Friday, May 29, 2009

Government-Run Health Care?

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A group called Conservatives for Patients' Rights began airing a television ad this week that criticizes government-run health care and falsely suggests Congress wants a British-style system here in the U.S.:

The ad neglects to mention that President Obama hasn't proposed a government-run plan and, in fact, has rejected the idea.

It claims that a research council created by the stimulus bill is "the first step in government control over your health care choices." The legislation actually says the council isn't permitted to "mandate coverage, reimbursement, or other policies."

The ad quotes a Canadian doctor who has been critical of his country's system, but leaves out the fact that the doctor has praised other government-funded systems, such as those in Austria and France.


Conservatives for Patients’ Rights is, as its name indicates, a conservative group, and it’s also quite obviously not a proponent of government-run health care. Its minute-long ad was launched April 27 with what the group said was a month-long $1 million buy. (We've seen it on CNN several times this week.) CPR was launched this year and is led by Rick Scott, former head of Columbia/Hospital Corporation of America.

The ad states that government-run health care systems, in particular those in Britain and Canada, take control away from patients and ration health care. CPR is certainly entitled to state its own view. But the ad implies that the U.S. Congress wants to implement a health system like those in Britain and Canada. That's contrary to what President Obama and Democratic leaders in Congress have said.

Obama hasn’t called for such a government-run plan, also called a “single-payer" plan. In fact, he has flatly rejected it. The administration has said on the White House’s “Health Care” Web page (and previously on its transition site) that “President Obama and Vice President Biden believe” that government-run health care is “wrong.” And they also believe, the administration says, that the other extreme, “letting the insurance companies operate without rules,” is wrong. (The White House redesigned its health care page on April 30; a cached page with the quoted language is attached to this article.)

Obama has long said he would allow individuals or small businesses to buy insurance through a public plan – like the one now available to members of Congress. But nobody would be forced to drop his or her current insurance, and private plans would exist as they do now. This was the health care plan he promoted as a presidential candidate.

As we pointed out several times during the campaign, Obama's proposal was mischaracterized as a Canadian-style plan by his opponents. In Canada and Britain, all citizens have health care coverage, provided by the government and paid for with taxes. Only two Democrats ran for president on a single-payer platform: Rep. Dennis Kucinich, who called for "Medicare for all," and former Sen. Mike Gravel. Clarification, May 1: Gravel has called his plan a “single-payer Health Care Voucher plan,” paid for by the government. But advocates have said it’s not a true single-payer plan, since private insurance would still play a role.

More recently, single-payer advocates have felt shunned by the White House and Congress as the debate over changing the U.S. system has begun. In early March, no single-payer advocate was invited to a White House summit on health care, leading reporter Russell Mokhiber to suggest that Obama's message to such groups was to "drop dead." A day before the summit, the White House extended invitations to the president of Physicians for a National Health Program (which had been planning to protest the event), and government-health-care-backer Rep. John Conyers. The Wall Street Journal noted that they were but two out of more than 100 attendees.

Furthermore, some of the CPR ad’s assertions are misleading.

Recycled Stimulus Claims

In the ad, Scott, chairman of CPR, speaks to the camera, saying that "Congress buried an innocent-sounding board" in the stimulus bill, called the Federal Coordinating Council for Comparative Effectiveness Research. He says "it’s the first step in government-control over your health care choices." Actually, the stimulus legislation gives this council no authority to dictate insurance or medical policies.

We’ve written about the stimulus-created council before – and similar claims being made about it. The council is charged with supporting and coordinating comparative effectiveness research (something the government has funded since the late ‘70s). It is scientific research into which medical treatments are most effective and, in some studies, which are most cost-effective. Research may compare different drugs or different types of treatment; it can look at medical benefits, or benefits and costs.

To be sure, this type of research has its supporters and critics (see our previous article for more on that), but saying it will lead to “government control” over health care is Scott’s opinion. The stimulus legislation specifically says the council won’t issue any kind of health care requirements. At the end of the section describing the council, the legislation says:

American Recovery and Reinvestment Act of 2009: Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer. ... None of the reports submitted under this section or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment.

The support CPR sent us for the ad also includes a press release from the Department of Health and Human Services that states: "The council will not recommend clinical guidelines for payment, coverage or treatment."

The group's public relations representative told us that while some critics of the ad have said the law prevents the council from limiting health care choices based on costs, the acting director of NIH had said the opposite. But NIH Acting Director Raynard Kington didn't say anything about putting cost-based restrictions on anyone's health care. Kington told the House Appropriations Committee that "if we receive high-quality applications that meet the definition for comparative effectiveness research that include cost we will fund them." Funding research into which treatments give the best results for the least money is one thing, and it is a big leap from there to a government decree restricting care. Anyway, NIH has been backing "cost-effectiveness research" for years. In a breakdown of funding categories, NIH estimates that it specifically supported about $50 million in such research in both 2007 and 2008.

