How should reporters check the claims made by interest groups that don’t want to concede that anything works well in other countries?
That’s a really good question, and I wish I knew how to better cover what’s going on in other countries, short of going there. Do I believe some of these scary things I see from some of these groups, that everything in France and Canada is awful? No. The one thing we do know from other countries is that even if their systems aren’t perfect, the people are very happy with their systems. And the health outcomes of people in other countries are better than our health outcomes.
What will happen if we don’t make any changes?
Seventy-eight million baby boomers who are rapidly approaching Medicare eligibility will start consuming a lot of expensive health-care services. That is the potential tidal wave of cost that we’re looking at, and that’s the main reason that doing something about the health-care system is an imperative.
Is there a way to sort the candidates’ positions on health care into different buckets for journalists?
The Republicans have been pretty easy to sort because they’ve all been saying the same thing, which is, “more private market.” The Democrats tend to be different: you’ve got your single-payer advocates, the individual-mandate advocates, and the rest say, “Let’s build on the existing system.”
What can we expect in special-interest lobbying?
The usual players will be involved—the insurance industry, the doctors, the hospitals—but there will be a new player, the IT industry. I think Microsoft is a player we haven’t seen before. They want to lay the railroad track for the interoperable health-information network. Both hardware and software providers are throwing lots of money around.
How can journalists do a better job of covering the debate over the next few years?
Mostly by putting things in context. Do truth-squading when candidates start going after each other with charges and countercharges. Is that really true? Or did the candidate leave something out? Those are great stories; they’re really popular, and they’re fun to do. If I were to make one big recommendation to journalists covering health care in this election, it would be to work at translating the substance.
What should reporters be reading to stay current?
I read Health Affairs. The Alliance for Health Reform has been doing some really good briefings and they post the transcripts. The Congressional Budget Office, in their estimates of bills, has been doing a good job of explaining these things. They can read hearings online at thomas.loc.gov. Kaiser does really good stuff.
What will be the big story, and what will be the sideshow diversions?
The big story will be whether there will be some sort of change in the health-care system, trying to cover the uninsured and controlling costs. The big diversion might be Bush’s tax cut, which is set to expire in 2010; that could be a problem in 2009.
How do you go beyond the anecdote to make a story accessible? Anecdotal leads have almost become a cliché.
I think that you may want to write about the decision-maker. Go with the agony of the person who actually has to decide, the small-business person, although that’s starting to get cliché, too. Something other than the patients themselves. If I knew the secret, I would be doing it.
It seems to me that there needs to be a new way to think about these stories, in terms of the writing, in terms of the presentation.
Remember that at its core, it’s really about decisions over how we structure the system—basically government versus private sector. And within that, it’s, “Do we have a whole new delivery system, or do we build on what we have now?” Those are the two big decisions. And then within them, there are a zillion more decisions. But if you keep those overarching decisions in your head, it’s a little bit easier. The world is a different place than in 1993. This is going to be more “how” rather than “whether” we change the system.
People’s eyes glaze over when a story contains difficult concepts, such as risk selection. How do we keep readers from tuning out?
Find something that makes a great metaphor. For a story on s-chip, one of the issues was, “Will people drop private coverage and take government coverage?” It’s hard to explain. Jon Gruber, an economist at MIT, talked about tuna and dolphins. You want to catch the uninsured tuna without also catching the insured dolphins, but the two swim together and are in similar financial situations. I managed to do an arcane story in a way that listeners could understand.