Health Reform: Still the Best-Covered Social Policy Story, Ever.

Two years ago, I put myself in hot water by making the simple (admittedly somewhat hyperbolic) claim:

Because it is so easy to find bad reporting and public stupidity, it is easy to overlook something. Press coverage of health care reform was the most careful, most thorough, and most effective reporting of any major story, ever.

This column appeared on April Fools’ Day. Some readers didn’t quite believe that I was serious. I was. Others were simply horrified. Allison Kilkenny, writing in the Huffington Post, typified the reaction among frustrated left-of-center commentators who had just witnessed the “death panels” debacle, the demise of the public option, and similar depressing episodes: “Harold Pollack went out on a limb, and unfortunately fell off the edge.” Andrew Sullivan said something similar.

The Columbia Journalism Review’s Trudy Lieberman was more brutal:

Last week, The New Republic turned over its health care blog “The Treatment” to an odd commenter on media coverage—University of Chicago professor Harold Pollack, who runs the university’s Center for Health Administration Studies. I thought I knew most of those who dabble in these waters, but Pollack’s name took me by surprise. Pollack, a special correspondent for The Treatment, may know something about welfare programs and substance abuse, but we on Campaign Desk take issue with his credentials as a press critic and dispute his central point….

Better coverage than the Vietnam War; the civil rights movement; the consumer movement? Really? In the case of the civil rights struggle, the press helped change the discourse; Americans began to view race in a new way, which led to the eventual passage of the Civil Rights Act. During the Vietnam War, the media effectively changed the public dialogue from a war we couldn’t lose to one we could not win. In the early days of the consumer movement, media coverage of Ralph Nader led Congress to enact significant consumer protections. Coverage of health reform has hardly risen to that level.

Losing one’s credentials as a “press critic” is a particularly low blow. The only thing worse would be to lose the moniker “Democratic strategist” on the cable talk circuit. I appreciate where Lieberman is coming from, but I think she missed my point, which was actually intended to be sobering.

Of course, the actual stories and on-the-ground realities of Vietnam and the civil rights struggle were rather different. (I have to ponder Nader’s example a bit more.) What changed public dialogue over Vietnam wasn’t media coverage, but the human reality that tens of thousands of American boys were returning home in wheelchairs and wooden boxes with no end in sight, no visible signs of progress. What (ultimately) changed the public dialogue over civil rights was an equally simple reality of overt racial oppression whose proponents could no longer paper over in postwar America. A dramatic story like 9/11 can be beautifully covered for somewhat similar reasons.

It’s hardly surprising that one finds a different dynamic when a deeply divided polity spends months debating health insurance exchanges, Medicaid expansions, and accountable care organizations. Health reform is the centerpiece domestic policy accomplishment of the Obama administration. Many voters have therefore greeted claims made on behalf of (or against) the new law with what might kindly be called motivated skepticism. When voters bring such strong biases and ideological polarization, it is quite difficult to communicate the true merits and weaknesses of the new law.

And, as Paul Starr notes by email (posted by permission), a largely jaded public response to these debates is unsurprising, even in the face of excellent available news coverage:

Start with a public that’s generally skeptical about government promises. Enact a complicated law whose major provisions don’t take effect for four years. Add in today’s polarized ideological climate coloring all discussion of public problems. What part of the public’s response, or lack of response, is a surprise? And, honestly, why should many people who are busy with their private affairs bother learning about a law that, for all they know (or we know), may never go into effect?

Despite these realities, the depth and quality of old and new media coverage remains impressive. For every crudely misleading FOX News story, Wall Street Journal editorial (or, more hilariously, Investors’ Business Daily), one can find many counterexamples of truly excellent analysis and reporting. Excellent coverage appeared in the usual places, such as NPR, Washington Post, New Republic, and the New York Times, not to mention the Wall Street Journal’s real news section a few pages in. These leading outlets provide an excellent ecology for other outlets, such as local TV news and small-market cable shows that could never directly produce high-quality coverage on a consistent basis.

