I received this email today from someone I know:
Ok, this is worth every MINUTE (ONLY 4) to watch this! THIS HITS IT OUT OF THE BALL PARK ! AND IT ONLY has HAD 24,048 views
It was taken inside Congress with a Congressman. YOU HAVE TO WATCH THIS and YOU MUST PASS THIS ON!!!
So I watched the video. Mr. Rogers has a lot of things to say, most of them slamming Democrats for proposing health care reform that will socialize our health care system, punish ordinary hard working Americans, cause them to have their “good private insurance” taken away by the Federal Government, and lead to more people dying. After watching his rant about the evils of the proposed health care reform bill (not sure which one he was describing), I went and did a little fact checking on his claim that more Americans will die from cancer under the Democrats’ proposed universal health care system, which will burden the “85%” of people with great health care coverage at the expense of the 15% that don’t have coverage. This claim was based on his assertion that in the UK and Canada (where they have “socialized medicine”) cancer survival rates are less than in the United States. After my research, here’s what I sent back to the person who emailed me:
Hi. Since you included me on this list I assume I am entitled to respond. I watched the video you sent me and then did a little fact checking of my own. So here’s goes.
(cont)
First the statistics cited by Congressman Rogers are for people diagnosed in 1990-1994. That’s back when we had more people in the US on health care plans and they had better health care plans, and more non-profit plans vs. for profit plans, than today. So while the results from this study of patients diagnosed with cancer in 1990-1994 are interesting from a snapshot point of view as to survival rates across countries, they are most relevant for that period of time alone. They are at this point at least ten years out of date (for patients in the study diagnosed with cancer in 1994 who survived until 1999). The number of persons covered by health insurance in America and the quality of the health insurance coverage provided to Americans who do have coverage has declined since the early 1990’s. In the early 1990’s, the percentage of Americans with health insurance coverage was higher than it is than today.
In 1989, for example, according to the CDC (link) 65.8% of children 18 and younger received health insurance coverage through their parents’ employers. In 2006, that number was down to 55.2%. Indeed, across all age groups under 65 the percentage of covered individuals has declined between 1989 and 2006, with the most significant declines for people under the age of 44. The age group with the least decline? 54-64. Of course, this was before the recession began in 2008, so who knows how many more people are not covered because they lost their jobs or their employers cut their health care benefits. So, in the current situation we do not know what the data would show regarding survival rates for cancer. I suspect it would show that the rest of the world was catching up to us or surpassing us in many cases, especially since we have more uninsured and underinsured people today than in the early 1990’s, and because the medical technology which was one factor gave us an edge in early detection of cancer at that time is now more widely used in the rest of the world.
Second, there are a number of variables that go into any such data measurements, survival rates included. To assume that one variable, the health care system, is the sole explanation for the difference is just that — an assumption. For example, did you know that, according to the study the Congressman in the video cited, breast cancer survival rates are highest in Cuba? Yes, that’s true. Look it up. So I’m sure you will want to move to Cuba now, yes? No, I didn’t think so. France has the highest survival rate under this study for colo-rectal cancer for women. I know how you love France. Japan, btw, had the highest survival rates for men for colo-rectal cancer. Both France and Japan have a system of universal health care coverage. Here’s a link to a paper which discusses the Japanese system as it existed in 1991.
In general, Europe shows lousy cancer survival rates in this study [Note: the CONCORD study published in the Lancet] compared to the United States, because figures from Eastern European countries were included. What a surprise that the poorest countries in Europe in the early 1990’s, just out from under Soviet domination, would have terrible cancer survival rates. Here’s an excerpt from the the Lancet study’s findings on cancer survival rates:
5-year relative survival for breast, colorectal, and prostate cancer was generally higher in North America, Australia, Japan, and northern, western, and southern Europe, and lower in Algeria, Brazil, and eastern Europe.
Overall, the countries that led the top of this list are the United States, Canada, Japan, Australia, and France. So what we know based on this study is that overall cancer survival rates for certain cancers in those countries were higher than in other countries for cancer patients diagnosed 15 to 20 years ago. Since each of those countries had a different health care system, it’s hard to say that the system alone was the primary cause. It’s even harder to extrapolate from data this old that the same results would apply today. However, among this group, only the United States did not have universal health care coverage. Americans also spent significantly more for that coverage.
