A Guide That Isn’t

Too much brevity at the Chronicle

Readers of the San Francisco Chronicle can be forgiven if they came away totally confused by the paper’s attempt on Sunday to enlighten them with its 2008 Voters Guide, “The Road to the Presidency, Health Care: Insurance Funding.” The guide hardly clears a path to understanding the candidates’ positions on health care. Instead, it is little more than the newspaper equivalent of a TV sound bite—and one laced with so much jargon and short-hand that most poor readers would be lost in the wilderness from the get-go. True, the news hole for health care coverage has shrunk, and, there’s a premium on brevity, but this kind of brevity readers can do without.

In the guide, the Chronicle reports that Democratic candidates call for universal coverage. Okay. But further down it says that Obama is requiring only children to have health insurance. That’s not universal coverage even in the current American usage of the term: under ‘universal’ coverage, everyone needs to buy their own insurance if they don’t get it from their boss. There’s no mention of the Obama plan’s lack of an insurance “mandate”—the fact that it doesn’t require everyone to have health insurance—but the story does say that Obama proposes “affordable universal coverage via a mix of private and more expansive public coverage.” Points that are bafflingly inconsistent.

The paper also tells readers that Obama would create a National Health Insurance Exchange in which small businesses and those without “access” to other forms of insurance could enroll. Clinton, the Chronicle says, would create a Health Choices Menu operated in conjunction with the Federal Employee Health Benefits Program, and Edwards would have established regional Health Markets that “would offer portable, fiscally competing coverage, both public and private.” What in the world does all that mean? A true “guide” would explain the ins and outs of these options and tell voters how they would fare under each one.

For the Republican candidates, the Chronicle “guides” us through more of the same vague descriptions. Giuilani wants to “use free-market incentives to reduce costs and improve the quality of health insurance.” The quality of health insurance? Has the writer confused quality of health care with quality of health insurance? Or does she mean that good-quality health insurance will cover more ailments and won’t exclude folks with pre-existing conditions? It’s unclear. Early in the piece readers learn that the Democrats would outlaw insurance that allows “risk ratings” based on health conditions, a term familiar to actuaries, but not to the average man (or woman) on the street. Do these risk ratings somehow relate to the quality of health insurance? Romney, the Chronicle says, wants to deregulate the private health insurance market, but its guide doesn’t say how deregulation would affect voters. If it means that carriers would not have to offer maternity coverage, a goal long-sought by some insurers, young couples thinking of starting a family just might want to know that.

At the end of the story, the Chronicle discloses that the guide was based partly on information from the Kaiser Family Foundation which has compared all of the candidates’ plans. People can go to the Foundation’s web site and get the same plain vanilla facts. What they really need from the paper is analysis and explanation of how the facts relate to them. In the fall, the Pew Research Center for the People and the Press found that 77 percent of Americans said they would like to see more coverage of the candidates’ positions on the issues. In other words, they are saying they need a real guide.

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Trudy Lieberman is 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. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.