In the last couple of decades, a particular technique of news-story construction has become so common that I'm sure you barely notice it as something distinctive. It's the use of a device sometimes referred to as the "exemplar," in which a policy issue is explained through the profile of one individual, whose tale usually begins and ends the story. It's ubiquitous on television news, but print reporters do it all the time as well.
As the Affordable Care Act approaches full implementation, we're seeing a lot of exemplar stories, and I've been noticing one particular type: the story of the person who seems to be getting screwed. If it were true that most Americans were indeed being made worse off by the law, that would be a good thing; we'd learn their stories and get a sense of the human cost of the law. The trouble is that in the real world, there are many more people being helped by the law than hurt by it, and even those who claim to be hurt by it aren't being hurt at all.
To see how misleading some of these exemplar stories can be, let's take this piece from last night's NBC Nightly News, which uses an exemplar named Deborah Cavallaro, a self-employed realtor from Los Angeles who buys insurance on the individual market:
We learn in this story that her insurer is cancelling her current plan, which costs $293 a month, because it doesn't comply with the new law. They've offered her a new plan at $484 a month. That sounds like it sucks! But here are some things the story never tells us.
First, what exactly was her old plan? Deborah looks to be around 45. If she bought a plan on the individual market for $293 a month, I can guarantee you it barely deserved to be called insurance at all (I've bought insurance like this on the individual market). It probably had a deductible in the thousands of dollars and had substantial cost-sharing for any significant medical event. But the story doesn't tell us what sort of insurance she has.
Second, the reporter, Peter Alexander, tells us that "the administration points out that many people will get subsidies to offset the higher costs." So what about Deborah? Is she going to get subsidies? He doesn't say, but she well may, which would mean she wouldn't be paying more, or might actually be paying less. But again, this information is just spoken by the reporter, while the flip side—the victim of Obamacare—is presented in the form of a living, breathing person.
But wait. Maybe she's not a victim after all. How does the $484 plan her current insurer is offering compare to the other ones she could get? Did she or the reporter go to the California exchange and try to figure that out? Apparently, they didn't. But I did.
It took less than 60 seconds. Let's assume that Deborah has a high enough income that she isn't eligible for subsidies. I put in that I was 45 years old and got nine different choices for a Bronze plan, which in all likelihood most closely resembles what Deborah has now. The average monthly cost was $258, or $35 a month less than what Deborah's paying now for her bare-bones plan. And that's for a plan that, while it's the least expensive option, almost certainly involves less cost-sharing that what Deborah has to deal with now. She can get a Silver plan, with more generous coverage, for $316, only $23 more than she's paying now. Congratulations, Deborah!
I don't know why Deborah's insurance company wanted to sell her a policy for $484 a month, but when we look at all the facts, it turns out that she doesn't seem like such a victim after all.
Alexander closes the story by noting that the administration says that nearly half of all uninsured adults could get coverage for $50 a month or less. Well that's interesting. Can we meet one of those people, to learn about their struggles and triumphs? How about a story profiling someone who used to be uninsured, but is now on Medicaid and can finally see a doctor? I haven't seen many of those.
I'm not saying that there aren't going to be people who are going to end up paying more, because there are. But there are also people who are going to be paying less, and people, like Deborah, who are going to pay about the same but get better coverage. There doesn't seem to be a clear consensus on exactly how many people are going to end up paying more and how many will end up paying less, though Jonathan Cohn, one of the two or three best health-care reporters in the country, says that the experts he trusts the most "say the majority of people will probably end up paying less than they do now, as long as you account for subsidies, Medicaid, and the ability of young adults to enroll in special catastrophic plans or stay on their parents' policies." But what we do know is that 1) lots of people will pay less and get the same or better coverage than they have now; and 2) virtually everyone who pays more will be getting more.
That means that there are going to be very few people victimized by the law. Unfortunately, we seem to be seeing a lot of these stories; here's an almost identical story from CBS about a 56-year-old Florida woman that goes through the same routine: she's got an almost meaningless insurance plan ($54 a month for a 56-year-old woman? Good luck if you get sick on that plan); she got a letter from the insurer offering her a new plan for $591 dollars a month; this is terrible. The reporter, Jan Crawford, says the woman will be eligible for subsidies. How much? What kind of plans could she get? What will her actual costs be? We aren't told. When Crawford finishes, the anchor says, "Great reporting, Jan." This Florida woman has now been asked to appear on no fewer than three Fox News shows.
Journalists have a natural inclination to cover bad news over good and to be skeptical of the government, which is usually healthy. But if you aren't careful it can also lead to misleading reporting. If you're going to do a story presenting one person as a victim of the law, it might be a good idea to make sure they are what you say they are.
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