Last week, The New Republic turned over its health care blog “The Treatment” to an odd commenter on media coverage—University of Chicago professor Harold Pollack, who runs the university’s Center for Health Administration Studies. I thought I knew most of those who dabble in these waters, but Pollack’s name took me by surprise. Pollack, a special correspondent for The Treatment, may know something about welfare programs and substance abuse, but we on Campaign Desk take issue with his credentials as a press critic and dispute his central point. In his piece, Pollack argued:
Because it is so easy to find bad reporting and public stupidity, it is easy to overlook something. Press coverage of health care reform was the most careful, most thorough, and most effective reporting of any major story, ever.
Better coverage than the Vietnam War; the civil rights movement; the consumer movement? Really? In the case of the civil rights struggle, the press helped change the discourse; Americans began to view race in a new way, which led to the eventual passage of the Civil Rights Act. During the Vietnam War, the media effectively changed the public dialogue from a war we couldn’t lose to one we could not win. In the early days of the consumer movement, media coverage of Ralph Nader led Congress to enact significant consumer protections. Coverage of health reform has hardly risen to that level.
In fact, poll after poll has shown that about as many people approved of the reform legislation as opposed it, and suggested that most Americans lacked a basic understanding of the changes being proposed. How many people opposed the bill because they didn’t understand it? As the bill teetered on the verge of passage, politicians acknowledged this sad fact when they told the press that the public will come to like it when they learn what’s in it.
Calling the public stupid slips into blame-the-victim mode and smacks of elitism. It’s Peoria Joe’s own damn fault for not devouring the policy wonk materials Pollack argues exist by the boatloads. Everyone reads JAMA and The New England Journal of Medicine, right? Maybe that kind of talk is okay for ivory tower academics at the University of Chicago, but it isn’t for journalists—especially those in the MSM upon whom the public counts to not only deliver the news but to interpret what it means. Here is where the press fell down, a point we have made repeatedly on Campaign Desk and in the March issue of the print magazine.
The press failed to tell the public—people like Jeremy Devor, who lives a few hundred miles south of Pollack’s office, how the legislation would affect his family. You see, Devor has good insurance from his employer. Yet he was struggling to pay the out-of-pocket medical costs that were not covered. He had heard the president and the press say he could keep the coverage he had, but he knew it wasn’t working for him. When I met up with him, he wanted to know how he would be helped.
In numerous impromptu “town hall” interviews I conducted around the country, I found many people keenly interested in the health care debate. But they knew on some level that the media wasn’t helping them out. I would hardly call any of them stupid. Many had simply been misinformed, like an Army reservist working at Starbucks who had heard Obama planned to take away her health insurance. Others had heard so many conflicting stories about health care, like the man in Columbia, Missouri who told me health reform is “just kind of fuzzy to everybody.”
Did you try reviewing the coverage by any regional daily papers before writing this post? The Denver Post, as one example, dedicated at least four reporters from late summer through December, and provided dozens of in-depth articles on all major aspects of the health reform debate. Coverage I read in other dailies was often similarly thorough, fair and useful. Your standard seems to be that in-depth knowledge of the reform bills must translate to opposition to those bills, and that anyone who was in favor was misinformed?
#1 Posted by Michael Booth, CJR on Mon 5 Apr 2010 at 04:44 PM
Trudy, you may well be right--the MSM may have deserted the post but it's pretty damn sloppy for an insider such as yourself to assume Jon Cohn took the week off and have The Treatment to Pollack for a week. He's been writing on The Treatment for about a year....
#2 Posted by Matthew Holt, CJR on Tue 6 Apr 2010 at 01:00 AM
Interesting piece. Did you look at NPR's coverage? What kind of media did the people you spoke with around the country consume, and did any of them do any google searches?
I'm not sure that pointing to people protesting a tax they'll have to pay is a good example of people understanding the issue. Do most of those people understand why the tax is proposed? Or are they just voting against it because they don't like the idea of paying more?
It's tough to compare health care changes to the civil rights movement and vietnam. Those were relatively black-and-white issues, no pun intended. Racism and war, compared with single-payer systems, the intricacies of medicare, the relationship between hospitals and health insurance companies...
And one request - Can you provide links to the coverage you liked - the papers you mentioned? (for those of us just tuning into your blog)
#3 Posted by Lisa, CJR on Tue 6 Apr 2010 at 08:23 AM
Trudy Lieberman's perspective on media coverage might have been different if the final bill had introduced the single-payer system that she has been lobbying for over the past 20 years. (The much-lamented public option was the compromise concession for this crowd.) Since the reform law is a terrible disappointment, it therefore follows that the coverage must be at fault. Mrs. Lieberman writes from the Olympian heights of New York City, where people wonder why the United States doesn't more closely resemble the country they hear about from their friends in Cambridge, Berkeley, and Georgetown. Her expectation that coverage of the highly technical material contained in health reform ought to rival in impact the coverage of the Vietnam War or the civil rights movement just seems unrealistic, unproductive, and self-important. The fact that this centrist, rather conservative bill was barely able to get through Congress, and then only on a twist of the legislative rules, doesn't register with her.
