My latest essay says,

Illness deprives us of the sense of physical safety. Disease and injury are a throwback to the circumstances in which our physical environment is threatening and overwhelming. Thus, health problems tend to trigger our collectivist instincts.

I am trying to apply Douglass North’s view that beliefs determine institutions, and institutions determine outcomes.

Last night, I saw the premier of “Sicko.” One of the examples in the new Michael Moore film illustrates the role of beliefs.

The case was of an African-American man who died of kidney cancer. His weeping wife had been told by a doctor that there was hope from a bone marrow transplant, but the insurance company denied the treatment. You were left to conclude that the decision was based on profits or racism.

After the movie, I did a quick search on Google and Wikipedia for the treatments of kidney cancer, and I could not find bone marrow treatment. This reinforced the gut feeling that I had during that segment of the movie, which is that the guy’s cancer was so far gone that none of the standard treatments was going to work, and the bone marrow idea was a desperate, last-ditch “hail-Mary pass” that had no proven track record of success.

My gut instinct may be wrong–I do not know all of the facts of the case. But certainly there are cases where American doctors try hail-Mary, desperation medicine. My guess is that insurance pays for this sometimes, and Medicare does so fairly often.

In these sorts of cases, my guess is that other countries do not use as much hail-Mary medicine. My guess is that they tell the patient there is nothing more that can be done, and instead try to help the family let go.

Certainly, what happened to the American family was more inhumane. They got jerked around, with the doctor telling them one thing to get their hopes up, and the insurance company telling them something else to crush those hopes.

But this all gets back to the way that beliefs shape the health care system. My guess is that other countries believe that when someone has passed the point where reasonable, proven treatments are available, it is ok to stop throwing lots of resources at the patient and instead use those resources where they are more helpful. In the United States, this runs up against an intense belief in saving lives, an enormous faith in doctors, and a strong desire never to give up.

In this country, we have not really come to terms with the ethical issues concerning hail-Mary health care. Some people even view desperate, last-ditch measures as an entitlement. As long as we believe that, the component of our health care spending that goes for futile care will not go down.I attended the premier as a guest of Michael Cannon, of Cato. While I was saving his seat and Michael was getting popcorn, he ran into Michael Moore in the lobby. Moore shook Cannon’s hand and apologized that footage of Cannon was cut from the final release. “Sicko” has quick clips of opponents of socialized medicine, at which the audience is supposed to laugh. I don’t think that Cannon was too disappointed over his failure to make the cut. But it’s kind of impressive that Moore remembered.

Speaking at the premier, Moore was mild-mannered, witty, and self-effacing. He made a plea with the audience to reach out to conservatives and Republicans, and when this received a tepid response from his partisans, he expressed gentle disappointment.

I found the movie to be very non-threatening intellectually, because it was so obviously one-sided. Contrasting French yuppies with American homeless people does not really prove anything.

On the other hand, it could have a tremendous political effect. The woman next to me broke down and wept during a scene in which a group of Cuban firefighters salutes three 9/11 rescue workers brought by Moore to Cuba for treatment. My guess is that this woman’s reaction to the film was more typical than mine. I tend to be more analytical than emotional, and I distrust film as a medium. In October of 2005, after viewing a documentary that attacked Canada’s health care system, I wrote,

I would say that while I enjoyed the film on the Canadian system and I agree with its viewpoint, I come away feeling that one probably could make an equally compelling propaganda film for the other side.

Michael Moore has done that, and the potential damage to the belief system of Americans is something that concerns me. Michael Cannon was taken aback when I murmured on the way out, “I can see how Hitler came to power.” I think he thought I was over-reacting. I hope I was.