Rudy Giuliani is running a radio ad that is generating much comment and derision. Paul Krugman explains:
â€œMy chance of surviving prostate cancer â€” and thank God I was cured of it â€” in the United States? Eighty-two percent,â€ says Rudy Giuliani in a new radio ad attacking Democratic plans for universal health care. â€œMy chances of surviving prostate cancer in England? Only 44 percent, under socialized medicine.â€
You see, the actual survival rate in Britain is 74.4 percent. That still looks a bit lower than the U.S. rate, but the difference turns out to be mainly a statistical illusion. The details are technical, but the bottom line is that a manâ€™s chance of dying from prostate cancer is about the same in Britain as it is in America.
Defending Rudy, rightie blogger Don Surber spoke up:
The head of the National Health Service, Alan Johnson, took offense when Rudy Giuliani pointed out that the 5-year survival rate of prostate cancer is superior in the United States to places like England that offer â€œfreeâ€ health care.
Rudy is a prostate cancer survivor. Rudy said in the U.S. the survival rate is 82%, 44% in socialized medicine countries.
Johnson waded into this and piped up that he has a 74% survival rate.
So what? It is 99.3% here.
Rudy was not misleading anyone. He was only using old data. New data shows that the billions Americans spend on cancer research is paying off.
Lancet Oncology magazine ran the numbers last month, according to Medscape.
I looked at the Medscape article Surber linked. The numbers he provides are from an analysis “headed by Arduino Verdecchia, PhD, from the National Center for Epidemiology, Health Surveillance, and Promotion, in Rome, Italy, was based on the most recent data available. It involved about 6.7 million patients from 21 countries, who were diagnosed with cancer between 2000 and 2002.” So it’s about five years old.
Medscape also says, “The United Kingdom in particular comes out badly in the tables, showing cancer survival rates that are among the worst in Europe.” So comparisons with the UK are not necessarily indicative of “socialized medicine countries.”
But what about the 99.3 percent survival rate? I spent way too much time this morning cruising around for information, and I am way confused. For example, the Center for Disease Control gives a survival rate of 97% and a mortality rate of 26.5, which to number-challenged me makes no sense. I’m sure one of you will attempt to patiently explain it to me, though.
This is from the American Cancer Society:
The 5-year relative survival rate is the percentage of patients who do not die from prostate cancer within 5 years after the cancer is found. (Men with prostate cancer who die of other causes are not counted.) Of course, patients might live more than 5 years after diagnosis. These 5-year survival rates are based on men with prostate cancer first treated more than 5 years ago.
Overall, 99% of men diagnosed with prostate cancer survive at least 5 years. Ninety one percent of all prostate cancers are found while they are still within the prostate or only in nearby areas. The 5-year relative survival rate for these men is nearly 100%. For the men whose cancer has already spread to distant parts of the body when it is found, about 32% will survive at least 5 years.
There are relative survival rates and age-adjusted survival rates and all kinds of other rates, plus mortality rates that make it seem people are surviving and dying at the same time, and the numbers are all over the map. I hypothesize that all these different sources are basing their numbers on diverse criteria, and comparing one set of stats with another is likely comparing apples to oranges. And I have a headache.
As several truth-squading journalists — notably, The Post’s Michael Dobbs— have pointed out, mortality rates from prostate cancer in Britain and the United States are roughly the same: About 25 men out of 100,000 die of prostate cancer each year in both countries. (That’s the standard way of reporting mortality rates, deaths per 100,000 individuals.)
From there I finally got to Michael Dobbs’s explanation, and it’s very clear and good, and there is a line graph to help those of us who need visuals. The line graph reveals that African American men are way more likely to die from prostate cancer than either white Americans or Brits, which ought to be a concern.
The other point Dobbs explains is that prostate cancer tends to develop very slowly. I gather that nearly everyone survives at least five years from the onset of the disease, with or without treatment. So, because patients in the U.S. are diagnosed much sooner, our diagnosis-to-death stats are much better than Britain’s, even though the actual outcomes aren’t much different from Britain’s.
Back to Krugman:
So Mr. Giulianiâ€™s supposed killer statistic about the defects of â€œsocialized medicineâ€ is entirely false. In fact, thereâ€™s very little evidence that Americans get better health care than the British, which is amazing given the fact that Britain spends only 41 percent as much on health care per person as we do.