Furthermore, the bill was a moving target, constantly changing according to the political tides of the moment. In such circumstances, how could you expect the general public to keep up with the individual building blocks in the legislation? It's only now that we're learning how the complexities in the law affect our individual situations. That's as it should be. To berate newspapers for failing to include an academic disquisition on long-term care policies is to invite the industry to turn off readers even faster than it's been doing.
I thought the coverage was excellent. There was plenty available for anybody who was interested enough to follow it. The failings of our political system were certainly laid out in the light of day. Does the average reader or TV viewer comprehend the complexities of the farm subsidy program? Do they know how it affects them? What about the defense appropriations? What about any other piece of comprehensive federal legislation?
I would argue that the public is far better informed on this bill than it has been on any comparable issue in the past 15 years. And that is due largely to the increased sophistication of the media since health reform came on the docket in the early 1990s.
#4 Posted by John Ruxton, CJR on Tue 6 Apr 2010 at 12:16 PM
Trudy, I agree with the previous comenters. While I have great respect for your work in general, I think you're overstating the faults of the media in covering health reform this time around (I myself was hyper-critical of the coverage during the Clinton plan battle). I also think you're being high-handed in dismissing the work of excellent blogger-reporters like Harold Pollack who don't come out of professional journalism.
I saw excellent health reform reporting in many publications and Web sites over the past year and a half. To name a few, NPR (Julie Rovner and company), NY Times (Kevin Sack, Dave Leonhardt, and others, including occasionally Robert Pear), LA Times (Lisa Girion), New Republic (Jonathan Cohn), Miami Herald (John Dorschner), TheHealthCareBlog (Merrill Goozner and others), Time (Karen Tumulty), New Yorker (Atul Gawande), Washington Post (Alec MacGillis), and quite a few others.
My impression was that the coverage was significantly better this time around than during the Clinton plan battle, in part because the Obama administration succeeded in coopting and muting special interest groups whose criticisms dominated the coverage of the Clinton plan (see Robert Pear). I also have a feeling that experienced reporters and editors finally got fed up with the current U.S. health care system and saw that the status quo was no longer a viable option. Plus, much of the opposition criticism of the Democrats' health proposals was so wild and irresponsible that it was hard for reporters to take seriously.
Humphrey Taylor of the Harris Poll had an excellent piece on TheHealthCareBlog a few weeks back explaining that health care is so complicated that it's very difficult even for intelligent, well-read people to understand, which is what has made health reform such a devilishly difficult political endeavor. I think it's offbase to largely blame the news media for the public's generally poor understanding of the reform legislation and the issues -- particularly when so much misinformation and disinformation was being thrown out there by the opposition. I also think it's offbase to blame President Obama, who like President Clinton did an often-excellent job of explaining what health reform would mean to the average person.
I, too, interviewed people in the streets and found that far too many were getting their information from cable TV, talk radio, and wild screeds they received via e-mail and Internet. Responsible, evidence-based news reports are just another voice in the wild cacophony of today's American political discourse. But we in the evidence-based media must continue to work hard to keep the public well-informed during the long period of implementing the health reform law.
#5 Posted by Harris Meyer, CJR on Tue 6 Apr 2010 at 09:33 PM
Great post, the reporting was almost all horse-race.
Why the dearth of coverage on Romneycare in Massachusettes? How is that working out? Pros, cons, what should the health bill copy from MA, what should it leave behind? What about the San Francisco single-payer plan that bypasses insurance companies altogether?
The excise tax on "Cadillac" plans does not apply to union members only; it is based purely on the cost of one's plan. If they raise your premiums past a certain threshold, you'll be taxed extra.
#6 Posted by AJF, CJR on Tue 6 Apr 2010 at 11:40 PM
This cracked me up---
To wit--
The American press corps' impact on the public discourse peaked decades ago, when this post's author was in her prime...???
Sweet.
