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When Health-Care Reform Stops Being Polite and Starts Making Charts


Whoever is heading the Scary Flowcharts Division of John Boehner's office is quickly becoming my favorite person in Washington. A few weeks ago, we got this terror-inducing visualization of the process behind "Speaker Pelosi's National Energy Tax." Only problem: It didn't describe a process. Or explain what five of the nine colors referred to. Or make sense. As you might expect, the chart vanished without a trace.

Today, Boehner's office cranked out the gem I've copied above (click on it for a larger version). It's certainly better than the "Energy Tax" effort. This one, for instance, has some graphic design on it. (The other looked like a proud product of Microsoft Paint.) The problem is that it's not very scary. In fact, it's reminiscent of nothing so much as a Magic Eye picture: Stare at the whole thing and it's a bit bewildering. But focus in, and order reveals itself. And that order actually looks kind of good.

There are four arrows, for instance, pointing at the bright and happy pencil outline of "Consumers." Given that consumers -- which is the Republican word for "people" -- are the intended target of the chart, we'll focus there. The first arrow shoots out from "health insurance plans," which makes sense given that consumers buy such things. Then comes the low-income subsidy, which makes sense given that consumers will benefit from that help. Then health affordability tax credits, which make sense given that consumers want help affording health insurance. And finally, the individual mandate that consumers buy insurance, which makes sense for obvious reasons.

And that, pretty much, is as scary as Boehner's chart guy can make this plan look for the average American. Consumers will have to purchase health-care coverage and will be given financial help to make sure they can afford it. It's about as creepy as your mom telling you to eat lunch and handing you a crumpled $5 before you board the bus in the morning.

Which leaves this chart in a bit of a weird position: Those who don't read it won't be able to understand it. And those who do read it won't be scared by it. All in all, a less than intimidating outing from the minority leader's office.

But charts are infectious. Democrats, for instance, quickly responded to Boehner's chart with one of their own:


The New Republic, meanwhile, went ahead and made a chart of the current health-care system (click on it for a larger version):


The real takeaway of all of this is that I could create a flowchart of my lunch at Spice Express that made the whole thing look byzantine. But this stuff doesn't work unless it's building on an underlying reality. When Bob Dole brought out his famous organization chart of the Clinton plan in 1994, it played on a genuine problem with the plan: Very few people understood it. And very few people understood it because "managed care inside of managed competition" was something new and unfamiliar.

But this plan? You basically keep the health insurance your employer is giving you now, and if your employer isn't giving you health insurance now, then the government helps you shoulder the expense and lays down some new rules so insurers can't screw you over. It's not particularly complicated. In some ways, that makes it a worse bill on the merits, but it also protects it against flowcharts.

By Ezra Klein  |  July 15, 2009; 1:33 PM ET
Categories:  Charts and Graphs  
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Next: The Coincidences of Inequality


haha! these look like colorful milton bradley board games!

do we get red and blue plastic insurance cards to move on the angioplasty freeway, the tunnel of colonoscopy, four paces back in to the forest of paperwork and then.....lucky card! proceed to the exit...all is well!!!

Posted by: jkaren | July 15, 2009 1:44 PM | Report abuse

If you looked at a flow chart describing, say, the TCP/IP protocol (the technical standard that makes the Internet work) or the control systems for a Boeing 747, you would notice that it is very complicated and largely unintelligible to the lay viewer. But the fact that these things are complex does not mean that they don't work well. On the contrary, it is the meticulous planning that went into designing these systems that has ensured their high degree of success and usefulness. The simple fact is that complex problems--internet routing and communication, safe and reliable heavier-than-air flight, and effective and efficient healthcare--often require complex solutions.

The fact that Republicans would criticize something for being "too technical" when what is needed is a technical answer further demonstrates their committment to anti-intellectualism, also known as blind stupidity.

Posted by: bluegrass1 | July 15, 2009 2:04 PM | Report abuse


The one thing I'm not comprehending is the 8% of payroll as the play-or-pay figure. In my particular industry, we are, next year, going to be at something more like 20%. The savings, from paying rather than playing would be ginormous. What, in the House plan, keeps this particular industry from just bailing--and everybody else, eventually, from doing to same

Posted by: wendellbell | July 15, 2009 2:04 PM | Report abuse

I think Boehner is secretly making the case for a single payer system.

Posted by: SteveCA1 | July 15, 2009 2:15 PM | Report abuse

The Heliocentric Theory of Health Care Reform

Before Copernicus, people generally believed the sun revolved around the earth, but as we got more data it became increasing hard to reconcile this basic idea with the observed facts. People thought up the Ptolemaic system in which the heavenly bodies didn't just revolve around the earth, but they revolved in small circles called epicycles as they went around the earth. That eventually turned out not to be sufficient, so they hypothesized epicycles within the epicycles. The last few iterations of the Ptolemaic system were an incredible complicated messes that were almost beautiful.

That's what we are doing today with health care reform. We want a "uniquely American solution." So we have weak plans, strong plans, coops, exchanges, individual coverage, community ratings, etc., etc., etc. I still haven't seen we are going to handle the problem of people with pre-existing conditions. If we cover them, people will take out minimal insurance until they get sick and then switch. We need some more epicycles.

If Copernicus were alive today, I am sure he would say, "If you simply give everyone Medicare, you wouldn't need all this complication, and I'll bet it would be cheaper, too."

Posted by: lensch | July 15, 2009 2:20 PM | Report abuse


There's no penalty for companies right now. Why would they be more inclined to drop coverage when there is one?

Companies that do drop coverage won't save that money. They'll have to increase salaries by an equivalent amount to be competitive with firms that are offering health care coverage.

Posted by: SteveCA1 | July 15, 2009 2:21 PM | Report abuse

In Boehner's chart, the health care provider lady AND all the consumers have smiles on their faces, so the process they're trapped in must be OK, right?

Posted by: bdballard | July 15, 2009 2:32 PM | Report abuse

I took the liberty of rearranging the Repub Flow Chart utilizing the accepted standards for organization. Suddenly it doesn't look nearly as "frightening":

Posted by: Dakemesh | July 16, 2009 10:39 AM | Report abuse

Is that a Seth cartoon representing Consumers? Awesome!

Posted by: AaronSw | July 16, 2009 4:23 PM | Report abuse

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