Third, the health care systems to which the Congressman in the video specifically compared the US are vastly different than anything being proposed by Congress. The United Kingdom has a National Health Service which not only pays for care but also employs health care workers. No bill proposed by Congress proposes a system that would nationalize all of health care on both the payment side as well as the provider side, as the UK does.
Canada, whose survival rates are nearly as good as American ones has a single payer health care system. Under that system, the government is the sole insurer, like Medicare for people over 65 in the United States. So far as I know, no one expects the Congress to pass a health care reform bill which will be a single payer system. However, if they were to do so, cancer survival rates for poor people and people without insurance or marginally insured would quite possibly increase.
Studies from the same period of time as the Lancet study this Congressman used to support his claims (early 1990’s) indicates that survival rates in selected metropolitan areas increased in America based on socioeconomic status and access to health care, as opposed to Canada, where survival rates were consistent regardless of socioeconomic status. (Link). Cancer survival rates in the US varied greatly by socioeconomic status (here’s a link to one example on the effects of income on breast cancer) and by (and I know this will come as a shock to you) race. Yes, according to the CDC (link) you have a better chance of surviving cancer if you are White rather than Black.
Third, survival rates may not be the best measure of the success of cancer treatments in various countries. Many experts think that cancer mortality rates are a better indicator (link:
Dr. Marie Diener-West, a professor of biostatistics at Johns Hopkins University Bloomberg School of Public Health, told us that one can’t draw too many conclusions. “There are many different factors that could be playing a role,” she said. (A five-year survival rate is the percentage of people in a particular group who are alive five years after diagnosis. Calculating this requires one to follow the patients over five years.)
Stephen Finan, senior director of policy for the American Cancer Society Cancer Action Network (ACS’ advocacy affiliate), explains that one of the differences between England and the U.S. is that there’s a higher level of detection of breast cancer here, which increases the survival rate. “We see more breast cancer, and that’s because we place much more emphasis on screening than the U.K. system.” (The U.K.’s National Health Service invites women for screening every three years starting at age 50, while the ACS recommends a mammogram every year starting at age 40.) More cancers detected earlier increases survival rates, even if it doesn’t affect mortality rates.
Ward, an epidemiologist with the American Cancer Society, says that the U.K.’s screening program has been expanding but much more slowly than the program in the U.S. The Lancet statistics pertained to women diagnosed in 1990 to 1994. “We know in 1990 and 1994 the mammography screening in the U.K. was only just being implemented” – (it began in 1988) –- and in a much more limited age group.” That could further exaggerate the difference. If we knew the survival rate in the U.K. for 2001, it may be more comparable, she says, “because the screenings have been more comparable over time.”
In fact, a 2008 report in the British Journal of Cancer examined survival rates for women in England and Wales diagnosed in the late 1990s, finding that their five-year survival rate was 80 percent. The report said that “[b]reast cancer survival rose rapidly and significantly during the 1990s” and predicted that the rate would be 80.9 for those diagnosed in 2000-2001. Data from the U.K.’s Office of National Statistics show a large increase in five-year survival rates: Those diagnosed in 1991-1993 had a 68.2 percent rate, while those diagnosed in 2001-2003 had an 80.3 percent rate. Rates in the U.S. have been increasing, too, but at a much slower rate: For those diagnosed in 2001, the five-year survival rate was 89.8, according to the National Cancer Institute Surveillance Epidemiology and End Results.
Finan also says that “one of the problems in post-cancer treatment, a person could die in a short period of time, but it could be totally unrelated to the cancer.” For those reasons, he says, ACS epidemiologists will argue that the more accurate measure is mortality rates. “[W]hen you look at mortality rates … if a person dies from breast cancer, a person dies from breast cancer.” A mortality rate (or death rate) is the number of people who died, in this case from breast cancer, in a certain group in a given year or time period.
The most recent mortality rates for breast cancer are 26.7 per 100,000 women in the U.K. (2007 numbers) and 25 per 100,000 women in the U.S. (2009 numbers), according to Cancer Research U.K. and the U.K.’s Office of National Statistics, and ACS Cancer Facts and Figures 2009. The mortality rates “aren’t that different,” Finan says, “and it’s hard to parse out what causes that difference.”
