Re-examining Massachusetts Health Care

Post-election comments from the MSM miss the boat

Wednesday on WNYC’s Brian Lehrer Show, Richard Parker, who lectures at Harvard’s Kennedy School, talked about his son’s hockey coach, a third-generation Cambridge fireman who voted for Obama in 2008 but went for Brown this time. The fireman, like most public sector workers, has very good insurance—a so-called Cadillac plan with good benefits that the Washington health care cognoscenti want to tax into oblivion. “They’ll screw my system if we don’t stop them,” the coach told Parker. The anecdote raised an important question—how affordable will insurance be when national reform is fully enacted? Parker said that people in the state perceive national reform as all about expanding coverage, not affordability, which he called “the poison pill at the heart of the bill.”

My own reporting over the past year shows that people in Massachusetts are concerned about affordability. One fifty-four-year-old woman, who lives in a small town south of Boston, told me she is an independent who voted for Brown because he could make a difference in Washington. That difference: stopping the health plan. “I know the plan is all wrong,” she said. What exactly was wrong? It was just like the one in Massachusetts, which makes people buy unaffordable insurance, she explained. “The Connector [the state’s shopping service] wants to determine your affordability. They don’t care if you have past loans or alimony to pay,” she said. Her daughter makes $32,000 working two jobs and can’t afford coverage; she pays the penalty for not having it.

In their post-mortems on Tuesday’s vote, many in the MSM ignored concerns like these and clung to the master narrative that all was well with health care in the Bay State. Massachusetts provided the national model for reform, and the state’s vote may be its undoing. How ironic! A Washington Post story proclaimed: “Brown’s victory in Mass. Senate race hardly a repudiation of health reform.” The Post tried to make its case, saying that the law has covered “all but 3 percent of Massachusetts residents” and “retains majority backing” of people in the state. As proof, it cited a Boston Globe poll showing that 59 percent of state voters supported the law. The paper acknowledged that 69 percent had supported the law last year, but found a silver lining—only 11 percent of those polled wanted the law repealed. “Divining voters’ motivation is difficult,” the Post concluded.

What the Post didn’t report was that this year’s poll did not ask people who were directly affected by the law whether they supported it. A year ago, Harvard pollster Robert Blendon and his colleagues asked that question, and found that only 37 percent of residents in that group supported the law while 56 percent opposed it. Blendon told Campaign Desk that the earlier poll was funded by the Blue Cross Blue Shield of Massachusetts Foundation; this year Blue Cross wasn’t interested in funding that particular poll. Blendon’s shoestring budget didn’t allow for asking that relevant question, even though he said he would have loved to do that.

Later in the story, the Post moved into he said/she said mode, giving the edge to the positive spinners. Princeton professor Paul Starr said that the Massachusetts reforms were “sufficiently popular” enough that Scott Brown didn’t repudiate them. That popularity, he continued, “should encourage people that if it’s done at the national level, that it would work as policy and that it would be popular.” Wow! What a leap, in view of what residents told us. Starr was counterbalanced by a conservative analyst, the Cato Institute’s Michael Cannon, who said that “things are not as hunky-dory as people have been saying;” that the law has cost residents and businesses more than supporters say; and that fewer people are covered than state data suggest.

We’re not sure what Cannon had in mind about fewer residents being covered. But Campaign Desk has noted that, according to the latest Census Bureau figures, 5.5 percent of the state’s population did not have coverage in 2008, up from the 2.6 percent who didn’t soon after reform took effect. The Post and other outlets still use the old figure. Is this another part of the “all-is-fine” narrative?

The New York Times also seemed conflicted by what to make of the health care messages. The paper said it was “difficult to gauge” success or failure of the health care bill as a potent issue for voters. Said the Times:

Massachusetts already has near-universal health coverage, thanks to a law passed when Mitt Romney, a Republican, was governor.

It concluded that the national bill would have little effect on how many of its residents got coverage, “making it an unlikely place for a referendum on the health care bill.” As for the point Richard Parker was making, well, the Times missed it.

The PBS NewsHour didn’t stray far off the reservation either. It assembled a panel of its usual experts, The Washington Post’s Ceci Connolly and National Journal’s Amy Walter, and added Jennifer Nassour, chair of the Massachusetts Republican Party. Much of what they explored was predictable—are people angry; is Massachusetts as blue as everyone thought; what about those independents?

Massour did give some reasons for voter frustration, but no one connected any dots. She said that “Democrats in the [Massachusetts] House and the Senate decided that right now is a great time to increase our sales tax by 25 percent during a recession.” It’s reasonable to assume that people are unhappy about the tax, but the NewsHour show did not mention the reason for the hike: the state needed the money to pay for health reform. Massachusetts has no dedicated funding source for the subsidies it pays people to buy insurance, and the cost of those subsidies goes up because medical costs keep going up. It’s a shame the NewsHour didn’t link the tax increase to the lack of cost control in the Massachusetts law and the federal bill. How far that would have gone toward public understanding.

Gail Collins got it right yesterday in her New York Times column:

My positive thought is that we should appreciate what a good outlet democracy can be for public dissatisfaction.

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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.