The survey didn’t try to explain why the numbers are so low. It may be that people are more comfortable making these decisions based on word-of-mouth recommendations; perhaps they are just plain confused by the number of sites and don’t know whom to trust. The federal Agency for Health Care Research and Quality (AHRQ) found twelve rating schemes for physicians, twenty-six for medical groups, eighty-one for hospitals, and eighty-six for health plans—numbers daunting for even the savviest consumer. They raise the question whether such data can ever influence family decision making in health care.

A study I did a few years ago, also with the California Health Care Foundation, offers another cautionary tale about McCain’s focus on competition in health insurance. We rated Medicare HMOs in California and found that one health plan offered a terrific drug benefit. Later reports we did showed that the plan no longer provided its great drug coverage. What it now offered was the same mediocre benefit its competition was selling. Being wise consumers, seniors chose the plan with the best drug coverage, but too many people with high drug needs and costs blew the plan’s bottom line, so it simply reduced coverage. In insurance jargon, the health plan was “selected against,” and it adjusted its policies accordingly. Some enterprising journalists need to tell us how McCain’s call for competition in health insurance will deal with that.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.