As the U.S. Congress this summer holds its first serious health-care reform debate since the Clinton era, the resulting public furor has featured increasingly overheated claims about everything from so-called "death panels" to the supposed prowess of America's homegrown medicine. Many of the most wildly inaccurate statements have been directed abroad -- sometimes at the United States' closest allies, such as Britain and Canada, and often at the best health-care systems in the world.
NO HEALTH CARE FOR HAWKING OR KENNEDY
The lie: Stephen Hawking (who has Lou Gehrig’s disease) and U.S. Sen. Edward Kennedy (who has brain cancer) would not receive treatment in Britain, which has a government-run health-care system.
The liars: An editorial in Investor’s Business Daily on July 31 claimed: “People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service [NHS] would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.”
U.S. Sen. Chuck Grassley of Iowa — the senior-most Republican on the Senate Finance Committee, which must approve health-care bills — said Aug. 5 during a radio interview with Iowa City’s KCJJ, “Ted Kennedy — with a brain tumor, being 77 years old as opposed to being 37 years old — if he were in England, would not be treated for his disease because … when you get to be 77, your life is considered less valuable under those systems.”
The debunking: In both cases, this is nonsense.
Hawking, who is British, receives intensive treatment for his degenerative motor neuron disease at a local Cambridge hospital. Upon hearing the rumors of his non-treatment, the prizewinning theoretical physicist told The Guardian, “I wouldn’t be here today if it were not for the NHS. I have received a large amount of high-quality treatment without which I would not have survived.”
In Kennedy’s case, it is true that Britain assesses the cost-effectiveness of procedures and medicines before deciding whether to prescribe them. And the NHS does deny some procedures and drugs based on considerations such as the severity of a patient’s sickness, the cost of treatment, and the quality of life afforded. But doctors and NHS officials have stressed that Britons with Kennedy’s condition, regardless of age, would receive aggressive treatment, including surgery, radiation therapy, and chemotherapy.
The chief executive of Britain’s National Institute for Health and Clinical Excellence (NICE), which determines the rationing system, told The Guardian, “It is neither true nor is it anything you could extrapolate from anything we’ve ever recommended” that Kennedy would be denied treatment by the NHS.
Thus far, neither Kennedy nor Grassley have commented since Grassley’s initial remark.
CANADIANS HEAD TO THE UNITED STATES FOR URGENT CARE
The lie: Canada’s government-run health care is so bad that needy patients need to pay for care in the United States.
The liars: The advocacy group Patients United Now is running a television ad featuring Ontario resident Shona Holmes, who claims, “I survived a brain tumor, but if I had relied on my government health care, I’d be dead.” She says she traveled to the United States for lifesaving treatment.
In June, Sen. Mitch McConnell, a Kentucky Republican, said, “For cardiac bypass surgery, patients in Ontario are told they may have to wait six months for a surgery that Americans can often get right away.”
The debunking: Holmes did indeed pay $100,000 for care she received from Minnesota’s famed Mayo Clinic, considered one of the best medical centers in the world.
But Holmes’ treatment was not a lifesaving anti-cancer measure. The Mayo Clinic’s own Web site explains that she had a cyst — not a brain tumor — which was not necessarily life-threatening. (It also explains that Mayo is a nonprofit cooperative and strongly supports health-care reform.)
In general, Canadians are not flocking south for health care, and for good reason. According to a report from the Fraser Institute, a prominent Canadian think tank, both the Canadian and U.S. governments spend about 7 percent of their GDPs on health-care costs. (The United States, including private expenditure, spends about 16 percent of GDP on health care.) But all Canadians are covered for all medical care, plus some prescription drug costs. In the United States, 47 million are uninsured, and hundreds of thousands declare bankruptcy every year due to medical bills.
There are wait times in Canada, but nobody waits for emergency surgery; McConnell’s claim about bypass patients is untrue. In 2007, a non-emergency patient in Ontario waited about 61 days for elective bypass surgery, according to Canada’s health service. Such collected data is not made public in the United States.
