Where’s the Plan?

The media score well on their first-day budget stories

Yesterday morning, a friend e-mailed asking for my take on the President’s plan for health reform. Perhaps she was looking for my thoughts on who among the uninsured would be covered, whether there would be a public, Medicare-like plan for people to opt into, or if employers might have to foot some of the bill. My friend can be forgiven if she thought there would be a “plan” per se, because for months the media have been feeding expectations that President Obama would come forth with details and specifics that would cure the country’s health care miseries and lead to the promised land of reform.

But yesterday there were no such details and specifics, and not much leadership. Instead, the President’s budget called for a down payment on reform, without much of a payment schedule. He proposed setting aside a $634 billion pool of money that can be used to fund future health care initiatives over the next ten years. Maybe that means subsidies to help people buy insurance; it wasn’t exactly clear.

The President is leaving those details is leaving up to Congress, apparently trying to avoid the Hillary mess. Clinton’s magnum opus featured lots of complicated and confusing parts that made it easy for the special interests to ridicule and discredit the whole. Obama’s down payment has few parts, making it harder for special interests to publicly attack. But when Congress starts building those parts, it’s a good bet the key stakeholders will be around, monkey wrenches poised.

For the most part the media understood there was no explicit plan. The Los Angeles Times noted that Obama “does not lay out details for expanding access to health insurance,” and that he would not weigh in on proposals under discussion to require every American to obtain health insurance. USA Today reported that the budget “will not propose a specific overhaul plan.”

The broadcast media got it too. On World News Tonight, even Charlie Gibson observed that there was no plan. The most cogent assessment, however, came from Susan Dentzer, former health correspondent for The NewsHour with Jim Lehrer and current editor-in-chief of the policy journal Health Affairs. Dentzer told her viewers that the down payment was a down payment delayed. She explained that about half of the money for the reserve fund—about $318 billion—came from tax increases on wealthier taxpayers. During the campaign, experts projected that Obama’s health proposals would exceed $1 trillion annually, an amount that would cover only about half of the uninsured. “This is half again as much as that, $634 billion,” Dentzer said. She concluded:

So what’s actually being put forward here is a plan to spend some money, starting a couple of years from now, to begin to cover some of the uninsured. And that’s really the reality that has been created by the current fiscal situation we’re in.

In other words, the uninsured may have to wait.

We hope the press will get it when they do their second, third, fourth day stories, and keep on getting it throughout the year. A good starting place for further probing is page twenty-seven of the budget document. There, Obama lays out his eight principles for reform:

• Protect families’ financial health

• Make health coverage affordable

• Aim for universality

• Provide portability of coverage

• Guarantee choice (including the option to stay with your employer-based coverage)

• Invest in prevention and wellness

• Improve patient safety and quality care

• Maintain long-term fiscal sustainability

Now, all this sounds perfectly logical and utterly non-controversial. Geez, some of the principles sound like the things John McCain talked about during the campaign. McCain wanted to change the tax code to offer more choices, but said workers could stay on their employers’ insurance plan if they prefer. He also proposed making insurance more portable, and promised to promote wellness programs and preventive care like smoking cessation programs. Obama mentions investing in health measures to lower the cost of treating illnesses arising from obesity, sedentary lifestyles, and smoking. McCain also was prepared to let folks buy cheaper drugs in Canada, something people were doing in the early part of the decade, before the Medicare prescription drug benefit was passed. Page sixty-eight of the budget says Obama would do the same.

Journalists might also check out page thirty-six, where it says that the Obama administration wants to return to the pay-as-you-go budgeting that Congress used before the urgency of the stimulus package threw pay-go out the window. This is significant because it means that for every new program Congress enacts, there must be an offset. Either existing programs must be cut to free up money, or new money must be raised. Will this apply to health care? How will this impact efforts to find the money necessary to move beyond the down payment and ensure that all citizens can pay for medical care?

It might be good for today’s reporters to recall Clara Peller, the little old lady in the early-1980s Wendy’s commercials, who became famous for asking “where’s the beef,” implying that Wendy’s burgers had more meat than the competition. Walter Mondale used the phrase in his 1984 campaign against Gary Hart, suggesting that Hart’s proposals had no meat either. When it comes to Obama’s health proposals, journalists need to keep asking “Where’s the beef?”

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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.