Does Universal Health Care Make Cancer Kill You?

Betsy McCaughey Ross and John Stossel say yes, but Tim Noah says they're wrong and notes what the study showing strong performance for the US in the field of cancer survival actually concludes:

The significant differences observed in the study resulted not from a country's relative adherence to market principles in its health-care system, but rather from its relative wealth. "Countries with higher national expenditures on health … generally had better all-cancer survival." Survival rates tended to be highest in northern and Central Europe, middling in southern Europe, dreadful in the United Kingdom, and abysmal in Eastern Europe. Except for the anomalous poor survival rates in the U.K., these findings track with the relative wealth of the countries surveyed.

Meanwhile, though the UK is a wealthy country, UK per capital health care spending is ridiculously low. The salient thing about the NHS in all of these controversies is not so much its quality (very mixed) but its price (dirt cheap). The United States, meanwhile, spends a ton on health care and for our efforts get a system that performs well on this metric. But we could maintain our high level of overall health spending within the context of a different financing mechanism were we to choose to do so. Indeed, given that I don't see anyone proposing cutbacks of health expenditures to Canadian or British levels, that's almost certainly what we will do.

Comments

"Betsy McCaughey Ross and John Stossel..."

I'm generally a proponent of evaluating ideas separately from their boosters, but those two folks are the rare individuals whom you can set your watch by the wrongness of everything that emanates from them.

Posted by Petey | September 30, 2007 7:53 PM

It is a well-established scientistic fact that socialized medicine creates cancer cooties, which spread throughout society to make insufficiently Objectivist citizens die of any cancers they contract.

Posted by El_Cid | September 30, 2007 8:48 PM

Given that cancer is the 2nd leading cause of death, but that life expectancy rates are as high or higher in UHC nations than in the US, we either have to conclude that somehow the incidence of cancer in these countries must be lower (UHC prevents cancer!) or the claimed statistics are simply bogus.

Posted by Jonf | September 30, 2007 9:09 PM

Survival rate for lung cancer is extremely poor. If people smoke less, then lung cancer incidence declines. Fewer cases of lung cancer increases survival rate for all cancers combined, because other common cancers: breast, prostate, colon, have higher survival rates. If people smoke less in USA, then this may account for better cancer survival overall.

Posted by jojogunn | September 30, 2007 9:23 PM

jonf,
Given that cancer is the 2nd leading cause of death, but that life expectancy rates are as high or higher in UHC nations than in the US, we either have to conclude that somehow the incidence of cancer in these countries must be lower (UHC prevents cancer!) or the claimed statistics are simply bogus.

No, we don't have to conclude that. You are confused. The statistics tell us nothing about differences in the rate at which cancer occurs in the population, or in the rate of deaths due to cancer, between different countries. What they reflect is differences in the quality of treatment, and perhaps also diagnosis, of cancer. The U.S. is clearly superior.

Matthew,
But we could maintain our high level of overall health spending within the context of a different financing mechanism were we to choose to do so.

You should have ended that sentence with a question mark. The fear that health care spending would be inadequate--as in Britain and Canada--if funding were controlled primarily by the government is one of the primary reasons to be deeply skeptical of single-payer and quasi-single-payer funding schemes. Markets are much better than governments at matching supply and demand.

Posted by Mixner | September 30, 2007 9:52 PM

Fewer cases of lung cancer increases survival rate for all cancers combined, because other common cancers: breast, prostate, colon, have higher survival rates.

No. You're confused, too. The incidence of a cancer (i.e., the rate at which the cancer occurs in the population) and the survival rate of that cancer (i.e., the rate at which those diagnosed with the cancer survive for a given length of time) are independent variables. You cannot infer anything about a change in survival rates from a change in incidence unless you have evidence of a statistical relationship between them. Fewer cases of lung cancer would most likely mean fewer deaths from lung cancer, but that is not the same thing as a higher survival rate.

Posted by Mixner | September 30, 2007 10:03 PM

Markets are much better than governments at matching supply and demand.

This is an empirical, and testable, statement, in each and every single case in which it is applied, and is not a theoretical or a priori assumption, and in this case is difficult to apply given the huge variety of institutions which maintain governmental and 'market' aspects simultaneously.

By the way, Doug Henwood at the Left Business Observer had a very interesting conversation with single-payer advocate David Himmelstein on his radio show discussing "Hillary Care 2.0", Obama's plan, and Edwards' plan.

