Why is the media so invested in the status quo when it comes to health reform?

Published on
December 9, 2019

Long ago, as the infamous Clinton health plan was failing, I found myself in Germany interviewing the head of the German Association of the Pharmaceutical Industry, the country’s counterpart to big PhRMA, the U.S. lobby. He told me that the German government had ordered a 5% reduction in the price of some drugs and also a reduction of some over-the-counter drugs. I was astonished. How could this be done, I asked in disbelief, thinking, of course, about the American context in which PhRMA would never allow such a thing to happen. Indeed, that is the crux of the current struggle to lower drug prices.

“Ms. Lieberman,” the executive responded, “You have to understand one thing. Nothing comes between us and our principle of solidarity.” “Not even the profits of the drug industry?” I asked. “Not even profits,” he replied. Imagine the head of PhRMA saying — and believing — such a thing!

I’ve told this story many times, but the central point is more relevant than ever in the current debate over Medicare for All. The concept of solidarity, which loosely means a communal unity based on shared interests, objectives, or standards, undergirds the health systems of most European countries. In those nations, there is collective agreement that every citizen is entitled to health care and a way to pay for it through their national insurance systems. In our country, which prides itself on a long history of fierce individualism, the concept of solidarity is as foreign to most Americans as the German language itself. Yet paradoxically, as Yale Professor Emeritus Theodore Marmor has pointed out, our own Social Security retirement, disability, workers’ compensation, and Medicare arrangements are based on the very principle. But without some recognition of why solidarity is important, and national agreement that every U.S. citizen is entitled to medical care and the means to pay for it, this latest attempt at health reform is likely to fail like all the rest. Yet that idea of the social contract is the key ingredient missing in the current debate.

Although the Affordable Care Act firmly established the notion that everyone should be able to buy health insurance regardless of preexisting conditions — a huge breakthrough in the history of the country’s view of health insurance — it did not take the further step of guaranteeing everyone the right to medical care and the insurance to pay for it. “Winning the argument about universal coverage first is really important,” said Joe Kutzin, who heads the health care financing team at the World Health Organization.

“Is there agreement that no one should become poor or die because they don’t have health coverage? The United States political system doesn’t have agreement on that basic principle, and that can get derailed by discussions about wiping out the insurance industry.”

Kutzin is an astute observer. There has been no shortage of media stories about Medicare for All, but most have focused on why such a plan won’t work in America; how it would harm entrenched stakeholders; how much it would cost; why America can’t afford such a disruptive arrangement, and that people with health insurance are pretty much satisfied with their existing arrangements. Why rock the boat?

That switching to a more inclusive system would be disruptive and that 156 million Americans with job coverage are pleased with it have become the major talking points on Medicare for All. There has been little or nothing said about what former Washington Post journalist and now a single payer activist T.R. Reid calls “the moral imperative.” “Medicare for All is a mechanism that helps us all care for the least of our brethren. All the other advanced democracies have recognized this,” Reid told me.

A year ago this fall, The New York Times charted the path for the “debate” that has so far taken place. In its piece “Don’t Get Too Excited About Medicare for All,” the Times quoted Democratic pollster Celinda Lake, who said, ‘People read into ‘Medicare for All’ what they want to read into it,” and noted that the phrase was in danger of becoming an empty campaign slogan. But in the many months that have passed since that story ran, it has become less a slogan and more a vehicle for promoting the litany of reasons why the U.S. should not overhaul its health insurance arrangements.

There has been a glut of stories speculating how the current system’s big stakeholders would fare. Many reflect antipathy toward the concept of a more inclusive health care system and suggest profits might be at risk, since national systems do control prices of medical services, which often involves contentious negotiations with stakeholders.

Indeed a March headline in The New York Times declared, “Medicare for All Would Abolish Private Insurance.” ‘There’s No Precedent in American History.’” The story reported that doing away with an entire industry would be “profoundly disruptive,” “shake the entire health care system,” and “many would find the health insurance stocks in their retirement portfolios much less valuable.” Translation: Your 401(k) might be at risk if more people got health insurance and thus care. Was the Times saying coverage for every American via a national system is not in the national interest? Or was it just peddling its own distinctive brand of risk aversion?

