The Fact-Checker, by Michael Dobbs

I think you proved his point in your own rebuttal. You said the 5 year survival rate is higher in the U.S. only because more are diagnosed and treated here. If I am not mistaken I think you are in other saying we are getting better treatment due to our health care system. Is that not really the whole point. I am going to give you five noses for your rebuttal. Just be honest, is it that hard.

I agree with Rich. From the point of view of somebody who might get and die from prostate cancer (not me, but the men in my family and my male friends), the US health care system is superior to the NHS, because the five-year survival rates in the US are higher.

I am among the majority of individuals with health insurance who likes my plan and finds it affordable and with good coverage. I am not voting for anybody who is going to mess that up for me.

This is what I cannot abide in Guiliani. Instead of understanding he made a mistake, he changes the subject. I thought with the FC's last entry that the subject under discussion was the stats the mayor used to come up with his figure. Now we are being told that the discussion is really about how much better things are in the U.S. than in Britain, and the fact that you "are still not getting it." With logic like his, he may have to talk a lot longer.

Frankly, if the most intelligent minds in medicine today think that treatment is useless in half the men who are diagnosed, than I would prefer to be treated in the UK. Isn't it a trip to think of Guiliani's joy at being "cured", but impotent!

Congratulations- you got it right. The twisting of statistics the Guiliani folk are engaging in is the same sort of thing which led some hospitals to get ratings as horrible places based on the death rates of their patients- when they had large hospice components and thus were serving a population distinctly less healthy than the general one. On examination, it was not surprising that hospices had a high death rate.

You should, though, consider a followup- Giuliani spokesman Jason Miller wrote you "You are still not getting it. The point the mayor has made is that privatized medicine is better than socialized medicine."

Now THERE's a statement which calls out for fact checking- perhaps a further follow-up with the Guiliani campaign asking them to explain why so many countries with 'socialized medicine' have longer life expectancies, lower infant mortality rates, etc, than does the US.

When a large portion of the population does not have access to full medical care, there is a big difference between saying that those who get health care in a private system are better off than those who get it in a socialized system and saying that the population as a whole is better off.

The previous posters don't get the point. There's no proof that diagnosing and treating someone in year 1, 5 or 7 of prostate cancer leads to better health and longer life. At least half the people would die of something else and the other half may have the same benefit from later treatment. The answer is currently unknown, but it is not unlikely that the American system is wasting resources in this area.

What is known is that the statistics Guiliani is using may be correct, but they are thoroughly misleading and their implication in no way matches their reality. The conclusion Guiliani draws is not supported by any experts and will not be supported by anyone who understands this issue. Statistical spin is a very dangerous thing: its easy to do and it always fools the unsophisticated 50-75% of the population and it can often even fool the highly educated, even science, medical and engineering people can be fooled by well spun statistics.

It is a villainy and would convince me of Guiliani's character if politics weren't so generally heinous. But since it is, maybe it just convinces me he's a regular nasty politician.

If we screen babies for potential heart disease and say anyone with a heart has potential heart disease, we could increase our 30 year potential heart disease survival rate, but we have not changed anyone's health.

Rich says, "If I am not mistaken I think you are in other saying we are getting better treatment due to our health care system."
Hey, Rich! You're mistaken.
Read the article again. It's not that long, and it's not that complicated.

Please introduce me to Jason Miller.

I would rather be treated for anything, prostate cancer or a skinned knee, by a socialized medicine system than by what we have here in the US. I hate going to the doctor, because everything is treated with "here's a pill, go away". No time to answer my questions, no time to talk about how to avoid my problem in the future, no time for diagnosis, and I still have to wait 2 months for an appointment! If I have to wait, I want a doctor who isn't being rushed through every patient by an insurance company pushing them to cut costs. I don't want to come home from the doctor to find a letter saying "We don't think you're really sick, so pay for the visit yourself." I want to be treated by a socialized medicine system! Please!

There is a very simple, very accurate way to compare results. How many deaths are there from prostate cancer each year per 100,000 people? It turns out that the UK numbers and the US numbers are nearly identical. See

http://www.washingtonpost.com/wp-dyn/content/article/2007/11/01/AR2007110101991.html

The truth is that nobody who has socialized medicine wants our health system. We spend more per capita and yet do not lead the world in any significant health measure. For the nearly 1/6 of our population that is without health insurance, there essentially is no American health care system. It's broken.

OK If I am in the 1/2 group that would benefit by earlier treatment, wouldn't I rather be in the US and receive it? In fact I have received treatment.

Isn't there an easy way to understand why Rich and WashingtonDame are so wrong? If you DON'T EVEN TREAT anyone for prostate cancer, and you check men at 58 and at 68, MORE with prostate cancer at 58 will live 5 years than will men with prostate cancer at 68.

The Washington COMPOST is at it again. If you want another perspective other than papers for the socialist party (AKA the former Democrat party) go to the paper of record "THE GREAT NEW YORK POST"
http://www.nypost.com/seven/11052007/postopinion/opedcolumnists/uks_bad_medicine_901295.htm?page=2

and read Dr. David Gratzers article in full support of the next American President's claim that America has better health care than Briton.

Er, Madison and Rich, Dr Gratzer apparently failed statistics. You would do better to ask a mathematician for help with this than the guy who got the math wrong in the first place. In either case, the numbers clearly show that the number of men per 100,000 who die of prostate cancer is pretty much the same in the UK and the US. You can holler all you want about socialized medicine, but men with prostate cancer are just as likely to die of prostate cancer in the US as in the UK. Sorry.

Health care in the USA is probably better...if you can afford it. What worse, socialized healthcare, or no healthcare at all? Don't worry rich folks, you'll still be able to go to the best doctors in the world. The rest of us will go to the "second rate" ones. And you know what? I'll love it.

If I am not mistaken the oath taken by a Dr. means that he will cure us to the best of his ability. If this is correct then the only differance in health care systems is the cost and who is covered. Under a national system the entire population would be insured, not just the ones who can afford insurance.
I was fired from a fortune 500 company after heart surgery in order for them to avoid future insurance costs

Giuliani obviously is comparing apples and oranges, unfortunatley the writer of this article seems to be at least equally confused and seems to take this rebuttle nowhere. I give 2.5 pinochios to each. I wish I lived under socialized medicine though, simply because I am not in the executive class of people with the really good (prohibitively expensive) health insurance in the US.

I agree with the findings set forth in this article. However, the focus of the article does not deal with the crux of Guliani's claim that privatized health insurance is better than socialized health insurance. As with many politicians he takes a single health care example and, with intention, expands that to faultily include the universe of health care.

WashingtonDame is much closer to the truth of this issue than Guliani and his political health advisors when she says, "I am among the majority of individuals with health insurance who likes my plan and finds it affordable and with good coverage. I am not voting for anybody who is going to mess that up for me.

Yes, prostate screening seems to be a good strategy until proven otherwise. And yes, our system seems better in that regard, especially for people like WashingtonDame and myself who can afford health insurance. However, it is poor consolation to the growing hoard of Americans who have no "plan" and cannot afford the luxury of preventive health care, including prostate cancer screening.

I hope Guliani and his supporters dig in and fall upon this sword of principle, because every day they alienate a larger portion of the population.

Privatized health care was sold to the Congress and the American public over 50 years ago by the AMA and the insurance industry. They foisted responsibility for providing affordable insurance and access to health care upon the American business community. Their solution was for employers to fund health care insurance and ensure that Americans had access to care. But two important things happened.

