10th anniversary post: the future of news media

 

The Gazette recently moved into the US Bank building

Ten years ago this month, Chuck Peters, then publisher of the Cedar Rapids Gazette, spoke at Coe College about the future of journalism. He noted that the flood of data available on the Internet meant that news media no longer had a monopoly on information, and that this required some reinvention. He argued that newspapers in particular could facilitate "authentic communications... about things that matter" to the community it serves. His specific brainchild, a section titled We Create Here, lasted a short while, but the Gazette's efforts in that direction continue today with the annual Iowa Ideas Conference, Business Breakfasts on topical issues (one is happening next week on the subject of housing development), and a periodic panel of political columnists called Pints and Politics.

Reports have long been dire throughout the world of news media, but seem to be getting even more dire (Grynbaum et al 2024, Fischer 2024). Large operations--the Los Angeles Times, National Public Radio, the Washington Post--are making massive staff cuts. Corporate overlords that depended on, say, movie tickets to fund journalism, are slashing journalistic budgets when the tickets aren't getting sold. Cable news viewership is dropping; things are so bad that even the looming omnipresence of Donald Trump can't hold people's interest. But it's worst at the humble local level, where in contrast to feeling helpless about Trump and Gaza and Ukraine we should be feeling some efficacy; a widely-touted datum estimates five local newspapers shut down every two weeks. That doesn't count the ones that go from daily to once or twice weekly editions.

Jane and I still get daily delivery of the print edition of the Gazette, and I can remember when the New York Times printed transcripts of major public speeches, or when the Sunday paper had the list of baseball statistics throughout the season. A lot of institutions we grew up with, including churches, libraries, and four-year colleges, are struggling with identity crises as well, as revenues and audiences and respect dry up, while new generations find they can get along fine without relying on them.

Or can they? The disappearance of local media outlets removes a critical counterweight to local government officials, not to mention a way for people of all ages to learn about the community in which they live. As you are doubtless aware, national politics gets a lot more attention from everyone, but local politics has the most direct impact on our day-to-day lives. From small towns to big cities, decisions are being made about our future, but who is there to bring the discussions out of the conference rooms? Who has the credibility to question local power-brokers in an independent, informed way? Who can show a mirror to the community itself? Newspapers and other local media often fall short of the mark--it took the Gazette what seemed like forever to acknowledge climate change--but I don't think Reddit or City Council commenters can fill this role.

Perry Bacon Jr (from washingtonpost.com)

Perry Bacon, late of 538 and now a columnist with the Washington Post, argues that news organizations should go all in on their public service function, as they are forced to turn to foundation and individual donations to replace lost (maybe forever) advertising revenue. Given "the major crises in America," news media should focus on three major areas:

Government and policy news, particularly at the local and state levels; watchdog journalism that closely scrutinizes powerful individuals, companies and political leaders; and cultural coverage, from important books and movies to faith and spirituality. (Bacon 2024)

Football and celebrity gossip are fine, too, if they help to pay the bills, but local news should focus on helping people access information they need to function in community. 

Ownership is another issue. It should be local not national, for obvious reasons, and have an independent voice. I haven't noticed changes in content of the Washington Post since Jeff Bezos bought it, but a billionaire with an agenda (Rupert Murdoch? The guy who's buying the Baltimore Sun?) can do more harm than good. The local paper can, and in some cases has, become a tool of conservative insurgency instead of a means of unpacking/critiquing it.

Health care (II)

Senator Mitch McConnell of Kentucky,
principal architect of the Senate Republican health care bill

Senate leaders are trying to get to a vote in the next few days on the latest version of the Republican health care act, dubbed the Better Care Reconciliation Act. The bill is intended to repeal the Affordable Care Act of 2010 ("Obamacare"), while minimizing political damage to Republicans by preserving some of its more popular features.

