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.


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