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.
Schrag’s observation is astute. It isn’t just that the debate is the same and the press isn’t acknowledging it—the coverage actually suggests that things are different. “Not Yesterday’s Health Fight”, read the headline on an April column by The Washington Post’s E. J. Dionne. Robert Laszewski, who writes a popular blog called Health Care Policy and Marketplace Review, told me reporters keep telling him, “‘Bob, it’s different this time.’ And I say, ‘No, it’s not really different.’” As Schrag suggests, the media’s master narrative tells us that the debate is different because, unlike in the Clinton era, all the stakeholders are playing well together. Insurers, especially, are more cooperative, supporting coverage for everyone and agreeing to give up medical underwriting, a practice that has denied coverage to people at higher risk for health problems. “The health insurance industry is working on a transformation that could come right out of Extreme Makeover,” wrote AP reporter Ricardo Alonso-Zaldivar in March. In December 2008, a Boston Globe headline proclaimed: “Lobbies Backing Health Reforms, Insurers Change Their Tune From 1993-94 Debate.”
But look at what The New York Times had to say in December 1992: “In Shift, Insurers Ask U.S. To Require Coverage for All,” read the headline on a story in which reporter Robert Pear quoted Judith Feder, a Clinton transition team official, who described the apparent support for universal coverage and cost containment “as a major turnaround” for the industry.
It’s true that in early 1993, many of the same stakeholders—insurers, employers, and the American Medical Association—were supportive of comprehensive reform. Only when they realized what the Clinton plan required—spending limits, stricter regulation, a mandate that businesses provide coverage to employees, etc.—did they sour on it. Only then did the insurance industry unleash its infamous Harry and Louise ads that were so effective at turning public opinion against the legislation. A similar broad consensus exists now, but the press has misread it, argues Harvard pollster Robert Blendon. He says that “reporters covering Washington believe that the debate is over.”