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 Health & Beauty | November 2007 
Prostates and Prejudices
 Paul Krugman - The New York Times
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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.
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.
As a fact-check in The Washington Post put it: "The Clinton health care plan" - which is very similar to the Edwards and Obama plans - "has more in common with the Massachusetts plan signed into law by Gov. Mitt Romney than the British National Health system." Of course, this hasn't stopped Mr. Romney from making similar smears.
At one level, what Mr. Giuliani and Mr. Romney are doing here is engaging in time-honored scare tactics. For generations, conservatives have denounced every attempt to ensure that Americans receive needed health care, from Medicare to S-chip, as "socialized medicine."
Part of the strategy has always involved claiming that health reform is suspect because it's un-American, and exaggerating health care problems in other countries - usually on the basis of unsubstantiated anecdotes or fraudulent statistics. Opponents of reform also make a practice of lumping all forms of government intervention together, pretending that having the government pay some health care bills is just the same as having the government take over the whole health care system.
But here's what I don't understand: Why isn't Mr. Giuliani's behavior here considered not just a case of bad policy analysis but a character issue?
For better or (mostly) for worse, political reporting is dominated by the search for the supposedly revealing incident, in which the candidate says or does something that reveals his true character. And this incident surely seems to fit the bill.
Leave aside the fact that Mr. Giuliani is simply lying about what the Democrats are proposing; after all, Mitt Romney is doing the same thing.
But health care is the pre-eminent domestic issue for the 2008 election. Surely the American people deserve candidates who do their homework on the subject.
Yet what we actually have is the front-runner for the Republican nomination apparently basing his health-care views on something he read somewhere, which he believed without double-checking because it confirmed his prejudices.
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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