Unhealthy Overload

By Howard Kurtz
Washington Post Staff Writer
Friday, July 31, 2009; 12:44 PM

I read everything about the health-care debate, and it does get dizzying at times.

What, precisely, is the difference between the public option and the co-op option? To what degree would a new MedPac hold down Medicare reimbursement rates? How many more small businesses would be spared the insurance mandate if the payroll limit were raised from $250,000 to $500,000?

This is one complicated piece of legislation. The impulse behind the reform effort is that you've got to fix all the moving parts -- covering the uninsured, raising the needed revenue, holding down costs -- to make the contraption work. That has been a huge challenge for President Obama, because it's all too easy, with a 1,000-page bill, for opponents to whip up opposition to particular passages (Obama wants to tell you how to die!).

But it's a challenge for the media as well. The major newspapers, in my view, have done a pretty good job of reporting the details in the competing versions as well examining the real-world implications for doctors and patients ("Would Tax on Benefits Rein In Spending?" a Washington Post front-pager asked yesterday). The newsmagazines have done a decent job (Time's cover story yesterday, "Paging Dr. Obama," quotes the president as saying he's spent "a lot of time thinking about how can I describe this in clearer terms.") And while television has struggled, as it always does, with an abstract issue that lacks visuals, some serious efforts have been made as well. (The criticism of ABC for granting Obama 90 minutes during a health-care town hall obscured the fact that the network was giving the issue prime-time exposure.)

L.A. Times columnist James Rainey disagrees:

"America has a healthcare crisis, yes, and so do broad segments of the media, particularly television news. They have transformed the story of how to fix an overpriced and inadequate care system into an overheated political scrum, with endless chatter about deadlines and combatants and very little about the kind of medical care people get and how it might change.

"Campaign-style 'horse race' coverage seemed to me to have shoved aside more pertinent reporting, and on Tuesday, that view got some confirmation, in the form of research from the Project for Excellence in Journalism.

"The Washington-based watchdog group found that more than three-quarters of the coverage (by 55 outlets across television, radio, newspapers and websites) in the week ending last Sunday focused on politics and legislative strategy . . .

"The complexity of the debate has not been lost on anyone, but even accepting the difficulties, many outlets have shown a dazzling determination to highlight conflicts and legislative timetables while telling us almost nothing about potential changes in insurance and care."

Here's why, although Rainey makes some good points, he's partly wrong: The conflicts on the Hill are the story right now because they will determine whether or not Obama gets a bill, and what kind of bill it will be. The Blue Dogs in the House and the Gang of Six on Senate Finance may seem like inside baseball, but they are -- under pressure from constituent groups and special-interest lobbies -- battling over fundamental differences of cost, scope and regulation. (As for deadlines, as Rainey acknowledges, it's POTUS who kept stressing them in speeches and interviews.) The president may wind up with a bill close to his original concept, or the whole thing may go down in flames like Hillarycare. That's why the sausage-making is the story right now -- as long as journalists keep examining these measures, their likely impact and their often-inflated claims.

But even if the coverage were brilliant, can the public swallow this thing whole?

"As the health care battle enters a critical phase -- with lawmakers about to greet constituents during summer recess -- the reality is that the outcome will probably be shaped less by the intelligence of advocates on any side than by the ignorance of most Americans," says Politico.

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