One Step Forward, One Step Back

The AP gets it right on universal coverage, but new code words loom

Score one for the Associated Press! We at CJR have been posting for some time about the misuse of the words “universal” and “national” by politicians and the media to describe candidates’ health plans. On Monday, we urged reporters to use more precise language in describing Barack Obama’s proposed health plan, which is basically a mish-mash of coverage from various old and new sources that, somehow, might add up to more people having insurance coverage. So we were pleased to see an AP story Tuesday, about a new advertising campaign sponsored by a coalition of organizations called Health Care for America Now, that came closer to describing what Obama and others really mean.

Here’s AP reporter Jim Kuhnhenn’s lede: “Health care is returning as a campaign issue, with special interest and advocacy groups preparing to spend at least $60 million to push politicians to embrace universal access to medical coverage.” Those words—universal access to medical coverage—more accurately describe Obama’s approach to health care reform. Obama says he will make it easier for people to buy policies from mega-insurance carriers, and will also give them the option of buying from what he calls a National Health Insurance Exchange, which, a spokesperson said this week, will include the comprehensive benefits offered to federal employees and members of Congress through the Federal Employees Health Benefits Program. (Note: Through this program, employees still choose plans sold by commercial insurance companies.) This, of course, leaves unanswered the knotty question of whether people will actually be compelled to buy a policy. If they will not, it’s hard to figure where the universality comes in. It would be good for the media to keep pressing this point.

It turns out that Obama’s plan for universal access seems similar to principles advocated by Health Care for America Now (HCAN), a coalition that includes the AFSCME and SEIU unions,, Planned Parenthood, and the National Women’s Law Center. In its statement of common purpose, HCAN says that it stands for a truly inclusive system that gives people a choice of buying a policy from a private insurance company, keeping what they have now (usually also from a private insurance company), or buying from a public plan that guarantees affordable coverage without a private insurer middleman. Does that mean it won’t be like the federal employees program? The devil, remember, is always in the details.

HCAN’s ad sends a bit of a mixed message. Even though the group does not oppose private insurance policies, the ad also offers this rhetoric: “Will health insurance companies ever put your health before their profits? We can’t trust insurance companies to fix the health care mess.”

If that’s not puzzling enough, some of the same language found in coverage of the HCAN campaign is identical to the language used by America’s Health Insurance Plans (AHIP), the industry’s trade association. In an ABC News story this week, HCAN’s campaign director Richard Kirsch said: “We are looking for a uniquely American solution.” When the campaign was announced this week in Maine, Alison Vander Zanden, of the Maine People’s Alliance, said: “We’re looking for a uniquely American solution to the health care crisis that is truly affordable, that provides quality care, that controls costs and that is available to all.”

Gosh, that’s the same thing that AHIP said in a press release issued after the ad campaign launched. AHIP president Karen Ignani said that her group intended to make a significant contribution to the debate over blending public and private strategies “to achieve a uniquely American solution that can work and be enacted.” Those words—uniquely American solution— have shown up before. This spring, in an interview with Lee Newspapers, Montana Sen. Max Baucus, chair of the Senate Finance Committee (though which health care legislation must pass), said: “We will have insurance companies in America. We’ll have uniquely American solutions….” Uniquely American solution is a new code phrase, intended to prod the public into approving this vague and unspecified “solution” without really understanding what the words really mean.

A thorough semantic dissection of what those words actually mean is in order. The press needs to decipher the new code words, just like it needs to decipher familiar ones like national and universal. And, just as important, it must tell the public what it and the insurance industry—along with whatever allies it digs up, be they liberal or conservative think tanks, businesses, labor unions, or consumer groups—has to gain by or lose from this “uniquely American solution.”

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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.