Is Health Reform Dead or Alive?

Wanted: a newsmaker to give us the word

Last week, one Washington insider asked a Washington journalist why she had not written that health reform was dead. The journalist replied that she couldn’t do that until someone in power said so. Then she would have her story—with, of course, the headline declaring once and for all that health reform was dead or alive. Her comment is hardly surprising. For the last two years, the coverage of health care politics has, for the most part, hinged on what newsmakers—and I use that term broadly—have said. Reporters haven’t strayed far off the reservation, choosing to wait for the story that politicians, health care stakeholders, and advocacy groups wanted to tell. The one they want to tell right now is a narrative of ambiguity.

The headlines on stories from Thursday night’s presidential pep talk at a National Democratic Committee fundraiser reflect that ambiguity, and perhaps the media’s own ambiguity as well. From The New York Times came this: “Obama Maps a Way Forward for a Health Overhaul.” The Washington Post beckoned readers with: “Obama offers alternative path on health care.” Politico gave us: “Dems chafe as W.H. wavers on health care bill.” The Associated Press told us: “Obama Admits Health Care Reform May Die In Congress.”

Basically, the stories reported on the president’s remarks, in which the key line went something like this:

I think it’s very important for us to have a methodical, open process over the next several weeks, and then let’s go ahead and make a decision. And it may be that …if Congress decides we’re not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not.

That hardly sounded like the forceful leadership needed to pass a reform package—that package which Obama said he wanted before Christmas. Was the president deferring to Congress yet again on what the press has been telling us was his signature domestic issue? Thursday night, he seemed to say he had a new Number One domestic priority. “I think we should be very deliberate, take our time,” he said. “We’re going to be moving a jobs package forward over the next several weeks; that’s the thing that’s most urgent right now in the minds of Americans all across the country.”

The AP noted that “newly conflicting signals could frustrate Democratic lawmakers who are hungry for guidance from the White House.” Politico was more direct, noting that the president “has left Democrats as confused as ever about how the White House plans to deliver a health care reform bill this year.” In the past two weeks, Politico reported that Obama and his top aides suggested all of the following breaking the bill into smaller parts; keeping it together in one comprehensive package; putting it at the back of the legislative line; and needing to “punch it through” Congress, as the president said earlier in the week. How’s that for ambiguity?

But, then, the president has always been ambiguous about the reasons for reform in the first place. On the campaign trail, he talked about universal coverage, then about only covering kids. Last summer the raison d’etre became health insurance reform; in his State of the Union address, he pleaded for reform in the context of deficit reduction. It’s a good bet that the public, at least those attuned to reform, have caught on to the fuzziness even if the press hasn’t put it all together yet. Sunday on C-SPAN Newsmakers, Obama aide David Axlerod said the president was not looking for a “symbolic win” but for “actually getting something done and that’s what he’s working towards.” The press needs to ask if he’s looking for any win at all.

Ambiguous prognoses have come from other pols and been dutifully reported in the press. In a piece the AP moved a day before Obama’s remarks at the Democrat’s fundraiser, Erica Werner noted that there was “greater skepticism among some rank-and-file Democrats,” and asked California congressmen Dennis Cardoza and Jim Costa, moderates who supported the House bill, about the fate of health reform. They “burst out laughing,” Werner reported. “Those people [the ones circulating a letter in support of the public option] are delusional,” Cardoza said. But Arizona Democrat Raul Grijalva told Werner “Don’t write the obituary yet.” Nancy Pelosi had the last word in Werner’s story. “We are on track to have comprehensive health care reform for our country…and there are several paths to that goal.”

If Grijalva wasn’t writing the obituary, Secretary of Health and Human Services Secretary Kathleen Sebelius might have been. Way back in August, Sebelius said that the president could live without the public plan, and it turned out she was right. Last week, the secretary told the Senate Finance Committee: “I am not a principal in the negotiations. Nor is my staff.” What kind of administration would be negotiating major health reform bills without its Secretary for Health and Human Services in the thick of it?

Historical footnote: During the negotiations for Medicare, officials from the Department of Health, Education, and Welfare (as the agency was then called) were heavily involved, particularly Wilbur Cohen, who was once called The Man Who Built Medicare. Politico and the AP have done a jolly good job bringing to light the ambiguity (and absurdity) of this phase of reform.

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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.