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Finishing 'The Treatment'

A little less than ten years ago, inside a dark hotel restaurant in Utica, New York, Gary Rotzler told me the story of wife Betsy. They had been high school sweethearts and, by the early 1990s, had settled into their version of the American dream: Three young children and a home in Gilbertsville, a village of around 400 people nestled into the foothills of the Catskill mountains. When Gary lost his job at a defense contractor, he lost his health insurance. After piecing together part-time construction work, he got his old job back—but as an independent contractor without benefits. Betsy got sick and, after months of putting off medical care, was diagnosed with terminal cancer.

Betsy died a few months later and, when the medical bills for Betsy’s treatments arrived, Gary filed for bankruptcy. There’s no way to know whether, with more timely care, Betsy could have beaten the cancer. But she probably could have lived longer or in less pain. At the very least, insurance would have alleviated the anxiety over paying for Betsy’s treatments—and spared Gary the indignity of bankruptcy after she was gone.

The story was one of literally hundreds I’ve heard over the last decade-and-a-half—and the primary reason that making affordable medical care became such a passion. To my great fortune, it's a passion others have shared.

In early 2006, Franklin Foer called me with two pieces of news. The first was that he would be taking over as editor of The New Republic. The second was that he wanted universal health care to become the magazine’s new crusade. TNR had published my work on health care since the late 1990s, while giving me the room (and space) to develop what would eventually become my book on the subject. But making health care reform a crusade—that was new. And, for TNR, it had a special significance.

During the last great debate over health care reform, which took place in 1993 and 1994, TNR had published an article called “No Exit.” Written by a then-anonymous, self-declared policy expert named Elizabeth McCaughey, the article purported to expose all sorts of nefarious details about Bill Clinton’s health care plan. McCaughey proved to be no expert at all; her claims proved to be wildly inaccurate. But the article had enormous influence, introducing arguments that—however false—opponents successfully used to thwart reform. Taking up the health care crusade was a chance to make up for that episode. And, at a time when even many Democrats were too skittish to talk seriously about universal coverage, TNR would be carrying out its historic mission as a flagship for liberal thought. As we said in the first editorial of Frank's tenure:

Since President Clinton's health care plan unraveled in 1994--a debacle that this magazine, regrettably, abetted--liberals have grown chastened and confused, afraid to think big ideas. Such reticence had its proper time and place; large-scale political and substantive failures demand introspection, not to mention humility. But it is time to be ambitious again. And the place to begin is the very spot where liberalism left off a decade ago: Guaranteeing every American citizen access to affordable, high-quality medical care.

What I didn’t realize until much later was that my colleagues and I would be redefining more than TNR’s legacy. We were also among those journalists redefining the coverage of policy issues. One reason McCaughey's article had been pernicious was that it was weeks before other writers (including TNR's own Michael Kinsley and Mickey Kaus) exposed its fundamental dishonesty. That was the nature of media coverage then: It was dominated by a relatively small number of mainstream media outlets, abiding by the ethos of objectivity and operating on a daily news cycle.

By contrast, coverage of this past year's health care debate took place at internet speed—which is to say, instantaneously. News would happen and, presto, it was being reported. And it wasn’t just being reported by a handful of establishment news outlets. In addition to The New York Times and CNN, there was the Huffington Post and Talking Points Memo. The change didn’t fully register with me until the night the House passed the Senate health care bill, clearing reform for presidential signature. Sitting up in the House media gallery, next to Politico's Carrie Budoff Brown, I looked around at my colleagues—and realized how few of them would have been there last time around.

Was this a change for the better? I'm biased, obviously, but with some important caveats I think the answer is "yes." We (i.e., the new online media) could generally channel policy expertise more quickly. And we could, in some cases, dispense with conventions of even-handedness—conventions that cynics had long ago learned to exploit for their own purposes. We couldn't stop intellectual saboteurs from introducing new lies into the debate. (Thank you, Fox News.) But I think we were able to expose those lies just a little more quickly--and, hopefully, a bit more effectively.