First, the medical/health insurance industry finally had their own socialized medical system. Their system guaranteed funding and they were insulated from the financial impact on their consumer/customer. If your automobiles were "insurance funded" what would you drive and what would dealers sell? Only the best is the answer. But in this reality while many drive Cadillacs and Lexi, they drive past growing numbers who can only walk.

The consumer no longer felt the impact of fees since, and like WashingtonDame they liked their plans and found them affordable. Sure they did, someone else was footing the bill. Look at what happened to our cost of health care. Who was there to rein in health care costs? That's the second part of the equation.

Employers have seen insurance costs skyrocket. Why? Because all of their employees are getting Cadillac health care, and you better not take that away. After time that cost item on corporate ledgers has taken its toll. It is a huge factor in our loss of competitiveness internationally. Just look at the UAW negotiations recently for proof. Just listen to the rumblings at work about each year's corporate attempt to rein in health insurance costs by increasing co-payments and deductibles.

The reality is that our health care system is crumbling for the end-user and end-funder, the consumer. Most people are unaware that the huge number of uninsured Americans actually have health care. They have Medicaid, they have Medicare, and they have emergency room care.

Medicaid and Medicare are publicly funded insurance. Emergency rooms offer care-of-the-last-resort for those who have no other health care choice. It is the most expensive way to access health care and we force those without insurance to use it. And, we pay for it at Cadillac prices.

In summary, after considering the detrimental impact of privatized health insurance on our industrial economy and the explosive cost of providing care for the masses of uninsured one would have to subscribe to Guliani-math to approve the current system.

Mr.Guiliani may or may not be correct, but why does it really matter? We should all examine daily our contribution to society and not be too concerned with our lifespan and material possessions. Our only legacy is the difference we make in the lives of others. I admire Rudi Guiliani for his candid,forthright attitude and his desire for the most difficult job in the most trying times of our country.
Good luck.

A prostate cancer survivor.

Mr. Broyher: I agree with your life philosophy and all of our lives would be more meaningful and fulfilling if we kept an eye toward those principles. But one question came to mind as I read your post. Did you have health insurance that contributed to your prostate cancer survival?

I survived prostate cancer. My surgery was performed August 21, 2007. My PSA now is 0.0% The most important part of my survival of prostate cancer was the ability to choose my surgeon. The ability to select is the foremost critical aspect to survival of prostate cancer. According to the American Cancer Society, 'the most important factors are likely to be the skill and experience of your surgeon.' And this, 'Most large cancer centers where prostate surgery is done more often and surgeons have more experience, report fewer problems with incontinence.' (American Cancer Society, Cancer Reference Information, Detailed Guide: Prostate Cancer) My research into prostate cancer showed the statistics very close to those quoted in your article by Giuliani.

Socialized medicine would have had me go under the knife of a local surgeon. Based on the statistics I researched at Johns Hopkins, with a local surgeon my chances of survival would have been cut in half. My chances of survival with incontinence and impotence would have double.

I do not support Giuliani. But in this case, with my experience and intense investigation into the subject of my survival of cancer, his perspective is absolutely accurate when it comes to prostate cancer survival.

Those who support socialized medicine, I hope that you are one day faced with a decision that will impact whether you will live or die. Faced with the decision that you will remain maimed for life as in a radical mastectomy, or living as an incontinent, impotent vegetable after prostate surgery. The decision about socialized medicine will be a little more clear from the other side. It is not about providing health service. Everyone I talked with would have provided their service under compassionate care. It is about liberty and the personal freedom to choose who will work on my body. The decision on socialized medicine is about whether you control your body or the government is in control.

Anyone who would take away my liberty, deserves the consequences of the decision they would support. I hope you get your chance.

Jim Crowder,
Here's the problem. According to the article, after a study of 70,000 men who were followed for 15 years, researchers still can't say with any confidence that treating people the way we do in the U.S. definitively decreases mortality rates.

I completely agree with those of you who see clearly that our way is not necessarily the best. I once had a doctor tell me that the reimbursement my insurance company paid him meant that he could see me for four and a half minutes.

What drives me over the deep end is that in all of this, we are turning our backs on the very thing that has made this country so great. And that is this notion that we are clever enough, and educated enough and entrepreneurial enough to take an idea and make it better. If a product works decently, some American will always come along and make it work superbly. Why don't we take a system like "socialized" medicine, and take the things that are good about it and improve upon them. What would happen if we could figure out a way to take the bad things about "socialized" medicine and make them work better.

Forget Guiliani and this discussion. He's not up to the task. He's just a nasty politician like so many others for whom Guiliani is first and everything and everyone else is secondary.

I am perpetually amazed when those who decry "socialized health care" with straw-man arguments.

A few pointers if an adult discussion is to be had about health care.

1) Stop saying that universal coverage is going to "take away" or "mess up" your current health plan. It's not. This perception that other people having access to something means that you lose your access to it is false. (this is a favorite strategy in the same-sex marriage argument)

2) Realize that obscene amounts of money are being spent because we refuse to invest in preventative care-better and cheaper to help people not get sick than to cure them once they are.

3) Realize that epidemic spreads of diseases can be halted by providing coverage and medical support to as many as possible. Sick people with no doctors means more people getting you sick.

4) Realize that if you're a fiscal conservative, you should be behind the relief of the burden of health care on mid-sized and small-business employers. Not having to worry about providing health care would decrease the unemployment rate, allow for higher wages, and a better situation for the American business owner.

5) The opposite of our current economic system is not socialism or communism, it's real capitalism. We have not experienced "free" market capitalism in quite some time. The manipulation of large industries on laws and plans for eternal corporate sustainability completely undermines any fundamental notion of free market. Stop pretending that we do capitalism well. What we do is corporate communism.

6) Try to stay away from arguments based upon the implied idea that people with less money are therefore less entitled to live. That's just cruel and stupid.

As has been PROVEN repeatedly, Guiliani and his "staff" bend reality (lie) to get their point of view in print. IF the voters still believe the statements of a serial lie machine, then the folks who vote for them deserve what they vote for.

"Those who support socialized medicine, I hope that you are one day faced with a decision that will impact whether you will live or die. " LB

You don't get it do you? If you don't have any insurance, or enough money, YOU HAVE NO CHOICE AT ALL. Your only options are to 1. Die, or 2. Go bankrupt.

To Jim Crowder:

The point is given the current state of the art, you can't know if you are in the 50% that will benefit from treatment. If you are in the other 50% that won't benefit, you will get treatment that can have bad side-effects and will cost a lot of money. And that money cannot then be spent somewhere else where it might be more effective.

It's really quite simple. American hospitals do have better cancer cure rates than British hospitals. American screening (for insured people) is also better and that may really save lives, at least in some cancers.

However, Americans spend on average very nearly twice as much on their healthcare as Britons do. If the British increased their cancer spending to American levels, I should think they'd see better results.

Moreover Britain's health system is not the best model, as France's is vastly more efficient, getting better cure rates at lower costs, largely because French doctors make a fraction what America's medical plutocrats do.

The French are healthier and longer-lived than Americans by every measure.

Finally, all the good things you can say about American medicine only hold true for insured Americans. The vast number of uninsured ones guarantee that in vital statistics like life expectancy and child mortality, America will continue to lag behind countries like, famously, Cuba.

