Why is this not a major political scandal?

With all the page space and air time given to John Edwards’ hair cut and Hillary’s laugh and clothing choices, why doesn’t anyone mention the fact that Republican front-runner Rudy Giuliani is flat-out lying — and why don’t reporters bring up his intentional lies when they’re doing yet another piece on the personality and character of the candidates?

“My chance of surviving prostate cancer — and thank God I was cured of it — in the United States? Eighty-two percent,” says Rudy Giuliani in a new radio ad attacking Democratic plans for universal health care. “My chances of surviving prostate cancer in England? Only 44 percent, under socialized medicine.”

It would be a stunning comparison if it were true. But it isn’t. And thereby hangs a tale — one of scare tactics, of the character of a man who would be president and, I’m sorry to say, about what’s wrong with political news coverage.

Let’s start with the facts: Mr. Giuliani’s claim is wrong on multiple levels — bogus numbers wrapped in an invalid comparison embedded in a smear.

Mr. Giuliani got his numbers from a recent article in City Journal, a publication of the conservative Manhattan Institute. The author gave no source for his numbers on five-year survival rates — the probability that someone diagnosed with prostate cancer would still be alive five years after the diagnosis. And they’re just wrong.

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 man’s chance of dying from prostate cancer is about the same in Britain as it is in America.

So Mr. Giuliani’s supposed killer statistic about the defects of “socialized medicine” is entirely false. In fact, there’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.

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.

That’s all bad enough. But as Krugman points out, why aren’t candidates being called out for intentionally lying to the American public in the same way they’re called out for getting $200 haircuts?

By rights, then, Mr. Giuliani’s false claims about prostate cancer — which he has, by the way, continued to repeat, along with some fresh false claims about breast cancer — should be a major political scandal. As far as I can tell, however, they aren’t being treated that way.

To be fair, there has been some news coverage of the prostate affair. But it’s only a tiny fraction of the coverage received by Hillary’s laugh and John Edwards’s haircut.

And much of the coverage seems weirdly diffident. Memo to editors: If a candidate says something completely false, it’s not “in dispute.” It’s not the case that “Democrats say” they’re not advocating British-style socialized medicine; they aren’t.

The fact is that the prostate affair is part of a pattern: Mr. Giuliani has a habit of saying things, on issues that range from health care to national security, that are demonstrably untrue. And the American people have a right to know that.


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26 comments for “Why is this not a major political scandal?

  1. stnemmoc
    November 3, 2007 at 8:41 am

    Candidates on all sides in the presidential primaries lie. This is not at all limited to the republicans or Giuliani. There is a more specific article (along with other articles about both republicans and democrats distorting the facts) on Giuliani’s cancer statistic here.

  2. Katy
    November 3, 2007 at 9:50 am

    I’ve never understood how Canada and Britain can spend less on health care than the U.S and still have decent socialized medicine. Any clues to how that works?

  3. rootlesscosmo
    November 3, 2007 at 10:32 am

    Other bloggers have pointed out that during Giuliani’s prostate cancer treatment, he was covered by government-run health insurance–the same thing he’s mis-calling “socialized medicine.”

    The real question isn’t why these pigs lie so brazenly but why it works so consistently.

  4. Annie
    November 3, 2007 at 10:32 am

    Katy, I’d imagine it has, in part, to do with preventive care & early intervention. Think about the cost difference between going in for a cough that turns out to be pneumonia, getting a 10 day course of antibiotics, and moving on with your life, and not being able to afford to go in so that it gets worse and worse to the point where you’re hospitalized.

  5. EricP
    November 3, 2007 at 10:38 am

    My father recently had prostate cancer in Canada. After finding the mass, he waited 4 months for the test to find out that it was cancer and 9 months for the surgery to remove it. It was “free” but he had the cloud hanging over his head for over a year. Free comes at a high cost.

    A friend tore his rotator cuff a few years ago. He slept in a chair for 7 months and couldn’t work while on the waiting list. With injuries like that, the tendons retract from disuse as time passes. He’ll never have the mobility and strength in his shoulder he would have had had it been healed quickly. He didn’t pay any money for the surgery but there was definitely a cost of socialized medicine.

