Not long ago, I had the occasion to discuss health care with reporters and editors of the Washington Post. Entering the Post's conference room, I encountered as many as 20 writers on health-related issues from the Post's national staff, the business pages and the weekly "Health" section. As I looked around the room, recognizing faces and nodding to acquaintances, I thought of the collective talent in the room and commented that with the Post's resources, it ought not to be difficult to win a Pulitzer simply by documenting the dimensions of America's healthcare crisis.
Later, talking with a Post reporter not present at the earlier meeting, I recounted the story. "Not much chance of a Pulitzer here," he said, adding that the Post's huge resources in healthcare coverage were being squandered by lack of leadership and direction.
In fact, the Post--like most of the national media, both print and electronic--has shown little or no evidence that it is prepared to launch a sustained investigation into the need for healthcare reform. By and large, media have confined themselves to workaday reporting of events, contenting itself with transcribing the arcane transactions of Washington's power elite, healthcare industry lobbyists, and a passel of hired-gun academics and think tank policy wonks. Missing from the mix is reality.
A 'Wondrous' Oxymoron
Leading the pack, and setting the tone for policy makers and media bigfeet alike, is the New York Times. In a preelection editorial (10/10/92), the Times opined, "The debate over healthcare reform is over. Managed competition has won. The outcome is as wondrous as it is surprising." The new Congress, said the Times, "faces a delicious prospect: Come January it can start with a managed competition blueprint, dot the i's and send the president, whether his name is Clinton or Bush, a bill he'd be proud to sign."
Managed competition? The new panacea with the oxymoronic name is not exactly the result of a popular groundswell. No crowds have been reported to be chanting, "We want managed competition!" And while the phrase has popped up repeatedly in media reports in virtually every newspaper and television network, few reporters have managed to say exactly what it means.
In fact, "managed competition" is a nearly meaningless buzzword that, decoded, translates into completing the transformation of American medicine from one-on-one doctor-patient relationships to the establishment of Fortune 500-style corporate health conglomerates--highly profitable ones, indeed, that would monopolize an $800 billion industry.
Yet the phrase is routinely used by reporters now without even a short I.D. phrase attached to it. The Washington Post's Dana Priest quoted Judith Feder, Clinton health policy adviser (11/23/92), saying, "The campaign's position was that managed competition can work within the discipline of a global budget." The same article reported, without further explanation, that another leading Clinton adviser "is a believer in the purist 'managed competition' approach favored by conservative Democrats."
And just what is managed competition? So far, precise and specific definitions of managed competition policies for health care reform have been confined to the pages of academic journals and policy papers. Stripped to its core, the policy would create large-scale, corporate healthcare entities like HMOs (health maintenance organizations), run by a few large insurance companies. The law would define a minimum benefit package, less comprehensive than most private insurance provides. And penalties, like higher taxes, would force most people into these plans. Consumers would lose their ability to choose a doctor or hospital, since they would be allowed to use only those providers who participate in the healthcare consortium.
Not exactly the kind of healthcare "solution" that most Americans would write to Congress and demand.
The Wofford Factor
Media attention began to focus on healthcare reform in the spring of 1991 and peaked after the November 1991 election of Sen. Harris Wofford of Pennsylvania, whose call for health care reform was a key part of his come-from-behind victory. At that point major media did two things right--and two things wrong.
First, to their credit, media began to report that the news from Pennsylvania was that the American people wanted health care reform. An editorial in the Philadelphia Inquirer (11/10/91) exclaimed: "With a clarifying wallop much like the sound of a two-by-four smacking a mule between the eyes, Harris Wofford's Senate victory last week got the attention of the participants in the nation's stalled healthcare debate."
That was the tone of the coverage in virtually every newspaper and broadcast news organization. And, as a result of the media focus on healthcare, President Bush and the various Democratic presidential candidates scrambled to come up with a healthcare "plan" of their own.