Mr. Boyher,
Like Mr. Traugott, I admire and applaud you philosophical view and your life's guiding principle. But the part that disturbs me is your question, 'why does it matter?' It matters very very much, because we are on the brink of choosing someone to make many critical decisions for several hundred million Americans, and millions of others around the world will undoubtedly be affected by those decisions. So look closely looking at Giuliani being so darned arrogant about such a thing that he can't say "hey look, maybe the stats were wrong." Instead, he repeats the same thing over and over again in the face of glaring evidence from the experts to the contrary. He must be deeply convinced of the infallibility of his positions and his thoughts, and I do not see this as 'candid and forthright.' I find it deeply disturbing.
We already have a President like that, and lots of politicians in Washington like that too.

LB: "The decision on socialized medicine is about whether you control your body or the government is in control."

Your anecdote would make a lot more sense, LB, if Britain forced people to be treated on the NHS. However, Britain still has a large private medical sector that anyone is free to use if they want to pay. And even the NHS has provision that sometimes allows you to choose your surgeon or specialist. I doubt if every HMO plan does.

America would still have the same doctors under a public payment system. Whichever system you have, there's only the same number of people who can be operated on by the best surgeons. It's just that under your system, they only operate on the rich.

Sorry Mr. Dobbs. Whether you like Mr. Giuliani or not and whether you wish to use the data from the "questionable" Organization for Economic Cooperation and Development or not your article is at least as flawed as his which prompts me to write.

In Britain, and to a greater degree, continental Europe, the option of "watchful waiting" (a no treatment option) is very common; but very rare in the US. The logic being many patients are elderly and will die before the cancer kills them. In the US, we are more successful at early diagnosis and diagnosis of younger patients as you have noted. "Watchful waiting" is a death sentence for many (but perhaps not all) of these patients. The persistent myth that prostate cancer is always a slow killer (like your example of 15 years) is simply not true. Your quote by Otis Brawley also means that 50% of the prostate cancers are aggressive and need to be treated aggressively or these men will die. The result of aggressive treatment in the US: a big difference in survivability (and yes, some patients may have be overtreated and some have side effects). I represent that group of relatively young men treated aggressively for prostate cancer in the US. Your logic in this area is more flawed than Mr. Guiliani's.

You have misrepresented the facts to make your story in the same way that you have accused Mr. Giuliani and his sources. What's my beef with that? I am concerned that some reader will abandon confidence in the data presented to prostate cancer patients (PSA levels, Gleason scores, Partin tables, etc.) and die because you, like others, choose to "screw with the data" resulting in confusion in the general population.

If you don't agree with the politics of Mr. Giuliani and don't like our health care system just argue the issues and let the epidemiologists do their work.

Why do the socialists so eagerly want to gulp down the "KOOL-AIDE"? A little thirsty, perhaps? Please folks, take a step back from the "Jim Jones" diatribes and try to think on your own. Give your ingenuity and individuality a chance to work. The debate is about one thing: "Life Liberty and the Pursuit of Happiness VS Socialism". The former believes and trusts people, the latter disdains them.

So put that in your government funded pipe and smoke it!! Ooops I forgot, smoking has been outlawed.

As a prostate cancer researcher, I have criticized the conclusions of Giuliani's Dr. Gratzer in other forums for exactly the reasons given in the WaPo article. The crux of the debate over screening vs. not screening is whether the survival benefit of early treatment outweighs the diminished quality of life, morbidity and mortality associated with biopsy and treatment. In the medical literature, the competition between treatment modalities such as seed brachytherapy versus radical prostatectomy, is no longer waged solely in terms of survival but increasingly in terms of minimizing complications and side-effects.

Kudos to Mr Dobbs. A candidate has made a factual claim in support of a policy position. That factual claim is false. The Fact Checker has called him on it. This is an appropriate use of this column and I commend it. More like this please.

night-wing conservatives have a deeply flawed thought and philosophical process. They think that anyone who disagrees with them must be a 'kool-aid drinking socialist.' And more importantly, they equate anything done differently than what is current practice in the United States must be a step away from communism. Anything other than what we have here in the U.S. at the moment is wrong, by their estimation, and they are right.

They are like immature children who think the world is black and white.

"Jim", go back and re-read the blog entry. No where does it say that the author doesn't like Guiliani, and no where does it say that he doesn't like our healthcare system. You have decided to read those things into the text, which in my view is a dangerous thing to do in a discussion among reasonable people. The blog is debating facts. Quite simply.

So, can anyone tell the readers of the Washington Post whether or not this ad is still running on the radio? I keep asking Post reporters and none of them seem to know. Are radio listeners being happily fed a steady stream of baldly incorrect figures from someone who purports to be the next president of the U.S.? Do the voters want ANOTHER Misleader in the White House?

Raises hand.

I'll take the socialized medicine. I remember reading about the report suggesting that doctors reduce frequency of screenings for prostate cancer in the United States, and I'm not convinced that spacing out screenings more will be terribly harmful. A mandated annual PSA test may be more wasteful than good.

I do know that I'll be treated when appropriate in any other developed Western nation that practices "socialized" medicine, I know that I won't have to worry about a billing dispute between my insurance carrier and my doctor's office (like my friend who's credit was trashed by her hospital when it refused to bill her insurance co. and reported it to credit agencies). I know that the National Health Service isn't going to try and weasel out of covering me because it was a "prior condition." I know that I won't be subject to excessive radiation from "defensive medicine" tests that my doctor's lawyer ordered throughout my life (and the associated increased cancer risks). If I was particularly worried about prostate cancer and wanted regular PSA tests in the UK, I could always request them from my doctor. See http://www.cancerscreening.nhs.uk/prostate/index.html.

As for the concern about the government telling people what doctors they see... don't insurance companies already do this? I know that I have a list of doctors that I can see, and if I stray from that list, I better have wheelbarrows full of cash.

The argument by LB is particularly devoid of logic, as he throws out the boldly unproven assertion that he would be forced to go to a local and unspecialized surgeon by a national medical program and concludes with an emotional wish that I become an "incontinent, impotent vegetable." A well managed public health system could offer greater specialization of specific treatments by centralizing all treatment of prostate cancer or whatever other disease and eliminating the use of general surgeons for particular widespread conditions. Under a national health service, everyone diagnosed with a condition would be able to go to the special treatment center instead of those who are fortunate enough to have cancer center X as a member in his/her plan. A national healthcare plan would include more doctors than the balkanized corporate healthcare system.

Mr. Giuliani and LB both throw out red herrings of cooked statistics and pure, unreasonable conjecture. These fear and deception based arguments make me suspect that there isn't a strong public good argument against a national health program.

I do know that I wouldn't have had a conversation about corporate rules over providing health plans (and the costs of doing so) with a broker that I'm looking to work for part time while in college. The current system of attaching health insurance to employment acts as a tax on job creation, making it more difficult for me to find a part time job in financial services despite the fact that I'm still covered through my family's plan. The expenses of a national health service could be arranged differently so one does not incur additional taxes on hiring but instead on consumption. Synergies and efficiencies from consolidating the current healthcare system would bring additional savings (doctor's offices wouldn't need as many people working on billing and administration as they have nurses, for example).

At least Giuliani has something other than 9/11 to talk about, even if it's deceptive.

Statistics from health professionals and English Cancer Orginization show that Guilianis figures are WAY off base.
If he fudges these health facts, what else will he lie about?