Two months later the Kaiser Family Foundation conducted a poll with the Los Angeles Times and found people with employer plans are generally satisfied and that “large shares” of those surveyed say they are “grateful” and “content” about their insurance, a sentiment that has since rippled through the media. Writes Daily Beast columnist Michael Tomasky: “About 92 percent of Americans have health care, and the polls tell us that most people find their plans more or less satisfactory (yes, they don’t understand all the ways in which people in other advanced countries have it better, but still, the polls are the polls).” Former president Barack Obama offered a different number of satisfied Americans. “Eighty-five percent of the country has health care,” he said. “They may not love it, but it roughly works for them.” If the former president decrees our current arrangements are best left in place, is it any surprise that media stories also sidestep the fundamental question Kutzin has raised: Do we believe in universal coverage or not?

There has been a glut of stories, however, speculating how the current system’s big stakeholders would fare. Many reflect antipathy toward the concept of a more inclusive health care system and suggest profits might be at risk, since national systems do control prices of medical services, which often involves contentious negotiations with stakeholders. Doctors and drug companies don’t always get their way in those countries, but you don’t see media stories about diabetics dying because they can’t afford their insulin. Business Insider’s story “Medicare for All’s Thorniest Issue Is How much to Pay Doctors and Hospitals. Any New System Could Become a Convoluted Mess If It Goes Wrong,” speculated on what might happen to U. S. hospitals if every American could get health care. One health policy expert said: “The challenge is that when you expand Medicare to new populations, they’re going to use more health care.” That means, she explained, there would be more demand for services at the same time there could be cuts in provider payments. The implication: That’s bad news for the bottom line.

That story, like way too many others, have undoubtedly lost audiences by focusing on such details that are usually left for those fashioning legislative language or regulations. They are not the stuff of news stories or articles in the trade press, a point Kaiser Health News’s Julie Rovner recently made on NPR.  “We normally don’t see presidential candidates putting out proposals of this specificity,” Rovner explained. “This is mostly something that a president doesn’t do. Generally presidents like to leave it to Congress to work their will.” The goal of health care for everyone has gotten sidetracked in the weeds of legislative bill drafting.

In the end it may not matter since the stories and editorial opinion are beginning to conclude that the discussion of Medicare for All is over and should simply fade away in favor of more urgent topics. New York Times columnist David Leonhardt has argued that a new Democratic president should choose a priority other than health care. Doing otherwise would be a mistake, he says, “because both the moral and political case for some other issues is now stronger than it is for health care.” Leana Wen, the ousted head of Planned Parenthood and now a visiting professor at George Washington University, penned an op-ed for the Washington Post in which she urged we should “stop letting Medicare for All dominate the conversation,” and argued her patients “would be eager to hear how those vying to be the next president would address their struggle to afford prescription drugs. Would they press Congress to allow the federal government to negotiate directly with drug companies?” Doesn’t Wen realize that it is the national health systems in other countries that negotiate drug prices that make life-saving drugs affordable unlike in the U.S, and that those negotiations are what American drug makers fear most? Are Wen and others thinking small because they’ve made the political calculation that the loftier goal of a national health system is untenable in our political moment?   

Tomasky, too, wants to see the Medicare for All debate disappear. “I’m dying to see the candidate who says: ‘With all due respect, we’ve spent enough time on this. It’s very unlikely to become law. People are going to start turning the channel. I want to talk about wages.’”

Of course, that could happen. But right now I would argue they just want some honest and useful answers to their questions and how they might actually fare in a reformed health care system. Too many Americans know the current system is not working for them, no matter what its supporters say. As Washington University health policy professor Tim McBride noted in a recent tweet, 30 million Americans are still uninsured; those on Medicaid still face big challenges; and coverage under the employer health system has dropped five percentage points in the last 10 years. Not everything is as hunky dory as those wanting to cut off discussion of Medicare for All and build on Obamacare want people to believe.

In the run-up to the Affordable Care Act there were hundreds of media stories about Americans who needed health insurance and care, and those stories helped build support for the law. Where are the stories now about those still left out of the system and the significant challenges that remain for thousands still lucky enough to be in?

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care column.