The Congressional Budget Office (CBO) Monday released its assessment of the effects of the bill: the number of insured Americans will decline by 22 million in 10 years, while the federal deficit will decline by a total of $321 billion. The deficit reduction could in theory be greater, but the bill also repeals the tax increases on upper brackets included in the 2010 law (Kaplan and Pear). The CBO did not to my knowledge assess whether the law would fulfill President Trump's April promise that individual premiums and deductibles, which have risen pretty steadily for more than 30 years, would be "much lower," but a collection of health economists and policy experts consulted by The New York Times predict many people will face substantially higher deductibles, or premiums, or both. Rodney L. Whitlock, a former Senate Republican policy assistant, thought deductibles would reach "almost assuredly five digit" territory (Adelson).

Obamacare was passed after more than six decades of effort to pass a national health insurance bill that had previously yielded government health programs for the elderly (Medicare, passed in 1965) and the poor (Medicaid, also passed in 1965) as well as a series of bloodied presidents who attempted broader approaches. The policy window was open only because Democrats briefly had a "filibuster-proof" Senate majority of 60-40, and because provider groups were willing to negotiate with the administration which they had not been in the 1990s when Bill Clinton was President. A few Republicans were involved in policy talks in the summer of 2009, but withdrew coincident with the rise of the grass roots conservative movement known as the Tea Party.

President Harry S Truman (1945-53) advocated an early national health program

Health care policy efforts were sustained by the persistence of three problems:

1. Lack of insurance. According to the Kaiser Family Foundation, 15 percent of non-elderly Americans lacked insurance in 2013, a proportion that had been pretty consistent dating back to the 1980s. They weren't always the same 15 percent, as people cycled in and out of employment or eligibility for Medicaid, so the percentage of people with inconsistent access to insurance was somewhat higher. Lack of insurance is associated with major health problems, shorter life expectancies, inconsistent care and financial stress.
2. Under-insurance. This is harder to measure, but a large population had health insurance that didn't actually cover what they ultimately needed, due to limits on benefits, exemptions for pre-existing conditions, or what wasn't covered by the policy to begin with. This has contributed to the rise of crowdfunding appeals to pay for unanticipated health care expenses.
3. Rising costs. Health care inflation had been running well ahead of the consumer price index at least since 1980, when health care spending amounted to about 1/12 of U.S. gross domestic product. It is now about 1/6 of GDP, placing financial stress on consumers, businesses that provide health insurance for their employees, and governments at all levels.

The existence of these three problems created substantial obstacles to opportunity in America. In a country that prides itself on meritocracy, the ability to rise is handicapped when accident of birth dooms some of us to inferior health care, not to mention housing, education and so on.

The ACA, for both practical and political reasons, eschewed national health insurance for patches on the existing system (which is not only well-established but fiercely defended by the provider groups that had defeated earlier policy efforts). Roughly based on the approach taken in Massachusetts a few years earlier, it created incentives for employers to offer insurance benefits, virtual markets for individuals in each state ("health care exchanges"), subsidies for individuals and small businesses, and expansion of the Medicaid program. It mandated minimum "essential" coverage in all policies, that everyone have health insurance, that coverage could not be denied for pre-existing conditions, "community rating" for all regardless of age sex or health status, and that children could remain on their parents' health insurance until they were 26. All these emphasized access rather than cost control, though there were some aspects of the bill that sought spending efficiencies.

President Barack Obama, for whom the Affordable Care Act
of 2010 was a primary legislative achievement

Opposition was characteristically virulent, based largely on philosophical and political reasons. Some worried that government would become too large and powerful. There was also reflexive opposition from the Republican Party in Washington and most states that they controlled. Dozens of votes were taken in Congress to repeal all or part of Obamacare, but tellingly, in six years no hearings were ever held on what if anything should replace it once it was repealed. Republicans nationally proved a lot better at winning elections and talking the program down than at designing policy, and thus arrived at their moment of victory quite unprepared.

Serious health care policy makers note Obamacare needs fixing:

1. Costs continue to rise, after a hiatus early in the decade which may have been a fluke, or may have been a temporary effect of the severe recession which dampened demand for just about everything. Health care inflation didn't start with Obamacare, but is unsustainable and will doom the program even if nothing else does.
2. Insurance exchanges have had an uneven record in practice, even after the initial enrollment bugs were worked out. Many counties have one or zero companies offering policies to individuals, which doesn't provide consumers with any benefits of competition. A more stable basis for the program would surely help.
3. Millions of people have been added to insurance rolls, but millions more remain outside. The proportion of uninsured non-elderly Americans dropped from 15 percent in 2013 to 10 percent in 2015, but still, 10 percent. Weak penalties for not buying insurance were probably understandable early on, but the "introductory rate" era is past and they must be strengthened if coverage of the long-term ill is going to be sustainable. (See comments by Dan Mendelson, president of Avelere Health, on Morning Edition Monday.)

