Blue Mass Group

Reality-based commentary on politics.

Giuliani’s character pile-on

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Saturday, The Globe's Brian Mooney was the latest newsman to call out Giuliani for his fibs about health care, in an admirably direct fashion:

Republican presidential candidate Rudy Giuliani has made “socialized medicine” one of his favorite whipping boys on the campaign trail. But he is using a single, misleading, and outdated statistic to argue that the healthcare system in the United States is better than it is in the United Kingdom.

In a radio ad airing in New Hampshire, Giuliani says: “I had prostate cancer five, six years ago. My chance of surviving prostate cancer, and thank God I was cured of it, in the United States – 82 percent. My chances of surviving prostate cancer in England – only 44 percent, under socialized medicine.”

… ABC News, citing contradictory statistics from the British government, on Monday accused Giuliani of “fuzzy healthcare math,” igniting a minitempest. The website of the UK's Office for National Statistics reports that the five-year survival rate for men with prostate cancer from 1999 to 2003 was 74.4 percent, up 3.6 percentage points for men diagnosed from 1998 to 2001, most likely because of “increasingly widespread use of prostate-specific antigen (PSA) testing.”

I'm thrilled that our press is actually taking these claims seriously, and doing a little basic fact-checking. In addition to puncturing whatever was left of Rudy's reputation, it's also advancing the discussion of how the United States fares in comparison to other countries' systems. As far as I could tell, that discussion was simply not on the map three or four years ago — and perhaps not even in 1994. (Big shout-out to Michael Moore for that one.)

Anyway, I fear no Rudy — he was always a disaster waiting to happen. I'm anticipating a Mike Huckabee nomination, in which case we need to figure out how to deal with a charming guy with daffy ideas — again. The Dems don't have such a great track record with that.

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  1. Don’t worry about him.

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    I’m serious.  Despite all the talk about Evangelicals being the voting base of the GOP, the GOP Establishment is about People Of Means.  People who inherited Gobs of Money and then went on to grow that wealth into Oodles of Money.  George W. Bush was a great savior of the GOP because he combined that old wealth, a family of politicians, and a connection to Evangelicals.  But he’s history now.  And to get to the big money donors, you need the sort of personal connections that Mitt Romney has through his financial background and his father’s political career.

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    p>  John McCain may have written the campaign finance law to benefit Senators and hamstring Governors in their Presidential aspirations, but Mitt’s people found a way around McCain’s rules.

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    In the general, I don’t think Mitt would do well against Hillary or Obama–and John Edwards’ southern accent would probably yank 15 Electoral Votes away from the GOP in North Carolina, and Virginia would likely go Blue, too.  But in the primaries, if you think about who has historically won in the GOP, it has been a Bush, a Dole, a Reagan, a Ford (history’s greatest blip), and a Nixon.  Mitt’s got the Money, the family history, and he’s brought his “values” in line with that Evangelical base.  Romney will get the nomination.

  2. For having the wherewithall to look at FactCheck.org from time to time.

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    I’m on FactCheck’s email list; this analysis came out a week ago.

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    I really, really hate it when people intentionally use fake data to support their argument.  Yet another Bush legacy (and yes, that is a fair, fact-based swipe at the Bush administration).

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    Brian

  3. … on the epic journey the press is morally required travel for karmic redemption from their sins victimizing Al Gore for the Internet and Love Canal.

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    …the press is not interested in facts.  The MSM press is only interested in controversy.  Controversy sells ads, facts rarely do, and ads pay the bills for the MSM.

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    You would have to go to Kevin Drumm’s WashingtonMonthly,com web site to understand the issue.  Sometime last week, he had a chart that indicated that the mortality rate for prostate cancer differed very little among industrialized nations.  The diagnosis rate radically differed.  But people don’t die of a diagnosis.  They may not even die of the prostate cancer.  Indeed, people may die of the treatment.

    • First-Draft has a post with an excerpt from a fancast interview with David Simon related to this:

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      They’ll make more money putting out a mediocre paper than they would putting out a better paper. They know this. It’s their equation. They’re quite content with mediocrity.

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      Some other nuggets there too.

  5. Wow did you guys even read the factcheck article that you linked?

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    For starters:

    It included a chart showing that for every 100,000 men in the United Kingdom (not just England) during the single year 1997, 49 were diagnosed with prostate cancer and 28 died. Gratzer says he looked at the number who died over the people who were diagnosed. Specifically, he calculated, incorrectly, that 21 had survived, and calculated that number as a percentage of those diagnosed. His math was off; that equation actually produces a “rate” of 43 percent, not 44. (He also took figures that applied to the U.K. and said they were only about England.) But either way, such back-of-the-envelope calculations don’t produce anything that public health officials recognize as a “survival rate,” which is usually given as the portion of patients who are still living five years after they are diagnosed.