I would have to agree with Rich and others in saying you have invalidated your own argument. First you acknowledged that the five year survival rate is higher because we take better care to track and treat prostate cancer before it kills us. Second you rebutted yourself in saying that even the tracking of such things such as prostate cancer may do nothing to improve statistics. I did however see you caught a few followers who have had a hard in hospitals and have fallen under the assertion that "here's a pill go away", is Americas health care system. My personal belief is that they treat you more methodically because in doing so, they earn more. If there is no prize for going the extra mile, you don't compete as hard, we learn that even as children.
I have to give you the five nose rating, unfortunate because I'm an undecided and propaganda like this just weakens my view towards the people who would solicit such an opinion.

Now that Rudy has been awarded 4 Pinochios, Rudy's wife will sit on his face and demand, "Lie to me, Big Boy!"

It takes an outright fabrication for this horrible feature to actually take a stand on a deception by a Republican candidate.

This newspaper is ludicrous. The entire editorial staff needs immediately replacement.

Suggestion for Mr. Dobbs:
This new "fact checker" column is starting to turn into a real public service. Please keep it up, and follow up on the more interesting comment posts. For starters, why don't you see if the treatment options in the UK are different from those here. Do they use different techniques? Do they rely more heavily on "watchful waiting" (as one of the commentators alleged?) Does the NHS impose restrictions on the "radioactive seed" treatment that Giuliani received?

It's amazing how few people understand simple word problems.

According to the data used, prostate cancer is diagnosed earlier (say 58 years of age) while in GB it is later (say 65 years), in general. If you are younger, you're less likely to die (period) therefore the 5 year survival rate means nothing.

To make it accurate, in one way, you would need to compare either 58 years olds in both US and GB and look at their surival rate (while eliminating other factors, of course, than just treatment) or 65 years old. If early diagnostic and treatment help survival then Americans should have a higher rate of survival when diagnosed at 58 at the same age as the 5 years out used in GB (example: 70 for both population), otherwise the early screening and treatment don't matter either.

Since 58 year old have a higher survival rate than 65 years old, IN GENERAL, it's like saying your chances of a male dying in country X are 80 % percentage higher than country Z when country X's average age is 21 and 65 in country Z. All it means are the populations are different ages and there's a higher risk of dying as you get older. In other words, the comparison doesn't work.

Four pinocchios is too many for a claim that is backed by hard numbers, even if a PhD would not agree with the methodology. The quoted experts, by the way, didn't replece Giuliani's "bad" figures with the "right" ones, so they were merely expressing opinions.

To wit: "You would get an F in epidemiology...if you did that calculation."

So we're holding Giuliani to the level of a peer-reviewed epidemiologist? May I infer a B student would still rate a pinocchio or two?

Al Gore's team of scientists and policy advocates came up with a prediction of ocean levels rising 7 to 23 inches, which Gore used as the basis of a slide show showing the effect of 20 FEET of flooding in South Florida. Feet versus inches, a layman can catch that one. And Gore only rated one pinocchio?

You'll have a candidate on the stump at some point complaining about the nation's divorce rate, or maybe praising its decline or decline among some subset of the American population. If that candidate quotes a single divorce rate, Fact Checker is now obligated to award four pinocchios. That's because the divorce rate doesn't "track people" the way an epidemiologist would demand, but is merely the ratio of the tallies of divorces and marriages over a given time period.

I love the Fact Checker, but I think the judgement on this one was just wrong.

Great job following up. The original error was bad. But standing by it even after it was demonstrated to be false is really bad. It reflects on Giuiliani's character that he would do this.

It also reflects on Giuliani's opinion of the press that he would think he could get away with this. Thanks for helping to prove him wrong. Greg Sargent had a great piece on the media context here:

http://www.talkingpointsmemo.com/horsesmouth/2007/10/rudy_campaign_t.php

"The point the mayor has made is that privatized medicine is better than socialized medicine. If you can find one person who said they'd rather be treated for prostate cancer in the UK instead of the US, we'd like to meet them."

But of course the UK system only costs about 40% what the US does. And they deliver broadly similar outcomes. In my book, that makes the UK system much better because it is much more efficient (though they both have major issues). Outcomes vary condition by condition. For prostate cancer, the US probably is a little better than the UK (though not dramatically better as Giuliani would like to pretend). But overall the statistics show the UK actually does a little better than the US despite spending 60% less. See http://ezraklein.typepad.com/blog/2005/04/the_health_of_n.html for details.

"There are lies, damn lies, and statistics." Mark Twain

Mr. Guliani's statement, while precise, is not accurate. Regarding prostate cancer screening, two epidemiology 101 lessons apply: lead-time bias (http://www.fpnotebook.com/PRE12.htm), and length bias (http://www.fpnotebook.com/PRE13.htm). The rates he compares is comparing apples to oranges, not apples to apples.

That the disease-specific mortality rates are similar between the two countries is also misleading, because we do not know that the incidence is the same, the average ages at death, or all-cause mortality rates, for example.

The currently available scientific evidence does not permit conclusion of the clear benefit or harm of prostate cancer screening. People often wonder what the harms of screening could be, and they include interventional procedures with the risk of pain, infection, and other complications such as impotence and incontinence. If the prostate cancer never would have spread or the patient would die from other causes before becoming symptomatic from the prostate cancer, then the treatment might be considered unnecessary. However, in many cases, treatment extends longevity. As previously stated, at this point we are unable to identify which patients fall into which group. For objective information about prostate cancer screening, see the recommendation from the US Preventive Services Task Force: http://ahrq.gov/clinic/uspstf/uspsprca.htm.

Before comparing socialized medicine with our current system, it may be useful to discuss individual-based care versus population-based care. Let's suppose a treatment helps a few, has no effect of most, and harms some; it is net harmful for a population. If we are unable to identify who is likely to benefit, then the question is whether the service should be routinely administered to a population- knowing some who would benefit would be dined treatment, but for more people harm would be avoided. However, individuals may have their own perspective giving various weights to the chance of benfits and harms such that the balance changes for them. To what extent should a health system foster population-based or individual-based care?

Instead of prostate cancer screening, let's discuss full body cat scans. Or better yet, let's consider daily full body MRIs. The point in this hyperbole is that more is not necessarily better, perhaps an unsettling concept in our technophilic heavily marketed society. Overutilization (low efficiency) is a problem as is underutilization (low quality).

Our healthcare system will implode unless we decrease the number of services. Beginning with reducing the number of unnecessary services is a very good start, but defining unnecessary will not be easy. However, we can consider cost-effectiveness or quality adjusted life years gained. I don't know if there can be rational rationing to eliminate "waste", but improving efficiency, while maintaining quality, is a start.

It's important to understand that our health care system whether as currently exists or redefined, will only be sustainable if consumption decreases. Individuals' taking more responsibility for their health is an important step as will be the acceptance of population-based care. The statistics show it's inevitable.

All this talk about which is "better": socialized medicine or semi free-market, misses the main point. NOWHERE in the US Constitution is the Federal Gov't given ANY power over healthcare in this country. And since we are supposed to have a Fed Gov't of ENUMERATED POWERS ONLY, and the 10th Amendment says that "any power not expressly given to the Fed Gov't is reserved to the states and to the people", the Fed Gov't should BUTT THE HELL OUT OF HEALTHCARE regardless of whether it would help or hurt.

Now I'm sorry for the old "fuddy-duddy" civics lesson but SOMEONE has to have the guts to point out just how far we have strayed from the US Constitution which is supposed to be THE SUPREME LAW OF OUR LAND.

Geez....

I am intrigued by the US debate about 'socialised medicine'. It is odd that in Australia, where we have what by US measures would be called 'socialised' medicine, no-one ever calls it that.

