Reform efforts have danced around this impasse for decades. In the early 1990s, for instance, health experts promoted a pay-or-play scheme—an arrangement in which employers would be required to either offer their workers health insurance or pay into a fund to subsidize those who had none. There was also serious talk of an “individual mandate”—a requirement that everyone have insurance—and of making workers pay taxes on health benefits from their employers. (Both proposals are now on the short list.) Experts in the earlier debate also pitched a public plan under which people not covered by their employer would be enrolled in a government plan. The Clintons did not embrace that idea, but President Obama supports it. Early on in their respective campaigns, both Bill Clinton and Obama rejected the idea of single-payer, code for national health insurance. Indeed, single-payer is further off the table than ever despite enclaves of noisy advocates who have been virtually shut out of the political process.
Then, as now, there were outside conveners trying to influence political and public opinion. In the Clinton days, it was the Jackson Hole group—businessmen, insurance executives, and academics who met in a Wyoming lodge to hatch proposals for managed competition. Today it’s the Herndon Alliance, which includes former single-payer supporters, advocacy groups, unions, and think tanks that have rediscovered the public-plan option and fashioned language to sell it. They’ve taken their cues from Democratic pollster Celinda Lake, who found in a study paid for by the alliance that Americans were happy with their private coverage and would resist a Medicare-for-all solution. Doing what Frank Luntz has done for Republicans, Lake invented new buzz words—“quality, affordable health care”—and counseled Democrats to pair them with reassurances to the middle class that they could keep the coverage they had. Alliance partners have enforced the kind of language discipline that would make a Republican proud. Almost every statement about health care from a politician or advocacy group uses the words “quality” and “affordable.”
Exactly why the press is reprising its docile approach to this debate is a complicated issue that necessarily involves the long-standing question of how journalists define their role in society—whether they are leaders of the national conversation or mere amplifiers of it. In 1993, Holly Taylor, a health reporter at The Berkshire Eagle, in Pittsfield, Massachusetts, stood up at the annual meeting of Investigative Reporters and Editors and asked why the national media were reporting that managed competition was the only solution to the health-care crisis. Taylor told me at the time: “What I found frustrating was that everyone was writing about managed competition as if it were a fait accompli.” This year, it’s the same story. At the annual meeting of the Association of Health Care Journalists, Duane Schrag, a reporter at the Salina Journal in Salina, Kansas, echoed Taylor’s frustration after listening to a talk about health-care reform by Oregon Senator Ron Wyden. “I was just struck by how accepting the audience was of a solution that represents an encapsulation of the status quo with the same players and the same current costs,” Schrag says. Why, I asked him, did he think journalists weren’t pushing back? “Perhaps the media were caught up in the good news that after sixty years there’s a breakthrough and all the stars are aligned,” he says.