Government-Run Health Care?

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.