The Election Story Not Told

The irony of health reform

For months we knew that health reform was in big trouble. Tuesday night, we found out how big. Health care was the second most important issue to voters, behind the economy. (Nineteen percent of voters said health care was the most important issue; sixty-two percent said the economy.) The law was something the public had come to dislike.

Shortly before the law passed in March, Democratic pollsters Douglas Schoen and Patrick Caddell penned a Washington Post op-ed warning that their party was delusional when it came to health care. The battle for public opinion and comprehensive health care had already been lost, they wrote, and Democrats ran the risk of “unmitigated disaster” at the polls.

The Dems and the administration pressed on, touting the pluses of the health law, like allowing young adults to stay on their parents’ health policies, and glossing over the minuses, like the mandate that everyone carry insurance. The press followed their lead. During the drawn-out debate, the press barely discussed the mandate, as if on cue from the law’s supporters. Recently, to its credit, the AP noted that the Health Information Campaign, founded by former administration allies, ran an ad that failed to mention the requirement that every American must carry health insurance. Such candor from the media was rare.

If the media failed to discuss in detail the law’s less attractive points, it also missed one of the campaign’s biggest ironies. Republicans, with their repeal and replace slogans, stirred up discontent about a law that was basically built with Republican and conservative ideas. That irony escaped the media. Right after Congress passed the law, former labor secretary Robert Reich wrote a column on Talking Points Memo noting that “Obama’s health bill is a very conservative piece of legislation building on a Republican rather than a New Deal foundation.” So it seems that, for Republicans, transforming the health law into a bogeyman was more important than owning up to their own solutions for fixing the system.

In discussing Reich’s memo, I pointed out that key elements of the law were right out of the conservative playbook. The individual mandate surfaced years ago in conservative circles as a more appealing way to cover more people with private insurance. For them, it was a far better alternative than a single-payer system or requiring employers to provide coverage, a solution blown apart during the Clintons’ attempt at reform.

Tax subsidies, too, were a conservative idea embraced in 2004 by both George W. Bush and John Kerry. Bush also encouraged the use of high-deductible health savings accounts, a conservative notion for controlling health care costs that makes consumers responsible for more of their medical expenses. The theory goes like this: if consumers use fewer services, perhaps because they can’t afford them, the nation’s overall bill for medical care will come down. The National Center for Policy Analysis, a Texas-based conservative think tank, nurtured that one, while the lobbying efforts of Patrick Rooney, a conservative businessman who headed Golden Rule Insurance Co. (now part of United Healthcare), helped move them into mainstream respectability. The health law calls for policies with $4000 deductibles (for family policies) to be sold in the exchanges.

As the summer and fall wore on, health reform came to symbolize super high insurance rates and policies with higher and higher deductibles that many people knew in their gut would leave them vulnerable if a serious illness hit struck them. All this talk of insurance exchanges, shopping services, and disclosing insurance terms, which the law requires, didn’t mean much in the larger context of affording an insurance premium in the first place. Those, too, were conservative, market-based approaches to reform, but the press didn’t make much of that, perhaps because the Democrats supported those approaches too.

If the press missed the irony of the Republicans’ campaign strategy, it did report on the pluses touted by reformers and the administration. But in the end those pluses didn’t give Dems the political gravitas they were seeking. Perhaps that’s because some voters saw that the reforms weren’t going to help them very much. One young man hoped to get on his mother’s insurance policy, only to learn that she had coverage from the Federal Employees Health Benefits Program, and that he couldn’t get on until January, when he was almost twenty-six and would soon be ineligible. In the meantime, he bought an individual policy, and now must figure out how to pay for a twelve percent rate increase his carrier just announced.

With the Republican star rising, changes are afoot. Michael Leavitt, who was Secretary of Health and Human Services in the last Bush administration, told Politico that there is a 75 percent likelihood that the requirement to buy health insurance will be disrupted, whether it’s weakened, stalled, or modified. Tuesday night, Eric Cantor, the heir apparent for the job of House majority leader, said “I hope that we’re able to put a repeal bill on the floor right away because that’s what the American people want.” Is it what the people want, or what Republicans have wanted all along? Whatever happens, the U.S. health system is still its dysfunctional, fragmented, costly self, in need of repair or wholesale reform. Going forward, this is the story the media need to tell.

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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.