It seems that our system is much closer to the US system than are the European or Candadian systems. Also quite similar to most of the Democratic candidate proposals. The Post may want to do a comparison.

We have Medicare, which in AU is a government run and funded system which pays the costs of treatment in public hospitals, and pays a fee to doctors for regular visits. Doctors are free to charge a co-payment if they wish for regular visits - some do, but many do not. In principal, you don't get to choose your doctors in hospitals, but for local doctors you can go to anyone you like.

This is a universal safety net which provides, in general, good treatment for everyone.

There is also a parallel private system covered by health insurance if you choose. This system primarily covers hospital treatment, but depending on the plan may also cover things like optical, dental, physiotheraphy and other things. In private hospitals, you can choose your surgeon (or, more acurately, you choose your surgeon and then agree with the surgeon on a hospital). Private hospitals generally have better amenities. Privately insured patients have very short waiting periods for surgery.

One-third of health-insurance premiums are paid by the government on the basis that patients treated private reduce the burden on the public system.

Every taxpayer pays 1.5% tax to fund Medicare. If you earn over AU$50K (or $100K for families), you pay an extra 1% surcharge if you don't have private cover.

The theory is that most middle- and high-income people would rather pay for private cover than pay extra tax for the same treatment they would get anyway.

One key difference in AU health insurance is that insurers cannot refuse a person on medical grounds at all. Further, premiums are 'community rated' - that is the same for anyone regardless of health (although, of course, you can choose lower premiums in return for co-payments etc). The trade-off is a waiting period of 2 months for inital coverage and 12 months for pre-existing conditions.

The pool is kept large by a surcharge on premiums for anyone who does not maintain coverage continuously after the age of 30. So if you choose not to get insurance until you are 60, you pay a bit more.

Important prescription medications are subsidised by the government and cost up to about $30 for most people, of about $5 for low-income people.

In short, we have a pretty good parallel public and private system where everyone is covered, but you can pay more for convenience and amenity. And premiums are cheap (because so much is already covered by Medicare or Government rebates), about $2500 per year for families.

Employers rarely pay for private health insurance, although they can if they wish.

Thank you Adam, of South Australia, for your review of your country's health care system. I'm surprised that your system hasn't been introduced to the ongoing debate here in the US. Actually, I have imagined that the US would eventually evolve into a system very much like Australia's.

It has a number of strengths to offer: relief for businesses saddled with health insurance responsibilities, a private funded (partially) option for those who want and can afford that alternative, universal care for those who cannot, and opportunities for health care practitioners to choose which system they want to serve.

I'm curious about how pharmaceuticals are covered and how their pricing may be regulated, or unregulated as in the US.

Rudy is Right!
Because of higher screening rates, the U.S. has a higher survival rate for a cancer that would not have killed half its "victims" anyway.

But using Rudy's "logic" we have to accept that prostate cancer is far more widespread in the U.S. than the U.K. After all, the numbers are indisputable: millions more Americans have proven prostate cancer than Brits so America is clearly less healthy!

regarding prostate cancer-- regardless of where you live- people you can beat it. diet and stress are huge factors which you can control. you cannot wait for studies alone as you must be ahead of the curve- low fat, low cholesterol, diet including pomegranate which slows the psa doubling by a 1/4th and statins- plus remove all the unnecessary stress in your life (cortisol). michael milken who was diagnosed w/ advanced PC is doing well with diet. 15 years survival- why not 30,40 yr plus survival. as someone w/ loved ones w/ PC I know it can be managed- regardless of the politics of the above story. again- very low fat, low cholesterol diet, take statins and pomegranate ( juice, exact ) don't wait do this today !!!
( even if the dr says no proof it makes a difference- you have to be ahead of the curve-) my 2 cents.

Dear Mr. Dobbs,

Thanks for the update on this point. Unfortunately, it seems that your point is not getting through to many readers, like Rich and WashingtonDame. Therefore, I'd suggest that you try again with a more direct argument:

The data seem to imply that the US method of prostrate cancer treatment is actually giving false cure rate odds by incorrectly diagnosing prostrate cancer. Obviously, a disease is much easier to cure when if you didn't have it in the first place! The rate of incorrect diagnosis is high enough so that the number of people who die due to treatment cancels out with the number actually saved by the treatment. Thus, the treatment does not really help to save lives. The only effect is to transfer more money from patients to the health care industry and to injure the patients with the side effects of treatment, such as impotence.

Of course, it is not generally the case that doctors do this sort of thing on purpose. Detecting cancer at an early stage can be difficult, and there is a strong incentive to err on the side of falsely detecting cancer rather than possibly missing an early developing cancer. No one wants to have a patient die because they missed the cancer.

This is clearly a situation where large controlled scientific studies are needed to determine whether a diagnosis and treatment method is working. And it would certainly appear that Britain is doing better than the US at present due to the apparently smaller number of needless treatments.

Finally, I'd like note that Giuliani has a strong incentive not to be objective about this issue. Having undergone a difficult treatment for prostate cancer and given up his chance to be Sen. Giuliani, he has a strong incentive to avoid accepting the fact that there is a good chance that he didn't need the treatment. If he could actually accept the scientific result on this issue, it would provide real evidence of an important leadership quality.

re: Dave's comment on "false cure rate odds by incorrectly diagnosing prostrate cancer"

I agree with the gist of your argument, but the problem isn't bad diagnosis (our pathologists aren't worse than in england).

The problem is that there is no good way yet to predict with any accuracy which PCa will kill and which will not, Gleason scores etc notwithstanding.

Everyone should keep in mind a key statistic: If you are male, as your age approaches 100, so does the incidence of PCa, but only a small fraction of these are symptomatic, let alone the cause of death.

If all our screening does is increase the number of small lesions of questionable killing potential, of course any "treatment" short of killing the patient is going to make our "cure rates" look fantastic, compared to a system that focuses on lesions that are more likely to be progressive and harder to treat, as is typically done in europe by taking into account the behavior of a lesion over time.

And re: the comment about Giuliani's missing PhD, that is so beside the point it isn't even funny.

With today's multimillion dollar campaigns, every major candidate has more than enough resources to get the best advice money can buy.

If this is how they use their resources, it's a stunning preview on how they will use expert advice in the oval office.

Cherry-picking CIA reports, anyone?

I can simplify the point that the fact-checker is making and that Rich and others do not seem to understand. Take two men, Patients A and B, both of whom develop prostate cancer at exactly 57 years of age and whose cancer progresses at exactly the same rate. Patient A is in the US and Patient B in the UK. Patient A's cancer is diagnosed at 58 and treatment begins. Patient B's is diagnosed at 63 and treatment begins. Both men die at 67. Who received better treatment?

Measured by their deaths, neither received better treatment since both died of the same age of the same disease. But Rudy would say Patient A had better treatment because he lived for 9 years after diagnosis rather than only the 4 years after diagnosis that Patient B lived.

That is why the total death rate for Prostate cancer is a better measure rather than measuring how long the patient lives after diagnosis. Is there a higher death rate from Prostate Cancer in the UK than the US? No, it's virtually the same so the earlier diagnosis and more aggressive treatment in the US is raising health care costs without actually improving the likelihood of surviving prostate cancer.

Rudy is an easy target, but this article is really good. I have read several blog posts on the issue and no one explained why a calculation based on diagnoses and deaths is so far off. Excellent job, I had followed the issue and I learned a lot from this article.