A full repeal of the ACA would require 60 votes in the Senate to break a certain filibuster, so Republicans are pursuing only those changes that have budgetary impact in a "reconciliation" approach that cannot be filibustered. The Republican-controlled House passed the Affordable Health Care Act on May 4, 2017, without committee hearings and before the CBO had fully analyzed its effects. It was blocked in the Senate. Senate Republican leader Mitch McConnell revealed the somewhat different Senate version on June 22, also without committee hearings while pushing for a quick vote. Reservations within the Republican caucus, however, have prevented a vote thus far.

President Donald J. Trump has not been involved in the policy making process,
and his statements on health care have been vague and contradictory

The Republican approaches are less overtly assaults on the ACA structure than the "repeal" rhetoric of the last seven years would have predicted, but the dry-sounding policy changes may lead to the same effect. Sarah Rosenbaum of the Milken Institute School of Public Health at George Washington University charges: "A terrible blow to millions of poor people is recast as an easing off of benefits that really aren't all that important, in a humane way" (Ornstein). Rather than ending Medicaid expansion, for example, the current bill phases out the additional national support to states, which along with spending caps would create a strong disincentive for states to continue it. Medicaid spending caps would have the effect of reducing federal spending on that program, which is administered by states although primarily funded by the federal government (Adler, Fiedler and Gronniger).

Ending mandates on policy coverage, having insurance and community rating would lower the costs of policies for some, while driving it up for others. Moreover, without the individual mandate the viability of the mandate for pre-existing conditions would be doubtful, though the Senate bill has added a "lockout" provision requiring a six-month waiting period for getting insurance if one has let previous coverage lapse. What Brookings analysts concluded about the House bill--In general, enrollees who are younger, have higher incomes, or live in low-cost areas are most likely to be better off, while enrollees who are older, have lower incomes, or live in high-cost areas are most likely to be worse off (Brandt et al.)--is probably true of the Senate bill as well.

If access to health care is to remain part of our common life, it requires more than holding the line on repealing the Affordable Care Act. It requires advocates, because the complex set of system patches created by the ACA could be starved of funding more easily than it could be repealed by law. ("Perhaps let OCare crash and burn!" tweeted the President Monday morning, noting repeal is "Not easy!") Ensuring access while controlling costs is surely difficult, though the parties and interests in this ongoing policy process are making it more difficult than it needs to be, given the experience of other industrial democracies. That means seriously addressing the market failures (information, competition, merit goods) endemic to privately-produced health care. I don't know if that's even possible in such a polarized political environment, but signs of unrest in the states offer some hope.

EARLIER POST: "Health Care," 4 May 2013

DATA FROM KAISER FAMILY FOUNDATION
"Health Insurance Coverage of Nonelderly" (2013-2015)
"Premiums and Tax Credits Under the Affordable Care Act vs. the Senate Better Care Reconciliation Act," 23 June 2017

POLITICAL ANALYSIS: Nate Silver, "Mitch McConnell Isn't Playing 13-Dimensional Chess," FiveThirtyEight, 27 June 2017

Chuck Peters and the future of news media

(Peters in front of the white board in 405 Stuart Hall)

Chuck Peters, CEO of Gazette Communications, sees the future role of newspapers as facilitating "authentic conversations" among people in a community about "the things that matter." Newspapers and television stations can no longer serve as authoritative sources of information in a world full of readily-obtainable data. The 150-year-old model of the media industry, wherein the news presented people with information they couldn't otherwise get, adjacent to advertising that paid for the information, is effectively over. So, for that matter, is the world of institutions where the individual is told to "fit in and you will be protected." He spoke on "The Media in a Hyper-Connected World" at Coe College Friday afternoon to an audience of several dozen students, faculty and community members. He spoke for nearly an hour with neither notes nor visual aids.

