The predominant media narrative surrounding Bill Clinton’s recent remarks about the Affordable Care Act illustrates a problematic trend in which coverage of public policy simplifies complex issues into sensationalized sound bites. This trend toward reductionist headlines is particularly problematic in the realm of health care policy, which is one of the most misunderstood policy arenas in American politics.
At an October 3 rally for Democratic presidential nominee Hillary Clinton, former President Bill Clinton gave a speech on a variety of policy issues including Hillary Clinton’s proposals for expanding and improving the Affordable Care Act (ACA) to address the challenges of the existing insurance market system. The former president specifically outlined how the Clinton campaign’s plan to “let people buy in to Medicare and Medicaid” would address the customers who were left out of the private insurance market even after President Obama’s landmark health care reform law went into effect:
BILL CLINTON: Now the next thing is, we got to figure out now what to do on health care. Her opponent said, ‘Oh, just repeal it all. The market will take care of it.’ That didn’t work out very well for us, did it? We wound up with the most expensive system in the world and we insured the smallest percentage of people. On the other hand, the current system works fine if you’re eligible for Medicaid, if you’re a lower income working person, if you’re already on Medicare, or if you get enough subsidies on a modest income that you can afford your health care.
But the people that are getting killed in this deal are small businesspeople and individuals who make just a little too much to get any of these subsidies. Why? Because they’re not organized, they don’t have any bargaining power with insurance companies, and they’re getting whacked. So you’ve got this crazy system where all of a sudden, 25 million more people have health care and then the people that are out there busting it ― sometimes 60 hours a week ― wind up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world so here’s the simplest thing ― you raise your hands, you think about it ― here’s the simplest thing: figure out an affordable rate and let people use that ― something that won’t undermine your quality of life, won’t interfere with your ability to make expenses, won’t interfere with your ability to save money for your kid’s college education. And let people buy in to Medicare or Medicaid.
Here’s why: you can let people buy in for just a little bit because unlike where you are now, if you were on the other side of this, if you were an insurer, you’d say, ‘Gosh, I only got 2,000 people in this little pool. Eighty percent of insurance costs every year come from 20 percent of the people. If I get unlucky in the pool, I’ll lose money.’ So they overcharge you just to make sure, and on good years, they just make a whopping profit from the people who are least able to pay it.
It doesn’t make any sense. The insurance model doesn’t work here; it’s not like life insurance, it’s not like casualties, it’s not like predicting flooding. It doesn’t work. So Hillary believes we should simply let people who are above the line for getting these subsidies have access to affordable entry into the Medicare and Medicaid programs. They’ll all be covered, it will not hurt the program, we will not lose a lot of money. And we ought to do it. [The Huffington Post, 10/4/16]
Media jumped on just a fragment of Bill Clinton’s speech, framing his comments as an attack on Obamacare, a political gaffe, and a potential rift with President Obama and Hillary Clinton’s vision for health care policy -- framing that originated with the Republican Party’s so-called “war room,” which serves as a clearinghouse for opposition research. Much of the immediate coverage focused on the most inflammatory aspects of Clinton’s remarks, claiming Bill Clinton called Obamacare “the craziest thing in the world,” depicting his comments as trashing Obamacare, or declaring, “Bill goes rogue again.” Others emphasized that Bill Clinton later tried to clarify his purportedly “scathing” comments by changing his tune on the health care law.
This focus on sensationalizing Bill Clinton’s comments on the ACA fails to situate them in the broader context of the current health care policy debate. While the media has depicted his comments as an attack on Obamacare, in reality, Clinton was making the case for enacting the improvements to the Affordable Care Act that are an integral part of Hillary Clinton’s campaign. A July 9 health care fact sheet from the Clinton campaign explicitly states that despite the progress made by the ACA, “Hillary believes that we have more work to do ... to provide universal, quality, affordable health care to everyone in America. This starts by strengthening, improving and building on the Affordable Care Act.” The New York Times noted Clinton’s stance on the ACA in September 2015, writing, “Mrs. Clinton has also consistently said that the health care act … is flawed and that if elected she would work out the kinks.”
Additionally, Clinton’s comments are in line with President Obama’s view of the challenges facing his landmark law. In an article published by The Journal of the American Medical Association (JAMA) on July 11, Obama noted that there is still work to be done on health care reform, including the need for a “Medicare-like public plan” that could compete with private insurance. Obama has previously reached out to insurance companies, asking them to help him fix the ACA, and has pursued “fixes” to address issues like cost, market competition, and the need to entice young, healthy enrollees -- which is exactly what Bill Clinton was discussing.
In comparison, the Republicans have yet to produce a viable alternative to the Affordable Care Act, despite years of pledging to “repeal and replace” the 2010 law. This past summer, House Republicans unveiled an outline for an Obamacare replacement plan (not legislation), but as The Huffington Post noted, their plan would result in “fewer people with health insurance, fewer people getting financial assistance for their premiums or out-of-pocket costs, and fewer consumer protections than the ACA provides.”
While much of the coverage hyped Bill Clinton’s remarks by framing his word choice as a political gaffe, some media outlets actually addressed the substance of Clinton’s comments, noting that his criticisms of the existing health care system are accurate and in line with the proposals advocated by Hillary Clinton and President Obama.
This trend toward reductionist headlines and promoting coverage that revolves around catchy sound bites is reflective of a bigger problem in media coverage of policy issues in general. Media coverage tends to either ignore discussions of substantive policy issues in favor of flashier partisan fights or reduce complex policy debates down to digestible but often misleading sound bites. For example, a Media Matters study examining early news coverage of Hillary Clinton’s presidential campaign found that broadcast evening news shows devoted twice as much time to Clinton’s use of a personal email server than to her more-than-a-dozen announced policy proposals. Similarly, Harvard professor Thomas E. Patterson conducted a content analysis of four weeks of media coverage of the Democratic and Republican national conventions and found that the news media chose “damaging headlines” over policy and context in coverage of Hillary Clinton. As Patterson wrote, Clinton’s policy proposals have “been completely lost in the glare of damaging headlines and sound bites.”
The media emphasis on catchy soundbites is particularly problematic in the realm of health care policy because Americans are fundamentally uninformed about -- and polarized over -- the Affordable Care Act, and this type of coverage only further stigmatizes the ACA. The words we use to discuss complex policy like the ACA shape public opinion, which plays a fundamental role in determining future progress. Given the complexity of health care policy and the misinformation surrounding the Affordable Care Act, media outlets must approach discussions of the health care law (and all public policy) by devoting more attention to the actual substance of the policies instead of focusing on flashy talking points.