A Missing Ingredient in Health-Care Coverage

By Andrew Alexander
Sunday, August 30, 2009

The Post publishes health-care reform stories almost every day as it tracks the twists and turns of the epic debate. So it's surprising to hear from so many readers who ask: Why hasn't The Post explained what this is all about?

"Your paper's coverage continues in the 'horse race' mode," complained Bill Byrd of Falls Church. "Who's up, who's down . . . political spin, personal political attacks.

"How I would love to read more actual journalism on this issue," he e-mailed.

Make no mistake, The Post has produced some stellar health-care coverage. It's exposed heavy industry campaign contributions to key members of Congress who are drafting legislation. It's revealed those with personal investments in corporations that could be affected by the health-care laws they write. And it's burrowed into thorny questions about who should be authorized to deny patient requests for expensive but non-critical medical care.

However, readers say that too many other stories have been about process or politics. That's coverage The Post must own, of course. Washington is filled with policy wonks and decision-makers.

But readers seem to be saying: What about the rest of us? Over the past month, dozens have called or e-mailed to urge more explanatory journalism.

Many have said that Post stories routinely assume a foundation of knowledge that they simply don't have. Some said that they don't understand basic terms like "public option" or "single payer." They want primers, not prognostications. And they're craving stories on what it means for ordinary folks and their families.

In my examination of roughly 80 A-section stories on health-care reform since July 1, all but about a dozen focused on political maneuvering or protests. The Pew Foundation's Project for Excellence in Journalism had a similar finding. Its recent month-long review of Post front pages found 72 percent of health-care stories were about politics, process or protests.

"The politics has been covered, but all of this is flying totally over the heads of people," said Trudy Lieberman, a contributing editor to Columbia Journalism Review, who has been tracking coverage by The Post and other news organizations. "They have not known from Day One what this was about."

It's not for lack of interest. About 45 percent of Americans surveyed by the Pew Research Center for People & the Press recently said they have been following the health-care story more closely than any other.

But nearly half of those surveyed this month in a nationwide poll by the Kaiser Family Foundation said they are "confused" about reform plans.

Kaiser's president and CEO, Drew Altman, worries that the media have devoted too much attention to "accusation and refutation" stories instead of focusing on the "core questions about health-care reform that the public wants answered."

By "gravitating toward controversies" such as the recent boisterous town hall meetings on health care, he said, the media may "unwittingly" be allowing coverage to be shaped by evocative rhetoric and images.

Urban Institute President Robert D. Reischauer, a health policy expert, said that The Post needs to keep providing in-depth coverage of politics and process "because you're the newspaper of record on policy matters." But while conceding the issue's complexity, he worries that Post stories sometimes include "a lot of inside baseball, even more than I want to absorb."

Post editors face a huge challenge in serving a range of audiences. "We've tried to create a balance," said Frances Stead Sellers, who oversees health coverage. Much good work has appeared online, where "reform junkies" can get incremental coverage through the Daily Dose blog on The Post's special "Health-Care Reform 2009" page. The Web site also has some terrific primer-like "infographics" that provide baseline knowledge.

"We'll keep looking for more ways to make this challenging topic accessible to readers," she said.

Most readers who have contacted the ombudsman identify themselves as senior citizens and rely on the printed Post. The Kaiser survey found those older than 65 are the most confused by the issue.

I think they want more glossaries explaining basic terms, easily digestible Q&As, short sidebars that summarize complex concepts and graphics that decipher complicated data. And they want stories that say what health-care reform will mean to them.

Last Sunday's Outlook section carried a piece by former Post reporter T.R. Reid titled "Myths About Health Care Around the World." The writing was terse and anecdotal, without health-care gobbledygook. No he-said-she-said.

On the Post's Web site, it was among the most viewed articles on Sunday and Monday. It was one of the week's most e-mailed stories.

There's a reason.

Andrew Alexander can be reached at 202-334-7582 or at ombudsman@washpost.com. For daily updates, read the Omblog .

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