Wednesday, November 21, 2007

McCain scores on healthcare

Last month the National Journal came out with its rankings on presidential candidates' healthcare plans:

National Journal asked 10 health care specialists to assess the proposals from the top-tier presidential candidates who have unveiled such plans: Democrats Clinton, Edwards, and Obama, and Republicans Giuliani, McCain, and Romney. Former Sen. Fred Thompson of Tennessee wasn't included because he has yet to present a plan.) After consulting with those and other health policy experts, we created a system for rating the plans' probable impact on the uninsured, on government spending, on consumer costs, on employer-based insurance, and on the quality of care. National Journal's judges gave each candidate's plan a series of numerical grades, from 1 to 10, depending on how close they think it would come to achieving a given goal, such as covering the uninsured. A score of 10 indicates that the plan would come extremely close to achieving the goal, and a score of 1 means that it would not come at all close. The judges, who span the ideological spectrum, are primarily from research organizations, universities, and think tanks. The scores in the articles that follow are averages of the 10 judges' marks for each facet of the candidates' health plans.
Democrats scored higher on universality of coverage, while Republicans scored higher on economic impacts. Scores of impact for consumers, employers, and quality of care were more of a mix when it came to the two parties.
John McCain had the best showing by far among the Republican plans. McCain's score was the highest of any candidate for encouraging patients to seek value for cost, and for keeping healthcare costs in line with economic growth. On two goals related to quality, McCain tied with the Democrats for highest. McCain tied with Giulliani on financial impacts to employers, and with Giuliani and Romney on cost to the federal government. Three additional goals gave McCain the highest score among the Republicans, though lower than the Democrats. Only on continued employer coverage did McCain score lower than Romney, this because of a shift to individualized coverage:
The Republicans' plans would probably cause some erosion of employer-based coverage, but individual coverage would fill in the gap, in Butler's view. He cites John McCain's proposal as triggering a migration from "inefficient small-business plans to plans offered through organizations but still linked to business." McCain would replace the tax exclusion for employer-sponsored health plans with a refundable $2,500 tax credit for individuals ($5,000 for families)who buy health insurance. Individuals could get insurance through any organization or association, including an employer, and workers could carry the policies from job to job.
One of the judges of these plans was John Goodman, founder of the National Center for Policy Analysis. He has put up his own scores for the goals addressed by National Journal. On two ratings of competition, Goodman has McCain tied with Giuliani, and towards universal coverage - Goodman, like the National Journal judges as a whole, rates McCain highest among the Republicans and competitive on this with Obama. On the other 6 of 9 goals where Goodman gives a rating, including giving patients a broad range of providers, McCain outperforms all other candidates.
While believing that none of the candidates plans go quite far enough to enable consumer-driven health care, Goodman says the candidate whose plan is "most radical" is
McCain by a long shot. He would completely replace our arbitrary, regressive, wasteful system of tax subsidies for private health insurance with a $2,500 refundable tax credit for everybody ($5,000 for couples). By contrast, the leading Democrats would not repeal a single existing subsidy; they just add new ones. (That is why their plans are so costly.)

meanwhile -

Least Loyal to his Own Vision: Romney. He enters the contest with a huge advantage. He engineered a bi-partisan plan to credibly create universal coverage in Massachusetts. (Compare that to Hillary's failed reform.) So what does Romney do when he gets in front of primary voters? Pretends it never happened.

Of course, the Massachusetts plan did have some glaring faults, especially for libertarian-leaning folk like myself who absolutely loathe the idea of making it mandatory to buy health insurance. It stinks too much of fascism for government to make all individuals choose between a limited range of plans, a law that transfers wealth from individuals to companies. The car insurance analogy doesn't work here - you can still choose not to drive.

1 comment:

Brad Marston said...

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