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.
Since the beginning of the presidential campaign, I have found scant coverage of how real people would fare under the kind of reform envisioned by the health-care cognoscenti. In fairness, until June there was no bill to measure. But we have known enough about what was coming that it should have prompted some reporting along these lines. What will happen, for instance, to the owner of a South Bronx taco restaurant who finds he must pay thousands of dollars for insurance or face severe penalties for not being insured? Or to the factory worker who must pay taxes on her health insurance, just as her employer makes her pay more for fewer benefits?
In the fall of 1993, I wrote in CJR: “So far, neither the press nor the Clintons have built a consensus among the people who have to use whatever system Washington rebuilds.” The same is true today. Neither Obama nor the press have built a consensus for reform. It’s hard to assemble one when the public doesn’t know what reform actually means. An engineering doctoral student from the University of California at Berkeley and a Manhattan hairdresser recently asked me the same question: What is single-payer? And last spring, my journalism students at CUNY asked people on the streets of New York what they knew about the differences between a public-plan option and private insurance. “I didn’t know there is a difference,” one said. Another added: “Public, everybody knows about it; private, nobody does.”
President Obama says he wants a bill by October, so the press still has a chance to help the rest of us make sense of these crucial policy decisions. But they will have to do it quickly. It really is Groundhog Day for health-care reform.