Consider what happened in September, when the insurance industry released a study purporting to show that reform would cause insurance premiums to skyrocket. The Senate Finance Committee—the logjam in the legislative process—was set to vote on its bill in less than 48 hours. The study, commissioned by the insurance lobby and conducted by a private accounting firm, represented a clear effort to undermine support. It was the kind of move that lobbying groups make all the time—and, in the old days, it might have worked, since nobody would have seen through the study’s tilted assumptions until, as with McCaughey’s old article, the damage had been done. But within hours of its publication, several blogs, including this one, had published critiques showing just how flawed the study was. The critiques circulated in Washington and provoked a backlash against the insurers. Wavering Democrats said they were offended by the effort at political sabotage; the Finance Committee went on to pass the bill, as it had originally planned.

Not that fact-checking was the media's sole job over the last year. Speaking for myself, I certainly spent far more time on the more mundane task of explanation—whether it was describing how a particular policy proposal might work or laying out the political dynamics of a particular moment. Occasionally this writing got a lot of attention, because it included a reporting tidbit that qualified as a scoop. More often, it didn’t. But over time I came to realize that the mere sharing of information has enormous value—even to people in Washington who, you might suppose, already know what they need to know.

Indeed, one of the many lessons I learned over the last year is that, even at the very highest levels of power, people frequently operate with limited knowledge and perspective. That’s true of how they think about policy and that’s true of how they think about politics. As one high-ranking official memorably told me in February, while everybody was scrambling to salvage reform after the Massachusetts Senate race, nobody really sees the whole playing field.

This lack of adequate information is not always, or even usually, for lack of effort or commitment. Having spoken with and watched quite a few key players in this debate up-close for the last 16 months, I can tell you that they worked ridiculously long hours, at no small costs to their physical and emotional well-being. (One Hill staffer told a story of getting dressed one morning, bleary-eyed, a muffin in one hand and an earring in the other. She meant to eat the muffin but ate the earring instead.) No, the reason that people in this debate operated with imperfect information was that they were human beings and, thus, imperfect. Hopefully blogs like this one helped rectify that situation, at least a little bit.

To be clear, those of us covering the health care debate over the last year haven’t been perfect, either. Far from it. The new media can certainly react more quickly than the old media did. But speed is not always a virtue. Rushing to be first can mean rushing bad information into publication—particularly if, say, the information is based on one source that doesn't know as much as he or she thinks. And for all of the policy expertise some of us brought to the discussion, most of us—and I’d certainly put myself at the top of the list—were and still are relative novices at covering the political process itself.

That’s one reason I’ve gained so much admiration for colleagues like Julie Rovner, of National Public Radio, or Karen Tumulty, formerly of Time and now the Washington Post, whose sophistication spanned both policy and politics. It’s no accident, I think, that both came from “establishment” media, even though they were at ease blogging, and that both had years of experience as reporters. At a time when the financial support for their kind of journalism is increasingly hard to find, I wonder whether future policy debates will benefit from such broad expertise.

Another problem for the new media is that, as time goes on, we’ll fall into the same bad habits that plagued the old media. Groupthink? Biased reporting? Source capture? Rest assured, we’re as prone to that as the generation we are replacing. At various points, critics on the right and the left felt the reporting and analysis in this blog—and others like it—was incomplete, one-sided, or otherwise flawed. And I wondered constantly whether they had a point.

I remember, in particular, one moment of self-doubt when Marcy Wheeler, a (very) smart blogger from FireDogLake, took me to task over my analysis of how the Senate health care bill would affect middle-class Americans. Having spent so much time defending the health care reform bills moving through Congress, had I become ignorant—or at least overly dismissive—of their flaws?

After a long back-and-forth on that particular controversy, I decided I had been right. (I think Marcy concluded the same about her position--which means that readers, and historians of the future, will have to render their own judgments.) And I suppose that’s ultimately one of the best features of online journalism. It is more of an ongoing, evolving conversation—one in which it is easier to hash out and refine arguments. Those of us covering politics and policy today can make as many mistakes as our predecessors did. But perhaps we have more opportunities to become aware of those flaws and to correct them.

