Paul Krugman has attacked Rudy Giuliani for a dishonest ad on health care--or perhaps an ignorant one, as the case may be. This is a test for the media, as well as a scandal in its own right, Paul says. Will those feckless reporters and editors at The New York Times call Giuliani to account for this? Probably not, seems to be Paul's opinion:
OK, Rudy Giuliani has just released an ad claiming that the survival rate from prostate cancer is much higher in America than in Britain, thus proving the failure of socialized medicine.
So, will this get as much attention as, say, the Edwards haircut or the Hillary laugh? Will it get any coverage at all? Bear in mind that health care is the central domestic issue of this election — and Rudy has just showed that he doesn’t know a thing about it.
Giuliani's claims in the ad are indeed misleading. First, prostate cancer is a very bad example. Worse, in my view, is the implication that his Democratic opponents are proposing "socialised medicine" remotely similar to Britain's NHS. That can only be a deliberate deception.
To say that prostate cancer survival rates are much higher in the US than in England is not "just plain false", however. It is just plain true.
Five-year survival rates are higher in both America and England than
Giuliani said. In the United States they stand at close to 100 per
cent. In England they are 25 points lower. Figures for prostate cancer are notoriously misleading, though, because early
detection (at which the US excels) delivers little improvement in
mortality. Chiefly because of better diagnosis, America records a far
higher incidence of prostate cancer--and nearly all of those
early-detected cases survive five years. Men with prostate cancer,
which develops slowly, often die of something else. If you are a man
with prostate cancer, it may not matter very much whether your cancer
is diagnosed early, or whether you live in Britain or America.
But does Paul therefore think that cancer survival rates, correctly measured, are similar for all cancers, including those for which early detection is important? If so, he is mistaken. See this report,
entitled "Cancer Survival Rates Improving Across Europe, But Still
Lagging Behind United States" (and remember that England's rates, not
broken out, are among the worst in Europe).
Taking recent figures, female five-year cancer survival rates are
62.9 per cent on average in the US and 52.7 per cent in England. To
compare America's privately insured with England's NHS patients, you'd
need to bump up that American survival rate a bit (the uninsured most
likely have lower survival rates--otherwise why worry about universal
coverage) and bump down the English one (because some Brits have
private insurance, and so buy better care).
Nationally, American cancer survival rates are significantly better.
Certainly not by the 40-point margin Giuliani implied, but still. And
the politically salient question is this: If you have cancer, would you
rather be an American with insurance or an Englishman without? The
answer is obvious.
Which is more misleading, Giuliani's ad or Paul Krugman's assault on
it? I'd say the ad has the edge for deception, but there isn't much in