Republicans waved a new flag of health reform opposition right after New Year’s, when Florida governor Charlie Crist attacked the president for health care secrecy—the same sort of attack Republicans and other opponents used on Hillary Clinton back in 1993. Said Crist:
It seems that a bill that was crafted in a closed door, backroom meeting in the White House will end the same way. President Obama has broken his pledge to the American people to be transparent throughout this process and Harry Reid and Nancy Pelosi have only aided in the secrecy with sweetheart deals and dead of the night votes.
Crist, who earned his transparency bona fides by creating his state’s Office of Open Government, claimed the president broke a campaign promise to have “the negotiations televised on C-SPAN so that people can see who is making arguments on behalf of their constituents and who are making arguments on behalf of the drug companies or the insurance companies. That approach, I think is what is going to allow people to stay involved in this process.”
Republicans and the media smelled a good story. The St. Petersburg Times’s Truth-O-Meter ruled that Crist was right. The Christian Science Monitor picked up the thread, quoting Rep. Tom Price, a Georgia Republican who opined that “negotiations are obviously being done in secret and the American people really just want to know what they are trying to hide.” Jake Tapper and Diane Sawyer got involved and ABC viewers learned that the president had gone back on his word.
Obama told Sawyer “it’s my responsibility…to own up to the fact that the process didn’t run the way I ideally would like it to.” When Sawyer pressed about the deals in Nebraska and Florida, the president shot back that he didn’t “make a bunch of deals,” and blamed them on Congress. “I am happy to own up to the fact that I have not changed Congress and how it operates the way I would have liked,” he told her. House Republicans sent the president a letter decrying the “ongoing secret health care negotiations among Democrats in Congress” and insisting that Obama not sign any bill “crafted in a backroom deal.” A case of the pot calling the kettle black? Republicans made the same sorts of backroom deals in 2003, during the negotiations for the Medicare prescription drug benefit.
It strikes me that the president’s mea culpa on health reform transparency (or lack thereof) deserves media attention beyond simply passing along sound bites from Republicans who have latched onto a new reason to oppose health reform. Health reform transparency is more complicated than whether C-SPAN televises some proceeding like Obama promised they would in the heat of the campaign.
Here’s where the president and the press went astray. We have known for a long time what the bill would do and how different groups of people would be affected. But neither the president nor most of the media have have made those details transparent. If the president wanted the public to be involved in the process, as he told Diane Sawyer he wanted them to be, he needed to be honest and transparent about several things:
• How the requirement to buy health insurance would work and who would face tax penalties for not complying.
• How the public plan was just a bargaining chip to be traded away and that, as it was envisioned, very few could actually buy insurance from it.
• How, even with subsidies, millions of people would have to spend eight or ten percent of their income for health insurance.
• How Americans with employer-based coverage the president said they could keep face higher and higher deductibles resulting in more out-of-pocket medical expenses, leaving them underinsured if catastrophic illness strikes.
• How the lack of strong cost containment measures made the slogan “affordable, quality health care” virtually meaningless, because special interests with the most to lose didn’t want them.
A truly transparent process would tell Medicare beneficiaries that buried deep in the legislation are provisions that would require them to shoulder more their medical costs when they buy Medicare supplement policies Plans F and C, the most popular plans. Right now most seniors don’t have a clue they might have to pay more.
Would they learn all this on C-SPAN or at Obama’s next televised event? Maybe, maybe not. If Harry Reid had made his deal with Ben Nelson on C-SPAN, would there have been a deal at all? Who knows? My guess is that the two would have signaled to each other in a code that few listeners could make out. Or does the public still need a go-between like the press to explain it for them? In my book, the need for that press function has not disappeared.
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.