Barack Obama wants to do something about the health care mess, and soon. He said so at his press conference last week, where he introduced his new health chief, Tom Daschle, and Daschle’s deputy, Jeanne Lambrew. The president-elect said it was hard to “overstate the urgency” of their work, adding:
Now some may ask how at this moment of economic challenge we can afford to invest in reforming our health care system. And I ask a different question. I ask how can we afford not to?
So it was heartening to see that, at the end of the press conference, Debbie Charles of Reuters asked the $64,000 billion question: “How are you actually planning to fund your health care program?” Obama’s answer was enlightening, especially in view of all his campaign talk. Throughout the campaign he repeatedly said he would pay for his plan, which involves massive subsidies to help people buy insurance from private carriers, by repealing the Bush tax cuts on those with incomes over $250,000. Cost estimates for Obama proposals have ranged from $65 billion to over $100 billion.
Obama replied that costs must be reduced and the administration would work to streamline and rationalize the health care system while looking for additional dollars to pay for some short-term investments. He said there would be some aggressive initiatives around health information technology and prevention. Then came the real news: “I have not made yet a determination in terms of how we’re going to deal with the rollback of the Bush tax cuts for the wealthiest Americans,” Obama said. In other words, the rollback, which was to finance roughly half of the proposal, might not happen, or it might be deferred. Now, you would think that this is important information for the public, members of which may have come to believe that Obama had the dollars to pay for his plan. But judging from many major newspapers’ coverage of the press conference, many people probably didn’t get it.
The New York Times’s next day story didn’t get into how Obama would pay for health care coverage. Instead, it discussed Daschle’s qualifications for the job of health czar, including his authorship of a book which calls for a Federal Reserve-like governmental structure for health care. The story hinted at a looming fight with health care lobbyists over establishing such an agency. An Associated Press story missed the part about the tax rollbacks, too. Its story lapsed into a standard political critique, with advocacy group officials commenting on the wisdom of giving Daschle two roles—Secretary of Health and Human Services and White House health guru.
The Washington Post ran two stories, neither of which mentioned the tax rollbacks. One story noted how health might figure into the stimulus package. (The government plans to shove billions into health information technology.) The other story hinted at how the president-elect would deal with the cost of subsidies for the uninsured. That story reported Obama “has provided few details about what his health-care reform proposal would include. And he declined to outline how his administration would pay for an overhaul.” No mention of the tax rollbacks.
USA Today and yesterday’s New York Times Week in Review section came closer to telling readers the real news, although neither offered Obama’s exact quote. USA Today reported that Obama “did not say where he would get the money,” and noted that raising taxes on the wealthy was not likely to happen “until at least 2011.” The paper also offered important context, pointing out that an analysis this fall by The Lewin Group, an independent consulting firm, found that neither health information technology nor management of chronic diseases will raise enough money to pay for Obama’s proposals.
In yesterday’s Week in Review story, Kevin Sack, who has done some good explanatory journalism this year, wrote that Obama reaffirmed that his rollback proposal might be deferred because of the recession. Sack again noted that there was considerable dispute about whether the savings generated from health IT would go very far in reducing the national medical bill.
All of this suggests that the media need to step up their watchdog role and hold politicians accountable for their promises. Bruce Josten, executive vice president for government affairs at the U.S. Chamber of Commerce, told Roll Call a few weeks ago “there’s a huge difference between primary rhetoric, general election rhetoric, and ultimately governing rhetoric.” The lobbyists know that. Does the public?
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.