The List

The Most Outrageous U.S. Lies About Global Healthcare

As the U.S. Congress this summer holds its first serious health-care reform debate since the Clinton era, the resulting public furor has featured increasingly overheated claims about everything from so-called "death panels" to the supposed prowess of America's homegrown medicine. Many of the most wildly inaccurate statements have been directed abroad -- sometimes at the United States' closest allies, such as Britain and Canada, and often at the best health-care systems in the world.

NO HEALTH CARE FOR HAWKING OR KENNEDY

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The lie: Stephen Hawking (who has Lou Gehrig's disease) and U.S. Sen. Edward Kennedy (who has brain cancer) would not receive treatment in Britain, which has a government-run health-care system.

The liars: An editorial in Investor's Business Daily on July 31 claimed: "People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service [NHS] would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

U.S. Sen. Chuck Grassley of Iowa -- the senior-most Republican on the Senate Finance Committee, which must approve health-care bills -- said Aug. 5 during a radio interview with Iowa City's KCJJ, "Ted Kennedy -- with a brain tumor, being 77 years old as opposed to being 37 years old -- if he were in England, would not be treated for his disease because ... when you get to be 77, your life is considered less valuable under those systems."

The debunking: In both cases, this is nonsense.

Hawking, who is British, receives intensive treatment for his degenerative motor neuron disease at a local Cambridge hospital. Upon hearing the rumors of his non-treatment, the prizewinning theoretical physicist told The Guardian, "I wouldn't be here today if it were not for the NHS. I have received a large amount of high-quality treatment without which I would not have survived."

In Kennedy's case, it is true that Britain assesses the cost-effectiveness of procedures and medicines before deciding whether to prescribe them. And the NHS does deny some procedures and drugs based on considerations such as the severity of a patient's sickness, the cost of treatment, and the quality of life afforded. But doctors and NHS officials have stressed that Britons with Kennedy's condition, regardless of age, would receive aggressive treatment, including surgery, radiation therapy, and chemotherapy.

The chief executive of Britain's National Institute for Health and Clinical Excellence (NICE), which determines the rationing system, told The Guardian, "It is neither true nor is it anything you could extrapolate from anything we've ever recommended" that Kennedy would be denied treatment by the NHS.

Thus far, neither Kennedy nor Grassley have commented since Grassley's initial remark.

CANADIANS HEAD TO THE UNITED STATES FOR URGENT CARE

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The lie: Canada's government-run health care is so bad that needy patients need to pay for care in the United States.

The liars: The advocacy group Patients United Now is running a television ad featuring Ontario resident Shona Holmes, who claims, "I survived a brain tumor, but if I had relied on my government health care, I'd be dead." She says she traveled to the United States for lifesaving treatment.

In June, Sen. Mitch McConnell, a Kentucky Republican, said, "For cardiac bypass surgery, patients in Ontario are told they may have to wait six months for a surgery that Americans can often get right away."

The debunking: Holmes did indeed pay $100,000 for care she received from Minnesota's famed Mayo Clinic, considered one of the best medical centers in the world.

But Holmes' treatment was not a lifesaving anti-cancer measure. The Mayo Clinic's own Web site explains that she had a cyst -- not a brain tumor -- which was not necessarily life-threatening. (It also explains that Mayo is a nonprofit cooperative and strongly supports health-care reform.)

In general, Canadians are not flocking south for health care, and for good reason. According to a report from the Fraser Institute, a prominent Canadian think tank, both the Canadian and U.S. governments spend about 7 percent of their GDPs on health-care costs. (The United States, including private expenditure, spends about 16 percent of GDP on health care.) But all Canadians are covered for all medical care, plus some prescription drug costs. In the United States, 47 million are uninsured, and hundreds of thousands declare bankruptcy every year due to medical bills.

There are wait times in Canada, but nobody waits for emergency surgery; McConnell's claim about bypass patients is untrue. In 2007, a non-emergency patient in Ontario waited about 61 days for elective bypass surgery, according to Canada's health service. Such collected data is not made public in the United States.

HEALTH CARE IN EUROPE ONLY WORKS BECAUSE OF SINGLE-PAYER

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The lie: European countries all have long-standing single-payer systems -- which is why their health-care systems work.

The liar: Howard Dean, the former chairman of the Democratic National Committee, recently said, "The Europeans all have single-payer [systems] because essentially their health-care systems were destroyed during World War II. And they went to a single payer ... and then it turned out they loved it and didn't want to get away from it afterwards."

The debunking: This is an overgeneralization.

Europe has a broad range of health-care systems and health insurance plans; not all European countries are single-payer. It's an amorphous term, but usually denotes a system in which the government pays the medical bills, but doctors and hospitals are private, such as in Canada, France, and Germany. (In socialized systems, such as Britain's NHS or the U.S. Veterans Affairs Department, the government pays the doctors and owns the hospitals.)

