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October 29, 2007
Rudy and "Socialized Medicine"
I used to believe that one of Bush's primary problems was that he was governor in a state with an absurdly weak governorship. In Texas, the executive is only the fifth most powerful position, and so Bush's disengagement with public policy made sense. He'd never needed to be engaged. I hoped Giuliani would actually be better, as his time in New York required real substantive involvement with policy analysis. And yet it's the same old crap. Here's Rudy's new radio ad on health care:
Rudy's wandering around with the old prostate care canard. It's -- no pun intended -- crap. England and America have vritually the same mortality rates from prostate cancer. In England (as of 1997), 28 males of every 100,000 died from prostate cancer. In America, then number was 26. The difference comes in "incidence" -- there are many more diagnoses of prostate cancer in America, as we have an aggressive screening process:
Problem is, most of those cancers simply aren't deadly, or even necessarily damaging. They're slow-moving and benign. It's like saying we have a lower death rate from car crashes because we record more near-misses in the statistics. We may indeed have a slight advantage of prostate treatment, but it's not what Guliani is suggesting it is.
Not only are Giuliani's numbers wrong, but the whole metric is off. Prostate cancer isn't the only illness we treat. If what you're interested in is years of life lost due to the health care system, well, we have data on that too. This is from the same source as the prostate cancer stats (which are, I'm pretty sure, the ones Giuliani is using, as they're the ones Cato, who started this argument, uses):
America, you'll notice, doesn't do so well. And to make the old point one more time, we're actually having an argument over which system is better, even as Americans pay more than twice as much for care as the British. At that cost differential, there should be no debate. That there's any dispute at all is evidence that we're doing something terribly wrong. But don't worry. Giuliani is proposing a tax deduction...
Assignment Desk: Wouldn't it be interesting to find out if the gold-standard care Giuliani got during his prostate cancer came while he was on government-provided health insurance? He was mayor at the time, suggesting his care was coming through the city, which would suggest it was through the state insurance pool, which works very much like FEHBP -- which is what the Democrats are proposing to expand to all Americans, and what Giuliani is calling deadly, socialized medicine.
October 29, 2007 in Consumer-Directed Health Care, Health of Nations | Permalink
Comments
Facts for you:
1) The NHS is pretty bad, and a lot of people don't use it
2) The private sector is in large part composed of the NHS trading privately
3) No-one goes bankrupt here because of illness here
4) The NHS is good value
5) Please talk about the French medical system more.
Posted by: Marcin Tustin | Oct 29, 2007 3:40:07 PM
Ezra,
You are confusing "incidence" (the rate at which the disease occurs in the population) with "diagnosis" (the rate at which the disease is detected in the population). If the incidence of prostate cancer is higher in the U.S. than in Britain, then equal mortality rates from prostate cancer implies superior rates of detection and/or successful treatment in the U.S.
And your second chart is not data on "years of life lost due to the health care system," it's data on years of life lost for all causes. This is obviously determined by everything from homicide and suicide rates, to the rate of smoking, to the rate of fatal motor vehicle crashes. It doesn't tell you anything whatsover about differences in years of life lost due to differences in the health care systems.
Posted by: JasonR | Oct 29, 2007 3:42:07 PM
What are the other four? Lt Gov, sure, and I guess Speaker, and probably Senate majority leader. Who is the fourth? Senate minority leader? Agricultural Commissioner? Attorney General?
Posted by: Nicholas Beaudrot | Oct 29, 2007 3:42:26 PM
No-one goes bankrupt here because of illness here
Wow. So if you become seriously ill or disabled in Britain (what I assume you mean by "here") and can no longer work, the government will pay off your mortgage, your car, your credit cards, your student loans and whatever other debts and financial obligations you may have, will it?
Posted by: JasonR | Oct 29, 2007 3:46:49 PM
What are the potential years of life lost because we are the fattest and laziest society to ever exist?
Posted by: Dingo | Oct 29, 2007 3:48:16 PM
Jason: Incidence is only recorded upon detection. We have higher incidence because we have more aggressive screening. As I understand it, there's not a whole ton of debate on this question.
As for the years of Life Lost metric, the study defines it as "Potential years of life lost measures the years of life lost prior to age 70 due to causes considered preventable given appropriate medical intervention. As a result, deaths during childhood can have a major influence on potentially years of life lost." So it's only causes that the health system should be preventing. What you're seeing aren't homicides but a lot of infant mortality, which America is absurdly bad at addressing among minority populations.
Posted by: Ezra | Oct 29, 2007 3:52:06 PM
What's up with New Zealand? France and Germany, I get (large [presumably undertreated] minority populations, especially in France). But New Zealand? Is it skin cancer (the Kiwis I know live in constant fear of it)?
Posted by: Joe | Oct 29, 2007 4:09:44 PM
Ezra,
Jason: Incidence is only recorded upon detection.
But that's not "incidence." Incidence is the rate at which the disease occurs in the population, not the rate at which it is detected.
We have higher incidence because we have more aggressive screening.
