Corinne Ramey

Where Do the Candidates Stand on Health Care? Rudy Giuliani

Rudy's Giuliani's prostate has been in the news recently. It all started when Giuliani launched a radio ad in New Hampshire in which he compared his chances of surviving prostate cancer in the US to his chances in England. In the radio spot Giuliani says,

"I had prostate cancer, five, six years ago. My chance of surviving prostate cancer, and thank God I was cured of it, in the United States, 82%. My chances of surviving prostate cancer in England, only 44% under socialized medicine. You and I should be making the decisions about what kind of health care we get with our doctors, not with a government bureaucrat. What we need to do is to give people a $15,000 deduction for a family, a $7500 deduction for an individual so they can go out and by their own health insurance.”

Let's put the policy suggestion aside for a moment (but don't worry, I'll get there, too). Does Giuliani really have a better chance of surviving prostate cancer in the United States than England? Turns out his numbers are a little fishy. Although there are certainly differences in care between the US and UK -- doctors tend to have different philosophies about how to treat the disease -- mortality rates in the two countries are almost the same. Even Britain's health secretary disputed the ad, saying that the Mayor used erroneous statistics.

The Giuliani campaign got its numbers from City Journal, a publication of the right-wing Manhattan Institute. The article doesn't provide sources for its statistics. Giuliani's campaign staff sent this message to the Washington Post:

"Mayor Giuliani is an avid reader of City Journal and found the passage in the Gratzer article himself. He cited the statistics at a campaign stop, and the campaign used a recording from that appearance in the radio ad. The citation is an article in a highly respected intellectual journal written by an expert at a highly respected think tank which the mayor read because he is an intellectually engaged human being."

I'm glad to hear that the Mayor is an intellectually engaged human being, anyhow, even if that didn't include he or any of his staffers actually checking for the source of the skewed statistics. But on to the actual policy, shall we?

Giuliani is proposing market-based health care, and says that he'll make private insurance affordable through tax deductions. He has proposed income tax credits of up to $7,500 for individuals and $15,000 for families. He also opposes government mandates requiring employers or people to buy insurance. Giuliani says that he wants to increase the efficiency of the evaluation process for new drugs, which he believes is too heavily regulated.

According to Giuliani's website, Giuliani would create health savings accounts, which he says "provide incentives for consumers to maximize the value of services tailored to their needs." However, health savings accounts (HSAs) aren't all that Giuliani makes them out to be. The theory behind the accounts is that people are spending too much on unnecessary health care expenses. If they have to pay for it out of their own pocket then they'll spend less.

But this just isn't the case. Health insurance isn't expensive because Americans are spending unnecessarily. Many of the causes of high health insurance costs are related to high HMO profits and industry expenditures that are unrelated to medical care. For example, the pharmaceutical industry spends between $60 and $82.5 billion each year on marketing and advertising to health care providers. This comes out to over $200 per person in the US, money which would be better spent on actual medicine or preventative care. Additionally, there is evidence that HSAs lead people to actually skimp on preventative care, making health care more expensive in the long run.

Similarly, Giuliani's tax deduction isn't everything it's cracked up to be. Although the numbers sound impressive, the tax credit doesn't get to the root of the the real reason that lower and middle class Americans are struggling to pay the costs of health care and insurance. Since many of the uninsured don't earn enough money to actually pay income taxes, the promise of a tax incentive won't make a difference. If you don't pay any taxes to begin with, what difference will a $15,000 credit make?

Instead, the tax credit will offer an incentive for well-off people to leave their employer plans. Although these healthy people may be able to get cheaper market based health care, they'll be weakening the insurance pool. This will thereby raise the cost of insurance for low-income, elderly, and sicker Americans. One in seven Americans isn't insured today, and lower health care costs -- not just incentives -- are what will really solve health care problems.

And as for those drug regulations, do we really want to get rid of the same regulations that are keeping us safe today? There have been plenty of stories about unsafe drugs and prescription medicines that aren't safe for consumers, and lessening the regulation that we currently have won't necessarily make us any safer. Friday's Times reports that the FDA's "record keeping is so poor that it cannot say" which drugs have been inspected that foreign companies manufacture -- which account up to 80% of ingredients used by American drug makers.

As David Sirota wrote on the DMI blog, Giuliani has been hired by drug industry trade groups and he received over $100,000 in campaign contributions from drug industry executives in the few months he considered running for Senate in 2000. Might Giuliani be just a bit influenced by something besides concern for sick people on this issue?

So maybe Mayor Giuliani needs to take another look at some statistics -- preferably those that don't come from the a source with such a right wing agenda. Maybe if he knew that the US would save an estimated $161,000,000,000 on paperwork if they adopted a single-payer system, or that almost 90 million people under 65 were uninsured for part or all of 2005 and 2006, or that four out of five people uninsured during that time were from working families, he would consider a health care plan that catered more towards the middle class and less to the insurance industry. It's time for Rudy Giuliani to stop talking about his prostate and start talking about a health care plan that will help the middle class.

"Where Do the Candidates Stand on Healthcare?" series continues next week with a look at several other presidential contenders.

Corinne Ramey: Author Bio | Other Posts
Posted at 7:15 AM, Nov 03, 2007 in Health Care | The Candidates on Health Care
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