2009-07-23 18:22:16 UTC
Canadian Straw Man
July 17, 2009
More ads claim that Congress is pushing a Canadian-style health care
Two ads from related independent groups make claims about an overhaul
of the health care system, saying Congress wants a government-run
health care system:
One ad claims that “Washington wants to bring Canadian-style health
care to the U.S.” But the health care bills moving through Congress
don’t call for a single-payer system like Canada’s, and legislation
that does support a purely government-run system is quietly dying in
committee. Obama, too, has said repeatedly that he doesn’t back a
conversion to a single-payer system.
Another ad, targeting specific members of the Senate, similarly claims
that “Congress is rushing to take over health care.” It says that a
government health insurance option would cause “tens of millions” to
move from their current insurance to a government plan. That claim is
on the mark, according to one study, which found that millions would
move from private insurance to a much cheaper government option.
We've written before about conservatives claiming that Congress, or
Obama, or Washington, or Democrats in general want the U.S. to have a
Canadian-style, government-run health care system. The truth of the
matter is that the president has repeatedly said he doesn't. In fact,
since being sworn in as president, Obama has riled advocates of such
single-payer systems by largely excluding them from the health care
debate. He has answered several questions from members of the public
who asked at town hall events: "why not" have such a system. Sen. Max
Baucus of Montana, chairman of the Senate Finance Committee and one of
the leaders in drafting legislation, has said bluntly: "single-payer
is not going to get even to first base in Congress." Yet, the Canada
In an ad airing (for the third time this year) on national cable
channels, a group called Patients United Now says that "Washington
wants to bring Canadian-style health care to the U.S." The group's
back-up for the claim? An opinion piece that we previously found to be
riddled with errors; an article from CQ.com that says the National
Institutes of Health will fund comparative effectiveness research
studies that examine cost – which, the article notes, the NIH already
does; and another news article in the San Francisco Chronicle that
reported conservatives have criticized such research, saying it leads
to "rationing," while proponents have said it will improve health care
and reduce costs.
Patients United Now: "Survived"
Shona Holmes: I survived a brain tumor. But if I’d relied on my
government, I’d be dead. I’m a Canadian citizen. As my brain tumor got
worse, my government health care system told me I had to wait six
months to see a specialist. In six months, I would have died.
Announcer: Government runs health care in Canada. Care is delayed – or
denied. Some patients wait a year for vital surgeries – delays that
can be deadly. Many drugs and treatments aren’t available– because
government says patients aren’t worth it.
Holmes: I’m here today because I was able to travel to the US, where I
received world-class treatment. Government health care isn’t the
answer. And it sure isn’t free.
Announcer: Now, Washington wants to bring Canadian-style health care
to the US. Government should never come between your family and your
doctor. Learn more at PatientsUnitedNow.org.
Holmes: My advice to Americans? As patients, it’s your care. Don’t
give up your rights.
As we've said before, the stimulus legislation, the American Recovery
and Reinvestment Act, called for the creation of a council that would
coordinate and support comparative effectiveness research, which
examines which medical drugs and treatments are most effective, and in
some cases, most cost-effective. The government has funded such
studies since the late '70s. In this chart of research funding, the
NIH estimates it will have spent $50 million on "cost effectiveness
research" each year from 2007 to 2010.
To be sure, the cost factor prompts critics to say the research will
lead to the government, or perhaps insurance companies, denying
certain medical procedures based on cost alone. Proponents say such
research provides valuable information to the public and physicians on
which procedures work best and whether more costly treatments are
actually more effective. Patients United Now, a 501(c)3 project of
Americans for Prosperity Foundation, says in its back-up that funding
comparative studies is "a critical step toward rationing," but ARRA
specifically forbids the council coordinating such research from
issuing any restrictions or even guidelines on care:
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.
Patients United Now also points to Rep. John Conyers' "Medicare for
all" legislation, a single-payer health care bill that the Michigan
congressman has introduced for several years running. This year,
Conyer's bill, H.R. 676, was introduced in January and hasn't moved
from committee since. It quietly died in committee in the last
Congress and in previous attempts.
The ad begins with an emotional story from Shona Holmes, a Canadian
who says she would have had to wait six months to see a specialist
about a brain tumor. Instead, she traveled to the United States – the
Mayo Clinic in Arizona – to pay for faster treatment that restored her
deteriorating vision. Holmes' story has appeared in several newspaper
articles, and she has spoken to the House Energy and Commerce
Committee. An article on Shona's case on the Mayo Clinic's Web site
quotes her neurosurgeon as saying, "We needed to remove the cyst to
save her vision."
Her case and another, of Lindsay McCreith, who traveled to Buffalo,
N.Y., to have surgery on a brain tumor, are well known. Both filed
suit in Ontario to overturn laws that effectively ban citizens from
having private insurance or paying for care themselves. (Similar
provisions in a Quebec statute were struck down by Canada's Supreme
Court in June).
