After having spent the last year without health insurance and having tried an High-Deductible plan with an HSA, I’ve begun to think (with Milton Friedman) that one big reason health care costs are so high because we don’t pay them directly. I haven’t seen Sicko, but the film evidently includes an anecdote of someone losing the tips of their fingers to a table saw. I almost lost my left thumb and finger the same way, so I’m sympathetic — to an extent. I was without work at the time and didn’t have health insurance. Lucky me, I was able to sign up for the (very expensive) COBRA from my old workplace and able to get the surgery. Otherwise, I would have had to spend a lot more time in Charity Hospital. By the way, when you show up at a hospital dripping blood they don’t ask you for insurance coverage. They whisk you in and stitch you up. Then, when they find you don’t have coverage they say “We have to transfer you.” If you know you’re going to be transfered, and you can make it to the second hospital without dying, you should try to go there first. I didn’t and, as a result, by the time I got to the second hospital I wasn’t bleeding, so I was triaged differently and had to wait hours to get further help. Still, my cousin lost the tips of her fingers as a child. I grew up around a man who’s hand lacked a number of fingers. It looks strange, but it isn’t as if you are incapacitated. If I had to pay $10,000 to get the tip of my ring finger re-attached or $60,000 to get the tip of my middle finger, I’d probably skip the surgery. If I had to spend my money for my health care, I would make different decisions. The other reason I’ve heard for for high health care costs in the U.S. is liability insurance. On one trip back home from New York, I sat beside someone involved in “finance” for a health care group. He told me a story of a case that had just been settled after 3 years of legal expenses. His group was sued by a patient whose hand they had re-attached. The man’s hand worked, but he sued because his grip strength was cut in half or something. Dude, you got your hand! Be thankful! Still, I’m not sure what the whole answer is. Some people need ongoing medical care and those expenses can be a huge burden. It doesn’t feel “right” to tell someone whose child suffers from chronic asthma attacks, “Sorry, since you can’t pay, we can’t help you.” So I see the need for generosity in the system. I just doubt that Michael Moore has the answer.