Now that the Affordable Care Act is the law of the land and its system of private insurance, private doctors, and subsidies to buy coverage is firmly in place, we thought that old health care bugaboo about “socialized medicine” might fade away. No such luck. Not, at least, in Massachusetts, of all places, where Republican Sen. Scott Brown and Harvard law professor/consumer advocate Elizabeth Warren are duking it out for Ted Kennedy’s old Senate seat.
The notion of a national health system—with all citizens covered as a matter of right and paying taxes to support their medical care—pushes hot buttons in America, and the Brown campaign has sought to capitalize on them. It pounced on “evidence” that Warren once supported a single-payer health system that would work on a social insurance model instead of the private model on which the Affordable Care Act is based. Warren is a bankruptcy specialist and has studied the relationship between medical debt and bankruptcy filings in the US. She co-authored a chapter in a book called Health at Risk, which was put together by Yale political science professor Jacob Hacker and published in 2008. In Chapter 3, called “Get Sick, Go Broke,” she wrote:
We approach the healthcare debates from a single perspective: maintaining the financial stability of families confronting illness or injury. The most obvious solution would be universal single-payer health care. This would allow people to get the care they need—without risking bankruptcy to pay for it.
Uh, oh! Those words have come back to haunt Warren. At the end of June. she appeared on New England Cable News, where the network’s Jim Braude asked this: “Something like single-payer—government run healthcare, far lower administrative costs, that sort of thing—would be the Senator Warren prescription, would it not?” Warren did not answer directly, but said, “I think right now what we have to do—I’m serious about this; I think you’ve got to stay with what’s possible, and I think what we’re doing, and look at the dust-up around this—we really need to consolidate our gains around what we’ve got on the table….”
Braude pressed: “But you do support single-payer, do you not? “No,” Warren said, and challenged Braude to go back and take a look (at her earlier writings). Braude already had, and pulled out the offending paragraph, with its words about single payer healthcare. Brown’s campaign then picked up the exchange and issued a press release, saying, “Warren Called Out for Denying Support for Single-Payer—Caught Red-Handed Trying To Mislead Voters.” Jim Barnett, Brown’s campaign manager, offered a quote, picked up by The Associated Press, which reported “Brown’s campaign manager, Jim Barnett, said voters should reject what he said was Warren’s support for a ‘radical European-style, single-payer health care scheme.’”
Gotcha! It is worth noting that not all of the European social insurance systems are of the single-payer variety, and, for that matter, that few Europeans would think of their health system as radical. But let’s put such things aside for the moment.
The relevant question for reporters is: Is this sort of thing worth covering? How much play, if any, should the press give to comments like Barnett’s? Insurance Journal and The Boston Globe picked up the AP story and passed along the Barnett quote on the specter of socialized medicine.
Was it worth the ink and pixels? First, Warren seems to be saying that from the perspective of avoiding bankruptcy, there would be fewer of them if all people’s healthcare was covered. That’s pretty hard to argue with. But even if she meant more than that: What difference does it make if Warren once favored a national health system, given that there isn’t going to be one soon? Or, given that she may have changed her mind or her priorities, perhaps in the way Mitt Romney stopped emphasizing his previous preference for the Massachusetts reform law that became the model for the Affordable Care Act? Does that make him unqualified to be president?
The voters will decide, I guess. But they need help in understanding healthcare’s big questions, and what’s really behind the candidates’ words and apparently changing positions. That calls for a robust and honest discussion of the issues, which has been lacking.
Political forces are boxing candidates into a corner, causing them—as in the case of Warren and Romney—to run away from positions they once took. That narrows the debate, and it would be better if the press was not part of the narrowing process.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.