Peters noted that the emergence of social media, blogs and such like means "any individual in the world who cares about something can be connected to any other individual, without any institution intervening." This creates urgent issues of purpose, not only for news media, but for cities like Cedar Rapids, corporations like Rockwell Collins, and as eventually emerged during Q-and-A, educational institutions like Coe. [A remarkably parallel argument about upcoming changes in religion, for which religious institutions may or may not be ready, is made by John C. Dorhauer, author of the forthcoming Church 3.0.]

Besides the need to keep up with technological and social changes, even under old institutional models businesses and communities may have lost their way. He cited non-western critiques he had just encountered at an international conference to the effect that the West's pursuit of material goals has "alienated us from our higher selves, our neighbors, and the Earth." He said he was inspired down this path by representatives from the U.S. Commerce Department who came to Cedar Rapids after the cataclysmic 2008 flood, and who urged the city not to immediately re-create what had been here, but to take advantage of the "tremendous opportunity" to re-imagine the community for "the world that is emerging."

Peters clearly wants to do a new thing, though he was vague on the specifics. Perhaps he did not want to seem too prescriptive. He spoke of "authentic networking" in which "we are going to construct helpful local information" instead of filing reports and printing press releases. He spoke of institutions needing to think about how to make individual experiences more "powerful." This means not "using new tools to do old jobs," but by trial-and-error developing new institutions and jobs (much as the current media model emerged out of the needs and technological capacities of the mid-19th century).

This blog is about nothing if not community, and I have over the course of this first year made much the same point about the need for connection as Peters did. Visions of community are exciting, but change, particularly radical change, is scary. Facilitating "authentic conversations" requires:

1. having a sense of who is your audience; that is, who you expect, hope and/or need to participate in the conversations. Peters spoke of targeting communication to "pockets of passion," while at other times the effort might address the whole community. I don't know what this means.
2. the facilitator--in this case, the Gazette, maybe partnering with KCRG--to serve as an honest broker among the different parties to the conversation. This is very similar to the objective approach which most news media have practiced since the early 20th century, but which Peters demeaned as "pretended objectivity" driven principally by profit motive, further adding "objectivity is a lie." This attention-getting but analytically useless statement means, I think, that no one can be completely free of bias, but that's setting an impossible standard. Is expertise a "lie" because no one can ever know everything about anything? Is morality a "lie" because nobody's perfect? Is relief pitching a "lie" because there are occasional blown saves? To be sure we need to move past the faux he-said-she-said equivalency that plagues a lot of political coverage (and of which I've accused the Gazette, at least on their coverage of climate change). But how can the Gazette possibly invite "authentic networking" if it's seen as having its own axes to grind?
3. a structure to the conversation, which again would be, at least initially, provided by the facilitating media. The Gazette's first crack at realizing Peters's vision is "We Create Here," a new model of the Sunday business section, which says it is "Providing accessible narratives in our community to foster engagement. We are initially focusing on the regional economy, diversity and new ventures." (Section editor Quinn Pettifer was in the audience.) Sunday's We Create Here section consisted of two happy profiles of local companies, and two happy guest columns promoting the organizations headed by the respective column writers. Is there room in Peters's new vision for news media's long-standing role of critiquing politicians, business leaders, and other social powers?
4. staff, which the Gazette like other news organizations has been hemorrhaging in recent years. This means good reporters, looking for information, probing beyond the surface, doing the legwork the rest of us don't have time to do, and seeking out voices and perspectives that are missing from the conversation.

As a teacher of American politics, I have for a long time realized there is very little information I can impart to my students that they can't get anywhere else. But even in the age of electronic media I can add value by providing context, practicing critical thinking that is neither nit-picking nor cheerleading, and helping students see connections. And this too is an approach. I have never, ever left a class, or a course, thinking, "I totally nailed that." It's an ongoing process.

As we strive for communities that are sustainable, diverse, and provide opportunity for all, news media have an important place. They should, they must, adapt to changing times and technologies without abandoning that.

