A Bogus Cancer Statistic

Giuliani falsely claims that only 44 percent of prostate cancer patients survive under "socialized medicine" in England.

In a new radio ad, Rudy Giuliani falsely claims that under England’s “socialized medicine” system only 44 percent of men with prostate cancer survive.

We tracked down the source of that number, which turns out to be the result of bad math by a Giuliani campaign adviser, who admits to us that his figure isn’t "technically" a survival rate at all. Furthermore, the co-author of the study on which Giuliani’s man based his calculations tells us his work is being misused, and that the 44 percent figure is both wrong and “misleading.” A spokesperson for the lead author also calls the figures "incorrect survival statistics."

It’s true that official survival rates for prostate cancer are higher in the U.S. than in England, but the difference is not nearly as high as Giuliani claims. And even so, the higher survival rates in the U.S. may simply reflect more aggressive diagnosing of non-lethal cancers, according to the American Cancer Society.

Actually, men with prostate cancer are more likely to die sooner if they don’t have health insurance, according to a recent study published in one of the American Medical Association’s journals. Giuliani doesn’t mention that.
Analysis
Rudy Giuliani's latest radio ad, which began airing in New Hampshire this week, draws a stark picture for anyone diagnosed with prostate cancer in England. "I had prostate cancer, five, six years ago," the Republican presidential candidate says in the ad. "My chance of surviving prostate cancer, and thank God I was cured of it, in the United States, 82 percent. My chances of surviving prostate cancer in England, only 44 percent under socialized medicine.”

Giuliani is wrong about that. Fortunately for the English, their chances of surviving prostate cancer are far better than Giuliani claims: The actual five-year survival rate is 74.4 percent, according to the United Kingdom's Office of National Statistics. Even those in the U.S. have a better chance than what Giuliani states: The five-year survival rate is 98.4 percent in this country, according to the National Cancer Institute. (Furthermore, Milton Eisner, a statistician with the SEER program of NCI, which compiles these numbers, warns that the two countries’ statistics are “probably not comparable because they’re not done on the same scale.”)

Giuliani got his figures from a campaign adviser whose methods would make scientists and statistics professors cringe. Indeed, one of the authors of the report cited by the adviser says the figures in the ad are "misleading" and the math employed is "absolutely not" a legitimate way to calculate survival rates.

kind of like saying 2 + 2 = 7 in a Math class....

Recently (hat tip to Dean Baker) in the Wall Street Journal Fred Thompson couldn't give an accurate description of the government program he was attacking.

"I know this probably isn't a real popular thing to say, but we couldn't afford this prescription-drug bill," Mr. Thompson said last week on a swing through Iowa, home of Republican Sen. Charles Grassley, who helped push the program through Congress. "We basically put a $72 trillion commitment on top of an already-broken entitlement system. Not a responsible thing to do."

This is taking the "I'm the candidate who is going to tell you uncomfortable truths" a bit too far. In this situation Thompson took it so far as to be off on his numbers by over 62 trillion when discussing Medicare.

op-ed sent to AJC in response to Westmoreland

Opinion piece sent to AJC in response to Lynn Westmorelands article Open up your wallet and say "ahh"

There is nothing funny about resource allocation
by Jim Nichols

I wasn’t expecting parents struggling to pay health care costs across my district to be disrespected in a discussion of SCHIP. But in his piece entitled “Open up your wallet and say ‘Ah’ my Congressman Lynn Westmoreland made an analogy that did just that. In it he challenged the wisdom of spending when one is “in debt up to your ears and your credit cards are maxed out,” asserting that “a new credit card is not the answer.” First the “problems” he was citing were shortfalls in long-term budget projections. The combined budget shortfalls of Medicare and Social Security have more to do with health care cost inflation–which the rest of the industrialized world has learned to manage–rather than entitlement programs run amuck as Westmoreland infers. But more importantly it’s a question of tact; as my fiance stated to me after reading it, “if our child needed medical care we’d take out as many credit cards as we could to make sure they got treated.” Reading Westmoreland’s piece I felt the struggles of constituents being ignored.