The ad goes on to claim that "[s]ome patients wait a year for vital
surgeries." We can't say how many "some" are, but the back-up for the
ad points to one case in Ontario in which a man waited nearly a year
for skull replacement surgery. Another article in the Globe and Mail
in January 2008 cited a study conducted for the Canadian Medical
Association that found while most Canadians get treatment within
recommended wait times, some don't. "The average Canadian patient who
was not treated within the medically acceptable period in 2007 waited
a year for a hip or knee replacement and seven months for cataract
surgery," the Globe and Mail reported.
We certainly won't argue with anyone's desire to get surgery –
particularly for a brain tumor – sooner rather than later. But as
we've said about other ads, all this sets up a straw man argument,
criticizing Canada's health care system despite the fact that a purely
government-run system isn't what's being seriously considered in
Congress or being proposed by the president.
Government Running Health Care?
Another group, a 501c(4) called Patients First and backed by Americans
for Prosperity, has another ad on the airwaves, this one targeting 12
senators. The one-week, $1.3 million ad buy was announced by the group
AFP Patients First Ad
Announcer: Washington now runs your banks, insurance and car
companies. But do you trust Washington with your life? Congress is
rushing to take over healthcare too, paid for by $600 billion in new
taxes, and cutting $400 billion from Medicare. Plus, tens of millions
will lose their current insurance, and wind up on the government
health plan. What will happen to your family's healthcare if
Washington runs it? Tell Senator Warner to vote no on government run
The ad asks, "[D]o you trust Washington with your life?" and claims
that "Congress is rushing to take over healthcare too."
As we've said, not so much. But the ad also refers to a public health
insurance option, like Medicare, that some in Congress want to see as
part of an overhaul of the health care system. The numbers on taxes
and cuts (others would say "savings") to Medicare refer to draft
legislation being written by legislators in the House, who, according
to the Bloomberg News article cited in the ad, were still negotiating
on the inclusion of a government insurance option. Since then, a House
bill has been released, and it does contain such a provision.
The Patients First ad says that "tens of millions will lose their
current insurance, and wind up on the government health plan." That's
based on an analysis by the Lewin Group, which says it operates
independently as part of UnitedHealth Group, owner of the insurer
United Healthcare. Comparing the House bill to Lewin's findings, the
government plan, which would be significantly cheaper than private
plans, would attract about 43 million people, 32 million coming off of
private coverage. That's "tens of millions," as the ad says, and we'll
note again that the ad was released before the details of the House
bill were announced. According to the study, there also would be a
reduction in the number of the uninsured of 27 million. Those numbers
are based on enrollment in the public plan being only open to small
firms and individuals, and payments to doctors and hospitals being
similar to Medicare rates. The House plan would pay doctors Medicare
rates plus 5 percent. A Senate bill that passed the Health, Education,
Labor and Pensions Committee also proposes a public option open to
individual and small businesses; reimbursement rates would be
negotiated, however, which could well lead to fewer people moving to a
government plan. (For more on the Lewin Group study, see our previous
article about a health care ad that wasn't so careful in its
Lewin's estimate is just that, however, and the Congressional Budget
Office projected different numbers in an analysis of these two bills.
The CBO estimated that fewer people would take up the public option
under the House bill, finding that "total enrollment in the public
plan would equal about 11 million or 12 million, counting both
individually purchased policies and employer-sponsored enrollees." As
for the Senate bill from the HELP committee, the CBO said its public
option "did not have a substantial effect on the cost or enrollment
projections, largely because the public plan would pay providers of
health care at rates comparable to privately negotiated rates."
Different versions of this ad are aimed at 12 Democratic senators:
Mark Warner of Virginia, Evan Bayh of Indiana, Ben Nelson of Nebraska,
Mary Landrieu of Louisiana, Tim Johnson of South Dakota, Blanche
Lincoln of Arkansas, Max Baucus of Montana, Kent Conrad of North
Dakota, Harry Reid of Nevada, Mark Begich of Alaska, Michael Bennet of
Colorado and Thomas Carper of Delaware.
– by Lori Robertson
Correction, July 20: We originally wrote that one version of the ad
was aimed at Sen. John Warner of Virginia. He's a former senator; the
ad targets Sen. Mark Warner.
Galloway, Gloria. “Wait for surgery savages economy, doctors say.” The
Globe and Mail, 15 Jan 2008.
Congressional Budget Office. Letter to Rep. Charles B. Rangel. 14 Jul
Sheils, John and Randy Haught. “The Cost and Coverage Impacts of a
Public Plan: Alternative Design Options.” Lewin Group. 6 Apr 2009.
American Recovery and Reinvestment Act of 2009. Pub. L. 111-5. 17 Feb
U.S. National Institutes of Health. Estimates of Funding for Various
Research, Condition, and Disease Categories. NIH.gov. 15 Jan 2009,
accessed 16 Jul 2009.
Mayo Clinic. Profile: Shona Holmes. Mayo Clinic Web site. Summer 2007.
Reichard, John. "NIH Chief Doesn’t Rule Out Cost Component to
Comparative Studies." CQ Healthbeat News. 26 Mar 2009.