Former New York City mayor and Republican presidential candidate Rudy Giuliani is being attacked for a radio ad in which he claims that his chances of surviving prostate cancer are much better under the U.S. health-care system than under socialized systems such as that of Great Britain. Rudy himself is a prostate-cancer survivor, and while one can quibble about the details, his key point is correct.
According to Giuliani, 18 percent of American men diagnosed with prostate cancer will die from the disease, while 56 percent of British men will. And Rudy blames that on the rationing inherent in the British model of health care. Those numbers are accurate. They come from official data released by the Organization for Economic Cooperation and Development, by way of a study by the liberal Commonwealth Fund, not — as critics darkly hint — from a right-wing think tank (although Rudy apparently saw them in an article by Manhattan Institute scholar David Gratzer).
It is fair to note, however, that the numbers are somewhat dated. More recent information shows an improved British performance. The five-year survival rate for prostate cancer in the U.K. is 74 percent. Of course, it is 98 percent in the U.S.
Giuliani’s critics have a better argument when they point out that more men are diagnosed with prostate cancer in the U.S. We don’t really know whether that is because we actually have more prostate cancer (poor dietary habits may play a role) or because our advanced testing and screening procedures uncover small cancers that might otherwise go undiscovered. In this regard, prostate cancer might not have been the best example for Rudy to use. Because it’s a very slow-growing cancer and occurs more frequently in older patients, it’s possible that some of those diagnosed in the U.S. would not have died from the disease even if they weren’t treated. This “survivor-time” bias could skew the statistics.
Survivor time bias is not as big an issue for cancers that have faster metastasizing times or strike younger patients. But the U.S. advantage holds for other cancers, too, including breast cancer, colon cancer, and thyroid cancer. According to a study published this year in the British medical journal The Lancet, for survival rates in all types of cancers, the U.S. ranks number one among industrialized nations: 62.9 percent of women with cancer survive for five years, and 66.3 percent of men. Britain ranked 16th for women (52.7 percent for five years) and 15th for men (just 44.8 percent).
One of the most common arguments for socialized medicine is that it would increase screening and preventive care. Indeed, John Edwards actually wants to make testing mandatory for all Americans. It seems a little odd therefore to see Giuliani’s critics arguing that the U.S. does too much cancer screening.
Beyond the debate over numerical minutiae, the basic fact is that Britain’s system of socialized medicine is bad for your health. As of this writing, as many as 750,000 Britons are waiting to be admitted to NHS hospitals. Cancer patients can wait as long as eight months for treatment. Delays in receiving treatment are often so long that nearly 20 percent of colon cancer cases considered treatable when first diagnosed are incurable by the time treatment is finally offered. About 40 percent of cancer patients never get to see an oncologist.
No one pretends that the U.S. health-care system is perfect. There are serious problems. Costs are rising. There are too many people without insurance. Quality is uneven. The system needs reform.
But turning our health care over to the government, as Democrats like Hillary Clinton wants to do, could come at a very high price, not just in higher taxes and reduced choices — in lives. That was Rudy’s point, and he was right.
— Michael Tanner is director of health and welfare studies at the Cato Institute.