The journalism of health politicking

I am 42 and find myself rarely surprised by things anymore, but I have to say I was caught off guard the Senate voted down the latest GOP attempt at repealing Obamacare. A good splash of water on my own cynicism about the process is good for the soul.

I have a few things to note about news coverage and how we got here. It’s not original to say that news media too often focus on process and political tactics over policy. It’s easier to say what’s in the bill than talk about what it means, because meaning is hard. It requires CBO scores, and long chats with experts outside of the legislative arena, and that’s in a normal process. In the case of this latest repeal push, the bills themselves were kept secret right up until votes. It’s hard as a journalist to tell stories about what it means if you don’t even have the text as a basis for asking questions of experts and those affected by it.

This truncated process characterized by confusion rather than context is by design. It’s the legislator’s prerogative to keep a tight rein on the process to limit blowback, especially on bills that are controversial or polarizing. In this case the news media had some challenges doing its job of covering what was happening because the process wasn’t transparent. Journalists need to treat this as sunk cost even as they continue to ask hard questions politicians don’t want to answer.

Depsite all this, I want to highlight something I did notice in the past four months of this repeal/replace push. In the absence of a bill, news organizations did some footwork talking to people affected by current law, the Affordable Care Act. For example, The New York Times covered people who wanted repeal, people who gained from the ACA and wanted to keep it, and people who changed their mind on the ACA. With an ACA baseline in place, they did stories that modeled how the changes affect people, and it was rich enough in some cases that it accounted for issues such as geography and income. They even covered the psychological impact the debate was having on people living on the knife’s edge.

That’s just the NYT. All of the major news organizations did things like this over the past few months. The Washington Post did some noteworthy work on this as well, and I’d add big kudos to Sarah Kliff at Vox for her work on this beat. When it was best, it was a true multimedia storytelling effort that involved interviews and written stories, data visualization of impacts, video, and graphics that broke down a complicated legislative process. What I can say, looking at the body of coverage, is that the news media in the absence of a bill tried to contextualize different stakeholders and tell their stories, and it’s hard to argue it wasn’t robust and fair to different points of view.

And this body of coverage in turn leads to harder questions from journalists. Who exactly is going to benefit by this current repeal effort, who is going to lose, and how? I saw stories in this vein a lot the past two weeks, and tweets of pressers on Capitol Hill. It was laser-focused because the groundwork had been laid by excellent reporting involving real people from all over the country. And those hard questions were met with a lot of sputters by GOP politicians as it became clear the repeal effort was about passing something rather than building with policy goals in mind.

Stories are my whole point here. People aren’t wonks or activists, for the most part (and we can debate how good of a thing that is). They’re going to check in and out of the process and pay attention when they sense it matters most. Stories remain our most powerful way to break down complex policy and break through resistance to talking through it. People have an immediate psychological reaction to the term “Obamacare” that is largely baked in, but there is a real chance to engage people when we lose abstract terms and tell stories about people who’ve been affected by the law, for good or bad. The coverage I read, even as someone who wants the ACA to stay, led me to the conclusion that parts of the law need to be shored up to make it work better. As far as the relationship between news and democratic decisions, this is as it should be.

These stories also moved the needle for others, too. I noted earlier the story about the minds changed, but it’s noteworthy that the ACA has never been more popular than it has since the repeal effort got ramped up in February. Abstract ideas of repeal got replaced by actual policy proposals, and those points of comparison became a basis for weighing the pros and cons of a particular repeal version. Again, people wake up only when they feel like they need to, and for the first time people were learning exactly what the ACA was doing for them.

If people wanted to, if they were really as open-minded as they claim to be, they could use media to see through their own biases and misconceptions. They could confirm their negative views about other parts of the law, and arrive at a robust view of what we should or should not do. This is the marketplace of ideas — democracy — in action.

The point, of course, isn’t to get everyone to agree so much as get us talking and get us to acknowledge the real people behind policy decisions.

Going forward, it’s important that news organizations continue to tell these stories as a way to drive discussions about policy, because we aren’t done talking about health reform. Even if the number of people impacted negatively is somewhat opaque or overblown for political points, there are people hurting under the ACA and we shouldn’t forget about them.

So much of our news coverage is horse race, focused on winning and losing and tactics. It creates an atmosphere resistant to compromise. Stories are powerful. Stories are us. I am moved every time I see a person change their mind on something because stories, whether in media in their own life, turn abstract debates into something that puts a face on policy. Stories foster empathy when they are done well.

In a perfect world, we don’t need to have something affect us personally to have it change our mind because we have empathy as part of our basic way of being. But in the absence of empathy, in a culture that is so caught up in argument that we can’t hear each other, stories help us see each other. I want to be practical here — preach the value of empathy writ large, but figure out ways to appeal to it in specific circumstances.

Stories matter. In the midst of intense media change and worries about business models, I remain bullish on journalism’s future because we still need to tell our stories. Authentic, people-driven stories will always have an audience.

If there is anything I feel like I can hang hope on these days, it’s that.

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