Himmelstein talks also about the many power conflicts between various non-insurance / non-medical corporations in the health care debate -- i.e., although GM would save money with a single-payer system, it would also reduce the management's capacity to hold health care coverage over the heads of potentially striking workers.

There is no transcript, but you can download or stream the actual audio of the broadcast.

http://www.leftbusinessobserver.com/Radio.html#070920

Posted by El_Cid | September 30, 2007 10:32 PM

This is an empirical, and testable, statement, in each and every single case in which it is applied, and is not a theoretical or a priori assumption, and in this case is difficult to apply given the huge variety of institutions which maintain governmental and 'market' aspects simultaneously.

It's been pretty thoroughly tested on a global scale for about a century. The evidence that markets are superior to governments in this respect is overwhelming.

Posted by Mixner | September 30, 2007 10:51 PM

It's been pretty thoroughly tested on a global scale for about a century. The evidence that markets are superior to governments in this respect is overwhelming.

Posted by Mixner

Thus, exactly the reason I reminded us that actual facts and data were important here, rather than the sorts of irrelevant ideological statements such as above.

You can obviously feel free to keep asserting what is and must be true, but others are also free to want to see particular situations studied with an eye toward evidence and logic, rather than teleological ministrations based on ill-defined notions.

Posted by El_Cid | September 30, 2007 11:22 PM

There are numerous start-up drug companies hoping to strike it rich in America by coming up with effective anti-cancer drugs. These are risky enterprises and many run into dead ends, lose money, and go out of business. But we have gained huge advances in cancer treatment as a result of this capitalist competition. And we gain, too, when large pharma companies plow their profits back into R&D and venture capital for smaller companies (as Pfizer is doing now). This is the golden goose that Democrats are threatening to kill with their socialized health care proposals.

It should be possible to get health insurance coverage for the 15% in this country who don't have it without killing the private sector aspects of our health care system that give us the best cancer care (and the best care in many other fields) in the world. This isn't rocket science. First, encourage the 12-20 million illegal aliens to leave the country by requiring their employers to check for government-issued IDs and fining them if they don't. That would get rid of at least 25% of the uninsured. Second, mandate that everyone get at least a high-deductible, low-cost catastrophic health insurance policy, and subsidize those for whom this would cost more than, say, 15% of their income. Enforce the mandate with an additional employee-paid payroll tax which is refunded to tax payers upon demonstrating proof of health insurance coverage over the previous tax year. Third, require health insurance companies to insure all applicants -- even those with preexisting conditions -- at rates determined by their actuaries. If these rates exceed a certain percentage of an applicant's income, let the government subsidize the difference.

Posted by Fred | October 1, 2007 12:17 AM

So the argument for UHC no longer includes significant cost savings/lower overall expenditures? Great. Can you tell Ezra Klein, among others?

Posted by Thomas | October 1, 2007 12:46 AM

El Cid,

If you think you have evidence indicating that governments are better than markets at matching supply and demand, please present it.

Posted by Mixner | October 1, 2007 1:43 AM

"So the argument for UHC no longer includes significant cost savings/lower overall expenditures? Great. Can you tell Ezra Klein, among others?"

Great point. As David Gratzer pointed out, one of our top two cancer centers, Texas's M.D. Anderson, spends more on R&D than Canada.

Posted by Fred | October 1, 2007 2:28 AM

El Cid,

If you think you have evidence indicating that governments are better than markets at matching supply and demand, please present it.

Posted by Mixner

No, rather, if YOU have evidence indicating that either particular types of universal health coverage from single-payer to other varieties are subject to your ideological declaration, or even that all of them do, have at it.

Many more than I have simply tired of lazy excuses for thought being burbled forth by those who think they're some sort of market rationalists versus the big gubmit marxist mythmakers, yet usually getting offended when challenged to actually prove the relevance and soundness of their ideological declarations.

Posted by El_Cid | October 1, 2007 9:35 AM

El Cid's got a good point. Think of all the medical advances produced by the Cuban health industry -- total government control hasn't stopped the Cuba from leading the world in creating new drugs and medical treatments. Oh wait... that was in bizzaro world, where command economies produce more innovation than market economies.

Posted by Juan | October 1, 2007 10:07 AM

Re: No, we don't have to conclude that. You are confused.

