• Romney claimed that the 47 million Americans who lack health care are not covered because they say "I'm not going to play. I'm just going to get free care paid for by everybody else." Experts say that very few who are offered insurance turn it down and that the uninsured get worse care.
  
  
• Giuliani falsely blamed President Clinton for cuts in the military that occurred in large part under President George H.W. Bush and Secretary of Defense Dick Cheney. He said that “the Army had been at 725,000; it’s down to 500,000.” That’s true, but it was down to 572,423 by the time Clinton took office.
  
  
• McCain recalled that he "strongly disagreed" with Defense Secretary Donald Rumsfeld and had "no confidence" in his Iraq strategy "at the time." But he didn't say publicly that he had no confidence in Rumsfeld until December 2004, after Bush was reelected and well after the war began.
  .
• Romney falsely denied that an attack ad called McCain’s immigration bill "amnesty," though it does. One of his Web ads also attacks McCain for supporting "amnesty." He conceded during the debate that McCain’s bill "technically" isn’t amnesty.

• Giuliani claimed that "economists" say health insurance rates would fall by up to 50 percent if millions more shopped for policies individually. Once again, his campaign was unable to produce a single economist who supports that figure.
  
  
• Romney claimed his Massachusetts state insurance program had reduced the number of uninsured in Massachusetts by 300,000. That’s the number who have gained coverage under the system, but many were covered previously through other means.

 

The (slightly) narrowed Republican field debated at Saint Anselm College in Manchester, N.H. Former New York City Mayor Rudy Giuliani, former Arkansas Gov. Mike Huckabee, Sen. John McCain, Rep. Ron Paul, former Massachusetts Gov. Mitt Romney and former Tennessee Sen. Fred Thompson took part. Charles Gibson of ABC and Scott Spradling of WMUR-TV moderated.

Romney's Freeloaders

Romney offered a theory for the number of uninsured that is simply false:

Romney: And the reason health care isn't working like a market right now is you have 47 million people that are saying, "I'm not going to play. I'm just going to get free care paid for by everybody else." That doesn't work.

This idea – that most uninsured Americans simply don’t feel like having health insurance – has been heard before from this year’s GOP field. We addressed it here, after Huckabee claimed at a Dec. 10 debate that a third of the uninsured "think they’re healthy and invincible." Experts say this is simply not the case: Most people who are offered insurance do not turn it down, neither because of perceived invincibility nor from an unwillingness to "play" the insurance game.

The National Academies report that "only 4 percent of all workers ages 18 to 44 (roughly 3 million people) are uninsured because they decline available workplace health insurance, and many do so because they cannot afford the cost." A 2007 study published in Health Affairs found that 56 percent of the uninsured were neither eligible for public coverage nor able to afford insurance without assistance.  This study also found that 20 percent of the uninsured could have afforded coverage, but even leaving aside other factors like being turned down for insurance, that’s hardly 47 million people refusing to “play.”

Romney is also misleading when he implies that the uninsured are simply choosing between toeing the line and freeloading as two roughly equal ways of obtaining health care. While uninsured individuals can get a certain amount of free emergency care, it is by no means comparable to the care given to those with insurance. The Kaiser Family Foundation reports that the uninsured have less access to care, are more likely to be hospitalized, are often financially unable to follow treatment plans, get less preventive care and are in general poorer health than the insured. Poorer health among the uninsured could also affect their ability to purchase private coverage, since insurance companies often reject individuals with preexisting conditions.

Rudy's Historic Rewrite

Giuliani falsely blamed President Clinton for cuts in the military that happened mostly under a Republican administration:

Giuliani: Bill Clinton cut the military drastically. It's called the peace dividend, one of those nice-sounding phrases, very devastating. It was a 25, 30 percent cut in the military. President Bush has never made up for that. We – our Army had been at 725,000; it's down to 500,000.

