Medical Examiner

Sick Man

Guiliani’s flip-flop on health insurance for kids.

Rudy Giuliani

In his campaign for president, Rudolph Giuliani keeps suggesting that his experience as a prostate cancer survivor makes him uniquely qualified to evaluate the American health care system. To judge from his recent pronouncements, the lesson he learned as a cancer patient is that America has the best health care system in the world. Indeed, Giuliani has implied that without it, he wouldn’t have survived cancer. He thus sees little need, in his prescriptions for reform, for overhauling the system or greatly reducing the number of uninsured. What’s odd about Giuliani’s take is that it is diametrically opposed to what he said he learned from his prostate cancer in 2000, at the time of his actual diagnosis and treatment.

Before his illness, Giuliani the Mayor resembled Giuliani the Presidential Candidate. Both showed little interest in expanding coverage to New York’s poor or uninsured, and both Giulianis gave only tepid support and financial backing to an S-CHIP-style program for New York’s uninsured children. By Giuliani’s own description, however, all that changed when he came face-to-face with his own mortality.

At a packed and emotional news conference in May 2000, in which he announced he was dropping out of the race for the U.S. Senate as a result of his illness, Giuliani admitted to suddenly seeing the world very differently. He said his illness had changed him and that he wanted to reach out to minority groups and the poor. Most important, he said, he had newfound respect, understanding, and empathy for the city’s uninsured. It seems Giuliani couldn’t feel people’s pain until he, well—literally—felt people’s pain. But once he had, he stated that extending health insurance coverage to more of the city’s uninsured was his top goal for his remaining 18 months in office. ”One of the things that I felt from the beginning of [my illness] and continue to feel is a tremendous sense of compassion for the people that have to make decisions like this alone,” he explained. “One of the things maybe that I can do is figure out how we accelerate making sure that people are covered.”

A couple of weeks later, Giuliani made good on his promise. He reversed his administration’s earlier position, which sought to limit government involvement in addressing the problem of the city’s uninsured—especially children. Giuliani announced he was tripling his administration’s financial support for a program called Health Stat, which would aggressively recruit greater numbers of uninsured children for coverage under two existing government-run programs: Medicaid and Child Health Plus.

In other words, in the immediate wake of his own cancer diagnosis, Mayor Giuliani embraced government-run health insurance, or what candidate Giuliani now calls “socialized medicine,” and explicitly tied his change of heart, in deeply personal and emotional terms, to his own experience as a prostate cancer patient. When asked what the tripling of Health Stat would cost, Mayor Giuliani replied he didn’t know, but acknowledged it would be “a good deal of money.” (One estimate at the time put the cost to the city over four years at roughly $390 million.) His message was clear: He didn’t care what it cost, because it was the right thing to do, and he hoped New York would become “a model for the rest of the country.”

And Giuliani didn’t stop there. He later backed up the Health Stat campaign with advertising, and met with clergymen and other religious leaders to help promote his initiative, especially in immigrant neighborhoods where potential enrollees often fear any entanglement with the government. As the New York Times described Giuliani’s efforts in November 2000: “The almost military zeal with which the Giuliani administration has undertaken the Health Stat effort has impressed some health care advocates, who were initially skeptical about the extent of the city’s commitment.” In January 2001, Giuliani further extended the Health Stat program to 700,000 adults in New York City who were eligible for low-cost coverage but had failed to enroll in the relevant state program, Family Health Plus. The eligibility limit for subsidized health insurance at the time was $49,875 for a family a five—or what many Republicans have decried as decidedly “middle-class” in discussions of the S-CHIP bill before Congress.

It now appears that Giuliani has forgotten all about his and other people’s pain, and his previous backing of a significant expansion of the role of government in helping to ease it. Instead, he has tried to change the subject, by talking about what his survival chances would have been if he’d been born an Englishman. He claims that the likelihood of dying from prostate cancer in the United Kingdom’s nationalized health care system is twice that of similar patients in the United States. A difference does exist, but it’s much smaller than Giuliani says, and there’s little reason to attribute the discrepancy to a nationalized system. Other Western democracies have superb government-run systems.

And surely just as relevant is the discrepancy between survival rates—in this country—for those with insurance and those without. Earlier this year, the American Cancer Society made highlighting this discrepancy a focus point of its campaign to reform domestic health care. When Giuliani was seriously ill, he understood how important insurance coverage was to his successful treatment, and as mayor sought to dramatically expand the role of government in broadening the scope of coverage to the uninsured. Now that he’s well, however—and running for the Republican nomination—he apparently can’t remember what it’s like to be sick. How quickly, alas, the healthy forget.