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What the Media Isn't Covering in the Health Reform Debate--And Why It Matters

By Jack M. Balkin

If you've been ignoring health reform news so far, now may be a good time to start paying attention. Theodore Marmor and Jonathan Oberlander have helpfully encapsulated the current state of play in an NYRB essay. Congressional resistance is growing, and the media are highlighting voices critical of current proposals, ranging from alarmists to prudentialists to beleaguered governors.

They are curiously uninterested in three topics:

1) There has been virtually no coverage of the views of those Americans who want more thoroughgoing reform than is currently on the table.

2) We hear very little about the $1.4 million dollars a day spent by lobbyists to water down or otherwise obstruct reform. As Ezra Klein notes, "At times, the efforts at influence peddling border on the comic: One June 10 meeting saw Max Baucus's aides sitting down with two of Max Baucus's former chiefs of staff, who were representing different groupings of health-care industry interests."

3) I can almost guarantee that no mainstream TV outlet will explore in detail the real economic dynamics that now dominate health care--despite the fact that "few markets are as concentrated, opaque and complex, and subject to rampant anticompetitive and deceptive conduct."

We therefore get superficial coverage of the issues and a rigged debate between bland moderates and an obstructionist right. That bias is a major reason for a big push on reform now, rather than later this fall or winter.

If the media were up to a real health reform debate, they'd complement every story relating skepticism about reform efforts with a careful investigation of where things are headed given the status quo. They routinely fail this basic test of fairness. For example, on Sunday's Meet the Press, David Gregory aggressively pressed HHS Secretary Kathleen Sebelius about the possibility that reform would lead employers to drop private coverage because they could shift workers to a public plan. Gregory ignored the fact that employer-based coverage is eroding now. Similarly, media outlets persistently pair as sparring partners incrementalist academic experts with soi disant conservatives who in reality envision radical changes for tax treatment, risk pooling, and coverage determinations in health care. It's not a fair fight, and the longer it goes on, the more misinformation is likely to be spread about reform.

Most troublingly, journalists routinely let critics of reform take opportunistically partial potshots at legislation. Critics have perfected a "heads I win, tails you lose" strategy: they first complain about costs, then dismiss as "socialized medicine" any serious cost-containment strategies. Unwilling to investigate the many countries that somehow manage to avoid this Scylla and Charybdis, most journalists are incapable of moving beyond the ritual dance of cost-fright and socialism-scare.

If the media (or the "go-slow caucus") showed a genuine interest in the health policy issues raised by reform, I'd welcome a months-long Congressional debate on policy minutiae. Instead, we get endless coverage of political gamesmanship, relating perceptions of perceptions of who's up and who's down in the polls. It's no wonder the MSM is in crisis -- it "splits the difference" among viewpoints well to the right of the average American's views.

The longer the health care debate goes on, the more we can expect "dumbo journalism" about the hard issues at stake. We can rely on the elite media to translate their own frustration at trying to understand multiple, complex bills into reportage on an imaginary public's anger and skepticism about the same. In short, we can expect more Rush--and that's why there's a rush.

Full post as published by Balkinization on July 20, 2009 (boomark / email).