Sorry, you cannot have a higher life expectancy and a lower survival rate from the 1st or 2nd leading cause of death. Either the stats are false out the gate (my opinion; aftre all the same technologies are available in these countries as in the US) or the incidence of cancer must be lower-- or I suppose I can allow one other possibility: surival rates for other major causes of death (e.g., heart disease; diabetes) are higher and this makes up for the lower cancer survival rate.

Re: The evidence that markets are superior to governments in this respect is overwhelming.

Um, in healthcare the results are the opposite. Countries with either single payor or a strictly regulated universal insurance market perform better than the US in all the ways that count: lower expendtures per capita and overall outcomes as good as or better than the US.

Re: As David Gratzer pointed out, one of our top two cancer centers, Texas's M.D. Anderson, spends more on R&D than Canada.

Canada has a tenth the population as the US. I would be surprised if its spending were not quite a bit lower!

Posted by Jonf | October 1, 2007 10:23 AM

"Canada has a tenth the population as the US. I would be surprised if its spending were not quite a bit lower!"

Lower than America's total spending, sure, but lower than the spending at just one of the dozens of major cancer research centers in America?

Posted by Fred | October 1, 2007 10:32 AM

"So the argument for UHC no longer includes significant cost savings/lower overall expenditures? Great. Can you tell Ezra Klein, among others? "

There is room for large savings in medical costs while still spending more per capita than any other country.

On another note, there is significant R&D in the weapons industry despite the fact that the government is "a single payer" in the US for the capacity to wage war. Medical R&D should not stop simply because the US government becomes the only purchaser of medical care.

Posted by Njorl | October 1, 2007 11:11 AM

Re: Lower than America's total spending, sure, but lower than the spending at just one of the dozens of major cancer research centers in America?

With a tenth the population, sure why not? Moreover in this as in a great many other matters Canada and the US are effectively one country. One can of course accuse Canada of being parasitic off the US, though I would think the same criticism would apply to small population states (Wyoming etc.) which also lack major medical research facilities. And this is rather beside the point: the US already has these research faciities and would continue to have them under any sort of universal healthcare arrangement. And anyone who is worried that the governmment might be excessivey stingey with UHC need only look at Social Security: even the slightest attempt to pare benefits leads to electoral defeat. I suspect the same thing would hold true under UHC. Nor do I think the US would ever enact anything remotely as restrictive as Canada's program. Despite the dreams of the Left we will always have a large private payor market for healthcare. However that market will be (and should be) regulated so that it includes everyone. Insuring the, what?, 17% of our population that lacks insurance should not break the bank. Most of these epeople are young and healthy and would be net payors into the system for years to come. And those who aren't healthy, well, we are already payiong for thrir healthcare one way or another-- usually by some wholly inefficient and costly backdoor route.

Posted by Jonf | October 1, 2007 11:15 AM

The problem with cancer survival rates is that by themselves they don't tell you much. Without knowing the stage of the cancer when diagnosed you can't tell whether survival is improved or not.

Here's an example: Say that France recommends that everyone start getting screened for colorectal cancer at 55, but the US recommends everyone starts getting screened at 50. The US might catch more cases of colorectal cancer at an early stage than France (but we might also overtreat, treating patients with precancerous polyps who would never actually develop cancer) and it might improve cancer survival rates while not actually having any effect whatsoever on cancer deaths. Why? If a cancer in the US is diagnosed in someone at 51 and they die at 60 and a cancer in France is diagnosed at the age 55 and they die at 60 it would make France's survival rate look worse because the 5 year window for survival wouldn't have been met. The US patient is counted as surviving even though they didn't live any longer than the French patient, they just lived longer after diagnosis.

Posted by SteveH | October 1, 2007 12:39 PM

Sorry, you cannot have a higher life expectancy and a lower survival rate from the 1st or 2nd leading cause of death.

Of course you can. You still don't seem to understand the difference between a higher mortality rate and a lower survival rate. Country A may have both a higher mortality rate from cancer than country B, and a higher survival rate of cancer than country B. If a cancer occurs at twice the rate in country A as in country B, but country A has a 50% higher survival rate from the cancer than country B, country A will still have a higher mortality rate from the cancer.

Um, in healthcare the results are the opposite. Countries with either single payor or a strictly regulated universal insurance market perform better than the US in all the ways that count: lower expendtures per capita and overall outcomes as good as or better than the US.