A challenge to the Gazette on climate change

The Cedar Rapids Gazette, whose coverage of many issues (including the economy and health care) has been responsible, is creating a misleading impression of the state of debate on climate change. For years the predominant view among climate scientists is that human pollution is accumulating in the atmosphere, and that this accumulation has begun to affect the climate of the Earth. If unchecked, these changes will lead to irreversible damage to the ability of the Earth to support life as we know it. (This is popularly known as "climate change," or by an earlier and less accurate monicker, "global warming." 97 percent of climate scientists endorsed this view in this NASA survey).

The only scientific voices on this subject that I've seen in the Gazette, however, represent the small minority of skeptics. Last Sunday, the International Climate Science Coalition presented its third op-ed column since June by my (non-systematic) count, arguing that "the idea that we can cause [extreme weather events] and can prevent them from occurring is science fiction." Opposite them was a column by a North Liberty woman who has participated in the Great March for Climate Action and is a member of the Iowa City-based 1000Grannies.org. Her commitment to this cause is undeniable and admirable, and I find little to object to in her column.

I object to the impression created by the Gazette that hard-headed science is skeptical about human impacts on the climate, while environmental activists are pushing the view that we humans are playing a dangerous game. Seriously... scientists vs. grannies? This is not even close to being accurate.

So, my challenge to the Gazette: In your circulation area exist a nationally-known Research I university, another state university of considerable size, and at least three private colleges with highly-reputed science departments. The Gazette circulation area is, quite obviously, hip-deep in scientific experts. If there's a debate on climate science, we shouldn't have to go to Toronto to find one side of it. We ought to be able to find it here. Ask the scientists, and report what they say. Tell it like it is.

Losing Track of What Really Matters

Bruce,

There's no denying it. We are living under one of the most troubled administrations of the past century.

It now appears that the Obama administration deliberately LIED to the American people about the tragic terrorist attack in Benghazi, Libya last September.

And, after three years of secrecy, Barack Obama's IRS just admitted to targeting and harassing conservative grassroots groups because of their political ideology!

Scandals are dominating the news, even the elite media I patronize. The mass media must be foaming at the mouth. FOX News should probably check their blood pressure.

All of a sudden, it seems, there is a confluence of seemingly unrelated events that look bad for the Obama administration: the Justice Department snooping on phone records of Associated Press reporters, the Internal Revenue Service singling out Tea Party groups for special scrutiny, the Department of Health and Human Services soliciting health care providers for financial support for state health insurance exchanges, and the deaths of four diplomats in an attack on the U.S. mission in Benghazi, Libya. The events may individually be anything from unfortunate outcomes to administrative lapses to actual malfeasance either at low or high levels. I'm getting no vibes from politicians' responses; perhaps one could get a hint from the degree of expressed outrage, but as the right's amps are stuck on "11" this never varies anyhow. One clue is the existence of multiple congressional hearings. In the 1980s Iran-contra scandal--now, there was a scandal for you!--the convictions of Oliver North and others were thrown out on appeal because their trials had been compromised by statements at congressional hearings. Ever since, then, you can pretty much figure that if Congress is holding hearings they're not expecting anything criminal to result, just some political embarrassment.

I don't want entirely to dismiss the importance of the issues involved, particularly of the creepy business with the AP, although the unremitting outrage does get to looking fake, particularly when it comes from the throat of Senator Mitch McConnell, who tries very hard to act sincere, but just can't pull it off, or former Senator and presidential candidate Rick Santorum (above, with "Donate Now" button). And the news media, as The New York Times's Frank Bruni argued yesterday, find political fallout everso entertaining, even moreso than what substance the scandals themselves possess. (See also Larry Sabato's 20-plus year-old book, Feeding Frenzy.)

BUT! None of this gets at the core issues in this blog: issues of economic opportunity, environmental sustainability, and living with diversity that are going to determine whether and how we Americans are going to be able to live together in the years to come. If you're going to get outraged about Sibelius putting the arm on health care providers, spare a little anger for members of Congress and state government officials who are doing whatever they can think of to prevent people from getting health insurance. Or companies that crush unions in this country while they allow their products to be manufactured in death traps in Bangladesh. Or those who complain of government ineffectiveness while thwarting any effort to make it function. Or the sustained disinformation campaign on climate change. Or politicians who can't fix our immigration mess because they're afraid of offending angry xenophobes. Or haters who cry out against gay marriage and adoptions even as more and more children are being raised in single-parent families.

