An Rx for Reporting

Yesterday’s strategies failed on the health-reform story. Now what?
February 25, 2010

Just before Christmas, a CNN poll asked Americans whether they favored or opposed the health-reform bills moving through Congress. Forty-two percent favored them, 56 percent were opposed. This and other polls released last fall also suggested that most Americans lacked a basic understanding of the changes being proposed. Arguably, the two are connected. How many people were opposed to the legislation because they either didn’t understand or misunderstood it? A clerk at a store in West Virginia told the Charleston Gazette that she tried hard to follow the twists and turns of health reform. “I know it affects me,” she said, “but I can’t find out what it’s going to be.” A friend of mine admitted that she had stopped trying to figure it out. A small business owner in Manhattan concluded: “The press has done a horrible job of translation.”

Press coverage of the effort to reform health care has been largely incoherent to the man on the street. The three hundred or so posts I have written about health-care reform for cjr.org over the past two years tell the story of media coverage that failed to illuminate the crucial issues, quoted special interest groups and politicians without giving consumers enough information to judge if their claims were fact or fiction, did not dig deeply into the pros and cons of the proposals, and gave tons of ink and air time to the same handful of sources.

By now it’s a familiar critique—the press did not connect the dots, there were too many he said-she said stories, not enough analysis, and so on. And yet, after a decade in which the inadequacies of traditional press strategies—objectivity, top-down coverage, the primacy of the “scoop,” etc.—became ever more apparent to those of us who care about these things, those very strategies failed the country again on a story of monumental importance to every citizen.

Traditional journalism as practiced by the nation’s major news outlets, even as it has been recreated on the Web, is just not good enough for a story as big and complex as health care. Such stories demand a new paradigm, and while I don’t pretend to know exactly what that paradigm is or how we get there, the ways the press failed on the health-reform story provide some clues.

Traditional journalism relies on official sources to tell the story, and on health care those sources framed the narratives they wanted the public to hear. The “stars are aligned” refrain, heard from advocacy groups like Families USA and others, conveyed the idea that the chief stakeholders all supported reform. But what those stakeholders supported was “reform” that for the most part let them continue with business as usual. From the Democrats came the narrative of “affordable, quality health care”—empty, focus-group tested words that misled millions of Americans into thinking reform would bring health insurance to everyone and health care that was both cheaper and better. From Republicans we got the predictable fear-mongering about “government-run health care,” but few alternate solutions. The president himself gave us the “you can keep what you’ve got” assurance that left many people wondering, “If that’s the case, why should I care?”

Playing follow-the-newsmaker leads to he said-she said reporting, which does audiences a particular disservice on stories about contentious, difficult issues like health care—the truth is complicated and requires more explication than clashing quotes can deliver.

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In mid-January, for instance, USA Today botched a piece about whether the House and Senate bills would really cut costs and generate enough savings to cover subsidies for the uninsured. The story began with a conservative economist questioning whether the projected long-term savings were realistic. Then came a quote from the director of Families USA who assured us that the projected savings were “more than realistic.” There was a paragraph explaining that the Senate bill calls for $438 billion in cuts to Medicare and Medicaid over a decade and that almost half of those cuts would come from trimming Medicare payments to doctors and hospitals. Next the paper noted that a Department of Health and Human Services report said some of the proposed cuts “may be unrealistic” and could actually reduce access to care. That was followed by a fellow from the Urban Institute who suggested it would be “very hard” politically to get the cuts through. Then came a comment from a fellow at the Center on Budget and Policy Priorities, who said that in the past Congress had in fact adopted cuts to Medicare and that those cuts were “part and parcel of most major deficit reduction efforts in recent years.”

Huh? This tangle of competing claims, without any attempt by the reporter to help the reader understand who is more and less right, is not only useless to someone trying to decide how to think about these issues, but also utterly dispiriting.