In the House committee hearing (held March 26), Rep. Todd Tiahrt of Kansas expressed concern that such research would "lead to rationed health care." Kington, a physician, responded: "I certainly understand the concern that any policy effort might severely restrict choices in whatever way. But comparative effectiveness research doesn't necessarily lead to that. Comparative effectiveness research can provide useful information to clinician, to patients and providers that make better decisions about what works under what circumstances for which patients and might actually complement the movement that you noted toward personalized medicine."

A National Health Board?

In the ad, Scott also says the federal council is “modeled after the national board that controls Britain’s health system.” That’s not quite right.

Britain does have a board that conducts comparative effectiveness research. It’s called the National Institute for Health and Clinical Excellence (NICE), and it “produces guidance on public health, health technologies and clinical practice.”
But NICE is a part of the National Health Service. And it is that larger board that actually controls the British system.

NICE also has much broader powers than the comparative research council created by the stimulus bill: For instance, NICE issues guidance for prevention efforts and treatment, and it approves drugs for use.

CPR's support for these claims is an editorial from the conservative Investor's Business Daily. The opinion piece repeats several false claims about the stimulus bill that we previously debunked. For one, it states that the federal council will "decide which treatments you should get," despite the fact that the law specifically forbids this.

Suspect Testimony

The CPR ad quotes two health experts from countries with national health care, Britain and Canada, criticizing the way their governments run the health care systems.

Dr. Brian Day, a Canadian surgeon who was president of the Canadian Medical Association last year, is quoted in the ad saying that "patients are languishing and suffering on wait lists" and "actually dying as they wait for care." Day is certainly not a fan of nationalized health care as it's practiced in his country, arguing that it's inefficient and doesn't provide enough care. But he's no fan of the U.S. system, either. "I do not profess to know how to reform the US system other than to opine that, in terms of value for money spent, yours is the only one in the free world that is worse than ours," Day told us. In a statement on his Web site, Day praises the health care systems of countries like Switzerland, Austria, France, Belgium and Germany, all of which have nationalized health care. The quotes CPR uses in its ad accurately reflect Day's opinion of Canadian health care, but the context implies that he opposes national health care in general. In fact, he believes that national health care as it's practiced in Canada needs serious reforms – reforms that will make it more universal, not less.

Britain's Dr. Karol Sikora, who is also quoted in the ad, has written several columns taking issue with the health care system in his country, too. He told us in an e-mail message that the ad was "fine by me."

Footnote: In the ad, Dr. Day correctly refers to a 2005 Canadian Supreme Court case, Chaoulli v. Quebec, in which the court found that "delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care." The United States also has preventable health-care-related deaths, though not necessarily from delays. A Commonwealth Fund study found the U.S. leading 19 industrialized countries in the number of deaths that could have been prevented by better health care – 110 deaths per 100,000 people, versus 103 in the U.K. and 77 in Canada. For more on U.S. versus Canadian health care speed and quality, see our Ask FactCheck on the subject.

– by Lori Robertson and Jess Henig

Update, May 1: CPR has posted a response on its Web site, which the group has also sent to us, claiming that parts of this article are "blatantly erroneous" and adding, "Accordingly, we request that you remove this article from the ‘Fact Check’ site and issue any retractions to other media outlets as necessary."

We think that's nonsense. We don't remove or retract any of our criticism of this group's very misleading ad.

CPR argues that its ad does not claim that Congress or Obama were trying to adopt any specific country’s health care system, but merely “points out the pitfalls of government-run health care.” We invite readers to look at the ad and judge the credibility of that for themselves. We said this ad suggests and implies that Congress is moving toward adopting a Canadian- or British-style system of government-run health care, and we think that judgment puts matters mildly.

CPR then goes on to argue that Congress and Obama really do favor a single-payer system after all. But those claims fall short as well. CPR says "several" members of Congress support single-payer health care and mentions one bill that it says attracted 76 House cosponsors. That’s still a minority of Democrats, and this same bill died quietly in committee in the last Congress. The current bill hasn’t moved from committee since late January when it was introduced. Sen. Max Baucus, who is spearheading the health care effort, has said that “single-payer is not going to get even to first base in Congress.”

CPR further states that Obama "has previously voiced support for a government single payer plan." That was true six years ago, but once again is not the whole story. Obama said at a 2003 AFL-CIO forum that he was “a proponent of a single-payer health care program,” adding, “that’s what I’d like to see. And as all of you know, we may not get there immediately.” His stated position has changed over the years, however. He said in a 2007 magazine interview that he’d favor single-payer only if “starting from scratch” and that managing a transition from the current system to a single-payer system "would be difficult to pull off." And the fact remains, as we said in our article, the proposal he campaigned on was not a single-payer plan, and the administration recently said a government-run system is “wrong."

Correction, May 6: We originally wrote that PNHP had said Obama’s message to single-payer advocates was to “drop dead.” But the phrase was used in an article by Russell Mokhiber of the Corporate Crime Reporter newsletter; PHNP had posted his article on its site. We have changed the attribution above.

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