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    OK getting warmed up now here it comes:

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    Official figures do show a discrepancy between survival rates for prostate cancer in the U.S. and England. The U.S. five-year survival rate is actually 98.4 percent*, according to the National Cancer Institute. The rate in England is 74.4 percent, as we noted earlier.

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    [* I’ll take those odds!]

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    The factcheck article seems exceptionally laden with some kind of angst I thought they were usually more neutral sounding than this.  Who knows, maybe not.

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    In any case, you guys could have bothered to point out that the US survival rate was also incorrect, this time in Guiliani’s favor.  Seems to me the argument still stands after looking at both figures. 

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    Are you trying to get at the truth or just trying to mislead in a different direction?

    • … but this is a measure of the mortality of those who have been diagnosed, right?  For this to be compared to the US rate  as a tool to evaluate the overall health care systems (and using one small anecdote isn’t a reasonable way to do a comparison), they should be factoring in some extrapolated number of U.S. citizens who are never diagnosed because they don’t visit doctors for reasons of lack of insurance or affordability.

    • With the wealth of research available, Giuliani may well find other evidence to support his opposition to expanded federal health insurance programs. Indeed, when we challenged his bogus prostate-cancer figures, his campaign sent us links to a study by Lancet Oncology that found better cancer survival rates in the U.S. compared to Europe overall. But that’s no excuse for feeding a false statistic to the public.

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      Giuliani has a character flaw on display here:  with millions in the bank, he doesn’t pay people to check statistics and facts for him, so he says falsehoods in public. 

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      The best figures for prostate cancer mortality are from the WHO:  15.6 die per 100,000 in the UK, and 12 per 100,000 in the US.  Which is about the same.  Don’t forget, demolisher, that there is more to your health than just your prostate.

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      Consider that the UK pays 40% of what the US pays for its healthcare, and they still rank higher overall in WHO studies–Rudy’s wrong to imply America doesn’t need healthcare reform.

      • According to those stats, the US rate is a 20% reduction of the UK rate.  I don’t know what the confidence interval is, but I’d bet the difference is statistically significant.

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        I’m not arguing which system is better, or even that the 12 is directly comparable to the 15.6.

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        I’m just saying that they’re not really “about the same” in the same sense that a $60,000 salary isn’t “about the same” as a $78,000 salary.

          • According to the CDC the age-adjusted incidence is around 160 per 100K (although it’s a staggering 237 per 100K among African American men, compared to 154 for whites.) 

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            Cancer Research UK places the UK rate at just under 98 per 100K.  The site also has a chart with incidence and mortality rate from 16 different countries.

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            Other than the US numbers being from 2003, and the UK from 2004, I’m pretty sure we’ve got apples to apples here.  If there were significant undiagnosed cancers from the uninsured, wouldn’t other countries have a higher incidence than the US?  Or at least, somewhere close to the same icidence?

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            IOW, I don’t think this a case of underreporting.

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            —>Shane

            • … about comparing the proportion of incidence (per 100,000 capita) my statement still stands.  If the incidence rate among the uninsured is the same as (or close to) the incidence rate of the insured then we would expect the incidence rate of the combined population (insured and uninsured) to be the same.  It is likely that the rate at which uninsured diaganosis is counted in your cited sample is not 100%, however it is also likely that it is not 0%.  So if we assume that some portion of uninsured are being ‘counted’ in the cited statistic,… it would follow that the incidence rate among the undiagnosed uninsured (not in the sample, but in the real population) would be less than among those counted in the sample (insured and uninsured).  If true that this proportion is less, then we would further expect that combining the population would statistically reduce the incidence rate.

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              All of that is acedemic.  Measured bye outcomes, uninsured, undiagnosed people have substantially worse outcomes and are present in far greater proportions than in the UK, which I would suspect is close to 0 since it is easy to go to a doctor and get diagnosed there.

              • too many variables, too little time.

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                A few years ago, my then 84 year old father was diagnosed with prostate cancer.  He was given several options, among them (a) surgery, and (b) implanation of radioactive iodine pellets.  He was told several things.  One was that, at his advanced age, surgery would most likely be more life-threatening than the pellets.  In other words, he was more likely to die of something else than of the prostate cancer.  Being the very good engineer that he was, he weighed the options and chose the pellets.  And he’s still around four years later.

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                Shifting a bit, Since you are talking about comparing the proportion of incidence (per 100,000 capita) my statement still stands. quite frankly, you don’t know that.  You would have to know the age of diagnosis vs. the age of mortality.  Do a regression analysis on that variable.  Also, do a regression analysis on the variable representing the percentage of males in each country who get PSA tests (used to detect prostate cancer.).  If you do those analyses, you might have a reasonable statistic.  Otherwise, not really.

                • … a regression analysis, what can I reasonably assume with the caveat that I’m not doing a study here:

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                  First thing to note is that the tables cited were tables of incidence, not mortality.  But if you really want to verify that the two citations were apples to apples I guess you’d have to verify that the methods of ‘age-adjustment’ were reasonably close to each-other.  Assuming they  are then:

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                  For the CDC statistics, is there a population of uninsured &undiagnosed not counted for in the incidence reporting?  Sure.

