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.”
Still more had been led to believe that reform would solve all their medical problems, only to be disappointed to learn the truth. In Columbia, a fifty-seven year-old woman on Social Security disability, waiting to qualify for Medicare, said that early on she had heard politicians say that they would reduce the amount of time that she had to wait before she could get Medicare benefits. The waiting period was and still is two years. When I met her, she didn’t know that reducing the waiting period was off the table. The fix was too expensive for Congress to seriously consider; they needed the money to pay the doctors who were lobbying (and still are) to make sure that fee cuts mandated by Congress don’t take effect.
Then there was the matter of the public plan, supported by large portions of the public and ostensibly by the president, who said it would be a “good deal for consumers and would also keep pressure on private insurers to keep their policies affordable.” The media extensively covered the plan—ad nauseum, actually—but it was not until it became clear the plan was dead that most people learned they wouldn’t have been able to use it anyway. Not many in the media delved into details like these and connected the dots.
In the last ten days I have spoken to two groups of college students—in Brooklyn and in Wisconsin. Large numbers of students turned out. They were thirsting for information, and not just about whether they could stay on their parents’ health policies. They wanted to know about many aspects of reform. A Wisconsin pre-med student asked if the law could actually be implemented in a way that would be cost effective. Another student wanted to know why the AARP did not support a single payer system. One young woman told me she had insurance with an $8,000 deductible. She and her husband were ready to start a family and were worried about paying for maternity care out-of-pocket.
All year long, we have urged the media to explain the individual mandate and the penalties for not carrying insurance. But coverage was sparse for most of the year, in our judgment because the newsmakers and the pols glossed over the mandate, fearing that voters might not like it. Since much of the coverage followed what newsmakers had to say, the mandate got short shrift until very late in the debate.
Newsmakers didn’t talk much about affordability, either, except when they passed along the Democrats’ empty slogan about “affordable, quality health care for all.” There wasn’t a lot of explanation of how the subsidies would work, or how middle-income families, with incomes around $60,000, $70,000, or $80,000, will still have to pay a good chunk of the premium out of their own pockets to cover the $13,000 cost for a reasonably good policy. Again, the dots remained unconnected.
Pollack argues that “moderately informed and inquisitive readers could get more accurate information, more quickly, and more carefully-analyzed than one ever could before,” although he concedes that “one needed to know where to find this information.” Kaiser Family Foundation may have great data for those with patience and time to sift through it, and its news service may produce some fine stories. However, the public knows their local paper, and maybe the Associated Press. Not Kaiser Health News. The humongous bill may have been posted online, but even super-good lobbyists I know have trouble reading federal legislation, with its amendments, strike-outs, and references to buried clauses in sub-sections all the way in the back. Blogger Robert Laszewski clearly explained the affordability dilemma—more than once—but it’s a good bet most Americans had never heard of Laszewski’s blog. Few bloggers have PR agents touting their words.
When aspects of the bill were clearly explained to the public, they got it. Case in point: the excise tax on Cadillac plans. When union leaders told members what was at stake in the fight over these plans, which gave them good, comprehensive coverage usually in lieu of higher wages, workers understood and didn’t like it one bit. One firefighter in Cambridge, Massachusetts, who hailed from a long line of Democrats, voted for Scott Brown in protest. “They’ll screw my system if we don’t stop them,” he said.
Indeed there was decent reporting on the Internet by several randomly dispersed bloggers who know their stuff. But it doesn’t count as great coverage if you write mainly for people who already get it. Arguably, blog followers already have an intense interest in the subject. But great journalism must do more than preach to the choir, and much of the coverage preached to the choir, especially the policy wonks angling for their next appearance on the News Hour.
Quantity of coverage does not equal quality, a point Allison Kilkenny makes on The Huffington Post. There is no argument that there was tons of coverage, especially about the process of writing and passing a bill—in other words, the horserace. Stories touched on everything from stakeouts at the Senate Finance Committee to the House whip’s minute-by-minute nose count. Pollack himself says that he “religiously checked David Dayen’s whip count at Firedoglake.” But as we’ve noted, stories were often too brief for public understanding, lacked completeness, and left readers or viewers with half a loaf. When Campaign Desk found comprehensive stories that connected the dots and provided important context, how-to information, or took a fresh angle, whether in Montana’s Missoulian, the Kansas City Star, the Charleston Gazette, The New York Times, or Time magazine, we were quick to praise them. We wish there had been more.
Pollack notes that some experts who were not exactly household names became leading commentators, like Timothy Jost of Washington and Lee University. The press had pretty much ignored Jost until early last year when we featured him in one of Excluded Voices series to help bring new voices into the mix. Even so, by fall, the media were still relying on the same handful of sources. Pollack notes that Howard Gleckman wrote important material on disability policy. Maybe so, but the MSM never did much to spark a serious discussion on long-term care—another aspect of reform that was neglected during the two-year discussion.
Perhaps The New Republic piece was not so puzzling considering the magazine’s health care history. This was the same magazine that published stories by another provocative writer who didn’t have all the facts in hand—the infamous Betsy McCaughey, who helped to sink the Clinton plan and attempted to do the same last summer when she tried to kindle public anger over death panels. We hope The Treatment’s Jonathan Cohn returns to his posts this week. He is one of those bloggers who knows what he’s talking about.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.