Actually, most of the cutting to which Giuliani refers occurred during the administration of George H.W. Bush. At the end of fiscal year 1993 (which was Bush’s last one in office), the Army had 572,423 active-duty soldiers – a far cry from 725,000. In fact, to get to that number, one has to go back to 1990, during the first gulf war. Moreover, Clinton’s cuts in the military, while large, were nowhere close to 25 percent to 30 percent. Between 1993 and 2001, the Army went from 572,423 to 480,801, which is a decline of 16 percent. The entire military went from 1,705,103 to 1,385,116, a decrease of 18.8 percent.

Compare that with the far larger cuts made during the first Bush administration: In 1989, the military stood at 2,130,229 and the Army had 769,741 soldiers. By 1993, those numbers had declined by 19.9 percent and 25.6 percent, respectively.

And as we’ve pointed out before, it was the first Bush administration – specifically then-Secretary of Defense Dick Cheney – that began bragging openly of the peace dividend.

McCain’s Questionable Timeline

In his rush to criticize Donald Rumsfeld’s defense strategy, Sen. John McCain did some rewriting of his personal history:

McCain: Now, I strongly disagree with the strategy employed by Secretary Rumsfeld, and by the way, I'm the only one here that disagreed at the time. And I'm the only one at the time that said we've got to employ a new strategy and outlined what it was, which is the Petraeus strategy. And I said at the time I had no confidence in the then-secretary of defense.

It’s true that McCain was an early critic of Rumsfeld’s strategy in Iraq. In a November 2003 interview with PBS' Jim Lehrer, McCain said:

McCain: I respect the opinions of Secretary Rumsfeld and our military commanders but. ... All of the trends are in the wrong direction. … And so in my view we need more special forces, more Marines, more counter intelligence, more MPs, more of the kinds of forces that do counter insurgency work.

And it’s also true that McCain refused to offer Rumsfeld a vote of confidence. When President Bush reappointed Rumsfeld as secretary of defense following his 2004 reelection, McCain responded, “The president of the United States was reelected by a majority of the American people, and I respect his right. And I will work with the president obviously and with the secretary of defense." But when specifically asked whether his comment was a vote of confidence, McCain replied, "No, it is not."

But McCain's expression of no confidence came in December 2004 – well into the Iraq war. Rumsfeld's decision to invade with a much smaller force than the one suggested by his more traditional generals – the famous “shock and awe” strategy – was implemented in March 2003.

Hollow Denials on "Amnesty"

Romney was wrong when he denied that his attack ads described McCain's immigration bill as "amnesty" for illegal aliens:

McCain: [T]he fact is it's it [sic] not amnesty. And for you to describe
it as you do in the attack ads, my friend, you can spend your whole
fortune on these attack ads, but it still won't be true.

Romney: No, no, no, no. I get a chance to respond to this. I'm
sorry. I'm sorry. I don't describe your plan as amnesty in my ad. I
don't call it amnesty. What I say is – and you just described what
most people would say is a form of amnesty.

In fact Romney has been running an ad since Dec. 28 that says "McCain pushed to let every illegal immigrant stay here permanently" while Romney "opposes amnesty for illegals," adding: "Mitt Romney, John McCain, there is a difference." That's pretty clearly accusing McCain of supporting "amnesty." Otherwise there would be no "difference" on that issue. (The ad also falsely accuses McCain of supporting payment of Social Security benefits to illegal aliens. See our Dec. 28 article for more on the ad.)

Romney also released a Web ad called "Twists" on Jan. 4 that says "McCain supported this year's amnesty bill." And even as the debate was in progress, the Romney campaign sent out an e-mail saying, "Sen. McCain Still Won't Admit He Supported Amnesty."

We give credit to Romney for conceding during the debate that the McCain immigration bill "technically" would not have granted amnesty, which dictionaries define as a pardon. The bill would have required payment of thousands of dollars in fines and fees by any illegal alien applying for legal status. But Romney's denial that his advertising accuses McCain of supporting "amnesty" rings hollow.

