by Stephen E. Beller, PhD [email  /  bio]

Contributors:
Barry Carol
Sabatini Monatesti

Latest Update on 1/25/08: View updates here.
(Check back for future updates)

This site systematically analyzes the presidential candidates’ healthcare proposals and matches them to the wants and needs to 18 groups of voters. Several resources were used to compile this information, with the bulk coming from documents available on the Kaiser Family Foundation's Health08.org website at http://www.health08.org/sidebyside.cfm and on the Huffington Post website at http://www.huffingtonpost.com/susan-blumenthal/us-presidential-candida_b_79371.html.

In order to assure accuracy, please contact Dr. Beller to report any errors or omissions.

• Describing the Proposal Selection Chart
• Identifying the Best Candidates Based on the  Proposal Selection Chart
• Viewing the 18 Options in the Proposal Selection Chart
• End Note 1: Candidates’ Quality Improvement strategies
• End Note 2: Candidates’ Cost Control strategies
• End Note 3: Determining which is better: A publically-funded Universal Healthcare System with an option for Private Insurance OR  a Single-Payer program without any Private Insurance
• End Note 4: Determining if it necessary to increase taxes in order to fund a publically-funded universal healthcare program
• Examining how the Best Candidates were selected from the Proposal Selection Chart
• Viewing the Quality Improvement and Cost Control Strategies Summary Chart
• Matching the best candidates to the 18 voter groups
• Using the Candidate Comparison Grid to compare the details of the proposals

 

After analyzing the details of each Presidential candidate’s healthcare proposal, the best proposal appears to depend on one’s current health insurance plan, level of wealth, and priority for assuring good healthcare for all. This is reflected in the Proposal Selection Chart.

The Proposal Selection Chart provides a logical way to choose a candidate’s proposal based on three factors:

• The first factor is one’s Current Health Plan. Located in the first column of the chart, it identifies three typical health insurance scenarios:
• People who believe (a) they have good coverage (be it publically funded or private insurance), (b) they won’t ever lose it and (c) it keeps their health-related expenses low.
• People who believe they have good coverage and they won’t ever lose, but their health-related expenses are too high.
• People who (a) don’t have insurance, or (b) they believe their insurance policy is poor or inadequate, or (c) they have a high risk of losing their coverage and not getting adequate, affordable insurance in the future.
• The second factor is Wealth Level. Located in the second column of the chart, it identifies three levels of personal wealth: High, Middle and Low.
• The third column is Universal Healthcare Priority. Located in the third column of the chart, it identifies whether a person places a High or Low Priority on assuring that everyone gets good healthcare. High Priority means the person wants a Universal Healthcare System (UHS), which may be a federally-funded system based on the Federal Employees Health Benefits Program (FEHBP-UHS) that exists along with private insurance options, or a Single-Payer Universal Healthcare System (SP-UHS) that does not allow private insurers.

The forth column—Proposal Most Likely to be Chosen—identifies the type of healthcare proposal a person is likely to chose based on the factors in the other three columns. There are 18 voter groups.

In addition, the End Notes section includes other charts identifying how the candidates strategies for dealing with (or not dealing with) healthcare quality and cost control issues, as well as identifying important strategies that no candidate proposes.

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Each candidate’s proposal was analyzed based on the needs and desires of the 18 voter groups. This analysis considered whether the candidate proposes a universal healthcare system (UHS). It also took into account the number of strategies proposed to improve healthcare quality and control costs. While not all the strategies are equally important, the total number of strategies proposed gives some indication of how much attention a candidate is paying to these issues. Based on this analysis, the following identifies the best candidates:

