn’t done is to have the last word. Sicko certainly doesn’t prove that nationalized health care is the best system. But it makes it a lot harder to justify the current system, which is inefficient, unjust, expensive, and out of control. If you have another way to fix it, I’m happy to hear about it, but contentions that it’s not broken are off the table.