March/April 1994 | Contents
The Selling of "Clinton Lite"
by Trudy Lieberman
Lieberman is a senior editor at Consumer Reports specializing in insurance and health care financing issues.
In early October Representative Jim Cooper of Tennessee, the conservative Democrats' guru on health care reform, called a press conference to announce he was throwing his version of reform into the congressional mix. That event should not have been particularly newsworthy since the year before Cooper had introduced similar legislation, which resulted in only a few brief press references.
But this time Cooper was a more clever marketer, and he positioned his plan as a middle-of-the-road approach with bipartisan appeal. At the press conference, he distributed a chart that showed his bill -- a laissez faire version of managed competition -- smack in the middle of all the proposals on the table. Cooper's bill does not require employers to purchase insurance for their workers; it doesn't require individuals to buy insurance; nor does it establish a mechanism (aside from market competition) for cost control.
"The administration started with managed competition and went to the left. The Republicans took managed competition and went to the right. Our bill is squarely in the middle and is the only one with significant bipartisan support," Cooper told reporters. "It is the first health reform approach since Harry Truman to get major Democrat and Republican support," an exaggeration that went unchallenged. In 1973, Republicans supported federal legislation that propelled health maintenance organizations into national prominence; and in 1983, Reagan Republicans were the driving force behind major changes in the way Medicare pays hospitals, a significant health reform that has since been copied by other countries.
Reporters also received a statement from The Bipartisan Group on Health Reform which asserted that "with over forty co-sponsors . . . this bipartisan effort stands to be a major force in developing legislation that can be passed and signed into law during the 103rd Congress." Even with a handful of Republicans on board (19 of the 176 House members), Cooper's proposal had far fewer co-sponsors (48 when it was introduced) than other bills, including the president's with 99, the plan pushed by House Republicans with 138, and the one supported by advocates of a Canadian-type system with 91. The number of co-sponsors, however, is not necessarily indicative of support, since many co-sponsors of Cooper's bill, as well as those who have endorsed rival proposals, have attached their names to more than one plan.
As for support from the public, the polls showed that ordinary people knew little or nothing about any proposal, including the Cooper brand of managed competition.
Cooper revealed his marketing plan to Roll Call, the newspaper that covers Congress. He explained that one could try to push a bill through the committee route, a perilous strategy for the administration (and for him as well) since the leadership of the major subcommittees in the House with jurisdiction over health care (Henry Waxman and Fortney Stark, both California Democrats) has expressed support for a single-payer, Canadian-type system. Or one could follow what he called a strategy of "preemptive compromise," in which a bill with a grounds well of support or a "supermajority," as he put it, could be positioned as the ultimate agreement. Such a bill could then be substituted on the House floor for a piece of legislation that had gone the committee route. The finer points of this strategy leaked out after a small group of congressmen attended a meeting sponsored by Cooper and Senator John Chafee in late October. Members who were there told The Washington Post that a "goal was to 'control the debate' health care by positioning themselves in the 'mainstream' or 'centrist' position" and become a force with which the Clintons had to negotiate.
To succeed, Cooper and his allies needed help from the press to give their bill an aura of strong support, generate more co-sponsors, and drum up the public backing the bill sorely lacked. A review of media stories between October and early January shows that the press played right into Cooper's hands. Looking for something new and dramatic to say in the weeks following the president's late-September speech on health care reform, the media seized on the language in the Cooper press releases and elevated Cooper's vision, in the words of Newsweek, to the very "model" of compromise. In a piece decidedly negative toward "Big Sister" Hillary Clinton's approach and positive toward Cooper's, Newsweek pronounced the Cooper bill "less bureaucratically cumbersome," "fiscally more realistic," and "probably closer to the congressional center than the Clinton plan."
Liberally donating space to Cooper's self-serving quotes and sometimes making pronouncements of their own, a number of other influential news organizations helped promote Cooper's grand compromise. Shortly after the press conference, The Washington Times reported that the Cooper bill is "occupying the political center in the forthcoming battle."
ABC Nightly News pronounced the plan "serious and credible." The Los Angeles Times called it "politically palatable," and U.S. News & World Report reported in its Washington Whispers collumn that Cooper's proposal was "most likely to succeed" because it has "bipartisian middle-of-the-road support" and will cost less -- the very points made in the Cooper press materials. The New Republic flatly endorsed the Cooper plan. The New York Times waited longer than other publications, but it too latched on to the Cooper promotion. In MIDDLE-OF-THE-ROADER RIDES HIGH WITH HIS OWN HEALTH CARE PLAN, published in early January, the Times reported that "a lowly Democrat gains notice with a 'Clinton lite' plan," the catchy phrase Cooper himself coined.