No, we have a higher rate of diagnosis. That is probably in part because of more aggressive screening, but it may also be in part because prostate cancer occurs more frequently in American men than in British men. Unless you have evidence that prostate cancer occurs at the same rate in both countries, you cannot draw the conclusion that the more aggressive screening in the U.S. is of no value on the grounds that the prostate cancer mortality rates are the same.
As for the years of Life Lost metric, the study defines it as "Potential years of life lost measures the years of life lost prior to age 70 due to causes considered preventable given appropriate medical intervention. As a result, deaths during childhood can have a major influence on potentially years of life lost." So it's only causes that the health system should be preventing. What you're seeing aren't homicides but a lot of infant mortality, which America is absurdly bad at addressing among minority populations.
Deaths from homicide, suicide, car accidents, smoking, poor diet, etc., certainly include deaths that are "preventable given appropriate medical intervention." If the U.S. health care system is twice as good at preventing deaths from, say, attempted homicide as the British health care system, but the rate of attempted homicide is three times higher in the U.S. than in Britain, then the rate of homicide deaths in the U.S. will be higher even though the U.S. health care system is better at preventing them. Unless you control for differences in the incidence of the different causes of death between the two countries, you can't draw any meaningful conclusions about differences in the effectiveness of their health care systems at preventing those deaths.
Posted by: JasonR | Oct 29, 2007 4:11:38 PM
Why is it that the horror stories that the right prefers to trot out are usually for procedures (joint replacements) or ailments (prostate cancer) that are mostly covered by the government (i.e., Medicare) anyway? Sounds to me like the stats aren't nearly as favorable to their cause when it's something that primarily affects those under 65... like, say, maternity care.
Posted by: latts | Oct 29, 2007 4:17:46 PM
"Wow. So if you become seriously ill or disabled in Britain (what I assume you mean by "here") and can no longer work, the government will pay off your mortgage, your car, your credit cards, your student loans and whatever other debts and financial obligations you may have, will it?"
Wow. Way to be obtuse, JasonR! In case you're not being obtuse and are, in fact, just slow, the difference is that the providers of the financial instruments you listed all offer insurance to protect you (and them) against the event of your long-term disability.
So you might go bankrupt because the insurance products provided by the market to cover your financial obligations are inadequate or because you didn't purchase such products.
There is, however, no need to protect yourself against the specific risk of becoming ill since being ill does not create a new financial obligation. Hence, you can't go bankrupt from being ill per se.
Posted by: Andrew | Oct 29, 2007 4:20:49 PM
Rudy is just lying. You know nothing more after these guys speak than you knew before.
Posted by: floccina | Oct 29, 2007 4:20:59 PM
The Japan numbers make me think race has an effect and so all the numbers need adjusting.
Posted by: Floccina | Oct 29, 2007 4:24:36 PM
the difference is that the providers of the financial instruments you listed all offer insurance to protect you (and them) against the event of your long-term disability.
Huh? First, that's not a difference (insurance against these losses is also available in the U.S.). But even if it were a difference, the mere availability of such insurance obviously doesn't mean that people will buy it.
So you might go bankrupt because the insurance products provided by the market to cover your financial obligations are inadequate or because you didn't purchase such products.
Yes, indeed. So Marcin's claim that "No-one goes bankrupt here because of illness" is false, isn't it?
There is, however, no need to protect yourself against the specific risk of becoming ill since being ill does not create a new financial obligation.
Nonsense. There is obviously a risk if you have existing financial obligations that you will no longer be able to meet if you become ill and can no longer work. And illness can certainly impose new financial obligations that will not be covered, or will only partly be covered, by the health care system.
Posted by: JasonR | Oct 29, 2007 4:34:41 PM
We may indeed have a slight advantage of prostate treatment, but it's not what Guliani is suggesting it is.
I haven't read the study, but if the statistics don't include death from complications of treatment then the overall US death rate resulting from prostate diagnosis might actually be a great deal higher.
Treatment can result in injury and death. If higher rates of diagnosis also lead to higher rates of uneccessary treatment, then the US might be doing a worse job of "treating" prostate cancer. And the result might not show up in the statistics.
JasonR:
Perhaps you could explain how one determines "incidence" without a diagnosis?
Posted by: flory | Oct 29, 2007 4:39:46 PM
Ezra wrote:
"So it's only causes that the health system should be preventing. What you're seeing aren't homicides but a lot of infant mortality, which America is absurdly bad at addressing among minority populations."
Hispanics in the USA have lower infant mortality than non-Hispanic whites. Asians in the USA have much lower infant mortality than whites. BTW people of west African decent tend to have more multiple births.
Have you checked the rates of infant mortality among aborigines in Australia, native Americans in Canada of Maoris in new Zealand lately? I wonder if there is data on infant mortality by race in Great Britain and France?
Also fertility treatments affect infant mortality rates and Americans use more fertility treatments.
Also:
http://www.opinionjournal.com/best/?id=110006153
“The United States . . . has the most intensive system of emergency intervention to keep low birth weight and premature infants alive in the world. The United States is, for example, one of only a handful countries that keeps detailed statistics on early fetal mortality--the survival rate of infants who are born as early as the 20th week of gestation.
