Elizabeth Edwards on John McCain’s Health Policy

Someone has to translate

Elizabeth Edwards told some 500 health journalists the other day that John McCain’s health care plan was like “painting lipstick on a pig,” an expression from her neck of the woods that in this case means lofty-sounding words that pretty up some ideas that could hurt ordinary people who don’t understand what’s going on; that is, unless journalists tell them. The language of his plan sounds good, she argued, making it “hard to understand what’s wrong with it. “Someone has to translate for the public.” Edwards challenged reporters to do just that.

Translating for the public is good advice for journalists about the health platforms of all three major candidates, and Edwards, of course, is a partisan. But she’s worth hearing out.

First, she zoomed in on McCain’s proposal that would allow families “to purchase health insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business that will eliminate excess overhead, administrative, and excess compensation costs from the system.” Nice sounding words, Edwards pointed out; who can be against excess compensation except those who receive excess competition? Who doesn’t want to maximize choices, and want to believe that heightened competition is a good thing? But underneath those words, Edwards said, lurks the real meaning of McCain’s plan—relieving insurance companies from the burden of state regulation that sometimes does crack down on abusive practices, as the Los Angeles Times noted in California last month, for example.

Edwards’ interpretation:under McCain’s plan, policyholders would lose valuable consumer protections in some states that would no longer be able to enforce their laws. How is this better for consumers? McCain, Edwards argues, is “trying to give companies a pass on regulation by allowing a national playing field”—another of those pretty, hard-to-argue-with phrases that could spell danger. (And Edwards may have a point. It’s wise to dredge up from memory the “national playing field” arguments that were used years ago when banks, many regulated by the states, were allowed to move their operations to South Dakota, with its lax regulation, a shift across state lines that sowed some of the seeds of the consumer credit crises the country currently faces.) And as Edwards sees it, McCain’s health plan would give insurance companies carte blanch to sell whatever they want at whatever price by whatever sales tactics reel in the most prospects.

So taking Edwards’ advice to parse McCain’s language, let’s take another example. McCain wants to “reform the tax code to eliminate the bias toward employer-sponsored health insurance, and provide all individuals with a $2,500 tax credit ($5,000 for families) to increase incentives for insurance coverage.” Eliminating that “bias” could mean that employers may no longer deduct health insurance as a business expense, which would surely further reduce the amount of such employer group coverage and perhaps spark a movement to get employers to stop offering coverage altogether. (Even though the number is dropping, roughly 60 percent of people still get insurance from their employers.) If employers wipe out health insurance, more of their workers would have to wade into the jungle of the individual insurance market, where prices are high and only the fittest can buy a policy. Those who have had cancer—like both Edwards and McCain—would face a challenge.

Does one of McCain’s other proposals—that “insurance should be innovative, moving from job to home, job to job, and providing multi-year coverage”—include the “innovation” of getting rid of restrictions on covering pre-existing conditions that often keep people from just such a move? “As I traveled around the country,” Edwards said, “the thing I head most was the problem with pre-existing conditions. Coverage for pre-existing conditions is enormously important to people.” Most people don’t understand why they can’t buy insurance to pay for the very medical problems they have—a uniquely American notion.

It’s up to reporters to explain, and to parse the pretty phrases.

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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.