I'm not claiming that these are the only issues we should talk about, only that critical matters like these get swept under the rug while we're fulminating about who knew what and when did they know it. That may be fine with McConnell, Santorum and their ilk, who show no interest in any of my issues other than hostility towards anyone or anything that tries to address any of them. Which in turn leads me to suspect, much as I dislike conspiracy theories, that the manufacturers of outrage have a hidden agenda at work here.

Obama may get roughed up in this collection of scandals. That's his problem, not mine. But the real losers in all this are the poor, the sick, the vulnerable, the "other" and the environment. Again.

Under construction

The Chicago Regional Council of Carpenters has been picketing various construction sites downtown for the last week or so, and then today, easily the nicest day we've had so far in 2013, they were gone. Our local newspaper, The Cedar Rapids Gazette, has never reported on their presence, and nothing to say about their disappearance. Neither has the Council's own web site. I was thinking I should just ask one of the picketers, but then--poof!--they were gone. Just as well, perhaps, as I hate initiating conversations. I made a very poor journalist.

There certainly is a lot of construction sites around. On a brief walk around downtown today I saw:

the parking garage, taken across 2nd Av...

eventually it will be attached by a skywalk across 1st Av to:

to the downtown hotel and convention center 

(taken a few weeks ago; it's nearly complete now)

the downtown library, on 4th Av, scheduled to open August 24

something at 2nd St and 6th Av...

the new federal courthouse is in the background

the levee and amphitheater, which you can perhaps see across the river...

Here's a better view from a couple weeks ago:

Taken the same day:

This parking lot on 1st St will soon be the new CRST headquarters...

and, of course, there's the parking garage going in below the Armstrong Building...

No shots of the garage, but if you try to enter the public library by the old way,

you get into this empty triangular room, which some people find disconcerting

I didn't venture as far as the new fire station or the juvenile justice center, but you get the idea.

The news "blackout"--due, I'm sure, to the Gazette having shed too much staff, rather than ideological bias--means we don't know if the picketers are gone because the conflict was solved, a restraining order was issued, it was too nice out, or they were celebrating Tchaikovsky's birthday. I do know, from a 2011 Gazette story, that pickets in Iowa City that summer protested the use of nonunion labor at a University of Iowa construction site. I wouldn't be surprised if there weren't nonunion carpenters abounding on these various projects I saw today. Iowa is after all a "right-to-work" state--a cheesy euphemism if ever there was one--on top of which Governor Branstad forced the City of Cedar Rapids to abrogate its labor contracts in 2011.

American unions have a checkered history, with thuggery by the notorious Teamsters and featherbedding (requiring the hiring of unnecessary employees) by too many others. Milton Friedman famously charged them with causing inflation and distorting the labor market, though other economists question that. On the whole unions have been good for Americans--whether or not you're in a union, you can thank them for establishing traditions of weekends, safe working conditions, and health and retirement benefits--and their precipitous decline in the last 40 years has unsurprisingly coincided with declines in wages, job security, and working class standards of living in general. 

Less materialistically, the decline of unions coincides with a tilt in our society towards individualism. With cooperation for mutual benefit in disrepute, our lives are at the mercy of our employers and the government, because at their best unions were a check and balance on both.

I'm comfortably middle class, with an unusual degree of job security, and expect I'll enjoy or reap the benefits of most of the buildings currently under construction downtown. Coming around at last to the core question of this blog, we can't live together if some of us are prospering at the expense of others' well-being. And we can't live together if we're competing to see who works cheapest and longest, and everyone is sinking or swimming on their own.

Health care

(President Harry S. Truman, an advocate of national health insurance.)

It's been a tough week for the Affordable Care Act, the health care reform law passed in 2010 and currently in the implementation phase. A Politico story (see below for link) validated a spurious claim that has been making the rounds in the last year, to wit, that members of Congress are seeking to exempt themselves from provisions of the law mandating purchase of insurance from purchasing exchanges. President Obama is being criticized by members of his own party for lack of leadership and failure to communicate on health care, with Montana Senator Max Baucus saying "I just see a huge train wreck coming down" as the law is implemented. And Friday Caroline Humer of Reuters news agency reported few insurance companies are enrolling in the state-level insurance exchanges, which makes it questionable whether those exchanges will be able to operate as intended.

