Canadian Straw Man

Summary

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.

Update, Aug. 6: Shona Holmes’ claim that she "would have died" from her condition has been questioned. Please see our Wire post "Dying on a Wait List?" for details.

Analysis

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 claims continue.

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. 

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.

Shona’s Story

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.)

Update, Aug. 6: Holmes says in the ad that "if I’d relied on my government, I’d be dead." Her condition, a Rathke’s cleft cyst, is benign and "not typically life-threatening," according to the Mayo Clinic. We, of course, don’t know what Holmes’ doctors told her, and she has told the Canadian press that her doctors said the cyst would lead to death if not removed. A CBC News article quoted a top Canadian neurosurgeon as saying he thought the claim was "an exaggeration." Please see our Wire post "Dying on a Wait List?" for more information.

Update, Aug. 10: Holmes released a statement to FactCheck.org, saying that her husband "was told in no uncertain terms that if I waited the time scheduled to see specialists back in Canada I would be dead." Holmes is suing the Canadian government for money and can’t release her medical files, she says. "All experts who have reviewed my case, both before and after, made it very clear that I needed surgery within hours to days," she says. "I wish I could release my medical files, but unfortunately I am in litigation trying to recoup my financial loss from the government." We have posted Holmes’ statement in full.

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 July 8.

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 wording.)

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.

Sources

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 2009.

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 2009.

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.