In an October 1992 editorial, the New York Times proclaimed that "the debate over healthcare reform is over. Managed competition has won." This outcome, the Times announced (10/10/92), was "delicious" and "wondrous."
In fact, the debate over healthcare reform still goes on, but you might not know it from establishment media. While the New York Times and other elite outlets have rallied around "managed competition"--a system in which private insurance companies provide medical care through giant HMOs--grassroots activists continue to push for a "single-payer" system, similar to Canada's, in which insurance companies would be eliminated from the health care picture and government would provide universal coverage. Single-payer proponents often refer to managed competition as the "Insurance Industry Preservation Act."
The media slant in favor of managed competition seen before the 1992 election (see Extra!, 1-2/93) continues. While the phrase "managed competition" appeared in 62 New York Times news stories in the six months following the 1992 election, "single-payer" appeared in only five news stories during that period--never in more than a single-sentence mention.
The tilt toward the managed competition plan at the New York Times is so pronounced that it provoked a demonstration by single-payer advocates outside the paper's offices on May 12. Protesters pointed out a potential conflict of interest in New York Times healthcare coverage: Four of the paper's directors are also on the boards of health insurance companies.
The justification media managers give for the imbalance of attention is that while managed competition is supported by the Clinton administration, a single-payer system is not "politically viable." What this means is that news judgements are based on elite preferences, not on popular opinion: The New York Times' own polling since 1990 has consistently found majorities--ranging from 54 percent to 66 percent--in favor of tax-financed national health insurance.
The way elite media can marginalize opinions--even ones held by a majority of the population--was demonstrated by a May 5 discussion of managed competition on the MacNeil/Lehrer NewsHour. Robert MacNeil led a panel made up of three government officials -- a congressman, a governor and a state health commissioner -- who were mainly supportive of managed competition, and a representative of Physicians for a National Health Care Plan, Dr. Steffie Woolhandler, who supports a single-payer plan.
After Woolhandler argued that managed competition would increase costs and bureaucracy, and the other three guests disagreed, MacNeil said to her pointedly, "Dr. Woolhandler, that's three against one on the cost reduction thing"--as if this were a random sample of opinion, rather than a panel assembled by MacNeil/Lehrer.
Near the end of the discussion, MacNeil said he was asking the last question of Woolhandler "since you're in the minority"--to which she responded: "Robert, I'm not in a minority. Polls are showing two-thirds of the American people support government-funded national health insurance."
MacNeil continued: "If this [managed competition] is the program that has a political consensus and the other one that you advocate [single-payer] is considered impossible politically at the moment, why are you then against the one that is viable and would produce a large amount of reform?"
Woolhandler responded by rejecting the assumption that managed competition would provide meaningful health reform. But the other assumption of the question--that a proposal supported by up to two-thirds of the population should not be seriously debated if it doesn't have a "political consensus"--speaks volumes about the health of American journalism.