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Code Blue! Republicans leaning left on healthcare! Craig Stoltz

Health08Craig Stoltz is a web consultant working in the health
2.0 space. He has previously served as health editor for the Washington Post and editorial director of Revolution Health. He blogs at Web 2.0 … Oh really?
I recently had a hand in a project, called the Healthcare08
PoliGraph

, which seeks to find meaningful
distinctions among the presidential
candidates’ healthcare policies. This was tougher than it sounds.

This being the primary season, each party’s contenders are pretty
much sticking with the approved script. The Democrats are trying to outbid each
other for cradle-to-grave healthcare for all humans treading on U.S. soil. The
Republicans are quietly uttering free-market shibboleths to avoid alienating
their big contributors until the fall, when they’ll probably have to promise to
do something or other.

The PoliGraph project plotted each candidate’s stances on
six healthcare issues on big graphics. We plotted their positions along two
axes: from left (i.e., federalphilic) to right (federalphobic), and from most
important to least important (to the candidate, not us). 

By parsing the data carefully, we were able to find some
daylight between candidates, even within each party’s tight ideological clusters.

For instance, for all the fuss over comparing Clinton’s and
Edwards’s personal “mandates” that
people have insurance, when we dug into her plan we found her solutions more inclusive
of market forces than either Edwards’ or Obama’s. (This gets wonkish, but Hillary
gives small businesses incentives to
offer private insurance coverage to employees;  Edwards and Obama depend more on mandates and
expanding public programs to fill that gap. Hey, it’s something.)

But the most interesting thing that showed up when we got
done plotting everybody jumped out in plain red and blue. Several Republicans
held positions in the blue zone on some healthcare issues.

For instance:

John McCain is code blue drug prices, his positions
essentially no different from the Edwards/Clinton/Obama scrum: Let Medicare
bargain for drug prices, permit drug imports from other countries and give
federal support to develop generic drugs.

Mitt Romney and Rudy Giuliani are tap-dancing quietly in the
blue zone on stem cells. Romney says it’s okay to use stem cells left over from
IVF treatments for medical research, but doesn’t want federal dollars to fund
it. Giuliani generally supports the use of embryonic stem cell research and is
even sanguine with federal funding. But they are both keeping awfully quiet
about it. At least until the general election.

Of course, life being complicated and politics being
political, some folks were really hard to pin down on a simple left-to-right
axis. Ron Paul is against federal funding for stem cell research but apparently
has no objections to the practice itself. Is that “left” or “right”? (As is
often the case with libertarians, maybe it’s neither and both and har-de-har!)

And Democrat Mike Gravel’s views are, how you say, all over
the graph. Is his a-health-insurance-voucher-in-every-pot plan a pinky ploy to
go Canadian? Or is it a way to pump federal dollars directly into the pockets
of private insurers, and stealthily destroy Medicare and Medicaid?

Luckily, since it’s Gravel’s idea, we’re very unlikely to
find out.

We’ve decided to continue the PoliGraph project to plot the
changes in the candidates’ views on healthcare issues all the way through
November, when of course there will be only two candidates, (give or take a
Bloomberg).

What do you bet they’ll wind up nearly on top of each other
in the middle of the graph?

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9 replies »