The world of serious news consumers is also larger than one might suppose. Sixty percent of U.S. households have high-speed internet and can access. I attended a high school debate on health reform in which young people on both sides cited Congressional Budget Office analyses of coverage numbers, and the views of Jacob Hacker, Paul Krugman, Norman Daniels, and Heritage Foundation researchers regarding the individual mandate.

Over the past two years, including the past few weeks as coverage revs up for health reform’s days before the Supreme Court, I’ve just been really impressed by the depth and volume of what is written. Excellent coverage appeared many other places, too. Some is produced by the expected stars. Much is produced by dozens of lesser-known but highly-skilled peers.

What’s sobering are the unique circumstances that have allowed the different forms of media to do this well. This story has played out over years. Although it started with a core of people such as Jonathan Cohn, Ezra Klein, Robert Pear, and Merrill Goozner who were well-versed in health policy, there was time and space for many others to learn the ropes, cover the issues well, and earn recognition.

For various reasons, the health-journalism economy is much healthier and receives larger subsidies in various forms than do comparable ecosystems in climate change, education, and many other matters. Good health journalism provided a target-rich environment for advertisers. Major foundations such as RWJ, Kaiser, Century, Sloan, Heritage, and Commonwealth are quite active. Although foundations have particular public policy stances, they support research and dissemination activities that are generally at some remove from the immediate partisan and economic interests of the major players. Health Affairs, JAMA, the New England Journal of Medicine have run policy forums for many years and have strong links with many in the media. I and other TIE contributors have day jobs that complement our role commenting on health policy concerns.

This should make me happy. It doesn’t. Public ignorance is obviously rampant regarding the new law. Moreover, I wonder whether any other social policy issue of comparable import could be covered nearly as well. Watching what’s happening to the news business, I doubt it. Considering the major challenges we face in many areas, that’s pretty scary.

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. An expert on the intersection of poverty policy and public health, he has served on three expert committees appointed by the National Academy of Sciences. Pollack is also an author of reputable blog, The Incidental Economist, where this post first appeared.

11 replies »

  1. I went to France for hip replacement! It costs there around 18000. The result is great. The importaint thing is to do it in a serious clinic. For example me, I asked my friends and one of them recommended samci! the diagnostics and operation took place in Paris. I was pleasantly surprised by the prices.
    Good luck!

  2. Hey Steve, looks like Justice Breyer caught the US government at their lamest in their lie about what the mandate is. Not a tax, but a penalty.

    If the idiots who crafted this alleged well publicized legislation really paid attention to the facts of what is constitutional, you can’t penalize your citizens for choice. But, it really isn’t about the truth, but what is best for a political party first, and if the public seems to get a benefit too, oh, that’s nice.

    God, you partisan supporters really have no respect for truth and well being for public welfare, do you!?

    I hate this legislation for at least three reasons, in order of most to least importance:

    1. Politicians have no place to tell doctors and patients how to work together to maximize well being.
    2. Choice is never mandated.
    3. My specialty will be terminated by PPACA as it will make PCPs be the source for care, period. Why pay for expertise when you can make gatekeepers work cut rate and not be able to complain.

    Only a politician can dumb down and demean the process of health care. Because instinctively what goes on in the halls of government as of this millenium has nothing to do with care and well being.

    And you watch the people who were physicians become politicians leave their souls in their doctors’ offices when they go to DC!!!

  3. The bill took 13 months to pass. The GOP offered many alternatives. They were all covered. The merits of a public option wee covered in detail. Exchanges were described and debated. Death panels came up and we got the end of life counseling dropped. Multiple financial analyses were offered from CATO to EPI. There was scads of info on the issue, if you wanted to actually read it. Everyone from Goodman to Cutler among the health care economists opined. The major celebrity economists from Cowen to Krugman to Mankiw wrote on the topic. There was no shortage of data and opinion.

