brown vs. coakley: and who can be trusted to define "quality healthcare"

The issue: The Massachusetts Senate seat, which opened up after the death of former Senator Ted Kennedy

The vocab: Improving the "quality" of healthcare Americans receive. Which candidate defines the word quality most appropriately?

Let's start by breaking down who's backing the two candidates. It's not particularly relevant to the issues themselves, but fascinating nonetheless...

The pro-Brown celebrities: Scott Brown and his family are practically celebrities in their own rights - Scott was a star athlete in high school and played college ball at Tufts (and, in a baffling decision for an aspiring politician, posed very nude for Cosmopolitan magazine); Scott's wife, Gail, is a popular Boston-area television news reporter; One of Scott's daughters, Ayla, competed for 3 weeks in the fifth season of American Idol. On top of this all-star family cast, Scott Brown also has the support of ex-Red Sox pitcher Curt Schilling (who actually even contemplated running for the seat himself) and ex-BC quarterback Doug Flutie.

The pro-Coakley celebrities: President Obama is backing Martha Coakley, as well as the late Ted Kennedy's widow, Victoria Kennedy - i.e., some of the most powerful Boston-area political voices.

Tomorrow, Massachusettans will cast their votes in the Senate race between Republican attorney Scott Brown and Democratic Massachusetts Attorney General Martha Coakley. While there's been a lot of controversy bubbling over the negative campaigning that the candidates

have directed at one another (in fact, Brown is filing a defamation claim against Coakley for some mailings her party sent out), the biggest issue here is the implications in the healthcare reform vote.

Currently, there are 59 Senators who have voted in favor of the president's health care reform bill. The Senate needs 60 votes to push the reform through the Senate - and Coakley if elected, will be that 60th vote. If Bay Staters instead elect Brown, he has vowed to be the 41st vote against reform, which would effectively kill the legislation. According to the most recent poll, Brown (with 50%) leads Coakley (with 46%). While Brown's lead is within the statistical margin of error (translation: statistically, Brown and Coakley are tied), he's a lot better off than he was expected to be. Massachusetts is a predominately Democratic state - only about 13% are registered Republicans - and the state hasn't had a Republican senator since 1972. For Brown to even be in the same ballpark as Coakley is a testament to the voters' recognition of the implications of this race.

According to their campaign web sites, here are the candidates stances on health care issues:

• Coakley: She supports Obama's health care reform because she believes it will increase medical insurance coverage, will improve quality, and will lower costs (due to greater industry transparency and a change in the way incentives are used).
• Brown: He plans to vote against the reform bill because he believes it will raise taxes, will increase government spending, and that it compromises quality of care (especially for elders on Medicare). Instead, Brown is in support of bolstering the existing private insurance system, making it more affordable for people to obtain insurance.

Yes, it's undeniable that health care reform will lead to more government spending to pursue its goals of covering the uninsured; the question here, really, is if the spending is worth it. Both candidates want more people to be insured (but really, what reasonable person wouldn't?), but have different routes to achieving it - and the federally-funded vs. free market solution is a partisan debate as old as Lou Holtz.

But what I'm fascinated by is this: Both of the politicians claim that their solution will lead to a better healthcare quality. They can't BOTH be right (although I suppose, theoretically, both could be wrong). If we look at the evidence, who is being most empirically truthful?

First, let's operationalize the buzzword "quality." A high-quality health care system, according to the U.S. Agency for Healthcare Research & Quality, is one that does "the right thing at the right time in the right way for the right person and having the best results possible.” Translation: Every patient has different needs, and a good system allows healthcare professionals to address those needs in such a way that every person has the best health outcome possible.

How do we determine "quality"? Central to Obama's health reform bill is the utilization of comparative effectiveness research. The health outcomes of different treatments are compared (i.e., for different conditions, different levels of severity, by gender, etc.) with the goal of figuring out the optimal evidence-based treatment for different types of patients. This info would be distributed to healthcare professionals as well as patients. This would lead to (1) all stakeholders knowing more about their treatment options, and (2) less utilization of unnecessary and ineffective treatments, thereby saving money and healthcare resources. (The Kaiser Family Foundation has a great review of this concept, for those interested.)

Actually, private insurance companies are also in favor of improving quality/lowering costs using comparative effectiveness research. The real difference between the two perspectives is who is doing the research. Either the insurance company would figure out the best practices themselves, or the federal government would do the research. The biggest problem I see in the private market research is with the credibility of their findings. We make pharmaceutical companies hire third-party analysts for their clinical trials data for this very reason - when a private company holds a financial stake in the outcome, their results could very easily (and are quite probably) biased. Sure, the federal government isn't perfectly transparent, but we certainly can't expect private businesses to be more transparent.

Both Brown and Coakley are claiming their political standpoint to be more conducive to high quality healthcare. But Coakley's got the upper hand: When it comes to being able to trust the conclusions of quality/effectiveness research, this is best left in the hands of the federal government, which is required to be transparent and will be thoroughly scrutinized if it biased results in any way. Private companies may very well have health's best interest in mind, but because the industry doesn't lend itself to the same level of scrutiny and peer review, I'm not sure if private insurance company's findings would be trustworthy.

Both candidates claimed that their standpoint on health care reform would "improve quality," and as is evident, these claims can't be taken at face value. It's clear how Coakley's health reform "yea" vote would improve quality, but the same can't be said for Brown's "nay." Massachusettans cast their ballots tomorrow, and I hope everyone who votes has looked past the celebrity battle and has looked into the legitimacy of the aspiring Senators' rhetoric.