Tevi Troy, a visiting senior fellow at the Hudson Institute, writing on The Fox Forum, the news blog of Fox News, tidily summed up the outcome of the President’s Health Care Summit last week. The breakout sessions where some 100 people gathered into small groups to discuss the meat that will go into the legislative sausage grinder were “mostly unsurprising,” Troy wrote. How we get to reform is what causes disagreement, he added, and the “summit still has not provided the answer to that question.”
So, if nothing substantive—no agreement, no consensus—emerged, was there anything media snoops could learn? The New York Times offered a similar assessment, reporting that Obama “provided no new details of how he would extend coverage to the 46 million people who have no health insurance.” But then it noted a discussion of an individual mandate—the requirement to make everyone carry health insurance, either through a public program like Medicare and Medicaid or purchased from a private carrier. If they refuse, they would face some sort of sanction, perhaps a tax penalty.
The president of the Blue Cross Blue Shield Association, Scott Serota, made it clear that an “enforceable mandate”—that is, one with a penalty that stings—was the only way to get everyone covered. Health insurance will not work if people can buy it when they are sick and drop it when they are healthy, he said. Has Serota checked with his members lately? Last time I did, their underwriting manuals contained long lists of serious and not-so-serious medical conditions that keep people from getting coverage. So it would have been nice had the Times reporter pinned down Serota on that point. Serota seems to be in the word game business: making something sound plausible and even reasonable, but hiding the rest of the story. Too many times it’s only the plausible sound bite that gets reported.
The Times story went on to suggest that more word games may be in the offing. The prospect of a mandate requiring the working poor to buy insurance, for example, might not play well when it comes to the PR needed to sell the public on reform. The working poor usually earn too much to qualify for Medicaid but have no spare cash—what with paying for necessaries like food, rent, and gasoline—to buy a policy, especially one with decent coverage. A mandate might not sit well with small businesses either. Some of them struggle to make payroll even in the best of times, let alone buy insurance for their workers.
So Richard J. Umbdenstock, who heads the American Hospital Association, had a suggestion. The word “mandate” seemed to alarm people, he said. Instead, he advocated using a term like “responsibility.” Insurance should be viewed, he said, as a “responsibility on every individual, every institution and every enterprise in our society.”
Does that mean people like James Bell IV and Michelle Hernandez, poor uninsured people I met in Arkansas last summer, need to buy health insurance? They probably would if they could afford it and their diabetes didn’t prevent them from qualifying.
The press needs to watch for such words and examine what personal responsibility means for people like Bell and Hernandez, small businesses, and all the other institutions that Umbdenstock has in mind. That includes large businesses that don’t like mandates very much, and his own hospital members that have been known to reduce the hours of part-time employees so they don’t have to give them health insurance.
The summit’s takeaway for the journalists: keep an eye on the word gamers, explain what the euphemisms mean, and—most important—report on how the words and the policies they disguise affect ordinary people.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.