• The candidates most concerned with improving the quality and controlling the costs (i.e., increasing the value) of healthcare are: Clinton, Obama and McCain.
• Voters who want good care for all are willing to do what it takes—including paying increased taxes, etc.—to support a publically-funded UHS. Candidates who want a Federal Employees Health Benefits Program UHS (FEHBP-UHS) and want to keep private insurance as an option are: Biden, Clinton and Obama. Since Kucinich has dropped out of the race, no one is proposing a government-run Single Payer UHS (SP-UHS). Choosing between these two options is discussed in the end notes [3].
• If an FEHBP-UHS is desired, then Clinton and Edwards are the best choices because they also more focused on increasing care value, with Obama coming in second.
• If an SP-UHS is desired, then Kucinich was the only choice. Note that his plan (HR 676) was also the most detailed (has the greatest specificity), which means it may be the most credible. But since he’s no longer running, it’s off the table.
• On the other hand, any Republican is a suitable choice for voters who (a) are not concerned about the care others receive (they aren’t interested in good care for all) and (b) are confident they will always have excellent insurance, or can afford to pay for the care they need out-of-pocket if they lack adequate insurance. Choosing between Republican candidates would likely be based on their strategies for:
• Minimizing taxes and reducing personal health-related expenses
• Increasing healthcare value (cost-effectiveness), in which case McCain is probably the best choice since he proposes the most strategies of all Republicans for improving quality and controlling costs (as well as being the only Republican addressing the health need of veterans through the VA).

Note, however, that there are significant gaps in every candidate’s proposal. It would be useful to know how what it would require to (a) evaluate all the quality improvement and cost control strategies described in this document and to (b) implement the effective ones efficiently.

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tHE Proposal Selection Chart: The 18 Options

Note that end notes contain important supplemental information and can be access by clicking the end note links, which are indicated by a number in brackets: [#].

Assumptions: (a) anyone with existing health problems or risks factors has greater urgency for insurance coverage and (b) anyone with knowledge about the quality problems in our current healthcare system (see this link and this link) would want to implement strategies for improving care quality [1].

Current Health Plan	Wealth Level	UHC Priority	Proposal Most Likely to be Chosen
Ÿ Good insurance coverage Ÿ Low out-of-pocket cost Ÿ Low risk of ever losing the coveragei	High	High priority	(1) FEHBP-UHSii + Private Insurance
		Low priority	(2) Keep own insurance;  Reject tax increase and approve tax breaks (tax credits, deductions) for self;  Controlling care cost is unimportant
	Middle	High priority	(3) FEHBP-UHSii + Private Insurance
		Low priority	(4) Keep own insurance;  Reject tax increase and approve tax breaks (tax credits, deductions) for self;  Controlling care cost is not very important
	Low	High priority	(5) FEHBP-UHSii + Private Insurance
		Low priority	(6) Keep own insurance;  Tax issue less important;  Control care costs [2]
Ÿ Good insurance coverage Ÿ High out-of-pocket cost Ÿ Low risk of ever losing the coveragei	High	High priority	(7) FEHBP-UHSii + Private Insurance or SP-UHSiii [3]
		Low priority	(8) Keep own insurance;  Reject tax increase and approve tax breaks (tax credits, deductions) for self;  Control care costs [2]
	Middle	High priority	(9) FEHBP-UHSii+ Private Insurance or SP-UHSiii [3]
		Low priority	(10) Keep own insurance;  Reject tax increase and approve tax breaks (tax credits, deductions) for self;  Control care costs [2]
	Low	High priority	(11) FEHBP-UHSii + Private Insurance or SP-UHSiii [3]
		Low priority	(12) Keep own insurance;  Tax issue less important;  Control care costs [2]
Ÿ No insurance OR Ÿ Poor or Inadequate insurance coverage OR Ÿ High Risk of losing the coverage	High	High priority	(13) FEHBP-UHSii + Private Insurance or SP-UHSiii [3]
		Low priority	(14) Keep own insurance: If lost or inadequate, purchase new private insurance or pay out-of-pocket for needed care;  Reject tax increase and approve tax breaks (tax credits, deductions) for self;  Control care costs [2]
	Middle	High priority	(15) FEHBP-UHSii + Private Insurance or SP-UHSiii [3]
		Low priority	(16) (a) If no insurance or it’s inadequate, then FEHBP-UHSii + Private Insurance or SP-UHSiii [3] or (b) If current insurance is adequate, then Universal Public Program in case current insurance is lost or inadequate;  Don’t reject tax increase if necessary to fund the FEHBP-UHSii or SP-UHSiii [4];  Control care costs [2]
	Low	High priority	(17) FEHBP-UHSii + Private Insurance or SP-UHSiii [3]
		Low priority	(18) (a) If no insurance or it’s inadequate, FEHBP-UHSii + Private Insurance or SP-UHSiii [3] or (b) If current insurance is adequate, support FEHBP-UHS in case current insurance is lost or inadequate;  Don’t reject tax increase if necessary to fund the FEHBP-UHSii or SP-UHSiii [4];  Control care costs [2]