For McCain's part, he denied ever favoring amnesty.

McCain: Let me just say I've never supported amnesty.

McCain is right when he says that his bill required penalties to be paid by illegals trying to adjust their status. But he himself has in the past used the "a" word to describe what he had in mind – for instance, in an interview with the Tucson Citizen on May 29, 2003.

McCain: "Amnesty has to be an important part because there are people who have lived in this country for 20, 30 or 40 years, who have raised children here and pay taxes here and are not citizens.

And going back farther, McCain used the term in a 2000 press release to describe his support for a bill that would allow more Latino immigrants in this country to gain citizenship without having to return to their home countries. The release is still posted on his Web site.

Rudy's Fluctuating Fantasy Number

Giuliani repeated his unsupported claim that health insurance premiums would fall by 30 percent or more if millions more bought them individually:

Giuliani: Only 17 million Americans right now buy their own health insurance. If 50 million Americans were buying their own health insurance – because it would be just as tax-advantageous to do it that way – and we had a health savings account, people – economists believe there'd be a 30 [percent] to 50 percent
reduction in the cost of health insurance, and quality would come up.

That's a change from last October, when Giuliani claimed that the reduction would be "more than 50 percent." When we challenged the figure then, the campaign could produce no studies or statistics to support the mayor's statement. We concluded that "the only backup we could find is Giuliani’s own faith in the virtue of free markets."

This time Giuliani is saying that unnamed "economists" predict a somewhat smaller reduction of "30 to 50 percent," but once again his campaign cannot back up his claim. When we asked for the name of a single economist who had produced such a figure, in a peer-reviewed journal or elsewhere, it furnished us with a quote from a campaign adviser, Scott W. Atlas, M.D. He is a professor of radiology and chief of neuroradiology at Stanford University Medical School, but he is not an economist. And Dr. Atlas did not directly support the claim of a 30 percent to 50 percent reduction, though he did express a belief that insurance rates would fall "drastically":

Atlas: If we greatly expand the number of people who purchase
health insurance in the private market, we will be able to drastically bring down costs. As we expand the private market with value conscious consumers – as Mayor Giuliani wants to do – health care will not be immune to the laws of economics. It is a simple fact that with a more open and robust market with more consumers shopping for insurance they want instead of what government mandates impose upon them, and with more suppliers competing to attract that money, prices will come down, choice of insurance products will increase, and quality will go up.

We have no quarrel with anyone voicing personal faith in free markets. But Giuliani is wrong to say that "economists" have produced a precise estimate of savings. He implies scholarly support that – so far as we can tell and his campaign has been able to show – doesn't exist. 

RomneyCare Rewritten

Romney went a step or two too far in his claims about the Massachusetts health insurance reform he signed into law.

Romney: And since we've put our plan in place last April, we've now had 300,000 people who were uninsured sign up for this insurance. Private insurance.

We looked into this boast previously, when Romney said the figure was 200,000, and we found that it was not known how many truly had been uninsured versus how many had dropped other policies in favor of the state's offerings. Dick Powers, a spokesman for the Commonwealth Connector, the agency charged with implementing the health plan, told us that "certainly there are people who didn’t have insurance and people who did." 

The Connector's Web site, which does say it expected 300,000-plus to be enrolled by Jan. 1, 2008, estimates that that number includes "over half" of those who didn't have insurance before the state plan was implemented (an estimate that would put the previously uninsured at about 200,000). But we couldn't find a concrete number of how many of the uninsured have gained coverage under the state's health plan. The state agency that annually determines the number without health insurance doesn't have such up-to-date figures. The Massachusetts Division of Health Care Finance Policy found that 395,000 people in the state didn't have insurance between January and July 2006 (pre-reform), and it credited the state's health care plan for a drop of 40,000 of the uninsured by the same time period in 2007. It's likely that many more have signed up since then, as the deadline for getting insurance under the state mandate was Dec. 31, 2007.

