Just before Christmas, a CNN poll asked Americans whether they favored or opposed the health-reform bills moving through Congress. Forty-two percent favored them, 56 percent were opposed. This and other polls released last fall also suggested that most Americans lacked a basic understanding of the changes being proposed. Arguably, the two are connected. How many people were opposed to the legislation because they either didn’t understand or misunderstood it? A clerk at a store in West Virginia told the Charleston Gazette that she tried hard to follow the twists and turns of health reform. “I know it affects me,” she said, “but I can’t find out what it’s going to be.” A friend of mine admitted that she had stopped trying to figure it out. A small business owner in Manhattan concluded: “The press has done a horrible job of translation.”
Press coverage of the effort to reform health care has been largely incoherent to the man on the street. The three hundred or so posts I have written about health-care reform for cjr.org over the past two years tell the story of media coverage that failed to illuminate the crucial issues, quoted special interest groups and politicians without giving consumers enough information to judge if their claims were fact or fiction, did not dig deeply into the pros and cons of the proposals, and gave tons of ink and air time to the same handful of sources.
By now it’s a familiar critique—the press did not connect the dots, there were too many he said-she said stories, not enough analysis, and so on. And yet, after a decade in which the inadequacies of traditional press strategies—objectivity, top-down coverage, the primacy of the “scoop,” etc.—became ever more apparent to those of us who care about these things, those very strategies failed the country again on a story of monumental importance to every citizen.
Traditional journalism as practiced by the nation’s major news outlets, even as it has been recreated on the Web, is just not good enough for a story as big and complex as health care. Such stories demand a new paradigm, and while I don’t pretend to know exactly what that paradigm is or how we get there, the ways the press failed on the health-reform story provide some clues.
Traditional journalism relies on official sources to tell the story, and on health care those sources framed the narratives they wanted the public to hear. The “stars are aligned” refrain, heard from advocacy groups like Families USA and others, conveyed the idea that the chief stakeholders all supported reform. But what those stakeholders supported was “reform” that for the most part let them continue with business as usual. From the Democrats came the narrative of “affordable, quality health care”—empty, focus-group tested words that misled millions of Americans into thinking reform would bring health insurance to everyone and health care that was both cheaper and better. From Republicans we got the predictable fear-mongering about “government-run health care,” but few alternate solutions. The president himself gave us the “you can keep what you’ve got” assurance that left many people wondering, “If that’s the case, why should I care?”
Playing follow-the-newsmaker leads to he said-she said reporting, which does audiences a particular disservice on stories about contentious, difficult issues like health care—the truth is complicated and requires more explication than clashing quotes can deliver.
In mid-January, for instance, USA Today botched a piece about whether the House and Senate bills would really cut costs and generate enough savings to cover subsidies for the uninsured. The story began with a conservative economist questioning whether the projected long-term savings were realistic. Then came a quote from the director of Families USA who assured us that the projected savings were “more than realistic.” There was a paragraph explaining that the Senate bill calls for $438 billion in cuts to Medicare and Medicaid over a decade and that almost half of those cuts would come from trimming Medicare payments to doctors and hospitals. Next the paper noted that a Department of Health and Human Services report said some of the proposed cuts “may be unrealistic” and could actually reduce access to care. That was followed by a fellow from the Urban Institute who suggested it would be “very hard” politically to get the cuts through. Then came a comment from a fellow at the Center on Budget and Policy Priorities, who said that in the past Congress had in fact adopted cuts to Medicare and that those cuts were “part and parcel of most major deficit reduction efforts in recent years.”