Divining Obama’s Health Care Budget

Early signals and the need for sharp eyes

Sam Stein, who blogs at the Huffington Post, apparently has a pipeline to the health care gods—in this case, a senior administration official (unnamed, of course) who says the budget will call for tens of billions of dollars to be devoted to health care over the next ten years. The money will provide a pool of resources, as Stein puts it, “to help shore up the health care system on the benefits and coverage side.” Just what this means is hard to say, because the money quote from the official is well, government doublespeak:

On the benefits side and the coverage side we are going to have principles, but part of what we are trying to do is set up a legislative process where we can actually get this done. So don’t expect full details on the benefits side, what we are trying to do instead is provide some funding that could then fund a variety of different ways that go about covering the coverage/benefits side. We are focused on getting health care done this year and the budget is going to facilitate that.

Stein’s post becomes a bit more illuminating when he says the president won’t propose a companion bill along with the budget that spells out what he means by reform, a tactic that will allow Congress to craft something more to the liking of the legislative branch; that is, something compatible with competing ideologies. During the campaign, the Obama camp had said they would leave the details of health reform up to Congress. Of course, this raises one big question: Where is the presidential leadership on health care that the public has come to expect? Hundreds of press stories over the last year have reported that Obama had big plans for reforming health care, so it’s not surprising that people believe that will happen.

As Stein points out, deferring to the legislative branch is tricky, because some members of Congress prefer incremental reform, and there’s disagreement over how to get it funded. This is where the special interests reign supreme at getting their way. Look what happened in the stimulus bill. Bloomberg shed some light on one of those special interests today in a story about Pfizer. At the end of a routine business story came word that Pfizer CEO Jeffrey Kindler had been meeting with several members of Congress, including Sen. Edward Kennedy, “to press for comprehensive health care reform that expands insurance coverage to more Americans.” Kindler said there is about 80 to 90 percent agreement on how to increase access to health insurance. He doesn’t say who is in agreement—Congress as a whole, or Kindler and the select group of Congressmembers he has visited, or other potent special interest groups. Does this sound like the deal is done? What about the 10 percent who could set up a real road block?

In covering the health angle of the budget, we’d like to see the media cut through the wonk talk and tell it straight to the public. That might mean moving beyond their usual stenographic function and probing and plumbing all kinds of sources—and, yes, pressing special interest bigwigs like Kindler about just what they mean by “principles,” “comprehensive,” “increasing access,” and “expanding eligibility for public programs.” Those terms don’t mean a lot to average people who want to know if all those lofty-sounding phrases will actually bring about the care they need. Are they simply empty Orwellian phrases? Keeping in mind Stein’s quote from a senior official, reporters might want to reread George Orwell’s Politics and the English Language before they go much further.

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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.