Why are so many of the most pressing subjects in national politics also the most tedious? Social Security reform is certainly right up there. H. L. Mencken himself would have a hard time making an interesting story out of payroll tax caps and trust-fund solvency projections. What else? Poverty programs for Africa. Comprehensive energy independence plans. The looming current-account deficit with China.
And, of course, health care policy in all its detailed glory. Capitation rates. Health savings accounts. Single payer versus multipayer plans. Cost containment. Privacy issues. The uninsured. FDA testing reform. COBRA and HIPAA. The ghost of Hillarycare.
If you’re starting to nod off already, you’re not alone. Even more than in most policy areas, health care is one where the details matter a lot, but those details are almost mind-numbingly boring. This makes it a tough nut to crack for most journalists.
Jonathan Cohn, a senior editor at The New Republic, was obviously well aware of this problem when he decided to write Sick, an exploration of the history and operation of the U.S. health care system. How do you make the story of the origins of Blue Cross come alive? How do you decipher the intricacies of SCHIP and Medicaid? How do you describe the difference between experience rating and community rating without lapsing into incomprehensible wonk-speak? Or explain our continued attachment to linking health care to employment? Cohn’s solution is simple: he decided to treat his subject as an exercise in narrative journalism.
This is hardly a surprising decision since narrative has become a staple of contemporary reporting. What makes it unusual here is its scope. Rather than using the narrative formula to highlight a specific health care problem—as, for example, The New York Times did in early 2006 in its monster four-part, twenty-thousand-word series about the diabetes epidemic—Cohn uses a series of bite-sized narratives as a clever framing device to draw readers into what would otherwise be a dreary description of seventy years of health care policy.
This approach has its drawbacks (more on this later), but on its own terms it succeeds brilliantly. Take the story of Lester Sampson, a longtime worker at J.P. Morrell, a meat-processing operation in Sioux Falls, South Dakota. Sampson began working for Morrell during World War II, left for a few years after being drafted, and then returned after the war, eventually working on the plant floor for thirty years. During that time he chose to accept a reduced pension plan in return for a promise of continued medical coverage after he left Morrell.
So when he retired in 1985 and took a job with the local school system, Sampson declined its medical insurance because Morrell already covered him. Why bother with two plans, after all? The answer came a few years later when Morrell, under increasing financial pressure, unilaterally ended its retiree medical plan. The school system’s medical plan was open only to new hires, and although Medicare had begun covering Sampson when he turned sixty-five, its protection is spotty and full coverage required the purchase of a Medigap policy at a cost of about $400 a month—a big chunk of money for a blue-collar retiree. For a while, Sampson and his wife Audrey reduced their costs by taking annual trips south where they bought prescription drugs across the border in Nogales, Mexico, but after a few years, those trips stopped. The extra $400 a month kept eating away at their savings, eventually forcing them to sell their retirement home and move into an apartment in Sioux Falls.
In 2003, Congress passed a prescription drug bill that should have helped the Sampsons out. Unfortunately, the choice of plans was bewildering, and Audrey Sampson spent months trying to find a plan that would cover an expensive medication she took for a rare lung disorder. She never did.
It’s almost impossible not to come away from this story asking all the right questions. How could Morrell just unilaterally end its retiree medical plan? Why do employers allow employees to sign up for medical coverage only when they’re first hired? Why are prescription drugs cheaper in Mexico than here? And why was the 2003 prescription drug program so insanely complex?