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