CS: It’s been a big political issue in Britain lately. Essentially two things came together. There’s the fact that a lot of social care is underfunded and lots of people didn’t like that, and the fact that many people would find that if they had to go to a nursing home, they have to sell their home. What they wanted to pass onto their heirs would be gone very quickly. That kind of thing causes political waves in Britain.

TL: What happens in the US is that if a person goes to a nursing home, the spouse remains in the home. But after he or she dies, the home is fair game for Medicaid in something called “estate recovery.” Medicaid can come in and sell the house and use the proceeds to defray the costs of the owner’s nursing home stay that the state paid for.

CS: That’s interesting.

TL: That’s not very well known in the US, and you don’t hear many people talking about it. It’s a shame, really. We’re focused on bad nursing homes and have been for four decades now. So the stories you see—and some are legitimate stories—are about poor care given in nursing homes, and there’s a lot of it. But you don’t see a lot of reporting on the financial side of long-term care, and there should be.

Press coverage

TL: As we wrap up, let’s talk some about press coverage—especially about coverage of your reforms and ours.

CS: I think a lot of debate in Britain over our new health reforms was driven—sometimes for good, sometimes for bad—by the press coverage that the reforms got, and by the government’s presentations about reform. At first the government spun them as being a big, bold, radical proposal revolutionizing the NHS. In fact, they could have been easily spun as a cautious, evolutionary change from the approach being pursued by labor. Both are probably fair descriptions. They chose to sell it as a radical one and they very much later regretted that.

People didn’t want radical change in the NHS. The government hadn’t really talked about it before the election, so people were very suspicious and mistrusted the conservatives. That was a theme of a lot of press coverage.

TL: I covered the Affordable Care Act from the beginning, and constantly urged the media to explain what this act was all about, and that never happened. The lack of coverage partly explains why the Act is so unpopular today. People really didn’t know much about the individual mandate. It was never explained, nor was the issue of whether the subsidies people will get to buy coverage will be adequate. It’s a huge question—a very important political question, but it’s not being discussed.

CS: Do you blame the Obama administration for not finding the language or words or ability to sell that, or was it something to do with the media?

TL: It was both. The administration did not really articulate what they were doing, why they were doing it, and why it was necessary to have this kind of system. A lot of people thought we were getting something different—actually a national health system like you have. The Democrats said they had to pass a bill so people can find out what’s in it. That kind of tells you where they were at in terms of communicating what they had done.

The nature of the US media, to some extent, is to follow what the politicians are saying. So if the politicians are not explaining it, then they’re not explaining it either. There was a whole lot of education of the press done by liberal advocacy groups, which was helping to shape what was getting in the media. But they were not interested in talking much about the individual mandate either.

CS: I have a similar problem. It’s hard to look into a competing set of claims about what will happen in the future. You can’t go out and independently verify them because they haven’t happened yet. So how do you work out which one you give priority to?

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.