I would guess that the US anomaly will go away with time. Part of the huge rate of diagnoses is diagnosis of people with prostates containing a large stock of undiagnosed cancers when the new test was developed. As US doctors work through that stock, the number of new diagnoses will shrink to the number of new cases.

Is Pinochio inferring that they teach statiscal methodology in medical School? I think not!

Giuliani right in the cancer debate
http://www.suntimes.com/news/huntley/642965,CST-EDT-HUNT09.article

Piechota: "Giuliani right in the cancer debate
http://www.suntimes.com/news/huntley/642965,CST-EDT-HUNT09.article"

Why? Because Steve Huntley is apparently an idiot who is too stupid to understand basic math and logic? And this Gratzer guy is obviously a dishonest hack.

"The problem with those figures, explains David Gratzer, a physician, senior fellow of the Manhattan Institute and the original source for Giuliani's numbers, is that they ignore that a larger percentage of American men are diagnosed with prostate cancer. Once you compare American men with British men diagnosed with prostate cancer -- not overall mortality rates -- the Giuliani numbers hold up."

Yes the numbers hold up, because the numbers are statistically meaningless. The US screens more, so you have more diagnoses. The fact that the two countries have exactly the same mortality rate would actually suggest that the US is LESS successful in treating diagnosed prostate cancer. (I'm not making that arguement, I'm just using it to point out how numbers can be manipulated.) Don't allow yourself to be so easily mislead.

With both countries having the same mortality rate for the disease, a good arguement would be showing that in the UK men die at a younger average age from the disease. I don't see Gratzer/Giuliani doing that, do you?

Perhaps some general facts comparing our healthcare system with those of other wealthy countries might be interesting here.

Let's forget the immorality of the uninsured that lets poor people die. Forget the burden on businesses that make them less competitive. Just consider health care financing as a business decision. Develop statistics for measuring how we are doing. Look at the competitors (other countries). Look at their cost. If you are honest, you will become an advocate of a single payer system. Here are some facts. They can be checked at www.pnhp.org.

If you look at the 13 wealthiest countries and rank them according to the 16 basic public health statistics, the US ranks 12th or 13th in each one. Yet, yet we spend 2.5 TIMES as much per person as the average of these countries. Other countries get much better health care at much lower cost. (As a sanity check, WHO ranked the US 37th in the world in health care, above Bolivia , but below Slovenia.) All of these other countries use some form of single payer system. Of course, they have some problems, but most of these are because they are not spending enough. We would not have those problems. In spite of all these so-called problems, they get better care. Also Medicare is a single payer system, and it is one of the most popular programs in the history of our country. The plan I like simply gives Medicare (without limitations, co-pays or deductions and with complete drug coverage) to everyone. We could do this without spending any more than we are now.

The reason for this is that we waste at least $200 Billion a year on excess paperwork by physicians and at least $100 Billion a year on high overhead (15% vs. 1.3% for Canadians) of private insurance. Look here is a simplified example of what we are doing.

Suppose you have 100 dollars to give to 10 people. You could give $10 to each person. Alternatively, you could develop criteria that determine who is deserving, and then investigate each person. You might find that according to your criteria, only 5 people deserve the money. You spent, however $75, on your investigations, so now you can only give $5 to the 5 deserving ones. We spend much too much money denying people health care.

The basic problem is that the rules are made by private insurance companies whose only goal is to make money, not efficiency or good health care. If they can save a buck by having a physician fill out a 40 page form, they will do so.

What about choice? I am 69 years old and retired. During my career I had 5 HMO's and 5 indemnity health plans. I have much more freedom of choice under Medicare than I had under any of the private insurance plans. I have no more referrals, no more in plan - out of plan nonsense. As for choice of insurance plan, why would anyone want choice if everyone had a plan that covered everything? In any case, you could still have private insurance for those who can afford it as most European countries still do.

Some opposition to a single payer system is that it is pie-in-the-sky; we will never get it through. Maybe so. That's what they said about Social Security and Medicare. One thing is for sure. We will never get a rational health care system if we do not try.

Guiliani is a liar, just like gwb. It's that simple. He will lie about anything. He lies to his wives, to his mistresses, to his kids. that's just who he is.

I just happened to stumble on to this chat, so, from a total layperson with reasonable intelligence, some statistical knowledge/formal education, and good life experience, (having used both Medicaid and private insurance, this is what I think.

Having read (and studied) the article three times and after reading through all of the comments: I think that you cannot have this discussion about medical care (in this country) without considering the cost of medical litigations. Because, it contributes so much to the cost of care through the price of insurance for malpractice and to the amount of paperwork an MD or health organization must have to protect them from litigation. I wonder if that is because so many politicians (and commentators/journalists?) have law degrees. What is the ratio of the number of lawyers to doctors in America and in Great Britain?

To the commenters; saying that we should relieve American Business of the cost of medical care is ridiculous; saying that we make businesses here less competitive is a non-issue as related to socialized or private medical care. Life experience tells me that relief given to American Business does not flow down to labor but only benefits the leaders of American Business. If they want to be more competitive, they should stop taking so much for themselves and share the wealth more. Then we would not need laws to make them pay toward health care.

In addition, I wonder, how many of you have tried to use Medicaid. Believe me a truly ill person cannot get through all of the rigmarole fast enough to save themselves from anything. The stress probably adds to the death rate of those forced to use Medicaid. Can anybody comment on the FACT that in America, the rich get richer and the poor get poorer, and the gap increases every day?

What we need is a study of over all survival rates comparing U.S. private insurance to Medicaid in this country. Who would publish it? Not a Democrat, I would bet. I believe that with reasonable litigation private insurance works. I also believe that the Medicaid Program in the U.S. needs revision.

Now, every politician lies, but after Clinton, I cannot imagine anyone foolish enough to imply that republicans lie more then democrats. Guiliani did not assert that he was stating all of the facts. He stated a statistical finding and used it to draw conclusions, which may or may not be correct. Most of the commenters here have done the same.

I guess it is obvious that like most of Middle America I have no faith in the capability of democrats or the compassion of republicans.

And: If the Fact Checker writes an article that results in this much debate about what it says, then four Pinocchio's is obviously inappropriate.

PS: Could one of you commenters please give me the definition of recidivism? It is not in my copy of Webster's. Thanks

A better question is ,What is the survival rate for Americans that cannot afford health insurance ? Britain does not have even have a group to compare with.

If I were a man I'd sure take Giuliani up on this! This whole "socialized medicine" scare is just that - the pharmaceutical companies and the HMOs/insurance companies in particular, are scaring the American public with distorted facts and outright lies. And why? Is it because they're so very interested in Americans having the very best health care? NO, NO, NO!!!!

The ONLY thing they're interested in is PROFIT!!! Especially the HMOs...I've always wondered why they get to "practice medicine without a license", i.e., they get to tell physicians IF a patient can get a treatment, and oftentimes, WHAT treatment a patient can get. It's politicians like Hill the Shill that not only allow this, but encourage it by accepting "blood money". And it is blood money, because people are dying because they lack access to medical care.

And for those that cry, "let them get Medicaid", oh, how foolish and ignorant thou art! Medicaid, because of Bill Clinton, now comes in the form of block grants to the individual States, which means that virtually every State has a DIFFERENT MEDICAID PROGRAM. States can spend it any way they like. In my state, even though I am 55, too sick to work, but have no children under 19 living at home and am not yet 65, I DO NOT QUALIFY for assistance. Yes, the Medicaid system needs to be overhauled, but NOT by Hill the Shill!