    That doesn’t even mention the state of Canadian hospitals. If you can, you should visit a few. The difference between an American and Canadian hospital are huge. It might give you second thoughts about following Canada’s lead.

  6. Unree
    November 3, 2007 at 10:59 am

    The US medical system wastes money on unnecessary machinery. Once you have a gee-whiz toy in your hospital (nobody can stop you from buying it–that would be “rationing”), it’s hard to resist using it for unnecessary procedures, which get billed to patients. And the large American for-profit insurance and managed-care sector has to eat too, right? Set up all those cubicles and phone mail, hire bureaucrats to fight coverage claims, and pay dividends to shareholders. Hundred billion a year right there.

  7. Dianne
    November 3, 2007 at 12:24 pm

    The ultimate irony of the Giuliani claim? He was treated for prostate cancer while he was mayor. Using the government health care plan that all government employees get. In short, he was cured by “socialized medicine.”

  8. shelleybear
    November 3, 2007 at 1:00 pm

    To Katy:

    I’ve never understood how Canada and Britain can spend less on health care than the U.S and still have decent socialized medicine. Any clues to how that works?

    So glad you asked.
    imagine if the town you lived in needed new roads.
    As a home owner, you MIGHT have to pay the full amount out of pocket for all the space in front of your house.
    You might get a good deal.
    You might not.
    However, as a tax payer, your money is placed into a pool.
    The cost of the road is negotiated and spread out over everyone.
    Whether or not it is used, you have the option of auditing the costs involved in n efficient manner.
    Because everyone pays into the road, you cut the cost, and the whole town gets its road maintained properly at a lower cost (large pool of funds).
    Does this help?

  9. shelleybear
    November 3, 2007 at 1:03 pm

    EricP

    I lived in Canada for 14 years.
    No complaints.
    Sorry.
    No second thoughts.

  10. Hector B.
    November 3, 2007 at 1:14 pm

    Right, we’re all used to candidates lying to us, but few of us are used to a $200 haircut.

  11. aurora borealis
    November 3, 2007 at 1:44 pm

    I’m going to speak of my own experience, and the experiences of those close to me. I’m a Canadian, and I don’t know much about the American system, and I don’t know the ins and outs of health care in areas other than my own.

    EricP, I’m sorry to hear about your father’s experience. However, I should tell you that my own mother, after being told by her doctor that she needed a knee operation, was in and being operated on within three months.

    At the end of July this summer, one of the women I work with in my job as a support worker was told she needed an operation on
    her gallbladder. She has now had that operation and is recovering.

    In my own case, I have delivered three children in the same small town hospital and received excellent care each time. I can honestly say the doctors and nurses were skilled and helpful. I’ll be forever grateful to the nurses who, after I delivered my first by c-section, made themselves available whenever I rang the bell and needed assistance. They helped me get the hang of nursing
    and helped me begin my life as a mother with confidence. I left the hospital in good shape after these dedicated pros monitored my physical and emotional condition.

    As a rural Ontarian, there have certainly been times when I or my chldren have had to wait for care, but in urgent cases, after explaining the situation to the receptionist at our local clinic, I have always been able to arrange a same-day appointment.

    Finally, I have to wonder what you mean by “the state of Canadian hospitals”. Do you mean cleanliness, or equipment, or what? I’ve never been to an American hospital, so I don’t know what they’re like. I just know that within a ten minute drive of our house there is a clinic and a hospital. Within fourty five minutes is a larger hospital, the same one where I had my babies, the same one that provided excellent, compassionate care for my dying grandmother and aunt in their palliative care unit. And if I get in my car and drive for and hour and a quarter, I will reach the world class university hospital where my daughter goes to see a specialist-which, by the way, we had absolutely no problem getting referred to.

    My own mother, she of the knee operation, worked as an RN in the same hospital and worked her ass off every shift, to the point where patients from long ago ask after her, though she is eight years retired. She’s not an exceptional case-from what I’ve seen, she’s the norm. There are asshole doctors, sure, who don’t take a symptom seriously enough. I had this experience with a doctor who didn’t take my daughter’s pain seriously enough and she became more ill over four days with a bladder infection, until I took my daughter in and told the doctor we weren’t leaving-she or us- until we knew what the problem was.
    However, three urine tests were performed over those four days, with the first two coming back negative, including the one performed at the ER when I took her in. To this day, I’m confused over what happened there. So, of course, not all is perfect. And although we’ve had great experiences with nurses, I’m sure there are bad apples out there.