The exemption falsehood is the latest in a series of fact-free efforts to manipulate public opinion, dating back to Sarah Palin's 2009 crusade against putative "death panels," and even farther back to hoary charges of "socialized medicine." However, unlike death panels, which theoretically could have been in the law even though they weren't, the exemption story is fundamentally absurd. The law doesn't affect people with insurance, as long as the insurance plan itself qualifies. Members of Congress, who have very good health insurance, aren't exempt from a requirement to buy insurance that they're already buying. And even those required to buy insurance aren't required to buy it from exchanges.

So what is giving this lie legs? As should be obvious to anyone, some people really really really want this law to fail. This certainly includes former Pennsylvania Republican Senator Rick Santorum, whose 2011 presidential campaign appearances in Iowa featured lengthy tirades against the law. When I saw him speak at Mt. Pleasant, he claimed that America ceased to be a free country when the law was passed; he wondered why we're helping people get health care when we don't help them get food and housing (um, actually, we do); and raged against longer waiting times in doctors' offices. Swell guy, that Santorum, and no wonder he's pushing the exemption story to the max this week. If you're as angry about it as he is, which hardly seems humanly possible, write an angry letter your representative and send Santorum's group some money.

(Former Pennsylvania U.S. Senator Rick Santorum, whose public
persona is angry, and inaccurate to boot.)

That doesn't explain how the congressional exemption falsehood got into Politico, though. John Harwood of The New York Times points out, "In fact, lawmakers said, the talks the article referred to concerned preserving the same kind of employer-subsidized health coverage for Congressional employees that workers at private companies can receive under the law." I've sent a query to the lead author of the Politico story. He hasn't responded, nor has Politico issued a clarification or correction. I'll let you know if that changes.

The other criticisms are harder to assess. In an ideal world, the Obama administration, and particularly the President, would be noting that we're embarking on quite the grand social experiment, and issuing regular public statements of information and reassurance. But I don't know how reasonable it is to expect that, given that other stuff keeps coming up, like the civil war in Syria or the bombings in Boston, that have to be addressed, too. More basically, I'm pretty sure people overestimate the effectiveness of even focused presidential rhetoric. There is a lot of noise in the world of politics, more and more each week it seems, and even if the President's is the loudest voice in the country it still gets drowned out more often than not. There need to be more people involved in this effort besides Obama and Secretary Sibelius. Is Baucus helping?

It would be nice if the health insurers were feeling confident and enthused, too. Given that we've never done this sort of thing before as a country, some degree of uncertainty is inevitable. Nothing Obama says or does can undo that. Could the government do a better job of cushioning the insurers against whatever it is they're worried about? Maybe. Given that insurers were very much a part of the bill's formulation in 2009--if anything provider groups were too involved in the process, because few members of Congress were willing to negotiate their votes--you'd think this would have come up. But let us grant that at least some of the insurers' concerns are legitimate. Those should be addressed. Insurers should not, however, be indemnified against any conceivable loss or inconvenience. This isn't about them.

Health insurance is important to the central question of this blog: how are we Americans going to live together? Between 15 and 20 percent of adults 18-65 are without health insurance at any given point in time; expanding that point to a year, or two years, the percentage gets larger, as different people get and lose insurance. (Up-to-date numbers from the Kaiser Family Foundation here.) That number would, I'm sure, at least double and maybe triple or more, if we change the subject to underinsurance, that is, having insurance that does not adequately protect a person against medical emergencies. This is not a trivial matter. People without insurance have significantly higher incidence of major health problems, less consistent care, shorter life expectancies, and much more vulnerable finances. (For data see Katherine Swartz's chapter, cited below, and the sources she cites in endnotes 3-10. There is also a 2008 study by the Urban Institute.) Bottom line: Health insurance is critical to equality of opportunity. It matters very much whether people have it or not. It is not, as Justice Scalia suggested in his dissenting opinion, a luxury item that is purchased by people who have made it economically.  It is, for the past 30 years anyway, a significant demarcation between the "haves" in our society and the "have-nots."

