Truth telling on the campaign trail

In the relatively good old days of air travel in the mid-90s, one of the pleasures of flying the shuttle between Boston and New York or Washington was the free newspapers and magazines that included titles like the Economist, New York Review of Books, and others that one might willingly pay for. A real gem that I discovered at the time was the Columbia Journalism Review (CJR), which did an excellent job --in those days before blogs-- of analyzing how stories were covered in the press. The glory days of the shuttle have long past, so I haven't read the CJR in a while.Luckily the magazine started sending me health care stories and they're quite good. Two recent ones by Trudy Lieberman critique media coverage of health care in the presidential election. In The Missing Genre, Lieberman is surprised that journalists have stuck to making dry comparisons of the candidates' wonkish proposals without delving into the implications for everyday people.

[T]here have been plenty of stories like the one The Plain Dealer of Cleveland published before the Ohio primary that gave thumbnail sketches of [the] plans. Such stories employ all the buzz words: ”penalties, tax credits, incentives, affordable insurance. But stories about people like Charles and Kevisha [poor, urban African Americans with health problems and poor access to health care] have largely been missing, at least in the context of what the proposals would mean for them.That's curious. During the two years that Bill Clinton's health plan was debated and dissected, people stories populated the news columns, and ordinary Americans could get some idea how they would fare under his proposal. This time, though, reporting has pretty much followed the candidates' script. Reporters have been stenographers, diligently punching out the words candidates say rather analyzing how those words will affect and even transform people's lives.

Lieberman also takes McCain to task (McCain's Health-Care Disconnect) for bragging about the US system being the best in the world and for having unrealistic proposals.

Said McCain to his supporters: "I will campaign to make health care more accessible to more Americans with reforms that will bring down costs in the health care industry without ruining the quality of the world's best medical care." Politicians have used such language before in an effort to persuade the public that the system is not broken, and that a fix will damage it. This time, though, voters may well tune out that song. The system's warts have grown larger.Too many Americans are uninsured and have ended up in bankruptcy court or are nearly bankrupt because they cannot pay hundreds of thousand of dollars in medical bills. Even those with insurance can end up in bankruptcy, because health coverage no longer necessarily protects against the high cost of illness. A landmark study by Elizabeth Warren, a Harvard law professor, shows that high deductibles, copayments, exclusions, and other loopholes result in bills that many middle-class people cannot pay.

I'm not quite as surprised as Lieberman by the wonkish stories. The reason, I think, is that none of the presidential candidates has a plan that will resolve the Charles and Kevisha stories. It's not really possible to square the circle of cost, quality and access, and despite the seeming boldness of Clinton's plan in particular it really isn't going to make a fundamental change for those at the bottom. If I were Lieberman I would level my criticism at the fact that Medicare is hardly discussed by the candidates or the press, even though growth in that program is the gravest economic threat faced by the US over the next generation, and if we're to have reform of the health care system overall we will need to tackle Medicare head on.As for McCain, while he's certainly pandering to conservatives with talk about the US system being the best, he probably believes it himself. He's admitted he doesn't understand economics, so why would we expect him to grasp health care policy, which requires a grasp of economics and a whole lot more? At least McCain has spoken up about costs being an issue, in a way that almost none of the other candidates has. He hasn't even relied on the old conservative favorite of "waste, fraud, and abuse" as a solution to cost problems.