Health Care Scores

It's true, of course, that when the crazy kids downstairs at National Journal put together a bipartisan group to evaluate the presidential candidate's health care plans that the results showed the Democrats' plans to be good, whereas the Republicans' plans are bad. More telling, though, is actually the specific nature of where the different plans did well. This is especially true because in some respects the categories appear to have been gerrymandered to make the total scores less embarrassing for the GOP.

For example, these "economic impact" categories seem to have been defined in a very GOP-friendly way, with the three similar-sounding metrics here each having as much weight in the total rankings as does the entire subject of the uninsured and no consideration given to the idea that health care reform could have some positive economic benefits like freeing up labor market possibilities for people with pre-existing conditions. Either way, this is how they decided to do it, and you see that while the Democrats do a better job than the Republicans of delivering value — the central category — they're not as good at being stingy, which the rankers then double-count in the GOP's favor.

As you might expect from plans that are bad at delivering value, but good at delivering stinginess, when you get to the question of quality the Republicans start doing poorly. Do you think a plan should "enable consumers to make more-informed choices about health care?" Then you'll like Hillary Clinton (7) and Barack Obama (7) and might do okay with John Edwards (6) or John McCain (6) but you're screwed with Giuliani (4) or Mitt Romney (4). Clinton gets an 8 on giving medical professionals the best tools to improve care, while Obama and Edwards both pull 7s, McCain gets a 5, and Rudy and Romney each get pathetic 3s. In terms of giving providers incentives to compete on the basis of quality and price, McCain pulls even with all three Democrats, and Rudy and Romney once again fall behind.

So basically if you're looking for a cheap plan that doesn't actually improve health care quality the Republicans are looking good. If, in exchange for some high-value spending, you're eager to see the quality of care improved, the Democrats look better.

Similarly, in terms of consumer impact one question is about whether the plans would help people weather "increases in patient costs" the answer is that all three Democrats do better than all three Republicans. And again, would coverage be "available and affordable for the sickest people" — I think that'd be good, since sick people are the ones who need health care, and Democrats agree, scoring eight, nine, and eight on this measure. But if you don't care about sick people, but do care a lot about stinginess, then once again it's Republicans to the rescue since they do better on "would encourage patients to seek value for money."

On the question of employer impact all the Democrats beat all the Republicans in terms of would they encourage employers who currently offer health insurance to continue to make a financial contribution to their employees' health. But the Republicans do better on "would not cause financial hardship for employers." As ever, it's good to be the CEO when Republicans are in charge.

Last on the uninsured we once again see the Republicans doing terrible. They've got health care reform plans that don't help people who currently lack insurance, that aren't very good at ensuring health care for sick people, and that don't improve health care quality. The only think keeping them in the game is that their plans are cheaper. But the cheapness derives exclusively from the fact that they don't deliver the goods not through some brilliant cost-savings or efficiencies. That the plans differ in these systematic ways probably gives you a better idea of who to vote for than would any amount of peering into the details of the plans.

All of these proposals are vague in some key respects, and nothing that's proposed on the campaign trail is going to be enacted as is by congress. But these plans show something about the values and priorities of the different parties. Republicans, basically, are looking to make sure that the federal budget contains as much headroom as possible for tax cuts for high-income and high-wealth individuals while minimizing financial burdens on large employers. Democrats, by contrast, are looking to improve the quality and accessibility of American health care.

Photo by Flickr user Saveena used under a Creative Commons license

Comments

This is especially true because in some respects the categories appear to have been gerrymandered to make the total scores less embarrassing for the GOP.

Is this also why Clinton's plan comes out looking better than Obama's and Edwards'?

Posted by goethean | November 1, 2007 10:53 AM

It looked like McCain had the best plan...until you get to the last slide.

What good is a new health care system if it doesn't insure the uninsured?

BTW = Giuliani and Romney ended up getting everything wrong.

Posted by Rob | November 1, 2007 10:53 AM

The only think keeping them in the game

Think?

Posted by Adult | November 1, 2007 12:02 PM

It would have been interesting for the National Journal panel to rank the status quo as a baseline.

Of course, you would have to structure some of the questions differently.

My guess is that the Republican offerings would score very similar to the status quo. They are just putting a plan out there to say the have a plan, but do not really want to change the current system.

Posted by JFPhilly | November 1, 2007 12:08 PM

Where did they find Giuliani's and Romney's "plans?" I don't think their ridiculously less-than-modest proposals really qualify as "plans" in any real sense of the word.

