How McCain and Obama's Health Plans Would Affect Real People

By Trudy Lieberman , Columbia Journalism Review. Posted September 15, 2008.

This is the first in a series examining how the candidates' health care proposals will affect ordinary people and how the press could cover that angle.

So far, mainstream media coverage of health care during the campaign has been characterized by stenographic reporting -- simply transcribing what the candidates say, buzz words and all. Blogosphere coverage has trended the opposite direction -- way too much wonk talk, angels dancing on the head of a pin-type stuff. What have been missing are the people stories. Exactly how will all these economic and political calculations and pronouncements affect those who struggle daily to fill their prescriptions, find a competent doctor, or pay their medical bills? These are the people whose stories the media have yet to tell.

Plenty of coverage has depicted the McCain and Obama plans in broad brush strokes: McCain wants to rip up the employer-based health care system, replace it with tax credits for families and individuals, and require workers to pay income taxes on the value of their health insurance benefits from employers. He also wants families to make medical decisions. Obama would let people keep insurance from their bosses but make it easier for those who are uninsured to buy coverage through a public plan like Medicare. Neither would require people to carry health insurance (except Obama requires it for kids). Both candidates promise tax subsidies. How big they will be and who they will help is anyone's guess.

Last month, NPR aired just such a broad-brush plan-comparison story, featuring a health care policy researcher who drew distinctions between the two approaches. The most telling point he made was that "we pretty much have the same solutions that we've always had." Okay, the solutions may be shop worn, but that's no excuse for not showing people how they will be affected by them.

To begin what I hope will be an ongoing narrative about the candidates' plans and where ordinary people fit into them, I went to Helena, Arkansas, a town of 6,300 along the Mississippi River, whose population and importance peaked in the early 1900s during the sharecropper era. It's like many old river ports and tiny towns across America, in that the population vanished when the jobs did. There aren't many opportunities to go out and find employment with good insurance, the standard advice for decades. Helena's median family income in 1999 dollars was $21,500, compared to $50,000 for the U.S. at large.

The people I talked to represent the socio-economic strata of the town -- from the head jailer and the garbage collector to the insurance agent and the soybean farmer who owns 5,000 acres. They all have health issues. Most people do. Twenty-seven percent of the population is disabled, and all will be affected one way or another by the strategies for reform pursued by John McCain and Barack Obama.

What struck me was that even with insurance, which many had, people were still paying large medical bills out of pocket, reflecting the big cost shift from those who traditionally pay the health care tab to patients themselves. They are the underinsured, that group of 25 million Americans just now coming into public focus but hardly mentioned by candidates or the press. Another thing stood out: How little they knew about the coming health care battle being waged in their name.

"We're getting socialized medicine like Britain and Canada," one man told me. How did he know? "The people on TV told me," he said. All the words the media have produced are not sinking in. People need to see themselves in the context of the proposals. They need to know what's at stake for them. As Irwin Landau, my former editor at Consumer Reports, reminded me recently: What touches you personally will be more interesting than what is not personal. It will not only be more interesting, but it will help people evaluate the ad messages, the special interest spiels, the propaganda, and the demagoguery that will surely come. Judging from the people I met in Helena, the media have a big job to do going into the election and beyond.

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