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.”
One thing that is different this time is the Obama administration’s strategy. Instead of delivering a specific plan, the president outlined eight lofty principles—including the goal of universal coverage and making coverage affordable—and is leaving it to Congress to fill in the blanks. (By mid-June, there were signs that Obama had decided to assume more of a leadership role in the debate.) The press has reported this strategy as Obama learning from the Clintons’ mistakes. But this frame misses a larger point: the lack of concrete legislation to be picked over and explained—coupled with an accelerated timetable for action set by congressional leaders and the president and the dominance of rhetoric about how the “stars are aligned” for reform—have so far precluded a thorough debate.
As in the early nineties, the press is covering the process of reform, not the substance. Stories have yet to explore the consequences of an individual mandate, which some key members of Congress have proposed, and have dismissed it as though it were not controversial—which it certainly will be. Journalists have not explained how a public plan might work and who might be eligible—despite the hype, it’s unlikely everyone will be. They have not questioned the cost-containment measures the administration and Congress are promoting. Although Obama has talked a lot about lowering the cost of health care, cost-containment measures with teeth—like global budgets and spending caps—are nowhere in sight. There is not ample evidence to support the claim that health-information technology, preventive care, and disease management—the centerpieces of Obama’s cost-containment strategy—save much money, but the press coverage has managed to convey the impression that they would. Louise Russell, a Rutgers research professor and a leading scholar on preventive care, has written extensively that preventive care actually costs money, rather than saves it. Academics know her work, but the press has either ignored it or simply not discovered it. Instead, reporters go to the same sources over and over for more quotable conventional wisdom.