  1. Thanks to everybody for the engaged comments about our project. Let me shed light on a few of the issues raised here, and on our methodology for placing the candidates.
    1. Yes, it was extremely difficult to figure out what values to assign to each candidate. We took into account a variety of criteria, including written proposals, additional statements in debates and public forums, elaborations in the press, various “independent” analyses, and previous record of voting and policy actions.
    Trying to figure out how to weigh each of these was a mind-twister: Do two votes against a Medicare proposal push one to the right? What if that conflicts with a current campaign healthcare plank? Questions like this forced us, inevitably, into subjectivity and a frustration with the 2-D rendering we were providing.
    Short version: We were as informed and diligent as we could be but make no claims–I certainly make none–that the results are precise and unimpeachable.
    2. As for a couple of specific cases mentioned above: Let me tell you a bit about what we found.
    Ron Paul to the left on drug prices? It surprised me too. But when we stripped away the broad-stroke view of the guy as an anti-government ideologue, we found a few examples that were at least confounding and at most fairly clear beliefs that support government action. One example:
    Like most Democrats, he favors drug importation and the ability of the government (!) to bargain for lower drug prices with pharma companies. Recall we weren’t sliding him to the left because that made him “left,” as in “progressive” or “pinko” (to coin a phrase), but because he endorsed greater government involvement in setting drug prices. Surprising? Inconsistent with what we believe about Paul? Perhaps. But we did not place him on the PoliGraph in ignorance or lack of rigor.
    The Hillary-to-the-right-of-Obama on Healthcare Reform question: For this category, we were really looking at the overall vision of how to improve cost and quality. We separated out, to the extent it was possible, the issue of universal coverage (which we dealt with in its own category, where Hillary scores far “left” at the “government mandate” extreme).
    Again, strip away the cartoon of Hillarycare and Agent-of-Liberal-Satan, and you’ll see her policies are friendlier to free market forces than Obama and Edwards. I cite the example above of her support of using *incentives* rather than *mandates* to encourage small employers to offer *private plans offered by private insurance companies.* Her opponents are more strictly play-or-pay with their proposals regarding employer participation. And Obama calls for a greater expansion of public programs than does Clinton, who (at least in her proposals) views public plans as more of a “safety net” for those who fall through the cracks.
    You can say we’ve used smaller distinctions to nudge her further to the right than she belongs. A fair comment, but not a reflection bias on our part.
    One more point on Clinton. When I first read her proposal, I thought immediately that she was listing rightward–more inclusive of marketbased solutions–in order to play defense in the general election when her opponents will play the “socialized medicine,” “big government” card. I may be terribly wrong. I may have fallen for cheap rhetoric that belies her underlying belief that government can save all. But again, our team was not careless in our considerations.
    3. All of which raises an excellent question: Once we understood how complex was the task of trying to flatten the three-dimensional political sphere into two dimensions and two axes, why did we decide to do it?
    We think it’s valuable. Healthcentral.com is a community-oriented web operation devoted to engaging patients and their loved ones with their healthcare decisions. With election ’08 coming, we wanted to do something that would help them make more informed decisions about the key question of who they should vote for in terms of their healthcare views.
    Recall a key feature of this whole PoliGraph project is the ability for users to take a quiz where they can describe their own views (using the same blunt tools and the same simplified axes) on the same healthcare issues.
    We like the idea that we’re engaging people in this way. Knowing our final placement of candidates would be both inexact and subject to dispute, we think it’s a valuable contribution to the digitized, 2.0-ified world of Election08.
    It always sounds like a defensive cop-out when a journalist says “our intention was to create informed dialogue on an important public issue.” But it was and we have.
    Thanks again for all of your excellent comments.

  2. “It is alway interesting to read how healthcare and politics intertwine.”
    Life and politics intertwine.

  3. “I’d argue that candidate positions on stem cell research, FDA reform and related issues are very important factors in understanding what these folks are talking about — perhaps as important as their positions on universal coverage.”
    John, stem cell, FDA reform (Repugs created the need), don’t even come close to real healthcare reform – in the struggle for cost containment, access, affordability, transparency, accountabilty, the other issues are side shows meant to muddy the waters.

  4. Craig wrote: “The Democrats are trying to outbid each other for cradle-to-grave healthcare for all humans treading on U.S. soil.”
    I don’t think that the snotty tone fits here. Even GWB appears to acknowledge that medical care is something close to a human right or, providing it is society’s duty to some degree (given his misguided “if you don’t health care, you go to the ER” remark).
    More importantly, I find the “left to right” ranking a little unhelpful, not only in general, but for this particular topic. I am relatively new to this blog, but don’t most writers here try to make the case that publicly funded universal health care makes economic sense, too (e.g. for Detroit, to again mention this almost outworn example)? Does Craig want to strengthen the republican talking point that universal health care is a leftist thing, “socialistic medicine”?

  5. I continue to be at a loss as to why “universal healthcare” is such a major issue. Maybe I’m just fortunate that I’ve lived between the UK and Australia most my life so haven’t had to worry. While I don’t think either system is ideal, I certainly wouldn’t trade either for the US based user pays system. So why do so many Americans not like the idea of having accessible healthcare for all?
    Admittedly, measures have to be put in place to make sure those that make an active effort to be healthy aren’t disadvantaged. Subsidies for extended private cover, gym memberships, taxes on alcohol, cigarettes, and junk food are all things I’ve seen put in place in other countries.
    I wait with much anticipation this US election for a number of reasons, the outcome of this debate one of the larger ones. I just hope that should a universal program be put in place that the current and looming economic conditions are not blamed on it’s implementation by future candidates.

  6. “Left of whom, Attila the Hun?”
    That’s just silly Peter.
    Your comment highlights the fact that different groups define healthcare in very different ways. Is universal coverage the only healthcare issue worth talking about?
    You seem to think so.
    I think that’s a dangerous and short sighted way of looking at the universe. Craig has done a good job of examining at the candidate’s healthcare proposals across the board. I’d argue that candidate positions on stem cell research, FDA reform and related issues are very important factors in understanding what these folks are talking about — perhaps as important as their positions on universal coverage. Of course Republicans are leaning left on healthcare in a lot of places. It only makes sense. They need to win the moderates and the kinda moderates this year.

  7. “Code Blue! Republicans leaning left on healthcare!”
    Left of whom, Attila the Hun?
    Republicans believe individuals should help themselves out their own problems – not the government. Except of course when Republican investors find themselves in a self created mortgage/stock crisis created by their own greed and lies.

  8. The author has a right to his opinion .. but it runs contrary to most of the authors on the WaPo op-ed page (e.g., Dave Broder, E.J. Dionne).
    Then again, let’s not allow reality get in the way of a fun, happy headline.

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