If that sounds like coverage is becoming more of a collaborative process than a competitive one, that’s because for me it has frequently seemed that way. My relationship with Ezra Klein is a case in point. If you read this blog, then you probably read Ezra’s, as well. (If not, you really should!) We cover the same beat and, as best as I can tell, talk to many of the same sources. We should be rivals, I suppose, but I’m proud to call him a friend. He’s taught me an enormous amount—as my frequent links have hopefully made clear—and he's made this entire debate far richer than it would otherwise have been. 

Speaking of collaboration, this would be a good moment to thank a few people who helped with this blog. Covering health care policy is difficult, even for somebody like me who’s been writing about it for what seems like forever. I can’t tell you the number of times I came across a policy or politics question, read through the available material, and said to myself: “Huh?” To help me sort through those situations, I frequently relied on other writers, like Austin Frakt or Jeffrey Young. I also built a small committee of experts to whom I could turn for a quick reality check.

Some of them made appearances on this blog as guest contributors. But one person remained mostly anonymous. It's Larry Levitt, a vice president of the Henry J. Kaiser Family Foundation and the single most knowledgeable person on health care policy I've encountered. He is intellectually honest to a fault—even when it’s politically inconvenient—and he has the patience of a saint. Also, to my very good fortune, he’s been based in Rome for the last year, making him awake and available by e-mail at precisely the late hours when I tend to write. Although I quoted Larry rarely, I turned to him constantly—and owe him a huge debt.

(By the way, among the Kaiser Foundation's many other contributions to this debate was the establishment of Kaiser Health News, the independent news service for which I've been writing a column that also appears at I'm hardly objective about this, but I imagine their influence will only grow as the debate moves to implementation--and their expertise becomes even more valuable.)

I’m also grateful to the writers who shared this space with me. Anthony Wright provided the perspective of somebody who deals with health care policy on the front lines. Suzy Khimm was a ridiculously dogged journalist who, among other things, had the good sense to tell me--on more than one occasion--that reporting had proven my hunches wrong. Trust me when I tell you she'll be breaking big stories for a long time to come. And I’m not sure I can sufficiently thank, or recognize, the contributions Harold Pollack made to this project. Instead, I’ll simply let you in on a personal insight: He is every bit as decent and kind a person as his writing suggests. (He's incredibly smart, too, although I guess you knew that part.)

My name is the one at the top of this blog. But it is part of The New Republic, which means it is part of a bigger enterprise, managed by editors and supported by researchers of uncommon talent--and by that I mean not just Frank, whose support for the blog and the idea of health reform never wavered, but also online editors Greg Veis and Zvika Krieger, who managed this website. Among the less glamorous duties they drew: Staying up late so I could file my items for the next day's home page just before midnight. (Yup, just as I am now.) Editors never get the credit they deserve. That's particularly true in the cases of those three.

This is probably the longest item ever to run on the Treatment. And, as you may have guessed from the self-referential tone, it will also be the last. TNR created this blog to cover the debate over whether to pass comprehensive health care reform. That debate has ended. Now it is time for this blog to do the same.

Of course, the story of health care reform isn’t over. In a sense, it’s just beginning. Implementing the new law will involve its own, very different set of challenges. And that’s assuming it withstands the coming efforts to repeal it. While I’ll be on hiatus from full-time blogging for a short time, in order to finish a print piece or two, I'll make cameos over at Jonathan Chait's venue as events warrant. (My apologies in advance to readers about to become further confused about our respective identities.)

But just as this isn’t the end of my life as a health care reporter, so this isn’t the end of my life as a TNR blogger. To my surprise, I found I actually liked blogging. I even started a Twitter feed, although I've had trouble convincing Noam to do the same. I'm not giving up either endeavor.

More on all of that soon. In the meantime, I’d like to thank The Treatment’s readers--those of you who followed it religiously and those of you who stumbled here through random links, those of you who shared its sense of mission and, yes, those of you who hated it. You were part of this story, too. I’m grateful for your attention, support, and feedback.  Please stick around for the next chapter.

Update: Perhaps fittingly, I accidentally left out a few passages when cutting and pasting last night. I've now restored them.