ⁱ Among those who are without health insurance, at least 80% had it but lost it, so the risk may be greater than most people realize (see this link). Primary causes include job loss or change, employers dropping coverage for their employees/retirees, and serious illness. Even the long-term fiscal viability of Medicare is questionable (see this link and this link).

ⁱⁱ FEHBP-UHS=Federal Employees Health Benefits Program Universal Healthcare System
ⁱⁱⁱ SP-UHS=Single-Payer System Universal Healthcare System

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Determination of the best proposals for the 18 options was done by:

1. Matching the 9 High Priority Universal Healthcare options with candidates whose proposals support a FEHBP-UHS or SP-UHS.
2. Since Quality Improvement is relevant to all 18 options, selecting the candidates who have a strong focus on improving quality by virtue of the number of strategies in their proposals that address quality improvement, as per the Quality Improvement and Cost Control Strategies Summary Chart below.
3. Matching the 16 options in which Cost Control is important with the candidates who have a strong focus on controlling costs by virtue of the number of strategies in their proposals that address cost control, as per the Quality Improvement and Cost Control Strategies Summary Chart below.

This Quality Improvement and Cost Control Strategies Summary Chart is based on data from the Quality Improvement and Cost Control Strategy Grids at End Note 1 and End Note 2, respectively. An analysis of these data indicate that the candidates most serious about improving quality and controlling costs are Clinton, Obama, Richardson and McCain; with Clinton and Kucinich scoring highest.

Note, however, that there are significant gaps in all candidates’ proposals.

Total number of strategies in candidates’ proposals are in last two rows	C l i n t o n	E d w a r d s	G r a v e l	K u c i n i c h	O b a m a	R i c h a r d s o n	G i u l i a n i	H u c k a b e e	H u n t e r	M c C a i n	P a u l	R o m n e y	T h o m p s o n
QUALITY IMPROVEMENT Strategies	16	16	3	9i	11	14	4	2	1	8	0	3	4
COST CONTROL Strategies	7	9	0	8ii	8	6	4	5	1	8	1	1	5

ⁱ Kucinich given 1 Quality Improvement Strategy point for not needing private insurance incentives and disincentives.

^{i i} Kucinich given 3 Cost Control Strategy point for not needing private insurance incentives.

Following are candidate’s proposals that are best suited to each of the 18 voter groups (best candidates in bold):

• 1, 3, 5: Clinton, Obama
• 7, 9, 11, 13, 15, 16, 17, 18: Clinton, Obama
• 2, 4, 6, 8, 10, 12, 14: Huckabee, McCain

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The grid below shows details of each candidate’s proposal.

C l i n t o n

E d w a r d s

G r a v e l

K u c i n i c h

O b a m a

R i c h a r d s o n

G i u l i a n i

H u c k a b e e

H u n t e r

M c C a i n

P a u l

R o m n e y

T h o m p s o n

Universal Healthcare System (UHS)

· Government-Run Single-Payer System (SPS)

u

· Government-Run Federal Employees Health Benefits Program (FEHBP)

u

u

u

· Health Markets

u

· Vouchers

u

Allow Private Insurers

u

u

u

u

u

u

u

u

u

u

u

u

Mandates (individual and/or employer requirements)

· Requirement for Individuals to receive coverage (Osama – Only children required)

u

u

u

u

u

u

· Requirement for (large) Employers to provide coverage or help their employees purchase it

u

u

u