Ridiculously inane analysis. Doing nothing would score pretty highly using these metrics.

Also, they are just speculating that an individual mandate, i.e. punishing people who don't get health insurance, would really cover enough additional people to merit a 9 rather than a 7. It's not clear that people who can't afford health insurance or don't want to pay for health insurance wouldn't just risk getting punished under the Edwards/Clinton plans.

Posted by bob | November 1, 2007 12:51 PM

Can someone explain to me why McCain does well in "whether the various plans would bring the growth in health care spending in line with the overall economy's growth rate?"

I don't see it at all, unless he's imposing either massive co-pays or rationing, but I can't imagine that he is.

Perhaps the assumption is that when you hit the limit of his tax credit you will stop going to the doctor or buying medicine?

Posted by bob | November 1, 2007 12:57 PM

I just went to the web page of McCain campaign. His plan is a way of writing a pageful without offering anything major, and it includes proposals ranging from obvious to inane.

Obvious: information systems should be improved. Duh. Recording standards should be uniform. Why not.

Obvious combined with dubious: Protect consumers by vigorous enforcement of laws against fraud etc. That is supposed to be a sweetener for tort reform. Now, if you want to rely on the government to do what torts do, the government should be pro-active not merely on bussiness fraud and market collusion, but about the soundness of healthcare. If my bicycle mechanic will overlook a frayed brake cable during "complete maintanence" and I will have an accident as a result, he or she can be completely honest, but inept and negligent. And usually you figure that something is wrong before trying to come to an abrupt stop before an intersection. Since consequences of health care mistakes are more profound, some protection is needed that goes beyond "more competition" (posthumously, we can select a better doctor?).

Inane: promote innovations like clinics in retail outlets.

Dubious: more competition and more variety of plans to increase their affordability. The problem is that it is precisely the variety of plans that annihilates their affordability in case you actually need a medical plan. Variety of plans delivers relief to those who do not need them anyway.

This is how he formulates it:

# Families should be able to purchase health insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business that will eliminate excess overhead, administrative, and excessive compensation costs from the system.
# Insurance should be innovative, moving from job to home, job to job, and providing multi-year coverage.

As we know, the most profound innovations are toward eliminating "excessive compensation". If the plans are "innovative", how the hell can the consumer know their long-term effects and reliability? Reading books of small print?

Currently the problem is not the lack of innovation in medical plans but that they cost too much if you need them. For individual consumers who voluntarily select from a variety of plans, this is an inherent problem.

My summary is that what is reasonable in McCain plan is cheap pablum, and the rest does not cost the government much and delivers no benefits whatsover.

Which gets high marks because of the current "common wisdom" among people whom a "serious journal" would ask for opinion.

Posted by piotr | November 1, 2007 1:07 PM

and nothing that's proposed on the campaign trail is going to be enacted as is by congress.

This is the same Congress that passed FISA, condemned MoveOn, is seriously considering retroactive immunity for telecoms, and probably is going to confirm Mukasey.

Posted by Duncan Kinder | November 1, 2007 1:11 PM

One of the biggest pieces of gerrymandering is the graph for "Brings the rate of growth for health care spending in line with the economy's growth rate." It sounds good until you read the context and realize that it's referring only to federal health care spending. There's nothing in the "consumer" section about that, even though that's probably a hell of a lot more relevant to most people than how the tab is divided between corporations and the government.

In fact, because the people judging the proposals were apparently chosen in the usual "fair and balanced" manner (academics and public health wonks on one side, conservative think-tank hacks on the other) the whole possibility that costs can be reduced by reining in our massively inefficient insurance bureaucracy is dismissed out of hand. Instead we get "analysis" from people like "Goodman, who was instrumental in the development of health saving accounts," making fact-free absolutist declarations like "You cannot control health care costs unless someone is forced to choose between health care and other uses of money."

What a load of crap. Shame on the National Journal.

Posted by Redshift | November 1, 2007 5:18 PM

And the Kucinich single-payer, non-profit, universal proposal? I'm surprised you didn't mention it--or the reason for its absence, whatever that might be.

Posted by Mellifluous | November 2, 2007 6:10 AM

So, they ranked the candidates on whether "the federal government would get its money's worth"?

I'm very gratified to hear it, because I was not aware that the federal government had any money. If it does, why does it keep taking so much of mine?

How would I get my money's worth from health spending on me? Give the money back to me to spend as I see fit, which is the Giuliani plan.

Posted by John R. Graham | November 2, 2007 4:13 PM