Rudy Is Right and Krugman Is Wrong

From the Manhattan Institute City Journal website:

Malignant Rumor
On cancer survival rates, Rudy’s right and his critics are wrong.

David Gratzer
31 October 2007

This week, Rudy Giuliani’s presidential campaign released a radio ad in which the candidate praised American health care for curing him of prostate cancer and wondered what might have happened to him under the socialized medicine practiced in the United Kingdom, where survival rates for that condition are far lower. In the ad, now running 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.” He drew those statistics from an article that I wrote for the Summer 2007 issue of City Journal.

The ad has already aroused intense criticism, most of it claiming that survival rates in Britain aren’t nearly so low. ABC News’s Rick Klein, in a blog entry entitled “Rudy’s Fuzzy Healthcare Math,” writes: “To hear Rudy Giuliani describe it in his new radio ad, the British medical system is a scary place. . . . But the data Giuliani cites comes from a single study published eight years ago by a not-for-profit group, and is contradicted by official data from the British government.” Kevin Drum, blogging at CBS News, declares simply: “Giuliani is full of shit.” Ezra Klein of American Prospect agrees on his blog: “It’s—no pun intended—crap. England and America have vritually [sic] the same mortality rates from prostate cancer.”

Let me be very clear about why the Giuliani campaign is correct: the percentage of people diagnosed with prostate cancer who die from it is much higher in Britain than in the United States. The Organisation for Economic Co-operation and Development reports on both the incidence of prostate cancer in member nations and the number of resultant deaths. According to OECD data published in 2000, 49 Britons per 100,000 were diagnosed with prostate cancer, and 28 per 100,000 died of it. This means that 57 percent of Britons diagnosed with prostate cancer died of it; and, consequently, that just 43 percent survived. Economist John Goodman, in Lives at Risk, arrives at precisely the same conclusion: “In the United States, slightly less than one in five people diagnosed with prostate cancer dies of the disease. In the United Kingdom, 57 percent die.” None of this is surprising: in the UK, only about 40 percent of cancer patients see an oncologist, and historically, the government has been reluctant to fund new (and often better) cancer drugs.

So why do the critics think that Britain’s survival rates are as high as America’s? The main reason is that they are citing overall mortality rates, which are indeed, as Ezra Klein writes, similar across various countries. That is, the percentage of all Americans who die from prostate cancer is similar to the percentage of all Britons who do. But this misses the point, since a much higher percentage of Americans than Britons are diagnosed with prostate cancer in the first place. If you are a patient already diagnosed with prostate cancer, like Rudy Giuliani, your chances of survival—as Giuliani correctly said—are far higher in the United States.

Likewise, though Rick Klein is right that official UK data differ from mine, those data look at five-year survival rates—that is, they track cancer patients for five years and report on their survival. Their approach is different from mine. They don’t examine what we might call a “snapshot,” as my data do: that is, examining how many people with a particular disease die during a given interval of time—say, a year.

True, the OECD data are seven years old, as Rick Klein also points out. However, newer studies show a similar trend: Americans do better when diagnosed with cancer than their European counterparts do. Since the publication of my City Journal essay, the prestigious journal Lancet Oncology has released a landmark study on cancer survival rates. Its findings:

• The American five-year survival rate for prostate cancer is 99 percent, the European average is 78 percent, and the Scottish and Welsh rate is close to 71 percent. (English data were incomplete.)
• For the 16 different types of cancer examined in the study, American men have a five-year survival rate of 66 percent, compared with only 47 percent for European men. Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.
• American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent for European women. For women, only five European countries have an overall survival rate of more than 60 percent.

These data, recently released, are now the best available. They too confirm Giuliani’s point: he was fortunate to be treated here.

I’m not denying that American health care has its problems. On the contrary, I’ve just written a book advocating reform. And the Giuliani campaign isn’t denying it, either—the mayor has advocated reforms of his own. But as Americans consider how to improve our health care system, we should understand what we do well and what other countries do poorly. Failing to do so would be the public policy equivalent of malpractice.

Dr. David Gratzer, a physician, is a senior fellow at the Manhattan Institute. His most recent book is The Cure: How Capitalism Can Save American Health Care. He advises the Giuliani campaign.