IGF CultureWatch

Michael Moore's documentary, "Sicko", has started a new round of thinking about reforming America's healthcare system. For gay Americans, especially gay men, the stakes in this debate are unusually high and the answers are not obvious.

"Sicko" has two basic messages. The first is that America's system of privately run healthcare is broken, leaving millions without insurance and many of the rest frustrated by inadequate and expensive coverage. The result is a country that, according to the World Health Organization (WHO), ranks 37th in healthcare.

The second message of "Sicko" is that other countries - like Canada, Britain, and France - do a much better job of giving all citizens quality healthcare through government-run programs.

Along the way, Moore tells us horror stories about Americans whose insurance companies would not cover some life-saving treatment they need, about elderly and sick people dumped by the side of the road, and about 9/11 rescue workers who have to go to Cuba to get medical care.

These anecdotes are compared to happy tales from countries like France, where doctors make house-calls (!) free of charge, new mothers are given a state-paid assistant to do the laundry, and life expectancy soars.

All of it is punctuated by Moore's trademark humor, sarcastic and sardonic, which alone makes the film worth seeing. He is the funniest propagandist in the country.

Funny, but not terribly effective. A really good propagandist would give one the sense that the other side has been given a hearing, been considered, and been found wanting. With Moore, you get beaten over the head by clear good and evil. While Moore just wants cancer patients to get the treatment they need, the other side is all rapacious plutocrats putting profits ahead of lives.

If you're thinking at all during a Moore documentary, you're constantly wondering, what is he not telling me? I'm no healthcare expert, but I know enough to be wary of the direction Moore suggests.

His comparison of the U.S. to other countries is misleading, to say the least. The WHO report that ranks the U.S. just above Cuba looks at five factors: overall population health, including life expectancy; responsiveness of the system to patient needs; "inequality" of health within the population; "distribution" of responsiveness within the population (how people of varying economic status are served); and the "fairness" of the system's financial burden (who pays).

The first two factors can be measured objectively, and on these the U.S. does very well. Americans live longer on average than almost all other people. We're just a half year behind the British and 1.5 years behind the French in life expectancy. It's hard to say how much of even this modest gap is attributable to the countries' healthcare systems, as opposed to diet and exercise habits.

The U.S. ranks first - first - according to the WHO in healthcare responsiveness. Responsiveness means things like "respect for the dignity, confidentiality and autonomy of individuals and families to decide about their own health," and "prompt attention, access to social support networks during care, quality of basic amenities and choice of provider." Even with all the problems in their healthcare system, Americans report higher levels of patient satisfaction than citizens of any other country.

Of course, the U.S. loses out on the remaining three egalitarian and more subjective factors weighed by the WHO's international staff. Nations with government-run healthcare systems like France - and oil-rich Oman and socialist Cuba - do much better providing everyone healthcare and spreading the costs to those who can afford it. That's why the overall U.S. score is comparatively low.

It's a point Moore stresses. Everybody in those countries gets "free" healthcare, regardless of ability to pay, while some 47 million Americans have no health insurance and many receive needed care only when they go to the emergency room.

But this indictment by itself suggests no obvious reform. There is no such thing as free healthcare. Consider the example of Moore's favorite country.

France, which ranks first in healthcare according to the WHO, pays for its generous system with very high tax rates that absorb large portions of household income. That limits the freedom to spend on other things - like education or housing or travel - that some people value more highly.

High taxes and heavy regulation of business and labor markets, requiring extended paid leave for things like convalescence, produce anemic growth rates and chronically high unemployment. France is now having one of its periodic existential crises about falling behind more market-oriented countries.

The WHO report does not even consider a country's contribution to advanced medical education, new technology, innovative treatments, and drug research - all areas in which the U.S. unquestionably leads the world. The 36 countries ranked ahead of the U.S. enjoy such good health in part because of American creativity and profit-seeking American companies.

The tradeoff - more evenly distributed healthcare in exchange for some sacrifice of individual liberty and economic dynamism - might be worth it. But we at least must recognize the tradeoff exists.

