In part I of this article, I provided a little background on the history of the public option, including how John Edwards was actually the first to propose it during the Democratic primary campaign. I also demonstrated how the media has largely ignored the glaring inconsistencies between Edwards’ characterization of the public option during the campaign, and how Obama has promoted it to the public this year. Edwards quite openly acknowledged that a public option could result in the entire health system gravitating towards a government-run, single payer system. Obama, on the other hand, has flatly denied this is the case saying it’s all about “choice and competition”.
I also singled out Julie Rovner from NPR as an example of a media health policy expert who has failed to fully (and fairly) report on the public option. Including the fact that many of its original (and current) proponents believe it could ultimately lead to a single payer system. Instead, Rovner has been a consistent voice of support for the Administration’s assertion that this is only a “myth”. I asked Rovner to comment on this prior to publishing part I. Here is the relevant excerpt from her response (emphasis mine):
I think what’s been missed in much of the debate is that the public option construct envisioned by the Democratic candidates during the primaries is fundamentally DIFFERENT from the one that’s on the table now…
Edwards’ plan would have opened his “exchanges” to basically any business that wanted to join, hence giving the public plan very wide availability. That’s what led him to say that over time, if it proved popular enough, the public plan could have morphed into a single-payer system.
But that is NOT the case with the current plans now under consideration. They all have very strict “firewalls” that limit availability to the new marketplaces that will include a public option (or not) to those in the individual market and small businesses (the size varies by each bill). That’s why the CBO estimates that only a few million people would end up in the public plan. And that’s been my (and most other reporters’) justification for reporting that these plans wouldn’t represent a government takeover of the health care system. In their current form, they couldn’t, at least not without a change in the law to open them up to the larger population.
What Rovner says is basically true: the public option outlined by Edwards was different in design than what is being considered in Congress now. But so was the public option outlined by the President during the campaign. In the run-up to the election, Obama repeatedly said of his health plan not only that “if you like the plan you have you can keep it”, but also that “if you don’t like the plan you have” he was going to provide a set of options, including a public plan. In other words, Obama also envisioned an insurance exchange open to everyone.
The so-called “firewall” that Rovner refers to was only crafted in the Spring after early estimates showed that in excess of 100 million people would transition into the public plan within the first 10 years. In other words, it was a little too obvious that the public option would quickly lead to a single payer system. So this relatively simple design change was made.
But guess what? There are many Democrats in Congress – and even some Republicans – who are pushing to expand the initial eligibility for the exchanges. Even if they are unsuccessful, under the House bill expanding the exchanges is under the discretion of the Secretary of Health. This means that no further change to the law would even be necessary, contrary to what was asserted by Rovner in her statement above. The “firewall” was put up overnight and it can be torn down just as quickly. And there will be a lot of public and congressional pressure to do so.
So Rovner’s statement is completely reasonable – but only as an excuse for her selective coverage on this issue. But the job of the media is not to provide selective coverage, especially when from all appearances it’s being done in support of a partisan agenda.
The fact that the public option became the center of the health care debate all but obligated the media to provide a fuller history of it’s inception, and to cover the full range of possible policy ramifications. Especially in light of the fact that so many people – both opponents AND proponents of reform – have claimed that the public option could ultimately lead to a single payer system.
And I’m not just referring to John Edwards, but a whole host of proponents of reform, as outlined in an earlier article on this topic at BigGoverment.com. Notably Rep. Jan Schakowsky (D-IL), Rep. Barney Frank (D-MA), Sen. Russ Feingold (D-WI), Paul Krugman from the NY Times, and Ezra Klein from the Washington Post. The corroborating statements from any one of these individuals were newsworthy enough to warrant coverage by Rovner and others in the media. Is there any doubt that if a Republican President had been implicated in misleading the public over major legislation that this would have been major, tier one news? (It probably would have been treated like Watergate.)
So I don’t accept Rovner’s rationalization of this, for her or anyone else in the media. And let’s not forget that NPR is publicly-funded, which only increases Rovner’s obligation to provide fair and non-partisan coverage.
Unfortunately, it’s the American people that stand to pay the price for the media’s failure to provide comprehensive coverage of the public option. Is there any doubt that if the broader media had highlighted the ulterior motives behind the public option that it would have been killed off in Congress long ago? As it is, it’s only barely survived to this point. And yet even now, the Democratic leadership is doing everything they can to cram it into the final bill.
While I am wholeheartedly opposed to the public option, and believe it will ultimately create a crushing burden of debt, this is not even the biggest travesty of the whole affair. The media has failed America not because health reform legislation is on the verge of passing, but because the wrong reform is on the verge of passing. By employing a disingenuous strategy to force through the public option, the Administration and Democratic leadership have missed a real opportunity to implement much-needed insurance reforms on a truly bi-partisan basis. Reforms which would have had a much better chance of actually lowering the growth rate in healthcare spending, as opposed to the Democrats’ legislation which is primarily focused on expanding coverage.
One such example is the long-term decoupling of health insurance from employment. An idea which had significant bi-partisan support under Sen. Ron Wyden’s (D-OR) proposed bill, and which could have dramatically altered the market dynamics causing healthcare costs to skyrocket. This was also a key component of Senator McCain’s plan during the election, so there is no question there would have been significant Republican support for this idea.
But this idea was never even seriously considered, primarily because of the President’s simplistic campaign promise that “if you like what you have you can keep it”. Which we now know was really just a cover for the hidden agenda of the public option. Fair and balanced reporting on this would have quickly cut through this spin, and America would have been better off for it.
And what happened to the idea of promoting greater portability of insurance? Those “firewalls” that Rovner referred to will result in utter chaos when it comes to changing employers. Sure, the uninsured, unemployed and those working for very small businesses will enjoy the convenience of having continuous insurance through the exchanges. But anyone else who changes jobs regularly, especially the 50+ million temporary workers in America, will be required to bounce from within and out of the exchanges frequently based on their employment status. And remember that these firewalls were only necessary to limit the initial growth projections in the public option. (And also to limit the government subsidies paid to participants in the exchanges.)
A system of health insurance exchanges (or one national exchange) open to everyone, without a public option, would have had bipartisan support, and would have solved once and for all the portability issue. Combined with some or all of Senator Wyden’s ideas, it also could have dramatically lowered healthcare costs in the long run. But by continuing to promote the public option, the Administration drove a wedge right through the possibility of bi-partisan reform. While some of the media has stood on the sidelines and watched, many of its most prominent personalities have marched in lockstep behind the Administration’s flawed agenda.
Without a doubt the media has failed in their basic responsibility to inform the American public on this issue (with some notable exceptions). And considering the amount of media time and access the Administration has been granted, there is just no excuse for this. Of course the blame extends far beyond just NPR and Julie Rovner. Rovner is an extremely thorough and well-intentioned reporter, and there is no one else in the media more knowledgeable on health policy issues. But perhaps it’s time for Rovner and others in the “non-partisan” media to reflect more closely on their reporting, and to ask themselves whether they have let their desire for this Administration to succeed influence their coverage on this and other issues. Most of them would still passionately defend their record, no doubt. And this is their right.
But whether they recognize it or not, most of America has long since judged their coverage to be biased and unfair. This judgement will only become more pronounced in the years ahead as the hidden consequences and unexplained trade-offs of healthcare reform become increasingly evident. Unfortunately by then it may be too late for them to rescue their credibility. Perhaps it already is.