    I know this is a rambling post, but I have heard lots of American politicians point to our system and say how awful it is, and I wanted to share actual experiences with you guys, to give you a balanced view. I suppose they feel it is preferable to have a system where you may or may not get care, depending on whether your insurer feels like honouring their commitment or not. If they feel like fighting you, well, good luck. That’s not even mentioning the millions whose insurance consists of prayers and vitamin pills.

    Our system isn’t perfect. But I think of how, with my firstborn, we
    would have been unable to afford the required insurance to give birth in a hospital. I could have found myself hiring whatever midwife I could afford and praying nothing went wrong. People deserve better than that. I hope you guys are able to work out a system where everyone gets looked after.

  12. Sally
    November 3, 2007 at 2:56 pm

    Any clues to how that works?

    Yup. There are a bunch of things:

    1. The administrative costs are lower. The American system is incredibly inefficient, because healthcare providers have to put in a huge amount of work sorting through insurance paperwork.

    2. Doctors in other countries get paid less. They still make a good living, but not nearly as good as doctors in the U.S. do. Also, medical education is free (or nearly free) in other industrialized countries, so doctors don’t have huge amounts of debt to pay off and don’t need the staggering salaries.

    3. American healthcare providers do a lot of unnecessary testing. When my dad fell down and hurt his arm in England, for instance, the doctor asked if he could wiggle his fingers and then decided that it wasn’t broken because he could. He didn’t do an X-ray. In the U.S., he would have done the X-ray. Outcomes in other countries are as good or better than outcomes in the U.S., so it doesn’t seem like the extra testing is actually useful, at least in the aggregate.

    4. Because people in universal systems have consistent care, they take care of problems when they’re easily curable, not when they’ve become very serious. In the U.S., many people put off getting care until they have acute problems that require expensive intervention like surgery. They go to the emergency room, which is very expensive, instead of going to a doctor’s office, which is much cheaper. Unless you actually let people die in the street, which Americans aren’t willing to do, it’s more expensive, in the long run, to deny people basic care than to provide it.

    5. In general, and with some exceptions, hospitals in universal systems lack some of the perks that hospitals in the U.S. have. You’re less likely to have a semi-private room, for instance. I’m pretty sure that the standard thing in British hospitals is a ward with a row of beds, rather than two patients to a room.

    6. Drug companies sell drugs for cheaper in countries with universal systems than the do in the U.S.

    I’m not claiming that it would be easy or painless for the U.S. to switch to a universal system. It might even be that if you currently have good insurance and don’t get sick until after you’re 65, a universal system would be a little bit worse for you. For people who don’t have insurance or who get chronic health problems before they hit Medicare age, as well as for the society as a whole, though, it would be much better.

  13. Katy
    November 3, 2007 at 3:55 pm

    Thanks everybody for the wonderful “how it works” moment! I appreciate it!

    Up here (Canada), our current government seems to have a huge hard-on for the U.S system of everything, so it is interesting that our system costs less (especially as it is the ‘fiscal conservatives’ who are trumpeting a two-tier or even a privatized system).

    My experiences with Ontarian hospitals have been overwhelmingly good. I’ve had friendly and knowledgeable doctors and generally reasonable wait times. If you want certain perks (semi-private room etc) many insurance policies work on that. My only complaint is that OHIP (Ontario’s health plan) has covered less and less over the past few years dropping eye check ups and other necessary services. But I still love that when I have asthma problems or I faint and fall over for no reason, I don’t have to worry about the cost of the visit or whether I can afford to have it checked out. I just go. Which is pretty damn sweet.

  14. November 3, 2007 at 5:08 pm

    Great post. I read that article as well and it really gets me the way Guiliani gets away with what he says. It’s very hard to understsand why the media would rather talk about expensive haircuts than out-and-out lies.

    Thank goodness for Factcheck.org – I forgot about that site, I’m going to put it on my link list!