Rather than a single post-World War II wave of health-care reform, numerous European countries have experimented to find systems that work. For instance, both Switzerland (in 1994) and the Netherlands (in 2006) moved to models the United States is now considering. Hospitals, doctors, and insurers are for-profit and private. But the systems are highly regulated, and insurance is mandatory and government-subsidized.

CANADA AND BRITAIN MAKE YOUR HEALTH CARE CHOICES FOR YOU

The lie: In Canada and Britain, individuals lose the right to make their own health-care choices.

The liars: The advocacy group Club for Growth and the Republican National Committee (RNC)

The debunking: Both the RNC and the conservative Club for Growth have warned that a government takeover of health care would put a bureaucrat in between patient and doctor -- as in Britain and Canada.

The latter group's ad ominously announces: "$22,750. In England, government officials decided that's how much six months of life is worth. Under their socialized system, if a medical treatment costs more, you're out of luck."

This is not true. Patients in Canada and Britain retain autonomy to help decide upon their courses of treatment and to choose their own doctors.

In England, the $22,750 figure represents not what "six months of life is worth," but the price at which the NICE determines a single drug is not cost-effective. Exceptions to the ceiling are permitted in some cases; and Britons retain the option to pay for private care. (In which case, rationing occurs as it does in the United States: Those with ability to pay do so.) The system is designed to prevent one of the key reasons for high health costs in the United States: With limited medical knowledge, patients assume the most expensive option is the best.

A NICE representative told The Guardian the ad is "a gross misrepresentation of how [the agency] applies health economics to try and address the central issue: how to allocate health care rationally within the context of limited health-care resources."

THE UNITED STATES HAS THE BEST HEALTH CARE IN THE WORLD

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The lie: The United States has the best health care in the world.

The liars: A slew of U.S. presidents, politicians, journalists, commentators, and everyday citizens

The debunking: There is one yardstick by which U.S. health care distinguishes itself: cost. The United States spends more -- in total dollars, percentage of GDP, and per capita -- than every other country on Earth.

On virtually every other broad metric, the claim that U.S. health care stands for global excellence is demonstrably false. The United States doesn't take a top spot in either the World Health Organization or nonpartisan Commonwealth Fund rankings. The American health-care system is not best in terms of coverage, access, patient safety, efficiency, or cost-effectiveness. It does not produce the best outcomes for diseases such as cancer, heart disease, or diabetes; for the elderly, the middle-aged, or the young; or in terms of life expectancy, rates of chronic diseases, or obesity.

Which countries do come out on top? Often -- France, Switzerland, Britain, Canada, and Japan. On the World Health Organization's list, the United States comes out 37th.

The List

Five Urgent Homework Assignments for Congress

It's August, when U.S. lawmakers take time off to visit their home districts or travel abroad. But there's a pile of critical work waiting for them once the vacation's over.

LET GATES AND HOLDER HAVE THEIR TEAMS

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Pending: Congress took off for its August recess with 10 nominees for the Department of Defense and Department of Justice left in the lurch, awaiting confirmation. These include New York Rep. John McHugh, nominated for Secretary of the Army, Joseph Westphal, who is up for under secretary of the Army, and Juan Garcia, who would be assistant secretary of the Navy.

What’s the problem? Kansas Sens. Sam Brownback and Pat Roberts have placed a legislative hold on the nominees, not due to any objections to the candidates, but to protest the Obama administration’s decision to try Guantánamo Bay detainees at the military penitentiary at Fort Leavenworth, in their home state. Brownback and Roberts are demanding personal briefings by Gates and Holder on the detention issue, further analyses on the costs of relocating the prisoners, and more information on the detainees being moved.

Leaving aside the NIMBYism and short-sightedness of Brownback and Roberts’s objections, holding apparently qualified defense and judicial appointees hostage during a time of war is not really the best way to make your point. If these senators believe that closing Guantánamo would put the country at greater risk, how do they justify making it harder for these critical departments to do their jobs? Even the conservative Washington Times, which supports the two Republican senators’ position on the detainee issue, has chastised them for their tactics.

These are far from the only appointees being held up for dubious reasons. “Regulatory czar” Cass Sunstein’s appointment has been put on hold by Texas Sen. John Cornyn, who believes the Harvard law professor might institute legal rights for livestock.

PASS A FREE TRADE AGREEMENT. ANY FREE TRADE AGREEMENT

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Pending: Free trade agreements with Colombia, South Korea, and Panama have been awaiting congressional approval for years

What's the problem? President Obama spent much of his meeting with Mexican and Canadian counterparts this week defending "buy American" provisions in the U.S. stimulus act, but Congress has bigger trade issues to tackle. A free trade agreement (FTA) negotiated with Colombia in November 2006 is still waiting for congressional approval after then President George W. Bush tried and failed to push it through in 2008. Agreements with South Korea and Panama signed in 2007 are also in the queue.

