Where Will the Money Come From Redux

Maybe not from us, say health care special interests

The president scored a big one last week when he appeared on national TV with representatives of six big stakeholders in the health reform debate—the AMA; AHIP, the insurers trade group; PhRMA; the SEIU; the American Hospital Association; and AdvaMed, a trade association for the medical technology industry. At the press event, the assembled players announced they had signed a letter agreeing to help the administration reach its goal of “decreasing by 1.5 percentage points the annual health care spending growth rate—saving $2 trillion or more” over the next decade—a figure a trade association official told me was a “phony number based on projected rates of growth.” Obama used the words “historic” and “watershed” to describe the groups’ pledge, and Americans got the message that doctors, hospitals, insurers, technology manufacturers, and unions were really going to do something about health care costs.

As the week went on, it was clear that some of these trade groups had made promises with which their members did not agree. The American Hospital Association (AHA) began hearing from member hospitals wondering just what its trade association had committed them to. At first, the AHA appeared to blame the media, saying that “some early news reports misstated the savings goal as 1.5 percentage points per year over 10 years.” Some letter signers then said they had actually agreed to more gradual spending reductions.

But wait a minute: Wasn’t the president saying the same thing as early media reports? AHA executive vice president Richard Pollack wrote to his member hospitals, saying: “The groups did not support reducing the rate of health spending by 1.5 percentage points annually.” The association’s senior vice president for communications, Rick Wade, told me “You could read the [original] letter two ways.”

By the end of the week, the percentage point saga had reached Robert Pear of The New York Times. Pear reported that the industry was now backpedaling on its pledge to reduce spending, and the White House was flip-flopping on what the president actually said. According to Pear, Nancy-Ann DeParle, director of the White House Office of Health Reform, first told him that “the President misspoke” during Monday’s announcement. An hour later she called back and said: “I don’t think the president misspoke. His remarks correctly and accurately described the industry’s commitment.” Budget director Peter Orszag weighed in on his blog, reprimanding the Times for making “a mountain out of a molehill.”

Too bad the media didn’t pick up Pear’s story the way they jumped on the president’s “historic” announcement; they could have used the opportunity to reveal some pretty interesting politics. At its core, the story was a question of who’s using who: Was the White House using the industry, or was the industry using the White House? One thing is certain: everyone was using the press. This was a story where follow-up was in order, but these days the media’s attention span is short. Washington’s politicos know that.

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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.