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Give 'Em HELP Harry

The Senate Finance Committee has been the focus of so much attention, for so long a time, that it's easy to forget another committee in the Senate passed its own version of reform several months ago.

The Health, Education, Labor, and Pensions (HELP) Committee had only partial jurisdiction, of course. It couldn't touch Medicare or Medicaid and it couldn't call for new revenue. But it had the opportunity to design a coverage system, including insurance exchanges, plus it had the chance to introduce some quality incentives.

So how good a job did the committee do? And, in an ideal world, how much of HELP's work would Majority Leader Harry Reid incorporate into the final measure that goes to the Senate Floor? To get some guidance on those questions, we've decided to publish the second installment of the Truman Scale.

For readers who missed it the first time, the Truman Scale is TNR's own rating system for health care reform measures. Named for the first president who tried seriously to pass universal health insurance, the Truman scale--which goes from 1 (worst) to 10 (best)--is a composite of scores on three separate criteria:

Security Will it expand insurance coverage substantially--and make sure the insurance people have is good insurance?

Cost Will it pay for itself--and will it reduce costs over the long run?

Quality Will it actually make medical care better?

The scores themselves are not mine. They come from a panel of experts I've assembled; you can see the names below. I did, however, decide how to weight the scores. The security score counts three times, the cost question twice, and the quality once.  My thinking is that cost and quality are pretty closely related and that, together, they should count as much as security.

And how did HELP grade out--and how did it compare to the Finance bill? The most conspicuous difference is on the coverage front. The HELP bill calls for more generous subsidies and sets a higher standard for insurance protection. It also has a real public insurance option. The judges rewarded that with a high coverage score. HELP didn't do as well on cost and quality, finishing a bit lower than Finance in each category, although several judges decided not to grade HELP on cost at all, given the committee's limited jurisdiction.

Summing up the prevailing thinking, Harold Pollack commented:

On security, it's much stronger than Baucus, though still has affordability issues, especially for older workers in small households. CLASS benefit a plus if it is retained in the final legislation. ... It's more costly than Baucus in the near-term. Public option provides a framework that could be helpful in long-term cost control.

Below are the scores, followed by the composite. For the sake of comparison, I'm also including the corresponding scores for the Baucus bill in parenthesis.

Notice something? HELP's bill does better overall. The politics of reform--and the U.S. Senate--are such that we'll probably end up with something much closer to the Baucus bill. But that doesn't mean we should be happy about it.

By the way, coming soon are scores for the House bill and--perhaps most important of all--scores for the status quo.


Security 8.1 (5.7)

Cost 5.3 (6.7)

Quality 6.5 (6.3)


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 did not submit scores for the HELP bill, either because they believed it was too incomplete to judge or because they were not able to submit their scores in time for publication.