Given the heavy need for healthcare among those with HIV infection, an expensive, chronic and potentially fatal illness, a question for gay readers is this: are there any special reasons to be concerned about reform? And given that the gay experience with government has not been happy, should we worry about state-run healthcare? That's the subject of the next column.

In Washington, being publicly discredited is no bar to employment for the industrious and well-connected. If you are sufficiently shameless, being a disgraced former official needn't prevent you from reincarnating as a highly paid lobbyist or think-tank pundit or deputy something-or-other. There seems to be no getting rid of some people.

A similar case is that of notorious junk science peddler Paul Cameron. He keeps generating his slanderous statistics about gay people, and uninformed reporters and editors keep eating up the stuff. The latest reminder came on July 5 as I was checking out the latest issue of Bay Windows online. Near the top of the screen, in the EDGEwire newslink box, was the headline, "Family Research Council Study: Gays Die Young."

The study in question is by Cameron and his son Kirk. While the EDGE article uses verbs like "claims" and "purports," provides "balance" by reporting contrary views, and points out the anti-gay nature of the Camerons' Family Research Institute, it respectfully cites the Camerons' Ph.Ds without mentioning that the senior Cameron was expelled by the American Psychological Association in December 1983 for using unsound methods and misrepresenting others' research.

For decades, Paul Cameron has been the favorite "expert" of anti-gay obsessives. His institute publishes pseudoscientific reports filled with false claims, such as that child molesters and sex murderers are disproportionately gay. His work has been used by syndicated columnists, members of Congress, and Pentagon officials. Therein lies the problem: Paul's preposterous pamphlets would vanish without a trace if others did not keep recycling them or if reporters were more careful about checking their sources.

Perhaps Cameron's most oft-quoted claim is that gay men have a dramatically shorter life expectancy. After Cameron disseminated brochures claiming that the average male homosexual life span was 43 years, many people repeated it in print and on television as a serious statistic. Problem is, there is no scientific basis for his claim. Cameron arrived at that figure by examining obituaries in gay newspapers during the height of the AIDS epidemic and averaging the reported ages of death.

Even assuming that the readership of those papers was representative of the entire gay community and that the obits were representative of all gay deaths - both assumptions are questionable - this method excludes everyone who did not die. That is like surveying the obituaries of soldiers killed in Iraq and concluding that the average life expectancy of soldiers is in the low 20s.

Readers of EDGE who are unfamiliar with Cameron might get the impression that he is a serious researcher, however flawed his methodology and conclusions. In actuality, as the Box Turtle Bulletin website reports, Cameron refers to homosexuals' "parasitic lives," decries equal rights as "Super Rights," accuses homosexuals of running a "shadow organization" in the U.S. military (which would come as a surprise to the more than 11,000 service members discharged under "Don't Ask, Don't Tell"), and calls homosexuals a threat to Western Civilization. The latter assertion is especially ironic considering that Cameron approvingly cites the work of the commandant of the Auschwitz death camp.

The Camerons are not the only phony experts used by irresponsible news organizations. On the same day as the EDGE story, the Gay and Lesbian Alliance Against Defamation (GLAAD) issued an alert denouncing a June 21 report by The O'Reilly Factor in which Fox News Crime Analyst Rod Wheeler described a nationwide epidemic of lesbian gangs. Without citing sources, Wheeler claimed that the Washington, D.C. area alone has more than 150 lesbian gangs, that they recruit children, and that many gang members use pink-painted Glock pistols. (This last stray bullet of wild invention hit the gay gun-rights group Pink Pistols, which has nothing to do with gangs and whose name is not intended literally.)

As GLAAD reports, Detective Patrick Word, president of the Mid-Atlantic Regional Gang Investigators Network, stated, "There is no evidence whatsoever of a lesbian gang epidemic in this region … our membership reports only one lesbian gang." According to a report by the Southern Poverty Law Center (SPLC), Wheeler is a "food defense specialist" for the American Institute of Baking who was suspended by the D.C. Metropolitan Police Department in 1994 after testing positive for marijuana use.

