At this point in any debate over health reform, journalists inevitably get lost in all the wonk talk, the economic calculations, the political prognostications, the fancy rhetoric that disguises hidden agendas, the Capitol Hill guessing game. It’s easy to forget about who we are writing for—ordinary people, who realize there’s something cooking with health care but just don’t know what’s in the pot.
That was evident last week during a webcast presented for journalists and the public by the Association of Health Care Journalists, The Commonwealth Fund, and the CUNY Graduate School of Journalism. My students conducted “man-on-the-street” interviews, asking people about their understanding of the differences between public and private health insurance. “I didn’t know there is a difference,” one said, “Public everybody knows about it, private nobody does.” Another explained the difference this way: “With public insurance, you don’t get as many benefits as you can than with private health insurance.” Still another person thought that “public means access for everyone. Private may be a little more, better care for individuals that have the money for it.”
The discussion about whether there should be a public insurance option to compete with coverage sold by private insurers has bypassed most Americans. It’s the flashpoint in the debate, and is problematic at this point. Its advocates argue such an option would offer cheaper premiums because of leaner administrative costs. Insurers oppose the unwanted competition, saying that insurance problems can be handled in other ways, like equalizing premiums for men and women. They also fear that a public plan would open the door to a single-payer system—which they dread.
It’s hard for ordinary people to understand the arguments for and against if they don’t know the basics, and our man-on-the-street interviews show they do not. So far, mostly experts, stakeholders, and members of Congress have engaged in the debate, and the media has been noting their pronouncements, passing them along to their audiences. Clearly there’s a big disconnect. Reconnection is needed soon, before the ads and commercials begin peddling their persuasive and subtle messages. A recent poll by the Kaiser Family Foundation found that the public can easily be swayed on the details of reform, and special interests have plenty of leeway to shape the direction of the debate.
MoveOn.org is trying to do just that with ads it has begun to air in Washington D.C. and in Montana and Iowa, the home states of Sen. Max Baucus and Sen. Charles Grassley, key members of the Senate Finance Committee, the gatekeeper to reform. It’s not clear what sort of plan Baucus supports, and Grassley opposes a public plan. The ad urges viewers to support Obama’s public plan, which, it says, “means affordable health care for everyone.” Does it really? That assertion needs to be carefully examined, because the program’s scope will depend very much on what it will do and the rules for eligibility. If advocates are resorting to wild claims, can insurers be far behind? How is the poor viewer to sort all this out?
No one, including MoveOn.org, really knows what Obama’s public plan would do, because he hasn’t said. In fact, his aides have said there are different ways to reach that goal. It might look Medicare, or the Federal Employees Health Benefits Program, which is basically a menu of private policies that meet a minimum benefit standard set by the government. The government acts like any other employer. Or will it be something in between? There are no details right now, and probably won’t be any until a proposal makes it out of committee. For the moment, “public plan” means different things to different groups.
On the podcast for journalists, Reed Abelson of The New York Times—who has written a fine piece explaining the option—and Noam Levey of the Los Angeles Times offered some tips and questions for reporters and editors who might easily find themselves in the weeds on this one:
• Explain what is meant by a public plan—who can join; what do they get; what it costs; who’s left out; who sponsors it; what regulations apply.
• What’s the practical implication of a plan—can enough people use it to provide a real choice, as advocates claim? Will it be touted as reform but actually fall short, as the Health Insurance Portability and Accountabilty Act (HIPAA) did in 1996? That’s a story journalists missed back then, as CJR pointed out at the time.
• Show how it will affect different groups of people.
• Move beyond the ideology. There’s a lot more to talk about than insurers demagoguing “socialized medicine” and advocates hoping for single-payer through the back door.
For more from Trudy Lieberman on health reform, click here.
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.