Amid the partisan cavils against expanding the State Children's Health Insurance Program and within the broader debate over health-care reform, free-market conservatives intone darkly about the evils of socialized medicine. What, precisely, are these evils? Apart from citing some delays experienced abroad in the scheduling of nonemergency surgeries, opponents seldom say. That's beginning to change, however. In op-ed pieces that appeared in the Wall Street Journal on two consecutive days earlier this month, two conservative commentators— John Stossel of ABC News and Betsy McCaughey, former lieutenant governor of New York, and current Hudson Institute fellow and chairman of the Committee To Reduce Infection Deaths —argued that government-funded medicine would eliminate the advantage Americans currently enjoy relative to citizens of other countries when it comes to surviving cancer.
American medicine is indeed superior to other countries when it comes to treating most cancers. "I have had lots of people ask me for help in finding hospitals and doctors, particularly for cancer," Republican presidential candidate Rudy Giuliani has said.
I've had lots of people ask me that. And I've had some people from Europe ask me that, to get help to come into an American hospital. I've never had anybody ask me for help to get into a Cuban hospital or a Canadian hospital or an English hospital. They all want to come to America.
It's a fair point. Granted, nobody seeking entrance to a Cuban, Canadian, or English hospital would likely seek help from an American politician. But there's a reason that foreign potentates turn up at New York's Memorial Sloan-Kettering Cancer Center and Houston's M.D. Anderson Cancer Center on a regular basis. The international nature of the medical-student body at Harvard and Johns Hopkins is not a figment of your imagination. The United States is pre-eminent in the treatment of cancer and in most other high-end medicine, too. Michael Moore's stubborn refusal to acknowledge this fairly obvious reality undermines his argument for national health care in Sicko.
But if the United States can take pride in better cancer survival rates than in the socialized nations of Western Europe, does it follow that adopting some version of the socialized medicine practiced there would wreck that advantage? To Stossel, the answer is so obviously "yes" that he doesn't bother to argue the point. McCaughey, however, devotes her entire column to making this case. As with (subscription required) her famous New Republic takedown of Hillarycare, McCaughey's argument outruns the facts.
"The evidence shows," McCaughey writes,
that universal health coverage does not improve survival rates for cancer patients. Despite the large number of uninsured, cancer patients in the U.S. are most likely to be screened regularly, have the fastest access to treatment once they are diagnosed with the disease, and can get new, effective drugs long before they're available in most other countries.
The most important point here concerns the relationship between cancer survival rates and universal health coverage, but McCaughey states it oddly. If the worst thing one could say about socialized medicine was that it would "not improve survival rates for cancer patients," I don't see how anyone could object to its adoption. We can have government-funded medicine without losing our edge in cancer treatment? Bring it on! The reason to implement universal health care isn't to lengthen cancer survival rates. It's to give people access to medical treatment. Socialized medicine is a funding mechanism, not a clinical-research program. Presumably, clinical research would continue at the same pace and would continue to lengthen cancer survival rates.
What McCaughey means to say, I think, is that universal health coverage worsens survival rates for cancer patients. Exhibit A is "the largest ever international survey of cancer survival rates," which showed that
in the U.S., women have a 63 percent of living at least five years after diagnosis, and men have a 66 percent chance—the highest survival rates in the world. These figures reflect the care available to all Americans, not just those with private health coverage. In Great Britain, which has had a government-run universal health-care system for half a century, the figures were 53 percent for women and 45 percent for men, near the bottom of the 23 countries surveyed.
The phrase "near the bottom" is the tip-off that McCaughey's reasoning is faulty. All 23 countries in the survey were European, and virtually all of them provide universal health care. If there were something inherently wrong with the ability of socialized medicine to deliver cancer treatment, one would expect to see a dramatic difference between U.S. survival rates and survival rates in all of these countries. But it's clear from the study (actually a series of papers published in the September 2007 Lancet Oncology) that this isn't so. The Lancet papers aren't available free of charge online, but this chart from a news account of the study in the Daily Telegraph tells the story. For women, cancer survival rates are 61.8 percent in Iceland, 61.7 percent in Sweden, 61.6 percent in Belgium, and 61.1 percent in Finland. That's just a whisker behind the 62.9 percent survival rate in the United States. For men, cancer survival rates are 60.3 percent in Sweden, 57.7 percent in Iceland, 55.9 percent in Finland, and 55.4 percent in Austria. That's a more sizeable gap, but it's doubtful one can attribute it to socialized medicine. How could universal health care be good for women who have cancer but bad for men who have cancer?
Nowhere in the Lancet is it suggested that differences among cancer survival rates are attributable to whether a country provides universal health care or not (though an editorial does make the obvious point that something would appear to be seriously amiss with the management of the National Health system in the United Kingdom). 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.
The United States is wealthier than all these countries, so it's hardly surprising that its cancer survival rates are highest of all. (What's surprising is that the United States ranks so poorly on other health measures that apparently are less closely linked to national wealth, such as infant mortality and life expectancy.) To argue that universal health care would wreck the U.S. lead in cancer survival, you'd have to argue that universal health care would wreck the entire U.S. economy. That seems doubtful, though—especially if the burden of supplying private health insurance were eliminated entirely for private industry.