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                  Are 100% of uninsured left out of the sample in question?  Probably not.

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                  Is it 0%.  No.  It is reasonable to assume there is some set of uninsured who have been diagnosed and whose diagnosis are represented in the incidence rate cited.

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                  So we have the following sets:
                  1) Reported incidences – includes some extremely high portion of insured and some portion of uninsured)

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                  2) Unreported incidences – includes some extremely low portion of insured and some portion of uninsured)

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                  If we assume that incidences are reported near 100% for insured and some smaller number for uninsured, it follows that any reported incidence rate for a group primarily made up of people that report all the time (set 1) would be higher than the actual rate of the combined population.

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                  If you assume the rate among the whole population is X then the rate for set 1 is likely some number higher than X and the rate for set 2 is likely some number lower than X. 

  6. When it comes to prostate cancer specifically, a 2003 study of cancer patients in Kentucky, published by the American Medical Association’s Archives of Internal Medicine found: “Among patients with prostate cancer, 3-year relative survival proportion was 98% for the privately insured and 83% for the uninsured.”

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    Well, that certainly is rich!  Factcheck says that our uninsured people show lower survival than insured and that supposedly defeats Giuliani’s argument against “universal health care”.

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    But our uninsured still have a survival rate almost 10 POINTS HIGHER than England’s “universally insured”.

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    All I can say about that is:  Wow.

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    Maybe someone needs to create factcheckcheck.org…

  8. it’s also advancing the discussion of how the United States fares in comparison to other countries’ systems. As far as I could tell, that discussion was simply not on the map three or four years ago…

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    And before leaping to conclusions, try reading this NYTimes column by Greg Mankiw:

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    i.e.

    Any reform should carefully focus on this group to avoid disrupting the vast majority for whom the system is working. We do not nationalize an industry simply because a small percentage of the work force is unemployed. Similarly, we should be wary of sweeping reforms of our health system if they are motivated by the fact that a small percentage of the population is uninsured.

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  9. “We’re Americans!  We’re the greatest nation on Earth!  We’re the smartest and the bravest and the brightest!  So when we decide to institute socialized medicine, watch out QE2!  We’ll do it better, stronger and faster than any wig-topped Brit ever imagined possible.  We’ll employ our American Can-Do Attitude and trademark ingenuity and leave your pathetic cancer fatality rate in the dust and improve upon even our stellar survival rate.  Because we’re AMERICANS!  E pluribus unum!  All for one, and one for all!  And that includes health care!  For all!  Without barrier or prejudice!  /then the band strikes up a rousing rendition of “God Bless America”/

    • “Nine-eleven will not have shaken our determination to have the best health care system in the world!  Ever since 9/11, I’ve realized how much our nation needs the best care in the world, and no 9/11s will 9/11 us from 9/11ing the 9/11est 9/11 in the 9/11!”

      • Yes, how could I have left out the Giuliani mantra?

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        “We’re post-9/11 Americans!  We’re the greatest post-9/11 nation on Earth!  We’re the smartest and the bravest and the brightest because of my leadership on 9/11!  So when we decide to institute socialized medicine in this post-9/11 world, watch out QE2!  We’ll do it better, stronger and faster than any wig-topped Brit stuck in 9/10 dreamland ever imagined possible.  We’ll employ our American Can-Do Attitude and trademark Exploit-9/11(TM) ingenuity and leave your pathetic pre-9/11 cancer fatality rate in the dust and improve upon even our stellar post-9/11 survival rate.  Because we’re AMERICANS!  E pluribus [9/1]unum!  All for 9/1 one, and 9/1 one for all!  And that includes health care!  For all post-9/11 Americans!  Without pre-9/11 barrier or prejudice!

  10. As the NYT columnist wrote last Friday:

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    “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.

    • Krugman claims that sometimes he doesn’t get to spell out everything he’d like in the short space of a column. He occasionally expands it on his blog. So I was interested to see how he filled in the key line: That still looks a bit lower than the U.S. rate, but the difference turns out to be mainly a statistical illusion.

    • More misleading from your side, sounds like to me!

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      Yea sure 74.4% is “a bit” lower than 98.4% – 24 points lower.  (Turn the numbers around and think about the 1.6% and 25.6% who did not survive, eh?)

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      As I pointed out earlier its also nearly 10 points lower than our uninsured rate.

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      Statistical illusion indeed, wonder how much time Krugman will need to whip one up for you to gobble down.

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      I wonder, if you guys get your way and we get crappy socialized medicine and doctors revolt or other things inevitably come to pass and our death rates start going up, will you feel responsible?  I’d hate to be a prostate cancer sufferer with you do-gooders looking out for me.  Whats a few points worth of death here and there anyway, as long as you get your blind progressive wish right!

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