Moreover, to the extent that uninsured and underinsured people get their medical care in emergency rooms, it raises health costs for everyone. Did Senator Santorum ever wonder, if they're not paying the cost of emergency care, who is? Did he ever wonder if someone in his family would have a medical emergency and have to wait for uninsured people who got there first?

I support implementation of the Affordable Care Act, if only because it is the only game in town. It is the only means currently available that will address the critical problem of uninsured and underinsured people. Single-payer is not on the table. And Republicans, for all their full-throated opposition to "Obamacare," have offered nothing in the way of alternative methods once they achieve their goal of repealing it. Indeed, several G.O.P. senators, including Iowa's Charles Grassley, who were engaged in health care talks with the administration in 2009, fled as soon as the Tea Party turned up the heat that August. Once in awhile, Paul Ryan or someone will pop up with a suggestion, but do these ever get committee hearings or floor votes in the Republican-controlled House of Representatives? There have been over 30 votes to repeal the Affordable Care Act; how about something of substance?

Moreover, the style of reform enacted in the Affordable Care Act has worked, at the state level, in Massachusetts. Massachusetts is not America, of course; its population is overall better-educated and had a higher proportion of insured people before its health care law was enacted in 2005. Perhaps most importantly, implementation of health reform in Massachusetts was facilitated by cooperation between Republican Governor Mitt Romney, legislative Democrats, and provider groups.

The Massachusetts experience shows that health care reform can work. For sure there will be problems along the way, but those can and will be overcome if people in power work together to overcome them. On the other hand, with enough fear-mongering, misinformation, and foot-dragging, the Affordable Care Act can very well be effectively undermined. Obama's legacy would suffer, people would have even less faith that government can do anything right, insurance companies could do things the hugely profitable way they've always done them, and maybe the rest of us would enjoy shorter waits for doctor visits. Maybe those would all be good things. But those are picayune matters, compared with the opportunity to what we need to do:  make people more healthy, promote economic opportunity, and keep America from becoming even more divided than it already is.

SOURCES

John Bresnahan and Jake Sherman, "Lawmakers, Aides, May Get Obamacare Exemption," Politico, 24 April 2013, http://www.politico.com/story/2013/04/obamacare-exemption-lawmakers-aides-90610.html.

John Harwood, "The Next Big Challenge for Obama's Health Care Law: Carrying It Out," New York Times, 30 April 2013, A10.

Caroline Humer, "U.S. Insurers Wary of Health Reform," The Gazette (Cedar Rapids, IA.), 2 May 2013, 1A, 8A.

Robert Pear, "Obama Says Health Care Law Is 'Working' and Changes Won't Be Widespread," New York Times, 1 May 2013, A15.

Katherine Swartz, "Uninsured in America: New Realities, New Risks," in Jacob S. Hacker (ed), Health at Risk: America's Ailing Health System--And How to Heal It (Columbia, 2008), 32-65.

ALSO WORTH A LOOK...

Linda Bergthold, "Obamacare: Will the Trains Run on Time?" HuffingtonPost.com, 30 April 2013, http://www.huffingtonpost.com/linda-bergthold/obamacare-will-the-trains_b_3189634.html: soberly positive expectations for implementation

Bill Keller, "Five Obamacare Myths," New York Times, 16 July 2012, http://www.nytimes.com/2012/07/16/opinion/keller-five-obamacare-myths.html?src=me&ref=general&_r=0... somewhat dated, but a useful reminder of the junk that was circulating last summer

Glenn Kessler, "Obama's Claim that 90 Percent of Americans 'Don't Have to Worry' about 'Obamacare," WashingtonPost.com, 30 April 2013, http://www.washingtonpost.com/blogs/fact-checker/post/obamas-claim-that-90-percent-of-americans-dont-have-to-worry-about-obamacare/2013/04/30/01414c02-b1f7-11e2-9a98-4be1688d7d84_blog.html: how Obama has exaggerated claims for the benign impact of the Affordable Care Act. Particularly Kessler points out that the underinsured, whom Obama has overlooked in his speeches on the subject this week, will need to get better insurance, which will cost 'em.