    Yes, the final details of any legislation are written by the agency in charge after the bill was passed. Thus has it ever been.


  4. The question is whether or not the information was available. So;

    1) Name one significant piece of legislation that did not have alterations later.

    2) Any major piece of legislation, once passed can be effectively demagogued. The information is available, but very few people actually read it. They believe what they hear on cable TV. The one issue that actually is true is that the mandate is unpopular. Most other features of the ACA poll positively.

    3) Waivers? Go look at the numbers. 90+% of waiver requests were approved, even from non-cronies. The waivers were a feature, not a bug. Prior to the subsidies becoming available, it was clear that many companies and individuals would not be able to afford some of the new requirements.

    The facts make me quite happy, as I actually go look them up. Anytime you want to list some, feel free.


  5. Actually it wasn’t Steve, a broad outline of the objective was out there, most of the detail are just now being written.

    For example no where in the bill did it say anything about me a TPA having to buy birth control for my clients.

  6. Any public poll I have seen that gets beyond the ridiculous question of ‘Do you like Obamacare?’ shows the public knows almost nothing about the overall legislation and that majorities often have incorrect opinions even on the most basic facts about the legislation.

    Its laughable that posting the legislation online in any way impacts how the average American citizen feels about the legislation too.

    Sadly, what I have seen the Internet due to public opinion and knowledge on policy positions is not to empower individuals to strive for better information & varied opinions but allow people to seek out & validate what crazy/crack-pot/half-truths that they want to validate what preconceived opinions they already had on a particular issue.

    Contrary to empowering people to act in solidarity, I would the Internet allows Americans to wrap themselves in isolationist cocoon indoors cut off from their neighbors and local area.

  7. If there really was extensive coverage of the economic arguments as you claim occurred, then 1) why did the Democrats in unity pass it without significant alterations that are occurring now, 2) why did no Democrats use it for reelection example, only to lose the House in 2010, and 3) why did Obama, Reid, and Pelosi support mass exemptions from at least implementing coverage for the moment for their cronies?

    Man, facts must really piss off partisan rhetoric without accountability, eh?

  8. All of the details of the ACA were published as it was being done. The entire bill was available for reading. There was extensive coverage of the economic arguments. The information was there if you wanted it, both from the right and the left. If all you do is watch cable TV, then you were out of luck.


  9. Actually, Harold may be on to something here ….

    Quickly – because I have to hop on a call – I think his comment has more to do with the evolving economics of the news business and the content economy than it has to do with the politics of the thing …

    It’s easy to forget that the critics as a class used to complain loudly that nobody covered the important stories. Now they just don’t like how they’re covered.

    More from me on this later. Like it.

  10. I think the authors of this blog site have a responsibility to readers to expect, at least ask at the very least, to have an author of a post come to a site that prints said post and take part of the thread that ensues. It is easy if that is not an option, omit the thread so readers know this is fluff and pagentry at its partisan best up front.

    Come on, does this guy think that anyone who does not worship at his altar is a moron and doesn’t deserve to vote if they don’t echo his belief system to the exact ‘i’ and ‘t’? Really, “public ignorance is obviously rampant regarding the new law’. Let me offer this dissenting point, projection and minimizing your opponents’ points of view is just immature defense mechanisms, and how ironic most extremist commentary from either end of this debate practices such defense techniques oh so accurately.

    Oh, and reliable commentators (obviously NOT of Democratic ilk) of late are reminding the public of Ms Pelosi’s exclamation repeatedly of late, semantics aside, she did say pass the bill to learn its details. Isn’t that what is going on these past 2 years now!?!?

    It’s a shame the justices can’t hear from the court of public opinion. What was the last poll statistic, still over 50% do not approve of the legislation as going on? Hey Professor Pollack, why not just reannoint your current occupant of the White House King of America and let tyranny reign? Oh yeah, that damn Constitution keeps rearing its ugly head, what a bitch to academia!