  15. kate
    November 3, 2007 at 7:02 pm

    Eric: My partner in my carpentry business tore his rotator cuff, he has no health insurance as we can’t afford it. There is no way he’ll see a doc, whether last year or this year, he deals with the pain and tries to heal on his own.

    I have no health insurance, if I get sick, I have tough it out and hope for the best or go to the emergency room and wait for five or six hours, depending on traffic, to just be seen. Last I went was when I had a tick bite that wouldn’t go away and had strange symptoms like Lyme Disease (a seriously disabling disease by the way). Reluctantly after a week of nothing getting better, I went to an emergency room to have it looked at. They tested it and yes it was Lyme’s Disease. I was given an ointment and two large antibiotic pills and sent on my way after four hours.

    I now have a bill of $550 for that ‘service’ which at this time I cannot pay, so it will have to go on my credit report which is just one more stone added to the wall that keeps me in poverty.

    When my kids were young I was working fulltime as a single parent receiving no child support (another story). I had company sponsored health care for which I paid $250 a month from my paltry $250 a week paycheck.

    The deductibles were higher than I could reasonably afford and also did not include dental or eye care. I never had my children’s eyes checked and a hernia that my son had which was determined to be ‘dangerous’ was ignored. Why ignore you ask? Because the health care I was paying for told me I’d have to cough up $2,000 up front for the surgery to get him fixed.

    I quit working and got on state aid with Medicaid. I got my kid’s eyes checked and they had dental checkups, all covered under Medicaid. What was discovered? My children all had cavities that needed immediate treatment and the chronic headaches that one of my daughters complained about repeatedly that effected her ability to do schoolwork were caused by severe near sightedness and a wondering right eye. Eye glasses were mandated immediately to correct her vision so that she could participate in class. Even today she still needs glasses to even pass her driver’s exam.

    I also was able to rush my son into surgery a month or so after getting on the program so that he could have his hernia corrected. The surgeon told me that his chances for rupture were extremely high if the surgery was not performed and was shocked that I had waited so long to take care of it.

    Also, might I add that due to chronically not being able to pay the medical bills, doctor’s offices would quite often take the children’s medical records hostage until the bills were paid. Thus, it wasn’t until I was on Medicaid that my children finally had a consistent and thoroughly documented medical history.

    Frankly, I don’t think that fancy hospitals or state of the art equipment are needed for most of the routine care that is out of reach for most Americans. In fact, I’d bet that a large portion of the services I received could have been administered in a tent and at this point, if that’s what it took to get the care I need, then I’m fine with it.

    Let the rich folks have their fancy hospitals and let them pay for them out of pocket. The rest of us will do fine with what our federal tax contribution can afford.

  16. shelleybear
    November 3, 2007 at 8:05 pm

    Notice Eric hasn’t followed up?
    Oh well.

  17. EG
    November 3, 2007 at 10:29 pm

    I wonder the survival rate for people in this country who have prostate cancer but have no health insurance is. Oh, I forgot, the Republican party doesn’t care about poor people.

  18. Sally
    November 4, 2007 at 12:59 am

    I wonder the survival rate for people in this country who have prostate cancer but have no health insurance is.

    Well, since upwards of 80% of men diagnosed with prostate cancer are over 65, there probably aren’t too many of them. The overwhelming majority of Americans over 65 have access to scary, scary socialized medicine through Medicare.

    I think that cancer survival rates are probably a bit skewed by the Medicare effect, since cancer is more common in older people. It’d be interesting to compare rates of things that exclude elderly people: childhood cancer survival, for instance, or infant and maternal mortality.

  19. RKMK
    November 4, 2007 at 6:04 am

    Lived in Canada for 26 years here, with chronic asthma and sinus problems. No complaints. I’ve got a local (PP) clinic where I go every three months for my birth control and other girlie stuff (i.e. pap smears) which, free, and they also provide standard medical services (i.e. antibiotics for my recurring sinus infections). I broke my nose when I was 14, and due to my age, my mother was wary about me having plastic surgery, but if I ever want my deviated sceptum fixed, it’ll be covered. My mother recently underwent cataract surgery on both eyes, over the summer; only a month’s wait on a surgery that was neither elective nor particularly urgent, and last summer, she had a carpel-tunnel related surgery, again, no wait times.