One advantage enjoyed by phony experts is that those who interview them and report their published claims are seldom prepared to challenge either their claims or their professional credentials. At best, dissenting views are quoted, as in the EDGE story, but with little context to facilitate an informed evaluation.

When counterposed quotes from newsmakers are substituted for investigative reporting, the implication is that there are no objective facts to be ascertained. Amazingly enough, the resulting "he said, she said" standoff is treated as a reason for boasting - as with Fox News Channel's slogan, "We Report, You Decide." This gives uninformed gut reactions the same standing as specialized expertise.

We are fortunate that groups like GLAAD, Box Turtle Bulletin and SPLC are active in refuting anti-gay propaganda disguised as news, but there are far more news outlets than they can handle, in an expanding array of media. All of us who are consumers as well as subjects of the news must be vigilant. When you find a reporter giving credence to the work of an anti-gay "expert," call the reporter and the editor on it. Instead of merely berating them, use the occasion as a teaching moment. First, though, be sure to do more careful homework than the reporter.

If I were the religious type, I might be preparing for Armageddon right now.

You see, last weekend my partner Mark and I drove out to his parents' house to help with yard work. This in itself would be unremarkable except that, as recently as Christmas, Mark's father insisted that I would be welcome at their house "over [his] dead body."

We arrive. Mark's father greets us at the door. He appears to be breathing normally. This is progress.

Mark and I have been together for nearly six years. When we first started dating, he was fresh out of law school, living with his parents while he looked for a job. He had not yet come out to them. "I figured I should wait until I had someone special in my life to tell them about," he explained to me.

"Isn't that sweet," I replied to him. "What a bad idea," I thought to myself.

Just as I feared: when Mark finally did come out to his parents, I personified for them everything that had gone wrong. I was "that man" (they could never bring themselves to use my name) who had corrupted their son. Never mind that Mark had been dating guys for years before meeting me: in their minds, his being gay was all my fault.

We hoped that their wrath would subside quickly, but it didn't. They refused to come to our house. They refused, even, to meet me. So we decided to ambush them. One Sunday, Mark's sister invited everyone out to lunch. "We won't tell them you're coming," she explained sympathetically. "In a public place, they'll have to be nice to you."

Mark's family is Asian. Like many Asians, they believe in "saving face." They abhor public scenes. (By contrast, my family is Italian. We believe in expressing ourselves. Public scenes are our forte.)

When Mark's parents arrived at the restaurant that day, Mark took a deep breath and blurted out, "Mom, Dad, this is John."

"Nice to meet you," I offered. They responded with a look that could wilt flowers.

We managed to get through lunch. But our ambush only caused them to dig in their heels deeper. They refused to attend Mark's 30th birthday dinner because "that man" would be there. They refused to attend his sister's engagement party because we were hosting it at our house. We seriously worried that they might refuse to attend her wedding.

When they finally bought their plane tickets for the wedding (held at a Mexican resort, on "neutral" territory), we were apprehensive. "These all-inclusive resorts have unlimited alcoholic beverages?" we asked his sister. "We'll need them."

Adding to the drama was the fact that my own parents would be attending. My Sicilian mother meets my Filipino mother-in-law. An irresistible force meets an immovable object. Our friends wanted ringside seats.

The wedding went off without a hitch. My parents-who have been wonderfully supportive-introduced themselves to Mark's parents. "You have such a lovely family," my mother said to Mark's mother. I watched for the flower-wilting look, but I couldn't detect it. Maybe the margaritas had kicked in.

But it wasn't just the margaritas. The wedding seems to have been a turning point. Maybe it was Mark's parents' seeing us interact closely with my parents, and realizing that they were missing out. Maybe it was their seeing that I actually had parents, rather than having emerged directly from hell. Whatever it was, they softened. Dramatically.

Mother's Day came, and we all went out to brunch. I didn't have to ambush them.

Father's Day came, and they actually visited our house. They complimented us on our garden, our food, our furniture. When they finally drove away, I turned to Mark and said, "Who were those people and what have they done with your parents?"

"I have no idea," he replied, dazed.