Weiss, of the ACS Cancer Action Network, told us that using mortality rates “has been a frequent practice of ours because of a long-held belief that survival rates … are not a very reliable comparison.”
Other experts we contacted agreed. Dr. Kathy Cronin, a statistician with the Surveillance Research Program at the National Cancer Institute, says that screening can affect survival rates “in a bit of an artificial way.” Cronin explains: “There’s somet[h]ing called lead-time bias. Screening would increase survival even if it doesn’t affect mortality because you’re diagnosing it sooner. … And length bias, where screening tends to detect slower-growing tumors.” That, too, would increase survival, even if it didn’t change outcomes. Mortality rates, she says, “would be a more direct comparison.”
Ward, of the American Cancer Society, lists another complication with looking at survival rates. “Survival rate depends on the stage of diagnosis,” she says. It varies from more than 90 percent for cases diagnosed at stage 1 to 20 percent for cases diagnosed at stage 4. “It’s very uncommon in cancer statistics … we do give overall survival rates, but if you really want to understand rates,” she says, “you look at survival rates by stage and that gives you a better sense of the impact of treatment.”
“I think it’s so easy to pull one statistic,” Ward says, “to use one statistic just as a way to prove your point without really taking into account all the relevant information and all the relevant statistics … to make these kinds of judgments.”
Even when looking at the more comparable mortality rates for two countries, differences can’t be pinned easily on one issue, such as the structure of a health care system. Nasso, of the Susan G. Komen for the Cure Advocacy Alliance, says: “We would agree that mortality rates are a better comparison … but even with two different countries, there are too many factors at play and too many variables to say that one factor could describe the difference between the two.” Nasso told us cultural factors, differences in demographics, and the different types of breast cancer diagnosed would be some of the factors one would have to look at it determine why mortality rates between countries like the U.S. and England differed.
So, it’s not as cut and dried as your Congressman on the video suggests. If you have good health care coverage through your employer or because you can afford the best care, your health care outcomes will be better. If you have sub-standard health care coverage or none at all, well, your chances are not so good. In fact, people without access to health care, or those whose claims have been denied for whatever reason the health insurance companies can find (and they can find a lot as I certainly know and you should too) are dying right now. If [my wife] hadn’t had me on her health care coverage when I became disabled, and if she hadn’t retained her right to pay the full price for continuing health insurance when she became disabled (a privilege that could be revoked at anytime by [her ex-employer]), I’d likely be dead by now.
Since I know you lost your health care coverage when you lost your job due to your [deleted], and now have to rely on a government program provided by [the state where this person lives] for health care coverage, I find it confusing that you would oppose universal health care coverage which would cover you and [significant other] as well, which would allow you to pay for private insurance or choose the government run program of health insurance (the so-called public option). Coverage that, regardless of whether it was under a private or public health insurance policy, would not exclude you or [significant other] because of your pre-existing conditions.
I know if we lost our current health care coverage for some reason I and [my wife and daughter] would be uninsurable because of our pre-existing conditions. Having some assets we would not qualify for Medicaid, so we would essentially have to choose between going bankrupt paying for our care out of our pocket before we could qualify for Medicaid or Medicare or dying (which would be the likely case with [my wife] because of her severe diabetes and other medical issues which require so many expensive medications). [My daughter] would be simply left out in the cold because of her [deleted] condition. She’d be uninsurable for the rest of her life absent legislation that would change that standard practice by health insurance companies. As it is, even with health insurance, we pay out of our pocket somewhere on the vicinity of $20,000 each year for our insurance, our deductibles under that insurance and then our co-pays after we meet our deductibles. And that number is going to rise. Recent reports in the paper here say that the local insurers who have a monopoly on health care coverage plans in this region (a standard practice across the country) are going to raise their fees between 6 and 20 percent depending on the plan. That’s for one year.
But hey, fight health care reform all you wish. Just do not expect me to agree with you, or to accept uncritically the misleading arguments being promulgated by many of those in Congress who oppose reform. Many of them take huge political contributions from the insurance industry (Republicans and Democrats alike). They know who butters their bread. They also know that universal coverage in other highly developed countries (Canada, France, Japan, Australia to name a few) provides health care to everyone, is much cheaper than what we spend in America for health care for fewer people, and that the evidence that the health care outcomes in those countries is not equivalent to what is provided in the United states is not supported by any credible evidence.