Nonsense. Countries with single-payer health care systems, such as Britain and Canada, tend to be plagued by shortages, rationing and waiting lists. Governments are not effective at matching supply and demand.

Posted by Mixner | October 1, 2007 1:52 PM

JonF, aren't we talking about some relevant health care outcomes?

The model of UHC you suggest the US would adopt is interesting: No cost containment, simply increased benefits from the government along with a still strong private market. And no benefit to most uninsured, since, as you say, most of them would be net payors. Tell me again, why are you so anxious for this "reform", if that's what you expect it to accomplish?

Posted by Thomas | October 1, 2007 2:27 PM

"Countries with single-payer health care systems, such as Britain and Canada, tend to be plagued by shortages, rationing and waiting lists."

Uh, now you're getting way out there. It's the United States where people actually report having more problems seeing physicians and getting care. I don't know how that fits in with your statement, but it has the advantage of being based in reality.

"The Commonwealth Fund 2001 International Health Policy Survey shows significant differences in the health care experiences of adults in Australia, Canada, New Zealand, the United Kingdom, and the United States. While each country excels in its performance on certain dimensions of health care - no one country is uniformly "the best" - several distinct health system patterns emerged upon close analysis. The United States in particular stands out as having the most severe health care access problems related to cost, the greatest medical expense burdens, and the most pervasive inequities in care between adults with above-average and below-average income."

"Also a concern for many was the ability to see a specialist: 17 percent of adults in the U.S. said it was extremely or very difficult to see a specialist when needed, as did 16 percent of Canadians, 13 percent of Britons, 12 percent of Australians, and 11 percent of New Zealanders."

"Difficulty getting care on nights or weekends was reported by large proportions of people in all five countries.Two-fifths in both Canada (41%) and the U.S. (41%), one-third in Australia (34%) and the U.K. (33%), and one-fourth in New Zealand (23%) said it was very or somewhat difficult to get care on nights or weekends."

"The survey asked: .Last time you were sick or needed medical attention, how quickly could you get an appointment to see a doctor? .. About two-thirds of New Zealanders (69%) and Australians (62%) said they were able to see the doctor the same day. In contrast, only 42 percent of British, 36 percent of American, and 35 percent of Canadian adults said they were able to get in this quickly."

Comparison of Health Care System Views and Experiences in Five Nations, 2001

Just so I get this straight, Britain and Canada are plagued by waits, shortages and rationing, but it's easier for people to get in to see a doc in Britain and Canada and the US are the same.

Yes, there were waits for "elective or nonemergency surgery" that were longer in other countries. But a plague? Doesn't sound like it.

Posted by SteveH | October 1, 2007 2:30 PM

Re: Countries with single-payer health care systems, such as Britain and Canada, tend to be plagued by shortages, rationing and waiting lists.

And the US is not???!!? Perhaps you are living in some other reality where American healthplans do not ration (AKA deny) care, and no one ever has to wait to see a doctor or have a non-urgent procedure done. Well, in this America that sure the hell isn't true. (By the way, there's a strawman here: there is no serious proposal out there to transform the US into either Canada or the UK. At most the proposals would transform the US healthcare into France's, Germany's or Switzerland's.)

Re: And no benefit to most uninsured, since, as you say, most of them would be net payors.

So far in my life I have been a net payor for police and fire protection. I have never needed the latter and have required the former only for very minor matters. I rather hope it remains like that too, and no, I do not feel cheated that I am getting no personal return on my taxes from the fire department or the police.

Re: No cost containment, simply increased benefits from the government along with a still strong private market.

Who said "no cost containment"? Both public and private programs in this country strive mightily to contain costs. Problem is A) they do so by unethical means (excluding some people fropm healthcare entirely) and B) they end up spending lots and lots of money trying to save money. Oops! The simple fact is that foreign healthcare systems, though not perfect, produce equal or better health outcomes for less expense. And while people do bitch about specifics (as I said, the programs aren't perfect) support for junking said systems and going to US style healthcare is practically non-existent. I cannot conceive what you folks find not to like about this. It works better than our system and it's more popular than our system. Opposition to universal healthcare (Yes, we canargue about how!) strikes me as bizarre as opposition to indoor plumbing, and as immoral as supporting slavery.

Posted by JonF | October 1, 2007 2:44 PM

JonF, I feel like we're going in circles: are you saying, contra MY's post, that we should adopt UHC so we can get the same results spending less money?

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