Then last weekend we went over to help them with weeding and planting. "John, work in the shade," his mother insisted. "The sun is too hot." She brought me a towel so I wouldn't have to kneel on rocky soil. She brought me bottles of cold water. (I checked the caps before drinking them. Tamper-proof.) Both she and his father were extremely gracious, and I don't think it was just for the free yard work.

In recent years gays have seen tremendous social and legal progress. There is much work to be done. But some of the most important work, and the most powerful, occurs on a small scale. It's mothers' introducing themselves to mothers-in-law (even when there is no "law" recognizing the relationship). It's yard work; it's brunch. Raise a margarita and drink to that.

There have been several attempts to expand federal hate-crime statutes, both to incorporate sexual orientation as one of the specified classes in the law and to increase federal involvement in the investigation and prosecution of these types of crimes. Each time the proposed bill has failed to pass.

The latest iteration of this legislation is the Local Law Enforcement Hate Crimes Prevention Act of 2007, approved by the U.S. House of Representatives on May 3 and now under consideration by the Senate.

One might oppose this bill for the wrong reasons, motivated by an animus against gay and lesbian Americans that refuses to acknowledge them in the law.

One might also oppose this bill for the right reasons, supporting the dignity of gay individuals but objecting on constitutional, legal, and philosophical grounds.

Hate-crime laws at the federal level violate the constitutional division of government by federalizing crimes that should be handled by state authorities.

Legal scholar Timothy Lynch of the Cato Institute told members of the House Judiciary Committee in April that the proposed law expands federal authority in an unconstitutional manner. He cited Chief Justice John Marshall, who observed that Congress had "no general right to punish murder committed within any of the States" and that it was "clear that Congress cannot punish felonies generally." Over time, however, Congress asserted that the Commerce Clause of the Constitution granted it the authority that Marshall said did not exist. Regarding this development, Lynch testified:

This Congress should not exacerbate the errors of past Congresses by federalizing more criminal offenses. The Commerce Clause is not a blank check for Congress to enact whatever legislation it deems to be 'good and proper for America.' The proposed hate-crimes bill is simply beyond the powers that are delegated to Congress."

From a legal standpoint, such a federal law would be redundant, at best.

One can understand if the call for hate-crime statutes comes from evidence of bad enforcement of the laws already on the books. We know that, in the past, police and prosecutors have been willing to look the other way when victims came from disfavored groups.

But as senior editor Jacob Sullum of Reason magazine pointed out in a recent column, "Unlike the situation in the Jim Crow South, there is no evidence that state and local officials are ignoring bias-motivated crimes."

Indeed, as Lynch testified, "all of the violent acts that would be prohibited under the proposed bill are already crimes under state law." Referring to the murders of James Byrd in Texas and Matthew Shepard in Wyoming, he added, "The individuals responsible for those murders were quickly apprehended and prosecuted by state and local authorities. Those incidents do not show the necessity for congressional action; to the contrary, they show that federal legislation is unnecessary."

Philosophically, passing this law would be wrong because hate-crime laws, however well-intentioned, are feel-good statutes whose primary result is punishing thought, violating our freedoms of speech and of conscience.

Wayne Dynes, editor of the Encyclopedia of Homosexuality, has noted that hate-crime laws, to be just, must be content-neutral. Yet in judging individual cases, he said, we would have to "get into the question of whether some hate" -- his example was that directed at an evil dictator -- "is 'justified' and some is not." He concluded that hate-crime prosecutions "will be used to sanction certain belief systems -- systems which the enforcer would like, in some Orwellian fashion, to make unthinkable. This is not a proper use of law."

Hateful thoughts may be repugnant to us, but they are not crimes in themselves. And crimes that follow hateful thoughts -- whether vandalism, assault, or murder -- are already punishable by existing statutes.

Passing this bill would also be wrong because it suggests that crimes against some people are worse than crimes against others. Hate-crime laws set up certain privileged categories of people, defined by the groups to which they belong, and offers them unequal protection under the law.

Beyond this philosophical objection, however, federal hate-crime laws -- those on the books now, those proposed -- are outside the scope of the authority granted Congress by the Constitution. New laws of this type should be rejected; older laws should be repealed.