Second, again to their credit, media began to focus on the enormous lobbying clout and influence buying of the insurance industry, drug companies, doctors and other special interests. Typical was a piece by Tom Hamburger of the Minneapolis Star Tribune (11/21/91), entitled "Big Bucks, Politics Hinder Health-Care Reform," which explained that in 1990 the insurance industry "contributed more than $4 million to congressional candidates." And Gary Lee of the Washington Post, who covers lobbying and public relations, penned a number of articles about the insurance industry's clout in the nation's capital. Many other news organizations picked up on an excellent report published in Common Cause magazine in January 1992 that analyzed the impact of the campaign contributions of insurers and the healthcare industry.
This is where things began to go wrong.
First, many news outlets blew it on holding presidential candidates accountable on their health plans. Early in 1992, I was asked by a reporter for a major city newspaper to analyze the "three plans" for healthcare reform, namely, a Canadian-style reform, the Democrats' pay-or-play plan to mandate employer-based insurance, and President Bush's patched-together plan for tax credits and assorted other half-measures. When I commented that the Bush proposal could not really even be called a plan, since it said nothing about controlling costs and made no attempt to provide coverage for millions of uninsured, the reporter said, "I know." But in his article, he refused to say that the emperor had no clothes.
Virtually all of the reporting about Bush's healthcare platform throughout 1992 gave the non-plan far too much credit. (An early New York Times editorial, 1/7/92, did call it a "fraud, bordering on public policy malpractice.") But far too many newspapers ran simple side-by-side comparisons of various plans, without taking pains to point out their glaring flaws.
Candidate Clinton's aimless drift on healthcare throughout 1992 was also given a free ride by the media. In the early stages of the campaign, Clinton's near-total failure to address healthcare was overshadowed by the media's attention to the "character issue." Then, Clinton's migration from support for the moderate Democrats' pay-or-play reform to his late-in-the-campaign endorsement for the conservative Democratic "managed competition" solution received little or no press scrutiny.
The second media flaw was that, by and large, news outlets swallowed the insurance industry's propaganda line about Canada's universal healthcare system. Gradually at first, and then like a mantra that appeared in almost every article about the Canadian system, we started to hear about "waiting lines" in Canada. There were unsubstantiated stories about Canadians flocking across the border to partake of America's health care cornucopia. Few and far between were stories about Canada's tremendous success in providing cradle-to-grave healthcare for every citizen.
There is a simple explanation for the media's collective unwillingness to present the Canadian system fairly. On June 28, 1991, a Wall Street Journal/NBC News poll found that 69 percent of Americans would support a Canadian-style system, while only 20 percent were opposed. The same 69 percent said they were willing to pay higher taxes for a system that guaranteed the best available healthcare for everyone.
Simultaneously, the insurance industry launched a multi-million-dollar campaign to discredit Canada's system. While media solemnly took note of the industry's influence over our political leaders, achieved via campaign contributions (e.g., Wall Street Journal, 11/27/92), it failed to report on the industry's public relations war effectively. In fact, it got taken in.
Then, when a handful of insurance industry executives, big business leaders, conservative Democratic politicians, and the New York Times editorial board decided that "managed competition" was the deus ex machina, most media followed dutifully along.
As the Clinton administration takes office, the prospects for real, sweeping healthcare reform are bleak. One of two things is likely: Either President Clinton and Congress will succeed in enacting into law the managed competition solution that the insurance industry wants, or else the sheer enormity of putting together any healthcare reform package will cause the whole effort to self-destruct, resulting in the appointment of a useless Blue Ribbon Commission to "study" the matter.
The slim chance for real reform depends on grassroots pressure. And that, in turn, depends on the media doing its job, namely, to expose the inequities of America's healthcare system, explaining it again and again so that even a Perot voter could understand it. Only then can the 69 percent that wants a Canadian-style system be energized to make their voices heard over the insurance industry's PR campaign.