So, yes, I would take Mr. Guiliani up on his erroneous claim because of ONE FACT. Here in America, I COULD NOT BE TREATED BECAUSE I LACK INSURANCE, CAN'T AFFORD IT, AND SO GO WITHOUT. That means that if I had prostate cancer here in the U.S., I WOULD DIE.

In Great Britain, I would at least have a fighting chance. So, whether you call it socialized medicine or any other name, for me it would be a GODSEND. But wait, according to those that would DENY ALL Americans access to healthcare, God has nothing to do with a country deciding to do what is right for its citizenry....

Sorry, but I just don't buy that it's GOD who's sitting on the shoulders of all those who say "nay" to universal healthcare, advising them to NOT provide for the sick and the poor....

More likely, it's "the other guy", telling people that greed, profit, and selfishness should take precedence over compassion, decency, and a will to the greater good.

The British health care system is based on the following principle:

Every citizen is entitled to be seen by a doctor. If the doctor says the patient's condition is life-threatening, the patient receives immediate free treatment and care, regardless of his ability to pay.

If the patient's condition is not life threatening and he cannot, or chooses not to, pay for treatment, the patient must wait his turn.

If the patient chooses, and has the wherewithal, to pay for private care, the patient is free to do so.

In other words, the system serves both those who are not able
to pay and those who are--with an advantage in promptness for those who can afford expeensive treatments.

My British mother-in-law has had both sorts of treatment and as far as I can tell, there was no trouble about either.

It seems to me that this system is obviously more humane and works a lot better than ours.

"They can always go to the emergency room" just doesn't cut it.

This won't be the first time Guiliani lies.

JuneB: try Googling "recidivism". You will get a definition.

And while we're talking definitions:

Insanity: doing the same thing over and over again and expecting different results. This is what we're in for if we elect another Republican, Giuliani or any other.

Also, JuneB, where do you get the alleged fact that lawsuits constitute a large part of the costs of healthcare? Healthcare economists peg it at no more than 5%. Which is not insubstantial but certainly not a major component of runaway healthcare costs.

To me, I'd rather pay that 5% to punish the incompetents. The medical profession fails to police itself, so somebody's gotta do it. Another sign of the sickness in our healthcare "system". You are absolutely helpless to fight off the incompetents. Once you get sick and end up in the hospital you will see.

The question isn't whether you would wish to get treated by the US vs. the UK medical system, the question is - for all those people without health insurance who will not get any cancer treatment at all, is the UK system better than nothing? I think the answer is obvious. "Socialized medicine" is only on the table because the present system and the folks who support it are obviously fine with larger and larger segments of the population having no health insurance at all.

A critical question which Giuliani hasn't answered is this: What is the survival rate for Americans of Rudy's age who have prostate cancer but no medical insurance? When do they get examined? When is their condition discovered? What kind of treatment do they receive?

Where's the Fact-Checker's disclosure that the Commonwealth Fund campaigns for universal health care (commonwealthfund.org)?

Also, I'd like to know how many of the men posting here -- as well as the fact-checker himself -- are willing to wait for their first prostate cancer screening until they're the average age men get them in the UK?

to Dr. Gratzer

sir. if under the excellent healthcare sytem of the U.S., 100% of the population with prostate cancer are identified early (vs. 0% in U.K.), and 50% of that population requires treatment for survival (we assume 100% of the U.K. poputlation diagnosed with prostate cancer require treatment for survival, because under inferior socialised healthcare, problems wouldn't even be detected until this late stage)... then.

the scottish and welsh (yes, they're part of the U.K. and the same socialised healthcare system) survival rate is 71%, vs. 49.5% in the U.S. (since half the 99% were going to survive anyway without treatment).

now this math uses only "facts" available on this, and the NYPost article. surely this must be accurate.

+ + +

this exercise in circular logic is ridiculous - but no less circular and illogical than the entire U.S. political system.

1. god exists because the bible tells you so.
2. guliani is right because his adviser is telling you he's right.
3. i am the voice of reason, so believe me.

+ + +

socialised medicine = everyone gets fair and equal access to healthcare, and is paid for by everyone, through taxes. if you want better healthcare than what the state will provide you, it's there for you to have - if you're willing to pay for it - twice.

privatized medicine = unfair and unequal access to healthcare - unequal for those who can't afford it. and unfair to everyone - even if you can afford it, because you're paying more for the privilege. but mainly because the people who supported the idea of privatized medicine in the first place are insurers - who are making a killing off the healthy, and big medicine - who invent new drugs every day, at ridiculously prices, to cure problems you don't even have, but will soon.

doctors live by the hippocratic oath. governments by the mandate of the people. insurers and big medicine need neither (as commercial enterprises, they exist only as long as the bottom line remains ripe for pillage).

who best has your interest at heart? doctors and democratically (i.e. not like it's done in the U.S.) elected governments, or salesmen?

chew on that fact.

Angelicus wrote" 5) The opposite of our current economic system is not socialism or communism, it's real capitalism. We have not experienced "free" market capitalism in quite some time. The manipulation of large industries on laws and plans for eternal corporate sustainability completely undermines any fundamental notion of free market. Stop pretending that we do capitalism well. What we do is corporate communism."

While I agree wholeheartedly with this analysis, I disagree vehemently with your choice of vocabulary.

The Republic is hardly a free market, nor a paragon of captialism. Rather the U.S. currently exists in a state of capitalism subverted.

By that same coin, the shining principles of communism are hardly espoused by allegedly "communist" countries like North Korea, China or the former Soviet Union.

Please do not continue your nation's wrongful villification of either socialism or communism by recontextualising it into corruption, cronyism and dictatorship.

Or if you must, at least do us non-Americans the favour of realising that you too live in a "communist" country.

A brief reminder?

Corruption: Bush vs. Gore, Gonzales, Scooter Libby, and anything to do with Karl Rove.

Dictatorship: Patriot Act, Gitmo, "War" on "Terror", No child left behind, except..., and general foreign policy toward Musharraf, House of Saad, Osama (before 9/11), Hussein (before Kuwait)

Cronyism: Estate tax, Cheney & Haliburton, Bush family & Big Oil

How many people will read this WP item vs. how many people will hear Rudy lie? Even with the proof in front of them there are several people who commented on the article that actually think the rebuttal proved Rudy's point. For Rudy [or his campaign staff], it's a no brainer. Keep lying.

Re: "This is getting completely ridiculous," e-mailed Giuliani spokesman Jason Miller. "You are still not getting it. The point the mayor has made is that privatized medicine is better than socialized medicine. If you can find one person who said they'd rather be treated for prostate cancer in the UK instead of the US, we'd like to meet them."

That's a no brainer also. Anyone who has prostate cancer and no health insurance would prefer to be treated in the UK.

Apparently Rudy doesn't know that there is a national health care system AND a private health care system in the UK.

I've got a question for Rudy and his buddies. In the UK, the infant mortality rate is 4.8 per 1,000 live births. In the US it's 6.3 per 1,000 live births. The infant mortality rate is more than 30% higher in the US than the UK. So, if you're a pregnant woman where would you prefer to give birth? The US or the UK?

Rudy, click your heels together and say 9/11 three times and you'll be whisked to the White House.

I love the attitude of WashingtonDame.

"I am among the majority of individuals with health insurance who likes my plan and finds it affordable and with good coverage. I am not voting for anybody who is going to mess that up for me."