SCHIP is a federal program designed to work in a targeted manner to capture low income children who do not fall within Medicaid qualifications, its one goal is to improve health care coverage of children–not end the health care crisis. Since 1997 the programs have reduced the number of children without insurance by about one-third. The best synopsis I can give of his position is that Westmoreland questions the wisdom of how the bill is paid for and sees it as a burden on taxpayers. I won’t waste space on the question of crowd-out rates or the claimed superiority of private health insurance, and would direct people to the nonpartisan Congressional Budget Offices analysis for context on those issues

Beyond the rhetoric I question framing the $157 billion cut to Medicare Advantage as a cut to Medicare. A change that saves taxpayer money and increases efficiency–providing people the same quality of care–is a cut? This cut has been a recommendation of groups such as the National Committee to Preserve Social Security and Medicare, and the American Medical Association; not to mention MedPac– the advisory body for the congress in charge of Medicare payment policy. According to MedPac the largest overpayments “average 19% more than it would cost to treat comparable beneficiaries under regular medicare, with half of these overpayments going to profits, marketing, and administrative cost.” This doesn’t devastate Medicare it creates a situation where more people get health coverage.

The context of the numbers, with claims of “staggering” and “upsetting” spending increases that create “Government-run health care” seem questionable as well. $130 billion over 10 years is $48.82 per-capita according to the budget calculator at Center for Economic and Policy Research website. To assert a better funded SCHIP would lead to government-run health care is a leap in logic. SCHIP and Medicaid are programs using private doctors and private health care plans where states negotiate the limits, rates, and package details. These are decisions made by people at the state level.

By cutting payments which typically go into marketing, administration, and profits; and increasing the cigarette taxes (which in-its-self is projected by the American Cancer Association to ‘prevent more than 900,000 Americans from dying prematurely because of smoking’) the SCHIP bill increases the number of children covered in this country. If one more parent is kept from needing to open an extra credit card to get the quality care their child needs, my $48.82 will be well worth it.

Mr. Westmoreland, please publicly clarify your position on SCHIP in a more precise manner. I will acknowledge that your criticisms on a point by point basis might be sound if the bill was intentioned as a long term fix to the health care crisis but the question at hand falls short of that framework. Claims that families of four with incomes above poverty are less deserving of reprieve and assistance than a family in poverty seems divisive–the nuances of government spending are not black and white questions of who works harder or which struggle is more burdensome. By using analogies about bad credit you frame it in that way. The problems with your piece–the representation, analogies, and logic—make the case that it will be the inability of those opposed to Universal plans to come up with workable solutions over the past 20 years that will give us universal health care... not Hillary Clinton.

New York TImes Editorial

on Health Care Crisis...

Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.

Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.

Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.

Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.

Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.

Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.

Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.

That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.

Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.

Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.

Former head of faith-based initiatives

Op-ed on the current Schip funding question by the first director of the White House Office of Faith-Based and Community Initiatives appointed by Bush in 2001.

Eight years ago this week, on July 22, 1999, George W. Bush delivered his first presidential campaign speech, titled "The Duty of Hope." Speaking in Indianapolis, he rejected as "destructive" the idea that "if only government would get out of the way, all our problems would be solved." Rather, "from North Central Philadelphia to South Central Los Angeles," government "must act in the common good, and that good is not common until it is shared by those in need." There are "some things the government should be doing, like Medicaid for poor children."

I helped draft the speech and served in 2001 as an adviser to Bush. He has made good on some compassion pledges. For instance, he has increased funding for public schools that serve low-income children. His $150 million program for mentoring 100,000 children of prisoners has made progress. In May, he pledged an additional $30 billion in U.S. aid to combat the global HIV/AIDS epidemic and save Africa's affected children.

On the other hand, poverty rates have risen in many cities. In 2005, Washington fiddled while New Orleans flooded, and the White House has vacillated in its support for the region's recovery and rebuilding process. Most urban religious nonprofit organizations that provide social services in low-income communities still get no public support whatsoever. Several recent administration positions on social policy contradict the compassion vision Bush articulated in 1999.

In May, Bush rejected a bipartisan House bill that increased funding for Head Start, a program that benefits millions of low-income preschoolers. His spokesmen claimed the bill was bad because it did not include a provision giving faith-based preschool programs an absolute right to discriminate on religious grounds in hiring.