Romney was also incorrect to say all of the 300,000 had signed up for "private insurance." Actually, most of them gained state-subsidized coverage. The Connector reports that "some 100,000 will be added to private commercial insurance and over 200,000 will enroll in subsidized or partially-subsidized state programs," including the state Medicaid and SCHIP programs. 

U.S. "Best" Health Care System?

Giuliani said the U.S. has "the best health care system in the world" because it is private:

Giuliani: The reality is that, with all of its infirmities and difficulties, we have the best health care system in the world. And it may be because we have a system that still is, if not wholly, at least in large part still private.

Fred Thompson and others at the debate agree with the "best health care system" assessment, which is an article of faith for many Americans. We won't quibble about which "system" is best, but we do note that the U.S. decidedly does not have the best health care outcomes.

The U.S. scores poorly on a number of crucial indicators. The World Health Organization ranked it 37th in health care performance in its 2000 World Health Report, just below Costa Rica. The CIA World Factbook rates the U.S. lower than France, Canada, the United Kingdom and the European Union average, among others, for both life expectancy and infant mortality (note that most of those countries use a form of the GOP-dreaded "socialized medicine.") A 2006 study of infant mortality rates by the charitable group Save the Children found that the U.S. was tied for second-to-last place among industrialized nations.

Update, Oct. 21, 2009: The WHO report ranking the U.S. as 37th has been questioned as out of date, ill-conceived and not always based on reliable data. See our Wire post on the criticisms for more.

Former governors Huckabee and Romney sparred over what each of them had said previously about the war in Iraq. Both, as it turns out, denied views that they had, in fact, expressed. Last night, Huckabee said he supported the surge before Romney did:

Huckabee: I supported the president and the war before you did. I supported the surge when you didn't.

Wrong. Romney first came out in support of a surge on Jan. 10, 2007, just before President Bush spoke to the nation on the topic. Romney said in a statement that "I believe securing Iraqi civilians requires additional troops." 

Huckabee, speaking on MSNBC two weeks later, on Jan. 24, wasn't so enthusiastic:

Huckabee (MSNBC, Jan. 24) : I'm not sure that I support the troop surge, if that surge has to come from our Guard and Reserve troops, which have really been overly stretched.

Huckabee had other opportunities in January 2007 to express an opinion on the surge, but he gave vague answers, often saying that the president was bold to make the decision without expressing his own opinion on the plan. E.J Dionne of The Washington Post called it "loyal distance" in a Jan. 16 column. This stance was illustrated on Fox & Friends on Jan. 11:

Huckabee (Fox & Friends, Jan. 11): Well, it's a pretty gutsy thing for the president to do, first of all, to say that there have been mistakes. And then to say we're going to put more troops in – I mean, he's putting a lot of things on the line.

Later in the exchange, Romney countered Huckabee's charge that he had supported a timed withdrawal:

Romney: I do not – I do not support and have never support a timed withdrawal. So that's wrong, Governor. You know, it's – it's really helpful if you talk about your policies and the things you believe and let me talk about my policies. And my policy is I've never talked about a time withdrawal with a date certain for us to leave.

Huckabee wins this one. It's true that Romney has never cited a date certain for pulling out the troops. But he has said that "there's no question" there would have to be a timetable, it would just be kept hush-hush. Here's what he told ABC's "Good Morning America" in an April 2007 interview:

Robin Roberts, ABC News: Do you believe that there should be a, a timetable in withdrawing the troops?

Romney: Well, there's no question but that the president and Prime Minister al Maliki have to have a series of timetables and milestones that they speak about. But those shouldn't be for public pronouncement. You don't want the enemy to understand how long they have to wait in the weeds until you're gonna be gone.

Romney: I'd read their writings. I'd read what they write to one another, and that's why when someone like Sayyid Qutb lays out the philosophy of radical jihadism and says we want to kill Anwar Sadat – when there's the assassination of Anwar Sadat, it has nothing to do with us.