Cooper used the press to advance the notion that his bill was winning a popularity contest. The Washington Post quoted him as saying his bill "is becoming so popular it's scaring people to death down at the White House." In a story headed ONE-MAN FORCE IN HEALTH CARE FRAY, USA Today talked of a threat to Clinton by a "mild-mannered," thirty-nine-year-old lawyer from Shelbyville, Tennessee, who told the paper: "I have the most popular health plan in America. It breaks the political deadlock. It's a doable deal." Time weighed with its own flattering profile of Cooper. "He's the Man with the Too Popular Plan" gave readers the impression that Cooper was on the march and perhaps unstoppable. "They're afraid our bill is too popular. We're right in the middle. We're the only bipartisan approach," Cooper told Time, trumpeting the refrain from his press conference.
One may fairly ask who, apart from Cooper and his forty-eight co-sponsors, found the plan soattractive -- the American people, who in reality knew little about it; the Washington cognoscenti; employers and health care providers who favor the bill because it barely disrupts business as usual? The press did briefly mention that certain segments of the business community liked Cooper's plan, but it didn't dig deeper.
None of the reporters whose stories CJR examined has bothered to search Federal Elections Commission records to see who had recently contributed to Cooper's election campaigns, a task left to the consumer group Citizen Action. Citizen Action found that Cooper, who is running for the Senate, was indeed the bagman for health and insurance interests, receiving in the first six months of 1993 some $ 164,000 from doctors, hospital employees, insurance agents, and insurance company employees. That sum was the largest amount given to any House member by individuals representing those special interest groups. Twenty-five thousand dollars came from employees of two large hospital chains.
Healthtrust and HCA-Hospital Corp. of America.
Several papers did pick up the Citizen Action press release. The Wall Street Journal, as part of its own story on Cooper's emerging stature, devoted a paragraph to explaining the large contributions from employees of Healthtrust and HCA-Hospital Corp. "He brings a moderate viewpoint to operate from," a Healthtrust vice-president told the Journal.
But what was missing from the coverage of Cooper's bill was solid analysis of how the bill would affect ordinary people -- analysis the polls say the public wants. As of late December CJR found no stories that explained how the plan would affect those Americans who are not insured and who still might not be if Cooper's plan becomes law. There was not even agreement among news stories on the number of people the plan would leave without insurance. The Palm BeachPost reported that Cooper "predicted [his plan] would provide insurance to nearly as many of the 37 million uninsured Americans as Clinton's plan." (Clinton's plan covers 100 percent of the uninsured.) The Washington Post quoted Cooper as saying his plan would cover "60 percent of the uninsured" (leaving 40 percent uncovered), while the Los Angeles Times noted that, "by Cooper's own estimate, the bill would not cover about one-fifth (or 20 percent) of those currently lacking health insurance."
No one pinned Cooper down on the numbers or interpreted them through the pocketbooks of families who would be affected. The bill calls for subsidies to help some families buy insurance, but what would happen if a family was too rich for the subsidies but too poor to buy coverage on its own? How would the family get insurance? Plenty of stories, however, quoted Cooper's solution: come back in a few years and pass another law to help these people out.
Where were the stories that examined whether the Cooper plan would actually reduce costs of the health care system? Health care purchasing cooperatives are the main instrument of cost containment, but in Cooper's plan only employers with fewer than 100 workers are required to obtain coverage through them, if they want to continue deducting the cost of health insurance for their workers. This arrangement would leave all other employers free to operate outside the mechanism for curtailing costs and to continue the status quo, if they wished. The Congressional Budget Office found that the earlier version of Cooper's bill would actually increase costs of the health care system, at least initially, a point reported by The New York times and The Washington Post in February 1993, but ignored in the latest wave of Cooper promotional pieces.
There were quick, passing references to various features in the Cooper bill, and a few papers did side-by-side comparisons of the bill's main elements with those of other plans. But what passed for "explanations" were so elliptical that they further obscured the issues. Newsweek's pro-Cooper piece, for example, told readers: "Individuals could deduct the entire cost of health insurance before paying taxes," and "Cooper's plan would be more affordable to taxpayers because it would not offer many of the bribes the Clinton plan proposes to win over various interest groups." What taxes? Which individuals? Under what circumstances would they pay them? Just how would the plan be more affordable? Would it lower tax rates? And what bribes did Newsweek mean -- coverage for prescription drugs and some long-term care, both of which are generally thought to be benefits the publc wants? Newsweek didn't explain.
How the press covered the Cooper bill perhaps best illustrates why a Kaiser Family Foundation and Harvard University poll found that the public has more faith in the American Association of Retired Persons, clearly not an objective source, to tell them the best course for health care reform than they do in the press. Twenty-nine percent said they had a great deal more confidence in the AARP; only 7 percent said the same about TV and newspaper reporters. Hardly a healthy state of affairs.