Traditional journalism craves controversy—even if it’s manufactured or beside the point—and the health-reform story produced a doozy: the public plan. For months press coverage focused on the politics of a public plan—who wanted it, who was against it, its chances for passage. Meanwhile, with a wink to the special interests who supported him financially during the campaign, President Obama didn’t fight for a public plan, and let the insurers, doctors, hospitals, and the business community (with a crucial assist from Joe Lieberman) kill it in the Senate. Even so-called supporters of the public plan, who made a lot of noise, knew it was essentially a bargaining chip. It was a charade the press should have exposed more forcefully and then dug into the true controversy: whether the health-reform law in Massachusetts, the model for the national bill, was working as well as the state’s officials and other cheerleaders maintained. When MIT economist Jonathan Gruber, the über-cheerleader for national reform, said on PBS’s NewsHour last fall that Massachusetts residents who must buy their own health coverage were getting lower premiums as a result of the state’s reform, he didn’t mention (and host Gwen Ifill didn’t ask) that those lower premiums were made possible because employees of small businesses were paying much higher premiums. Small business owners are now getting hit with increases of 20 to 45 percent or more. Indeed, red flags in Massachusetts did not fit the “its time has come” narrative the press and the newsmakers had embraced—though when Republican Scott Brown stunned Democrats by winning Ted Kennedy’s Senate seat in January, it became clear that the press should have paid more attention to those warnings.

Traditional journalism tends to be reactive, and the ill-effects of this were never more evident than with the “death-panel” debacle. Instead of bringing audiences around to a serious discussion of end-of-life care, the press let right-wing ideologues set the agenda with misinformation before eventually doing the stories that refuted the outrageous claims of Sarah Palin and others. But it was too little, too late. More than a month after the notion surfaced, I interviewed a volunteer at a sandwich booth at a Labor Day Italian festival in Scranton, Pennsylvania, who told me he was very worried about what he called the end-of-life committee. “I have heard all the arguments,” he said, “and nobody has convinced me it doesn’t exist.”

I’ve been a “traditional” journalist for more than forty years. I understand the circumstances and logic that gave rise to these journalism strategies, even as I am frustrated by how they hinder coverage. But more than two years ago, when I began writing about the coverage of the health-care debate for CJR’s Web site, I tried to use the freedom from the strictures of traditional journalism that writing online afforded to experiment with my own coverage—to try to produce the kind of coverage that I was asking the mainstream press to deliver. For instance, a tenet of traditional journalism is that we write for the average citizen, but so many of the health-care stories I was reading seemed aimed more at Washington insiders or the reporter’s colleagues and competitors. I reached into my past to find a way to do it better. I’ve long thought that Consumer Reports, where I used to work, produced some of the clearest, most useful explanatory journalism around. Once I asked then-Editor Irwin Landau who his audience was, and he said he always had in mind school teachers, people who had some money but not a lot, and who needed to understand not only what to buy and why but the economic and medical forces that shaped those decisions.

With such readers in mind, I tried to give them a thorough analysis of the issue at hand, but one that was grounded in deep reporting, not lightly informed opinion. Here the late Johnny Apple was my inspiration. His analyses for The New York Times invariably helped me understand issues I knew little about. It wasn’t simply that Apple was a talented writer, or a big enough star that he could get away with pushing opinions in the news columns; Apple was first and foremost a fine reporter, and his analyses reflected the authority and knowledge earned through that reporting.

But both Apple’s analyses and Consumer Reports stories tended to come in traditional, long-form doses. The trick for today’s audiences in my opinion is to take Apple’s trademark reporting and analysis and apply them to a series of shorter, pithier stories. Short shouldn’t have to mean shallow.

Last year, I tested that hypothesis with a nine-part series on health care in Massachusetts that attempted to be analytical and comprehensive, but broke the subject into more digestible segments of roughly 1,200 words each. I tried to report until I had a clear sense of what I thought about the key elements of the Massachusetts plan, then let those conclusions, and an explanation of how I arrived at them, drive my stories. The series became a running commentary on the state’s health-care system.

This approach worked in a way that a one-off, six-thousand-word piece would not have. Those blog posts got at the concerns of state residents, many of whom were not happy with the way health reform was affecting them—small business owners slapped with very high rate increases, older people paying several hundred dollars more for their coverage than younger ones, patients facing long waits to see a doctor—and allowed me to keep revisiting the issues, adding new context and new ideas as my thinking evolved with my reporting. Immediate feedback—another useful aspect of the Web—suggested that my readers benefited from this steady stream of more manageable bites, which is ultimately the point of what we do.

Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.