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?

TL: You really can’t. There’s a willingness on the part of the press to accept what they’re told, without weighing claims and seeing if one claim is more meritorious than another. We have this cult of balance, and it’s a problem.

In the US, you need to remember one thing; what was passed was basically a Republican plan. The ideas had been in the academic literature for years, and they were ideas Republicans would be totally comfortable with. But instead, the Republicans have run against their own plan, so to speak. And when the press fell down on the job of bringing the people along, it made it easy for Republicans to move on this strategy.

CS: In Britain, aspects of this reform were done by a coalition, which we are not used to. It had elements from both parties, which didn’t necessarily fit together well. Once it became controversial in the press, liberal Democrats forced a series of changes onto the bill to address some of the fears that the media had raised. What they did made a coherent piece of legislation a total mess.

TL: I guess we have some similarities here. We’re not really sure how the Affordable Care Act will play out, and you’re not really sure how the NHS reforms are going to play out. We’ll find out!

Related stories:


Healthcare in Great Britain vs. healthcare in the USA: part one

How the phantom of ‘socialized medicine’ came to be

The specter of ‘Socialized Medicine’ rides again


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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.