That reason reverses a principle Bush proclaimed in his 1999 speech: "We will keep a commitment to pluralism, not discriminating for or against Methodists or Mormons or Muslims, or good people of no faith at all." As many studies show, most urban faith-based nonprofits that serve their own needy neighbors do not discriminate against beneficiaries, volunteers or staff on religious grounds. These inner-city churches and grassroots groups would love to expand Head Start in their communities.

Last week, Bush threatened to veto a bipartisan Senate plan that would add $35 billion over five years to the State Children's Health Insurance Program (SCHIP). The decade-old program insures children in families that are not poor enough to qualify for Medicaid but are too poor to afford private insurance. The extra $7 billion a year offered by the Senate would cover a few million more children. New money for the purpose would come from raising the federal excise tax on cigarettes.

Several former Bush advisers have urged the White House to accept some such SCHIP plan. So have many governors in both parties and Republican leaders in the Senate. In 2003, Bush supported a Medicare bill that increased government spending on prescription drugs for elderly middle-income citizens by hundreds of billions of dollars. But he has pledged only $1 billion a year more for low-income children's health insurance. His spokesmen say doing any more for the "government-subsidized program" would encourage families to drop private insurance.

But the health-insurance market has already priced out working-poor families by the millions. With a growing population of low-income children, $1 billion a year more would be insufficient even to maintain current per-capita child coverage levels. Some speculate that SCHIP is now hostage to negotiations over the president's broader plan to expand health coverage via tax cuts and credits. But his plan has no chance in this Congress; besides, treating health insurance for needy children as a political bargaining chip would be wrong.

Bush threatens veto

The Senate Finance Committee approved an expansion of Children’s Health Insurance Program on Thursday. The vote was 17 to 4 with all Democrats and a majority of Republicans supporting the plan. According to the NYT's Bush has threatened a veto.

Lets look at the numbers.

$60 billion is $38.43 per-capita.

THe Bush plan costs $30 billion which is $19.21 per-capita.

The Democratic (and majoirty of Republicans) bill costs $19.22 more per-capita than Bush's proposal.

According to Republican Pat Roberts the bill would "provide health insurance coverage to approximately four million more children who would otherwise be uninsured." And Daniel E. Smith the Vice President of the American Cancer Society stated that the bill would “prevent more than 900,000 Americans from dying prematurely because of smoking,” to to the fact that most of the funding for the expansion comes from a .61 cent increase in the cigarette tax.

For $19.21 more dollars per-capita. We get 4 million more kids with insurance and 900,000 fewer premature deaths from smoking.

Hip replacement US vs. Canada

Something I did not know when discussing hip-replacement data US v. Canada, which was pointed out today by Princeton Economist Paul Krugman

On the other hand, it's true that Americans get hip replacements faster than Canadians. But there's a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That's right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that's what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

Which means when it comes to hip-replacements we are basicly comparing the US public system, to the Candian public system. Not some dramatic public vs. private show down. That is why I heard some people argure for the Medicare-for-all plan of someone like Kucinich (here and here and here and here).

update: Ezra Klien points out

A state-run system could decide, as Medicare does, that they'll pay for any and all necessary procedures, and do so quickly. Then there would be no rationing. There would be, as there is in Medicare, enormous spending and astonishingly fast cost growth. Instead, other systems, and their attendant societies, makes a judgment to devote relatively fewer resources to health care and relatively more to other things (like leisure!). That's a fair allocation of resources.

What we do in this society is devote relatively unlimited resources to health carefor wealthy and insured peopleand relatively fewer to health care for poor people. It isn't clear whether we think that's a useful way to spend trillions of dollars, or whether we'd prefer some alternate ordering of expenditures, with more going to preventive medicine and paid maternal leave.

good question on health care...

Ezra Klien has a good point to make on the question of health care wait times in other countries...

It's fascinating how much more concerned conservative types are with a Canadian who had to wait 3 months for a hip replacement than with the 18,000 Americans who die each year because they lack access to quality medical care

I think its a great point but I'm going to reframe it without dragging conservatism as a philosophy into the picture--since I'll assume many conservatives don't want to be included in a group that does believe wait times are more important than deaths from inadequate health coverage, which a study by the National Academies’ Institute of Medicine estimated to be at least 18,000 deaths per year.

Anytime questions of wait times come up, an obvious question becomes: Are long wait times a more important issue to be addressed than the 18,000 deaths from inadequate health care per year?