The final health care reform bill will probably look more like the Senate version than its House counterpart. And that result is backwards, according to a panel of advocates and experts convened by TNR.
As readers may recall, we have been asking members of this panel--whose names appear below--to weigh in on legislation throughout the debate. For each new piece of legislation, we've asked them to judge it based on three criteria:
Coverage (Would the bill make sure Americans can get health care--and would it protect them from financial ruin?)
Cost (Would the bill pay for itself--and would it help bring down the cost of medical care?)
Quality (Would the bill improve the quality of medical care?)
For each category, our experts have given a score from one (bad) to ten (good). We've then averaged the scores, but only after weighting them, so that coverage counts three times, cost counts twice, and quality counts once--roughly balancing the importance of coverage and non-coverage issues, but also breaking out cost and quality as separate categories.
We're calling the composite number the bill's "Truman Score," in honor of the 33rd president who famously crusaded, unsuccessfully, for national health insurance back in the late 1940s.
From the beginning of this year's debate, our panel has been bullish on legislation from the House. And that's still true now. The big advantage, our experts told us, was on the coverage side. The House bill would reach 5 million additional people and guarantee more generous insurance for all. That's an unambiguous advantage--and one that any progressive must take very seriously.
Our experts gave the Senate bill higher marks on the cost-control side, which matches the judgment of most economists and the major government forecasters. Remember, the Senate bill alone contains the independent commission to calibrate Medicare payments and the tax on generous health benefits--which, however controversial, is expected to reduce overall health care spending.
The House bill is not as weak on cost-control as often supposed; among other things, it's far more aggressive about reducing payments to the drug and insurance industries. But, over the long term, our experts agreed the Senate bill would do more to slow the rate of health care inflation.
That left just one category: Quality. A few panelists gave a nod to the House bill, several rated the two the same, but just one* preferred the Senate bill. This was a bit surprising, given that many other experts I know say the Senate bill is actually stronger on the quality side. Then again, insuring more people should, by itself, improve quality. The House bill also makes substantial investments in primary care and prevention. That helps, too.
Here, in any event, are the final scores...
HOUSE BILL
Coverage: 8.43
Cost: 6.75
Quality: 7.19
TRUMAN SCORE: 7.7
SENATE BILL
Coverage: 6.47
Cost: 7.47
Quality: 7.00
TRUMAN SCORE: 6.9
Full list of judges*:
Henry Aaron, Brookings Institute
David Cutler, Harvard University
Robert Greenstein, Center on Budget and Policy Priorities
Jacob Hacker, Yale University
Peter Harbage, independent consultant
John Holahan, Urban Institute
Chris Jennings, Jennings Policy Strategies
Larry Levitt, Kaiser Family Foundation
Len Nichols, New America Foundation
Harold Pollack, University of Chicago
Sara Rosenbaum, George Washington University
Andy Stern, Service Employees International Union
Anthony Wright, Health Access California
*Three judges were not able to submit their scores in time for publication. They are listed here because they were judges on previous entries. Also, one score arrived just after publication, so the scores have been modified (slightly) since posting.