    I have many good friends living in the U.S. that I keep contact in via LiveJournal, and every week, there are stories about not going to the doctor for an infection because they can’t afford the $50 co-pay to go to the doctor. One friend is suffering depression from myriad issues, ranging from the $200,000 law-school debt she’s having trouble paying off, to the recent death of her father, but her insurance doesn’t cover any kind of mental health care – oh, and speaking of her father, the long-term chronic illness that eventually killed him destroyed her mother’s finances, the insurance company won’t pay their bit, and her mother now needs to sell their family home. Another friend’s husband injured himself at work, again, insurance will only cover part of it, his worker’s comp appeal was denied, and she’s trying to cover his medical bills while raising two children on her own.

    Reading their stories are so bizarre to me (“Sick? Go to the doctor? What do you mean, you can’t afford it? $50 a visit?!? WHAT?”) but it’s just the norm for them. They’ve known nothing else. I suppose I should post more about our system up here, but you know, it’s the squeaky wheel that gets attention; I’m unlikely to blog about how I went to the doctor that afternoon for my birth control, and the visit was free, and my union benefits pay for 80% of the prescription. I’ll blog about how I went home to visit my parents, and how I’m allergic to the cigarette smoke, and oh, crap there go my sinuses again, but I won’t blog about how easy it was to go to the walk-in clinic (for free) and how, again, my union (BASTARD UNIONS!) cover 80% of my prescription for antibiotics, because, that’s the norm. I’m going to try and make an effort to do that more.

  20. Dianne
    November 4, 2007 at 7:38 am

    It’d be interesting to compare rates of things that exclude elderly people: childhood cancer survival, for instance, or infant and maternal mortality.

    Funny you should mention childhood cancer, because in general childhood leukemia survival rates are higher in Europe. For one type, ANLL, in particular the US survival rates in the early 2000s are just reaching levels that most European countries reached in the mid- to late 1990s. In general, European countries do as well as the US or better in the more treatable cancers, such as leukemia or testicular cancer, worse in the early detection cancers such as breast. This suggests that the problem, if any, lies in lack of awareness of early detection rather than lack of high tech medical care for advanced disease. If that helps.

  21. November 4, 2007 at 11:41 am

    It may be just semantics, but it’s worthwhile to remember that up here in Canada, Healthcare isn’t ‘Free’. You still pay for it. You’re not getting something for nothing. The idea that when you’re healthy, you pay taxes to help someone else and, and when you’re sick, someone else’s tax money helps you is not a terrible idea, and it helps to blunt the devasting individual costs of illness.

  22. Hector B.
    November 4, 2007 at 1:33 pm

    Prostate cancer is kind of unusual because most men who have it will die from something else first, so often it’s deliberately untreated.

  23. kate
    November 4, 2007 at 2:48 pm

    I recently saw a bumper sticker that read, “I don’t want to pay for someone else’s healthcare.”

    I honestly can’t understand how people can be so damn stupid. You spread the pool of costs over a wide swath and the cost is lower all around, what’s so tough to understand about that?

    Also, as is repeatedly pointed out, the cost of the bureaucracy created by the private health insurance companies is absolutely obscene. And when one considers that a huge portion of that bureaucracy is consumed by standard efforts to deny patients coverage it goes from obscene to morally bankrupt.

    When one considers that CEO’s and upper management take home huge profits generated by enabling death and suffering the scenario then moves to criminal.

    Efficiency that would have made Himmler proud.

  24. kate
    November 4, 2007 at 2:49 pm

    I recently saw a bumper sticker that read, “I don’t want to pay for someone else’s healthcare.”

    I honestly can’t understand how people can be so damn stupid. You spread the pool of costs over a wide swath and the cost is lower all around, what’s so tough to understand about that?

    Also, as is repeatedly pointed out, the cost of the bureaucracy created by the private health insurance companies is absolutely obscene. And when one considers that a huge portion of that bureaucracy is consumed by standard efforts to deny patients coverage it goes from obscene to morally bankrupt.

    When one considers that CEO’s and upper management take home huge profits generated by enabling death and suffering the scenario then moves to criminal.

    Efficiency that would make Himmler proud.

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