Memo To Health Care Reporters

Explain what the terms “national” and “universal” really mean, and what Obama’s plan really does

Too many recent health care stories have been confusing the terms “national” and “universal,” and using the term universal to mean something that it does not. These are dangerous practices. Misuse of these terms misleads people about what Barack Obama’s proposed health plan would actually do. Because of the slippery, shorthanded way we in the press have used the terms, Americans might actually think everyone will automatically be covered under Obamacare. They won’t be. How surprised poor voters will be when they realize that, if they want coverage, they have to buy it from Aetna, Cigna, or Blue Cross, or from a public insurance plan that will compete with the insurance giants (if such a thing isn’t torpedoed during the legislative process).

Michelle Singletary, who writes a widely read personal finance column for the Washington Post, reported last week that she met with Obama who ticked off his economic fixes, including what she called “a universal health-care plan.” In a New Republic blog post about liberal groups’ forthcoming ad campaign, Jonathan Cohn opines that “in the same way Harry and Louise came to epitomize the opposition to reform in 1994, chances of actually passing universal coverage this time around should be significantly greater.” The headline of a post on AOL’s news blog Political Machine proclaims “Kennedy Preparing Universal Health Care.”

An editorial in yesterday’s Concord Monitor said that the nation’s largest union has started to work with big corporations to lobby for “a national system of universal health care.” The next sentence says the U.S. Conference of Mayors has endorsed a bill that would “assure everyone coverage under a single payer system that preserves choice and the doctor-patient relationship.” (Readers might be wondering what’s the difference?) At a campaign stop in Pittsburgh, the Pittsburgh Tribune-Review said that Obama asked Americans “for a mandate to implement a national health care plan if he’s elected president.” And in St. Louis, Obama told reporters that millions of Americans “could be helped by his proposals for a voluntary national health insurance plan for the uninsured, self-employed and small business.” What the heck is a voluntary national health insurance plan?

The words “national” and “universal” have been co-opted by both Obama and, during her campaign, Hillary Clinton, to make their proposals sound like something they are not. The tactic seems to have worked. The press and the public are becoming believers. Previous posts have explained what the terms mean. It’s time for a refresher.

In health care parlance, a national health plan refers to the national insurance schemes of most developed countries, under which every citizen has coverage as a matter of right, and everyone pays into the system through various taxes. The systems are universal; everyone is covered without coercive mandates. People generally can’t opt out, so there are no worries about uninsured freeloaders, or hospitals shoving the cost of their care onto someone else. There are no private insurers dreaming up ways to make policyholders pay more, or scheming to drop the coverage of those who get sick.

Obama’s plan has none of those characteristics. Its aim is to get as many people as possible covered by insurance bought from private carriers, or from the as-yet-unformed public plan. Kids must be covered, says Obama, and their parents will be forced to cough up the money for the premiums. As for their parents, well, they can buy or not buy. (I get it now. That’s what he means by a voluntary national plan.) To entice them to buy, he says he will offer tax subsidies and make premiums cheaper—by $2,500 for the typical family—as if he has a crystal ball divining how health costs will rise in the next few years.

Of course, people who already have insurance through their employers, Medicare, Medicaid, or some other state program can keep it, allowing Obama to count them in the ranks of the insured. By the end of his first term, all of the currently insured and all of the newly insured will somehow add up to universal coverage—if all works according to the campaign rhetoric.

It’s hard to expect politicians to be honest during a campaign. But it’s a different story for journalists. So instead of trying to make the candidates sound like they’re really going to give us a universal, national health insurance system like the rest of the world, let’s be honest. Tell audiences exactly what the candidates mean. Forget the buzz words. Journalists’ credibility will go up, even if the candidates’ credibility goes down.

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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.