Eight reasons we need health insurance reform now. Some of Axelrod’s reasons for acting now have been said many times before, both during and after the presidential campaign—for instance, the number of people losing job-based insurance coverage is increasing and sick people can’t buy policies in the individual market. One reason for acting now, dubbed “Hard Times in the Heartland,” mentions that folks in rural areas have a tough time finding primary care doctors. That argument is not persuasive to some of us in New York City, where people with good insurance cannot get appointments with primary care docs because there aren’t many. High-priced specialists who tend to fuel medical inflation rule the roost here. It might have been more persuasive if the White House had acknowledged that people everywhere are having trouble finding primary care doctors.

Another reason for acting is that “The Tragedies are Personal.” Well, yes, most tragedies are. The e-mail says that half of all personal bankruptcies are due to medical expenses. That probably will not change, because the “affordable” policies many people will be able to buy will be the bare bones variety that will be insufficient when serious illness hits. The personal tragedy section also says that “the typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone.” All the more reason for seniors to be scared of reform efforts, and of losing what Medicare benefits they have. Was that what the White House intended to convey?

The next time Axelrod sends a “Dear Friends” e-mail, we suggest he find some writers who can make things clearer. But first the White House must be clear on what it wants out of health reform, and offer the electorate some substance, some clarity, and some direction. Without all that, the public is just going to stay misinformed.

If you'd like to get email from CJR writers and editors, add your email address to our newsletter roll and we'll be in touch.

Trudy Lieberman is a fellow at the Center for Advancing Health and 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. Follow her on Twitter @Trudy_Lieberman.