The Missing Genre

How do the candidates' plans affect ordinary folk?

Not long ago I met Charles, a fifty-four-year-old man living in a poor Cleveland neighborhood. He had run out of his blood pressure pills and he had no money to buy more. His arm was tingling and his vision blurry. He was dizzy, he said. Charles had come to a makeshift clinic set up in an old Catholic school, run by a woman who partners with student nurses to offer preventive care to people who receive almost none. The nurses said his blood pressure had hit the danger zone and they called EMS. Charles refused to go to the hospital. He kept asking me: “Who’s going to pay for it? Who’s going to pay?” Rose Marie Egensperger who runs the clinic on a shoestring, explained: “Folks have lived with symptoms so long their health isn’t their first thought. For 90 percent of the people the major concerns are money and how am I going to get home.” This time Charles lucked out—he got new pills from another clinic he had been to before. Who knows what will happen when he runs out again?

At a school across town, I talked to Kevisha, a bright, articulate eleven-year-old who described everything that was wrong with her teeth—three cavities that needed filling; a rotting, broken tooth that a dentist had dug out; the root canal she had no money to pay for, and the bridge she needed to keep her other teeth from crowding into the empty space. Students from a local dental program were sealing what teeth they could to prevent more cavities. When they were done, she looked up and asked, “Are you coming back, or are you all through?” Kevisha had already sensed that they would not be back, hwoever, and she knew the deal. She said she had a Medicaid card, but it doesn’t buy a $3,000 bridge. “She’ll never get that tooth replaced,” the supervising dentist said. “We can get her the fillings. But there’s no reimbursement for the bridge, no pro bono care for needs that extensive.”

So far, the coverage of the health care issue in the presidential campaign has focused on the bare, dry facts of candidates’ proposals, and there have been plenty of stories like the one The Plain Dealer of Cleveland published before the Ohio primary that gave thumbnail sketches of their plans. Such stories employ all the buzz words—penalties, tax credits, incentives, affordable insurance. But stories about people like Charles and Kevisha have largely been missing, at least in the context of what the proposals would mean for them. That’s curious. During the two years that Bill Clinton’s health plan was debated and dissected, people stories populated the news columns, and ordinary Americans could get some idea how they would fare under his proposal. This time, though, reporting has pretty much followed the candidates’ script. Reporters have been stenographers—diligently punching out the words candidates say rather analyzing how those words will affect and even transform people’s lives.

It’s easy for mainstream media to forget people like Charles and Kevisha. Both are poor, African-American, and live in dying sections of a deeply troubled city. But they need medical and dental care, and the question is: How will the candidates help them get it? Are tax credits an answer? That’s unlikely since neither Charles nor Kevisha’s mom probably pay much in taxes, if any. How would the public-private partnership envisioned by the candidates’ policy wonks help deliver coverage to them? They’ve already encountered the public part. Charles doesn’t qualify for Medicaid; in Ohio, single adults under age 65 don’t. Kevisha qualifies, but dentists don’t want to treat her. They say they don’t make enough money from Medicaid patients. As for the private part, how could they afford an insurance policy even with a tax credit of, say, $2500 which McCain proposes? Where would the other thousands of dollars come from to cover all the premium? How would Kevisha’s mom pay a fine for not buying health insurance that would be required under Obama’s and Clinton’s plan? (Obama’s plan, remember, requires kids to have coverage and their parents would be penalized if they don’t buy it for them.) How does she put food on the table if the penalty turns out to be garnishment of her wages at a hand lotion factory?

The candidates’ proposals also affect those higher on the socioeconomic ladder. Arizona is McCain territory, and the Arizona Daily Star has been running an ongoing series that looks at problems in the state’s emergency rooms. One story told of a 39-year-old man Rob Sweitzer who waited eight hours at a local hospital only to die, most likely of a severe and untreated infection, when blood filled his lungs and his heart stopped beating. The paper reported that Arizona’s emergency rooms are suffering from their own acute illness. The state has the longest ER waits, and it is among the worst nine states at providing emergency care. Patient access is poor, and there are extreme shortages of emergency physicians and on-call specialists. Just how would McCain’s plan or anyone else’s fix a national crisis that could affect anyone at any time, no matter their race or income or where they live? How is marketplace competition going to cure this illness when it was competition for on-call specialists in the first place that siphoned off doctors from ER duty?

As the campaign enters its next phase, voters will hunger for answers. Everyone has a dog in the health-care fight. It’s time for journalists to peel away the words tested by focus groups and the language selected by pollsters, and venture into the neighborhoods of Cleveland and Tucson where the real test of any candidate’s proposal will come.

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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.