Battle For the Grassroots

Campaign for an American Solution vs. Health Care for America Now

Timothy Noah over at Slate succinctly summed up the impending war over health reform. The lines of battle will be drawn between the insurance industry’s proposals and those advanced by Health Care for America Now, a newly-formed conglomerate of progressive non-profits and labor unions—which for the record, have never been enthusiastic about any change that hurts their leverage at the bargaining table. Health Care for America Now’s mixed approach to reform gives people the option of having commercial insurance, perhaps as a way to gather financial support from the SEIU and AFSCME unions, which still see health insurance as a bargaining chip at contract time. (University of Pennsylvania professor Marie Gottschalk explains all this in her book, The Shadow Welfare State, which I recommend to any reporter digging into labor’s role in the coming battles.)

A few weeks ago, Health Care for America Now launched a $60 million ad campaign hoping to enlist the grassroots in fighting for change. For them, this involves letting people keep their private insurance, buy new policies from commercial insurers, or buy into a public plan that is run by the government. The government plan, which will compete with private insurance companies, is a Medicare for All approach that is likely to be cheaper than commercial insurance and available to everyone, whether they are sick or well. And that scares the bejesus out of private insurers.

If (and it’s a big if) a public plan does indeed undercut commercial insurers, it could send the country down a path toward a single-payer system—or toward a truly national health insurance system, like the ones utilized by the rest of the world. And that’s why a donnybrook is brewing. The industry’s survival is at stake. Insurers have been lying low these many months, listing a set of blah blah principles, keeping their ears to the ground, and letting some of their friends in conservative think tanks write op-eds that support their positions. One, by Grace-Marie Turner of the Galen Institute, appearing in The Washington Times, supported high-risk pools, a similar approach to the industry’s proposed Guarantee Access Plan.

The industry’s first skirmish came this week in Columbus, Ohio, where its trade association, America’s Health Insurance Plans (AHIP), launched a listening tour, along with print and online advertisements gently reassuring the public that the industry understands its pain and agrees there is a problem. AHIP also began a drive to muster an army of 100,000 grassroots activists who are happy with their private health insurance and, presumably, will contact their local congressional delegations to support whatever the insurance industry is promoting. AHIP is good at this. A year ago, it activated its own sham consumer group, the Coalition for Medicare Choices, now 400,000 strong, formed years ago and run by a public relations consulting firm in Virginia. The group bombarded members of Congress with letters and eventually helped prevent lawmakers from reducing the (large) sums paid to insurers for providing a Medicare option called a Medicare Advantage Plan.

This year AHIP wasn’t so lucky. Again its Coalition tried to gin up letters to keep the excess payments flowing its way. But the organization was outflanked by doctors who conducted their own PR campaign to make sure that their fees for treating Medicare patients wouldn’t be cut. It was a trade-off for Congress, as payments for the docs had to come out of the extra money paid for Medicare Advantage plans. But don’t count AHIP out. It has undoubtedly learned from the loss; who knows what new battlefield strategies and tactics it will invent?

Health Care for America Now is following a similar route, using its ad to plant doubts in voters’ minds about the insurance companies while enlisting the grassroots to write letters, contact Congress, and be available for demonstrations in Congressional districts when the fight gets tough. It also wants money for future advertising. The group says it is not endorsing any particular plan, but I’d wager that they will push for a public program that leaves insurers out. Clearly, Health Care for America Now wants to be a player when the hardball politics begin.

Of course, any group has the right to lobby or organize as it sees fit. But the potential is enormous for voter confusion. The similar names, tactics, and buzz words deployed by both groups—likely shorthand for very different proposals—will boggle the mind of the average Joe. Journalists must explain who these groups are, identify their members, and illuminate what’s at stake for each of them. The “what’s at stake part” has so far been missing.

Neither The Columbus Dispatch nor the Cleveland Plain Dealer, which ran stories about AHIP’s listening tour, got to the nub of AHIP’s survival plan. The Dispatch story offered plenty of color—union members shaking water bottles filled with unpopped popcorn and Ohio residents airing their gripes about the health system. It quoted AHIP CEO Karen Ignani saying: “We plan to have a policy proposal and push for its enactment.” As I pointed out yesterday, AHIP’s web site offers plenty of clues about what it will push for, but the Dispatch story didn’t offer any of this information to readers.

The Plain Dealer did a bit better, but not much. It said that insurers want to build on the current system (whatever that means to the reader) and favor tax credits as the best way to extend coverage to the uninsured. Instead of delving deeper into what insurers specifically want, the article used six paragraphs for boilerplate explanations of the candidate’s proposals—and then blew it describing McCain’s. The PD quoted McCain adviser Douglas Holtz-Eakin as saying that Obama’s plan would, among other things, “encourage employers to cut workers’ coverage and put them on the government plan.” McCain would also encourage employers to cut coverage, but he would send workers to private insurers. Surely readers would like to know that.

There’s a war about to start, and the press should remember that, in war, the first casualty is truth.

Has America ever needed a media watchdog more than now? Help us by joining CJR today.

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.