#7 Posted by Pablo Manriquez, CJR on Wed 7 Apr 2010 at 01:08 PM
I think that Trudy points out, quite accurately, that the media was in many ways obfuscating the issues rather than explaining them. All of the subtle putdowns in the world cannot obscure the fact that most Americans expectations and needs after their eight year wait were not fulfilled in 2008 with the election of Barack Obama who proceeded to work harder towards preventing real health reform than providing it. We've ended up with a program that I think everyone agrees wont work, (just look at Massachusetts today) - with a four year delay attached to it. (According to a Commonwealth Fund study, that four year delay might as well be called a 400,000 LIFE delay, because that is how many Americans will die during that time when they would have received care in Canada or France or the UK, or any of the nations that try to get this right instead of try to find ways to get it wrong and justify that.) Obama also was elected on false pretenses, promising something (a public plan, a "monopoly service provider" prohibited by the WTO's General Agreement on Trade in Services) he knew that he was not able to deliver,(because of pre-existing, entangling, trade agreements.) The amount of money allocated to subsidies is clearly a fraction of what will be needed. So its inevitable that this program will collapse the only question is when. We would be well advised to throw it out and start over before our needs for affordable healthcare and the provisions of the treaties we have signed put us in a similar, disaster of a situation as we are currently in, in online gambling with Antigua. (We lost, they won, we were asked to pay a huge fine, but just a fraction of what we would be asked to pay if we walked into the trap that is being set for us.)
#8 Posted by Ed G., CJR on Sat 10 Apr 2010 at 09:31 AM
Some of the previous commenters were right, there was plenty of information out there and almost anyone could access it if they were sufficiently motivated and aware. Blogs like Erza Klein's were excellent for unveiling policy details and resources like T.R. Reid's work were invaluable for doing compare and contrast analysis between America and other countries.
But there was also plenty of disinformation out there competing for the attention of the casual and unaware audience. The coverage of Fox News and the Investor's Business Daily seemed designed to shock, anger, and increase ad revenue without regard on how this angered audience, enraged by false information and all the wrong issues, would impact the quality of the bill.
And much of the political press was so devoted to the circus show reaction to misinformation that they did not properly cover the republican obstruction, despite the bill including many of their initiatives and ideas - this was a conservative bill - and despite many democratic attempts to involve the truculent conservatives in the process. They did not properly cover the deals with the various industries that were brokered so that cost cutting ideas like drug reimportation and the public option we're left off the table months ago and the idea of using reconciliation to pass a stronger bill (like the house version) was impossible because of the process Obama chose to take. Obama used reconciliation to pass the weak bill, but he let the strong bill (which was weak by international standards) flounder in senate garbage.
Good reporting would have made clear that the senate is broken and that the senate process for crafting their version of the bill, written in a way that excluded voices outside the Baucus gang of six and the Wellpoint executive they employed http://emptywheel.firedoglake.com/2009/09/08/liz-fowlers-plan/ , was designed to fail.
So if you were sufficiently diligent and aware, you could find out all you needed to know about this bill and how a good health care bill should have read and how a good health care bill might have got passed in spite of the senate rules, which republicans have ruthlessly exploited while Obama's democratic party have let them without consequence.
But if you were a casual listener, or one who got their lead for the conservative lie machine, all you saw was chaos and yelling and talk of thousand page bills and nothing really explaining the issues in an enlightening way.
For instance, Roger Ailes and the Fox News group recently remarked
http://swampland.blogs.time.com/2010/01/31/paul-krugman-and-arianna-huffington-v-roger-ailes/
"If you say -- if (inaudible) words are in the Constitution, if the founding fathers managed -- they didn't need 2,000 pages of lawyers to hide things, then tell, then tell."
Well yes, it might be easy to do a one page bill that's simple enough for everyone to read. Medicare for everyone is extremely simple.
But if you are going to compel private insurance businesses to execute their services in a proper universal manner in spite of the liability, if you are going to bend the cost curve without owning a major component of the curve, then your bill can't be simple because it's not trying to solve the problem in a simple way. You can't use a simple means to solve a systemic problem without seriously disrupting the system. Obama made clear from the campaign he didn't want to disrupt the current system to meet the desired goals.
And the press was very bad at telling this story.
#9 Posted by Thimbles, CJR on Sun 11 Apr 2010 at 02:20 PM
The media has been largely ignoring the most important aspect of the healthcare bill, that the chances of mainstream America being able to afford decent healthcare insurance is going to remain virtually nil and Americans will fall farther and farther behind because of it.
The administration's bill hasn't done anything to control the cost increases here.
Withholding care and accounting tricks are no substitute for effective cost control.
No matter how slick they are, they aren't going to be able to tell people they can afford it when they can't for much longer.
The media is going to end up looking pretty stupid for not doing the math for people.
If you ask me, that's a pretty serious omission.
And that will be a big story.
#10 Posted by Mark, CJR on Mon 12 Apr 2010 at 09:17 PM