Enjoy your ride at the top of the pyramid scheme known as U.S. Healthcare. If you ever leave your protective circle of life where Wally and the Beav' still deliver the morning paper you will see that the base of that pyramid is crumbling beneath you.

By the way, since this article peaked my interest I decided to look at one of the plans. A five second search brought up links to the plans offered by different candidates. The first page of the Clinton plan states that it will allow the choice of continuing with whatever plan you have or of selecting an alternative. The goal being to have everyone insured.

http://www.hillaryclinton.com/feature/healthcareplan/americanhealthchoicesplan.pdf

I'm now going to finish reading her proposal and then read the proposals of the other candidates. One of them may have a better plan for funding itself or provide better alternatives to what she proposes.

What I'm not going to do is vote for a candidate that tells me how the for-profit insurance industry has a place in healthcare. Private insurance simply moves money from healthcare to their respective pockets, paying the minimum amount possible to retain clients while dropping anyone who becomes a liability. Eventually everyone becomes a liability, even you.

Rudy is, I believe, actually America's Criminal. Not only does he lie about health care, but he turned 9/11 into his own private mint, almost got a criminal friend of his, Kerik, named to one of the U.S.'s top jobs (Head of Homeland Security), is thought to be largely responsible for the deaths of numerous New York firemen, and has hidden, according to news accounts, all his mayoral records in a private corporation which he controls and to which he will not grant access. Back to helath care. If anyone does the research they will find that by any measure, the best health care systems in the world are in countries that offer universal health care and have by some definitions, believe it or not, socialized medicine. Canada and Great Britian are, however, not among them. Check instead, France, Germany, and some of the Scandinavian countries. In contrast, overall U.S. health care is merely mediocre. Thanks for considering these points.

Rudy is not an epidemiologist. He was trying to make a point!

To me, the readers of the Post would better be served with some non-biased facts about socialized medicine in other countries. I realize that it's only human for journalists to have an opinion, but you know what they say about opinions ....

To those of you who think the insurance companies are bad (which I do), imagine what it's going to be like with our government running healthcare! How about some statistics on how many people think they'll do a bang-up job!

I can't help but to both ask when did the Democratic party become the Socialist party and to say that I hope those who think they'll get better care in another country get to actually do that. Bye-bye!

Lucky I live Hawaii. Everyone who works 20/hrs or more a week must be covered by employer purchased insurance. I am 77 yrs old and have diabetes, heart disease, arthritis, periferal artery disease, maculaer degeneration, and bipolar disease. I work full time and have not missed a day of work in 3 years, and 4 months lifetime when I was quarantined. I have MedicareA and Kaiser.
My medical care has cost somebody (not me), L700,000 (0)(Italy. Plastic facial surgery); 4,500 sterling (0), England post-operative dentistry; $450,000 ($35,000) for 45 years of diabetes treatment; $150,000 ($156) (CAB6G)$100,000 for 2 angioplasty; $450 (0 Thailand) kidney stone surger; $6,000 for abdominal surgery; $18,000 ($1,800) for surgery and a iatric foot infection MRSA; $45,000 ($4,500) psychiatric treatment; $50,000 ($5,000 eye surgery; and about $90,000 in insurance co-payments. During the past 45 years I have earned about $4.5 million and spent out-of-pocket about $100,000 for health care. Insurers (including governments) paid about $800,000, but governments took about $1 million in income tax. I spent 8 yrs in the Marines (and get no benefits but got 3 degrees with KVet Bill), I trained 20 Ph.D's, 1,000 MBA's, and 10,000, BBA's, and helped spend $45 million on DOD supported computer research and development.
Whether all this was a good deal for the U.S.A. I couldn't say, but for me, I appreciate the help with the medical facilities and costs. I am a real supporter of government sponsored medical care, public education, and social insurance. Without it, I could have died several deaths, abandoned, broke, and friendless without the generous care of three foreign governments); ended up an ignorant, uneducated, sick, unemployed, blind, crippled homeless old beggar; ended up a penniless wounded veteran (like my mother's uncle or grandfather), ended up bankrupt with three young children and a penniless widow (like my mother's father); or, even worse, ended my life in a lunatic asylum like my father and my mother's great grandfather.
I always wondered what happened to the millions of people who lost their jobs, houses, ansd starved until Roosevelt like the sood Samaritan, picked them up and cared for them. He wanted health care in his Social Security bill but was told it was politically impossible, but he got OASI, UI, OAA, AB, APTD, and AFDC and later DI. I have patly paid for all of them, and benefited from some of them. Every one close to me in age has also.
Call it what you will, government provided and sponsored medical care and income assurance is essential for everyone except the very rich. The civilized world, except for us, already provides
it.

Thanks for Factchecker! On the issue of national health care, the lies are incredible. It is a sad thing that Americans are being scared off from a great idea when they love similar programs like Social Security. National Health Care -- it has a beautiful sound to it for all of us with insurance that we know is not adequate and for all of us without insurance. It is only threatening to the very wealthy with perfect insurance. And those people can keep on going to their docs.

Nation held hostage by the industrial-pharmaceutical complex: Take your money ($2T/year), make you sick.

Cut taxes? Better cut the sick health system.

Posted by: RB | November 7, 2007 10:05 AM

Isn't there an easy way to understand why Rich and WashingtonDame are so wrong? If you DON'T EVEN TREAT anyone for prostate cancer, and you check men at 58 and at 68, MORE with prostate cancer at 58 will live 5 years than will men with prostate cancer at 68"

I think that is the total point. Would you rather be checked and treated at 58 and never die of prostate cancer or not check and find you have it at 68 and next you know you are dead. I think I would prefer the first option in the U.S. where they screen you earlier and prevent it from being life threating later. I think once again you are proving Rudy's point. Good post and you explained why Rudy was right rather simply.

I can simplify the point that the fact-checker is making and that Rich and others do not seem to understand. Take two men, Patients A and B, both of whom develop prostate cancer at exactly 57 years of age and whose cancer progresses at exactly the same rate. Patient A is in the US and Patient B in the UK. Patient A's cancer is diagnosed at 58 and treatment begins. Patient B's is diagnosed at 63 and treatment begins. Both men die at 67. Who received better treatment?

Measured by their deaths, neither received better treatment since both died of the same age of the same disease. But Rudy would say Patient A had better treatment because he lived for 9 years after diagnosis rather than only the 4 years after diagnosis that Patient B lived.

That is why the total death rate for Prostate cancer is a better measure rather than measuring how long the patient lives after diagnosis. Is there a higher death rate from Prostate Cancer in the UK than the US? No, it's virtually the same so the earlier diagnosis and more aggressive treatment in the US is raising health care costs without actually improving the likelihood of surviving prostate cancer.

Posted by: SteveH | November 8, 2007 10:36 AM

The only problem with your argument is that you have no idea if the guy at 53 would have died sooner had he not been treated. That is the same argument in the article because they claim once screen half man need treatment and half may not. So in your case you would be taking a 50% chance you would die sooner without treatment or 50% chance you would die the same without it. Sounds to me like 50/50 is not real good so if the treatment would pretty much make that 90% or better than I think it is clear early screening and early treatment do the trick. How many do you want to give up because we are Briton and government run health care does not want early screening? Is one enough or two?

I agree with some of the other posts. You prove Giuliani's pt. in your rebuttal. He is not arguing that American's are better at surviving cancer, but rather that our easier access and better performance allow us a better survival rate.