The 41 percent is a step up; it was a lot less than that in the 1990s.
The figure shows spending for health care per capita in various nations, in 1998. I added “USA” and “UK.” In 1998, the U.S. was spending $4,178 per capita and the UK was spending $1,461 per capita. (From the University of Maine’s “The U.S. Health Care System: The Best in the World, or Just the Most Expensive?” [PDF]). There’s no question that the British NHS has problems, but my understanding is that most of those problem stem from gross underfunding rather than the nature of the system itself.
Anyway, comparisons with Britain have absolutely nothing to do with what the Democrats are proposing. In Britain, doctors are government employees; despite what Mr. Giuliani is suggesting, none of the Democratic candidates have proposed to make American doctors work for the government.
To righties, all universal health care proposals are the same. They’re all “socialized medicine” or “Hillarycare.” Since what Senator Clinton proposes now bears little resemblance to what she proposed as First Lady in 1993, it can be argued that even Hillary isn’t pushing “Hillarycare.” But what this shows us is that righties aren’t even looking at the arguments or proposals. Their reactions are pure knee-jerk groupthink, and their opinions are based more on irrational fears and emotions than on facts.
Giuliani’s cancer was treated by way of a therapy called Bradychardia, which involves implanting small, rice-sized radioactive capsules into the prostate gland. The technique was developed [PDF] by a researcher from Copenhagen, Denmark. Denmark, you’ll recall, is both in Europe and has a universal healthcare system. It’s a wonder Giuliani didn’t stalk out of his hospital on principle.
Moreover, Giuliani was unlucky enough to get prostate cancer at a fairly young age. But his experience was not typical. The average age at the time of diagnosis is 70 – which means that the domestic care Giuliani is lauding is being provided under the auspices of Medicare – a federally-run, single-payer insurance system.
Ah-HAH! Take THAT, Don Surber.
Since Mr. Surber cited the Lancet Oncology journal as a source, I poked around on the Lancet site looking for more information. Most of their articles are behind a pricey subscription firewall. But I did come across one that’s available for public view, from the October 2007 issue: “Increasing inequalities in US healthcare need taming.”
Although clinics in the USA offer some of the best anticancer services in the world, the proportion of Americans who cannot access these services is shocking. According to the US Census Bureau, in 2005 46Â·6 million Americans (including 8Â·3 million children) were without health insurance, with certain subgroups of the population faring especially poorly. For example, a quarter of people whose household income was less than $25â€ˆ000 were uninsuredâ€”this is not surprising, however, given that the average cost of a single adult insurance policy is $2268. Texas had the highest percentage of uninsured people with 30% of adults aged under 65 years without insurance. From an oncology perspective, uninsured people are less likely to have access to screening or early-detection facilities; are more likely to be diagnosed late with more advanced tumours; are less likely to receive appropriate treatment; and are more likely to die from their cancer. Clearly, to make progress in the war on cancer, access to healthcare is a fundamental requirement that precedes any concerns about specific treatments.
Even for those with insurance, coverage is often less than optimum. A 2006 survey by USA Today, the Kaiser Family Foundation, and Harvard School of Public Health, of 930 adults who had cancer or who had a family member in their household with cancer, showed that insurance plans for nearly a quarter of patients paid less than actually needed; one in ten patients reached the limit of what their insurance would pay for cancer treatment; one in 12 were unable to get a specific type of treatment because of insurance limitations; and one in 14 were unable to pay for basic necessities such as food, heating, or housing because of financial burdens encountered in paying for their treatments. Furthermore, 6% of patients lost their health insurance as a result of having cancer. More than 17 million US adults are underinsured, yet current legislation to ensure appropriate provision is inadequate. For example, although many US states recently mandated that insurers cover screening for cancers of the breast, cervix, prostate, and colon, several states have since passed exceptions to these mandates, thereby allowing health insurance companies a licence to underinsure. …
… Currently, about 2Â·5 million people are diagnosed with cancer in the USA each year, of which about one in six have no health insurance and will receive inadequate care. Given the wealth of the USA, these figures are frankly unacceptable. In the run up to the 2008 US presidential elections, the time is right to highlight these issues to make them a high political priority, and to finally eliminate this appalling inequality of care.