How does this skew the statistics? Because in the United States if an infant is born weighing only 400 grams [14 ounces] and not breathing, a doctor will likely spend lot of time and money trying to revive that infant. If the infant does not survive--and the mortality rate for such infants is in excess of 50 percent--that sequence of events will be recorded as a live birth and then a death.
In many countries, however, (including many European countries) such severe medical intervention would not be attempted and, moreover, regardless of whether or not it was, this would be recorded as a fetal death rather than a live birth. That unfortunate infant would never show up in infant mortality statistics.>
The problems with medical care in the USA are it cost too much and it drags out death.
Posted by: Floccina | Oct 29, 2007 4:56:11 PM
Ezra,
How can you say, "America, you'll notice, doesn't do so well?" All I know is I see that graph, and the thing that jumps out at me is that, as always, the US leads the world. USA! USA! USA!
I have produced a more inspiring, patriotic version of the graph here .
Posted by: David S | Oct 29, 2007 4:57:53 PM
flory wrote:
"Perhaps you could explain how one determines "incidence" without a diagnosis?"
I can think of one autopsy but, I bet that is not used.
Posted by: Floccina | Oct 29, 2007 5:08:32 PM
JasonR:
Perhaps you could explain how one determines "incidence" without a diagnosis?
One can't. And your point is....?
Posted by: JasonR | Oct 29, 2007 5:13:12 PM
What is wrong with the voices in this ad? Rudy sounds weird, like this is his first time reading the script. And the announcer guy at the end sounds like an ogre.
Posted by: Random Dude | Oct 29, 2007 5:17:54 PM
Jason: The one drives the other. As example, here's the Cancer Research UK site (no political agenda) on incidence numbers: "Although there has been a huge rise in prostate cancer incidence over the last 20 years, the increase in mortality has been much less. Much of the increase in incidence is due to the increased detection of prostate cancer through the use of prostate specific antigen (PSA) testing and surgery for benign prostatic hyperplasia (BPH)." That effect is exactly what we're seeing in these numbers.
Posted by: Ezra | Oct 29, 2007 5:40:46 PM
JasonR, firstly I meant that no-one goes bankrupt as a result of medical fees, but in fact long term illness in any case doesn't lead to bankruptcy because once all secured loans have had the securities enforced, there's no benefit in seeking bankruptcy of a debtor who lives on benefits, except to the lawyers. Similarly, if there are any other assets to claim, compositions or execution against those assets will usually produce a better return. So, to clarify what I said: no-one goes bankrupt as a result of medical costs, and almost no-one except perhaps those with significant business obligations on their own account goes bankrupt as a result of illness.
Posted by: Marcin Tustin | Oct 29, 2007 5:43:21 PM
To be a wonky devil's advocate for a moment, Jason does have a point about incidence versus diagnosis; maybe Americans just get a hell of a lot more prostate cancer than brits. Absent some reason to believe this though, the diagnosis story works well.
My real issue is with the error around mortality rate; even with three hundred million samples, the ninety-five percent confidence level gives you error bars on the order of ten people out of one hundred thousand (if my mental math is correct), so I'm not crazy about those statistics. Is there a maybe a less-error-prone estimate to use?
Posted by: dennis | Oct 29, 2007 5:45:34 PM
And Guiliani cleverly avoids our infant mortality rate, longevity rate, and maternal mortality rate. All leading indicators of our rush to the bottom of health care.
Posted by: Kathleen O'Connor | Oct 29, 2007 5:48:30 PM
Jason: I apologise; you're right, I didn't stipulate what two things I was distinguishing between when I used the word "difference". I presumed a level of intelligence not in evidence. Let me try again:
"There is obviously a risk if you have existing financial obligations that you will no longer be able to meet if you become ill and can no longer work."
There's a difference between the financial obligations created by getting sick (healthcare costs) and the existing financial obligations that you created yourself by choice (a mortage/car loan/credit card). In the latter case, the market provides a mechanism to protect you and the lender against an unforeseen event.
In the former case, in the UK at least, there is no requirement for such a mechanism.
It's the reason why a Briton visiting the US buys travel insurance (because amongst other things they may get sick and be faced with huge medical bills) but an American visiting the UK doesn't have that risk: they get treated free of charge. No-one's going to ask for your insurance details and no-one's going to send you a bill.
I realise that it's helpful to your agenda to conflate healthcare costs with other financial costs in order to be able to say that people can go bankrupt under a public health system but the point, which you seem to want to ignore, is that the health system is not the cause of their bankruptcy.
In Britain, becoming ill does not on its own create a risk that you will go bankrupt. In the US, it can and it does. It really is that simple.
Posted by: Andrew | Oct 29, 2007 5:49:15 PM
Kathleen O'Connor wrote:
"And Guiliani cleverly avoids our infant mortality rate, longevity rate, and maternal mortality rate. All leading indicators of our rush to the bottom of health care. "
See my post above. It is not clear that the USA has worse numbers than anyone else.
Posted by: Floccina | Oct 29, 2007 5:56:19 PM
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