The Obama administration has expressed reservations about some of the agreements, and conducted meetings with Korean trade representatives to renegotiate portions of the FTA seen to unfairly favor Korean automakers. It has also pledged to review labor and human rights standards in the Colombian agreement, a top concern of Democrats and their labor movement allies last time Congress addressed the issue. Obama's Office of the U.S. Trade Representative has submitted the both the Colombia and Korea agreements for public comment until Sept. 15. At this point, Congress will once again have the opportunity to debate and ratify the agreements.

In the meantime, however, costs are rising. The U.S. Department of Commerce estimated in 2008 that in two years since the FTA with Colombia was first signed in 2006, U.S. exporters had paid more than $1 billion in Colombian tariffs that the agreement would have eliminated. South Korea just signed a massive trade agreement with the European Union, causing the Wall Street Journal editorial board to issue rare praise for European economic policy, and worry that U.S. businesses will lose out. Local resentment in each of the three countries is also growing, most notably in Panama and Colombia, which are themselves struggling with the consequences of global recession.

MAKE A REAL STATEMENT ON CLIMATE CHANGE

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Pending: The American Clean Energy and Security Act of 2009, better known as the Waxman-Markey bill, was passed by the House on June 26, 2009. The Senate will begin debating its own version after the recess.

What's the problem? With the Copenhagen Climate Change conference approaching in December, it's critical that the United States take a meaningful measure to reduce its carbon footprint, for its own credibility on the issue if nothing else. Waxman-Markey would require a 17 percent emission reduction by 2020 and a cap-and-trade scheme to allow private firms to trade emissions rights. The bill is not quite as aggressive as environmentalists hoped for, but still better than nothing.

Waxman-Markey passed in the House by only seven votes and may face an even tougher struggle in the Senate. Opponents are building grassroots momentum against the bill, particularly in Midwestern states heavily reliant on industries on corn, coal, or other fuel sources. Indiana Sen. Richard Lugar received more than 8,000 letters opposing the bill in July alone.

In other words, passing a version of Waxman-Markey is not going to be cheap. The House version grew to nearly 1,500 pages with earmarks and giveaways for industry and congressional pet projects. Lobbyists are already setting their sights on the Senate's bill. The only good news? 71 percent of U.S. voters support the bill and half believe it will create jobs.

CUT OUT THE DEFENSE PORK

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Pending: The 2010 Department of Defense Appropriations Act was passed by the House on July 30 and awaits a vote in the Senate after recess

What’s the problem? Advocates of military appropriations reform thought they finally had a friend in Defense Secretary Robert Gates, who vowed to completely overhaul the process and cut needlessly expensive weapons systems out of the department’s budget request. Gates scored a major symbolic victory in phasing out the $2.9 billion per year F-22 Raptor Program. But the Defense Appropriations Subcommittee, led by Pennsylvania congressman and notorious pork-barreler John Murtha, wasn’t going to let Gates off that easy.

Still in the budget are big-ticket items like $400 million to build a new presidential helicopter that President Obama doesn’t want, $674 million for new C-17 cargo planes, and $80 million for a missile-defense system that is billions over budget, behind schedule, and likely doesn’t work (but is largely assembled in Murtha’s district). Perhaps most egregiously, the committee tried to add $330 million to the Air Force’s budget -- that the Air Force didn’t request -- to buy private jets to transport senior government officials.

That program was cut out of the bill before it was finally passed, but the Senate needs to take a much bigger axe to the budget. The defense appropriations process is fundamentally flawed -- driven by the parochial priorities of members of Congress rather than U.S. defense needs -- and urgent action is needed.

REPAIR FOREIGN AID

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Pending: The Initiating Foreign Assistance Act of 2009 in the House of Representatives and Foreign Assistance Revitalization and Accountability Act of 2009 in the Senate are still being debated in committee

What's the problem: For too long, foreign aid from the United States has been crippled by ineffective management, congressional earmarks, and short-term planning more focused on superficial "success stories" to bring to Congress than real results. With reform bills underway in both houses, genuine progress could be on the way.

Neither bill is particularly shocking or revolutionary, but each puts a premium on transparency and long-term planning. The Senate bill, for instance, requires all aid agencies to provide "comprehensive, timely, comparable and accessible information" about all aid programs online, on a program-by-program and country-by-country basis.

Passing these reform bills is an important first step, but Congress can do much more. After the recess, it should help the Obama administration fill vacancies as quickly as possible, and start by confirming an administrator for the U.S. Agency for International Development, which has been without an officially appointed leader for almost seven months.

Additionally, Congress ought to focus foreign assistance more on the recipients and less on their constituents. As the Rev. David Beckmann, president of the NGO Bread for the World, sarcastically told the Washington Post, "In the USAID budget, every dollar has three purposes: help build an Air Force base, support the University of Mississippi, get some country to vote our way." This is not an acceptable situation.