Turning Point: Health Care

He said/she said is bad medicine. Time to dive in to analysis

This is part six of a series on the start of the 2008 presidential election’s general campaign. Links to the rest of the series can be found at the bottom of the article.

Of the hundreds of stories I’ve looked at over the past six months, the blog post written by Megan Carpentier for Glamour stands out. Carpentier is a young woman who has seen the warts of the health care system both as a patient and as a worker, covered and uncovered by her various employers’ insurance policies. She examined how she would fare under the plans offered by Hillary Clinton, Barack Obama, and John McCain; she examined their plans, in other words, from the perspective of an ordinary American for whom the battle over health reform is ostensibly being waged.

Carpentier’s thorough analysis concluded that McCain’s plan “would do nothing for me,” and that the others might help her in the short run. She especially liked that both Clinton and Obama would force insurers to cover and renew policies for people with pre-existing conditions (including people who were born with a birth defect, as she was). Carpentier zoomed in on a major rallying cry for reform—bringing sick people under the insurance tent. Her post represents a genre of health reporting that has been missing so far, one that helps citizens answer the question: Will I be better off or worse off under this candidate’s plan?

Good explanatory journalism should reign supreme on health care, but by and large it hasn’t. What has passed for explanation and context has often dissolved into the all-too familiar “he said/she said” accounts that aren’t a lot of help. Often they have focused on Clinton’s mandate and Obama’s no mandate, without bringing much clarity to the subject, or on how many people would be covered under Clinton’s more universal plan or Obama’s less universal one, as if the word “universal” could be modified by the adjectives more and less. Some of the reporting by New York Times reporter Kevin Sack can be singled out for informing with clarity and precision. His stories on the financial struggles in Massachusetts to cover all the state’s residents and the troubles in other states trying to cover more people should give fair warning to any politician who says the states will serve as a model for national reform. Other reporters might look to Sack’s stories as a model.

The word that describes too much of the campaign’s health care coverage is: timid. When candidates’ have said things that are just plain wrong—like the Romney-Guiliani-McCain assertions that Democrats are proposing the dreaded socialized medicine—most of the press let the erroneous descriptions stand, at least until recently, when some outlets have pushed back against such spin. Nor have they challenged Obama on his continued claim that he has accepted no money from lobbyists. Just before the Oregon primary, the Salem News reported, Obama laid out his approach for fixing health care and “will stand up to the big drug and insurance companies and refuse all donations from Washington lobbyists and special-interest PACs, in order to make universal health care a reality for every single American.” As CJR has noted, Obama may not take donations from PACs, which aren’t important in presidential races anyway, or from those who are officially registered as Washington lobbyists, but he does indeed take big money from groups that lobby, including drug and insurance interests.

Meanwhile, there has been virtually no coverage of groups, including a majority of doctors, that support a single-payer option. It’s as if the policy establishment and the media have decreed such a plan has no chance so why bring it up. Why should we let the candidates limit the parameters of the discussion?

Julie Rovner, NPR’s health policy reporter, recently moderated a panel on health care reform sponsored by the Village Presbyterian Church near Kansas City. Rovner told me, “I was kinda shocked when I asked for a show of hands in a crowd of 250 plus people, and about 80 percent said they wanted single payer.” On a conference call with health policy types arranged by the policy journal Health Affairs, Rovner observed, “People, if anything, want to go more towards the government and less towards the market.” But she said she did not do a story discussing support for single payer in the heartland. Maybe she should. The Kansas City Star reported on the panel discussion, but it, too, didn’t mention single payer.

The public continues to hunger for a real debate and to rank health care very high when pollsters call. The issue is personal. After all, if you can’t get care because you have no insurance to pay for it, or you are afraid you won’t have enough money to cover medical bills down the road, you care.

How to cover it? A good way to start is with more analysis of the differences between the McCain and Obama approaches. American health care is at a crossroads in this election. Obama would mandate that employers to provide “meaningful coverage” (whatever that means) or by contributing to a competing public plan. He would also require insurance companies to cover people with pre-existing conditions. McCain goes in an opposite direction, away from employers. By tinkering with the tax code, he would make it financially unattractive for employers to offer insurance coverage. He would thus throw workers into the marketplace to buy their own insurance, and would reduce some regulatory barriers in an effort to lower the price. If workers had an uninsurable condition, McCain would send them to what he calls a “guaranteed access plan,” built on the high-risk pools some states have had for years. Those high-risk pools bear press scrutiny; rates tend to be high and benefits limited; some are underfunded. All together they do not make much of a dent in the problem of uninsured people in the nation.

Next on the list should be the money story—a monster with many tentacles the press has yet to grasp.

Who’s financing the campaign? All the presidential candidates have raised almost $1 billion in campaign contributions, according to Opensecrets.org. Health care interests have been big donors. It’s a good bet most will fight for the status quo. They tend to like things fine the way they are.

How will reform be financed—where will the money come from to finance the tax subsides, for example, that both candidates support to help people buy private insurance? Few news outlets have examined the topic and those that have dabbled in it have tended to tilt the stories with an “oh my god, how are we gonna afford all this” tone, which signals from the start that maybe reform is too expensive and works against serious analysis. If the candidates have been vague about the money details, it’s the media’s job to pin them down and illuminate their vision and leadership.

How will the cost of medical care be controlled? So far, candidates have offered little to prove that their ideas for cost containment will actually contain costs. Nor has the media pressed for specifics. Just how much money to the system will be saved by the much ballyhooed disease management approaches, which have had mixed results, or by the salve called preventive care, which by the way, has upfront costs that someone needs to pay. And exactly how will market competition touted by both candidates lower the price of an MRI?

Because so much is at stake, it’s disturbing to see a new crop of stories predicting that reform won’t happen. Insurance executive turned blogger Robert Laszewski told his readers, “the chance for major health care reform in 2009—or—2010 is a long shot.” Reporting on the annual meeting of the Midwest Business Group on Health, The Chicago Tribune observed that not one person in a crowd of 200 thought health benefits would be expanded one year after a new president takes office. The danger is that these kinds of stories can become a self-fulfilling prophecy. More of them and editors might get the idea the debate is over before it has even started.

It isn’t.

Read parts one, two, three, four, and five of this series.

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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.