A Tale of Two Visions — For Health Reform

McClatchy newspapers miss the story line

Earlier this week, Publius, a blogger at Obsidian Wings, took McClatchy’s Washington bureau to task for a story that described how John McCain and Barack Obama have very different visions for health care reform. Duh! Says Publius: “From reading Tony Pugh’s McClatchy piece on the candidates’ health care policies, you would think that John McCain is a modern-day progressive Robin Hood on health care.” Publius calls McCain’s health care proposal a “political weapon,” adding that “it lets him say something in response to questions from the public and the press about health care. What’s troubling, though, is that the proposal may not be bad politics, assuming the public remains misinformed.”

The McClatchy piece, doesn’t do very much to inform the public. Publius is right: The article fails to illuminate, is shallow in its analysis, and doesn’t do much to untie the knotty threads of health reform.

In the story, several paragraphs describing McCain’s tax credit proposal—you remember, the one that gives families $5000 to buy insurance policies that may cost $12,000 or more—are reminiscent of the sound bites issued after McCain announced his proposals in late April. McCain Douglas Holtz-Eakin trumpets the ten-year savings—$3.6 trillion—that would be generated from changing the way employer-provided health insurance is taxed. Then, another McCain talking point—the guaranteed access coverage plan that, Pugh writes, “would provide subsidies for low-income participants.” Sounds good, right? But the access arrangement is also a dumping ground for the uninsurables, people with health conditions that insurers don’t want to cover. Even though pre-existing condition coverage is a contentious point both between the candidates and with the electorate, McClatchy didn’t bother to bring it up.

The story moved way over the top with this line: “What many health experts find most attractive about McCain’s plan is the potential for containing health-care spending.” Pugh went on to quote Paul Ginsburg, the head of Washington policy research shop Center for Studying Health System Change, who explained why McCain’s cost containment is so attractive:

“I consider it the most important of his cost-containment ideas. If that tax exclusion is no longer allowed and all I get is a tax credit for $5000, well, maybe I’ll decide a (cheaper) policy is all I need or all I can afford. I’ll get less health insurance, which means I’m going to be paying more of the cost of care, and that is a cost-containment mechanism.”

Wowsers! Cost containment on the backs of patients pushed by corporate advertising to buy the latest and greatest drug—to demand the newest cure-all for… whatever—and encouraged by doctors to have unnecessary tests and treatments that boost their bottom line! McClatchy didn’t explore the fairness of this proposal, didn’t explore whether it would generate any savings, and, most important, didn’t discuss what would happen to patients’ health if bargain basement policies failed to pay for essential treatment. Just last week, The Commonwealth Fund, a New York City philanthropic organization, issued a report showing that such policies result in serious health and financial problems for patients. How nice it would have been for Pugh to connect Point A to Point B.

The story misinforms about Obama’s “universal” plan, too. Sadly, the label “universal” seems to be a landmine left over from the primary wars. As we at CJR have said many times, Obama’s plan isn’t universal. It doesn’t guarantee coverage to every citizen, and it doesn’t mandate insurance, except for kids. Obama’s plan leaves the choice to buy health insurance in the hands of the people.

Still, if you read between the lines, the story does question whether Obama is serious about reform. His health care adviser, M.Gregg Bloche, told McClatchy that sudden radical change can’t be imposed from the top down: “There are real limitations to what can be accomplished centrally with respect to health care.” And get this: While Bloche said Obama hadn’t definitively decided against requiring adults to have health insurance, he did mention other options, like automatically enrolling people in plans and then giving them the choice to withdraw. Sounds more like coercion than universal coverage to me.

“Congress will ultimately decide,” Bloche told McClatchy’s D.C. bureau. No kidding. But this raises another couple of questions: Will the press actually compel Obama to offer more than rhetoric on health care issues, or will it continue to report the empty talk designed to satisfy voters and the press? Is health care reform a political weapon for him, as it seems to be for McCain? Publius might be on to something bigger than he realizes.

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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.