Word comes from The Washington Times, in what the paper calls an “exclusive”, that Sen. Edward Kennedy has been secretly working behind the scenes to fashion a proposal for reforming the U.S. health system. Despite his illness, the paper said, Kennedy has been meeting with lawmakers, lobbyists, and assorted other health care mavens who want a say in the outcome. What’s more, he is working with a Republican, Sen. Michael Enzi of Wyoming, who is the ranking minority member on the Senate health committee. Kennedy’s spokesman, Anthony Coley, told The Times that the senator has been laying the groundwork for fast tracking a bill when Congress returns in January. “This is and has been the cause of Senator Kennedy’s life,” Coley said.
All this is reminiscent of Hillary’s Clinton’s secret plan to reform health care as we knew it back in 1993, and Kennedy’s own mid-1990s efforts at piecemeal reform. In 1995, he teamed up with another Republican, Sen. Nancy Landon Kassebaum of Kansas, to shepherd through Congress the now infamous Health Insurance Portability and Accountability Act (HIPAA), hoping to reduce the ranks of the uninsured by making it easier for some employed people to keep their insurance when they lost or changed jobs. But the requirements were so onerous, and the cost of new coverage so high, the law did little in that department. It did give favors to doctors and insurance companies, and its privacy provisions created a nightmare for journalists who try to get people in places like hospitals to talk to us.
We offer a few observations for the media, lest they be tempted to flock en masse to the win-one-for-the-Gipper story line that The Washington Times portends is coming. Hillary Clinton’s secret plan for health insurance became the story for too many reporters in 1993-94, when they should have been explaining how the Clinton plan would actually work and whether it would do what the Clintons said it would do. Ted Kennedy’s secrecy is not the story; what his bill will and won’t do is. That’s especially important since the outlines of confrontation are already emerging.
On Friday, a blogger for the conservative The Weekly Standard posted that “the liberal lion Ted Kennedy” is “still pushing for socialized medicine.” It’s unlikely Kennedy will propose anything close to socialized medicine or a single-payer system, which has been all but eliminated from this year’s health discussion. Instead, he probably will advance some version of the Massachusetts health reform law that he had a hand in creating. That law requires people to have insurance; if they don’t get it from a public program, they must buy it on their own or face tax penalties. But how will the public know the difference between Massachusetts health care and socialized medicine, unless the press improves on the work it did covering HIPAA?
HIPAA is a cautionary tale. We recommend that anyone serious about covering health reform in the next Congress take a look at a story CJR published after HIPAA was passed. We showed that most journalists had no idea what was in the law, and their stories were often just plain wrong as a result. Trish Riley, then director of the National Academy for State Health Policy, told us that “Everyone was so gleeful something was going to pass that the holes in Kennedy-Kassebaum (as the law was first known) were never well-documented.” We wrote that Kennedy-Kassebaum was “the perfect symbolic law giving the impression of solving problems without doing much.” As veteran health care journalist Susan Dentzer, now editor of the policy journal Health Affairs, said back then: “It’s fair to say that it kind of got kissed off.”
The press oversold HIPAA, telling the public that their insurance was portable and that they could take their coverage with them when they changed jobs, when, in fact, the law didn’t do anything of the sort. (HIPAA made it slightly easier for people with pre-existing conditions to get new insurance.) The media inflated the number of people who would have been affected by the law, and they didn’t bother looking at the gifts it bestowed on docs and insurance carriers.
There’s a real danger the press may reprise its HIPAA performance, bringing back all the legislators and special interests that previously took starring roles. We hope that doesn’t happen. But Kennedy’s meetings with the special interests, Barack Obama saying that reform will be decided in the legislative process (a.k.a the Congressional sausage grinder), and glowing comments like this one from the head of an advocacy group—“There really is a sea change that should not be underestimated in terms of attitude”—all give us cause for concern.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.