HEALTH CARE IN EUROPE ONLY WORKS BECAUSE OF SINGLE-PAYER
The lie: European countries all have long-standing single-payer systems — which is why their health-care systems work.
The liar: Howard Dean, the former chairman of the Democratic National Committee, recently said, “The Europeans all have single-payer [systems] because essentially their health-care systems were destroyed during World War II. And they went to a single payer … and then it turned out they loved it and didn’t want to get away from it afterwards.”
The debunking: This is an overgeneralization.
Europe has a broad range of health-care systems and health insurance plans; not all European countries are single-payer. It’s an amorphous term, but usually denotes a system in which the government pays the medical bills, but doctors and hospitals are private, such as in Canada, France, and Germany. (In socialized systems, such as Britain’s NHS or the U.S. Veterans Affairs Department, the government pays the doctors and owns the hospitals.)
Rather than a single post-World War II wave of health-care reform, numerous European countries have experimented to find systems that work. For instance, both Switzerland (in 1994) and the Netherlands (in 2006) moved to models the United States is now considering. Hospitals, doctors, and insurers are for-profit and private. But the systems are highly regulated, and insurance is mandatory and government-subsidized.
CANADA AND BRITAIN MAKE YOUR HEALTH CARE CHOICES FOR YOU
The lie: In Canada and Britain, individuals lose the right to make their own health-care choices.
The liars: The advocacy group Club for Growth and the Republican National Committee (RNC)
The latter group’s ad ominously announces: “$22,750. In England, government officials decided that’s how much six months of life is worth. Under their socialized system, if a medical treatment costs more, you’re out of luck.”
This is not true. Patients in Canada and Britain retain autonomy to help decide upon their courses of treatment and to choose their own doctors.
In England, the $22,750 figure represents not what “six months of life is worth,” but the price at which the NICE determines a single drug is not cost-effective. Exceptions to the ceiling are permitted in some cases; and Britons retain the option to pay for private care. (In which case, rationing occurs as it does in the United States: Those with ability to pay do so.) The system is designed to prevent one of the key reasons for high health costs in the United States: With limited medical knowledge, patients assume the most expensive option is the best.
A NICE representative told The Guardian the ad is “a gross misrepresentation of how [the agency] applies health economics to try and address the central issue: how to allocate health care rationally within the context of limited health-care resources.”
THE UNITED STATES HAS THE BEST HEALTH CARE IN THE WORLD
The lie: The United States has the best health care in the world.
The liars: A slew of U.S. presidents, politicians, journalists, commentators, and everyday citizens
The debunking: There is one yardstick by which U.S. health care distinguishes itself: cost. The United States spends more — in total dollars, percentage of GDP, and per capita — than every other country on Earth.
On virtually every other broad metric, the claim that U.S. health care stands for global excellence is demonstrably false. The United States doesn’t take a top spot in either the World Health Organization or nonpartisan Commonwealth Fund rankings. The American health-care system is not best in terms of coverage, access, patient safety, efficiency, or cost-effectiveness. It does not produce the best outcomes for diseases such as cancer, heart disease, or diabetes; for the elderly, the middle-aged, or the young; or in terms of life expectancy, rates of chronic diseases, or obesity.
Which countries do come out on top? Often — France, Switzerland, Britain, Canada, and Japan. On the World Health Organization’s list, the United States comes out 37th.
Daniel W. Drezner is professor of international politics at the Fletcher School of Law and Diplomacy at Tufts University and a senior editor at The National Interest. Prior to Fletcher, he taught at the University of Chicago and the University of Colorado at Boulder. Drezner has received fellowships from the German Marshall Fund of the United States, the Council on Foreign Relations, and Harvard University. He has previously held positions with Civic Education Project, the RAND Corporation, and the Treasury Department.| Daniel W. Drezner |