National health reform is a mammoth undertaking, and it is driving the nation's capital and its denizens to their usual excesses. Exercises in spin control and willful distortion by every conceivable side abound. Television ads target the public's raw nerves, while lobbyists swarm over the Hill. Health hearings and committee mark-ups are now standing-room-only events. Once a back-of-the-book story, health is now a prize beat in a city that thrives on the flow of power and information. Predictably, media critics are taking the press to task for its inside-the-Beltway coverage, and, just as predictably, the press is defending itself.

Most recently, criticism of the capital's health beat came in the second in a series of Times Mirror Center for the People & The Press surveys of press coverage of health reform, conducted in association with cm and funded by the Henry J. Kaiser Family Foundation, a nonpartisan trust. The study analyzed coverage during the fall of 1993, the crucial period in which the president attempted to explain his health care plan to the nation. In short, the study chides the press for focusing too much on politics (31 percent of all stories) and being too Washington-centered (66 percent of all stories filed from D.C.), while offering too few stories on the impact of reform on individuals and families (17 percent). Moreover, it implicates the press in the public's growing confusion over the details of health reform. Most astonishing is Times Mirror's Stuart Schear, the health and science reporter for The MacNeil/Lehrer NewsHour, is a 1993-1994 mediafellow in health reporting of the Henry J. Kaiser Family Foundation.inding (in another study) that 10 percent fewer Americans knew that the Clinton plan offered universal coverage in December 1993 than three months earlier, when the president introduced it. This drop-off occurred despite intensive media coverage, and the Times Mirror study concludes that the press is leaving the public behind as it focuses even more on the "horse race."

As Congress fashions a health reform bill in the months ahead, the media will enter a new phase of intensive coverage from which the public may or may not get the information it needs. Looking back on this past fall's debate and coverage may clarify what the press can do differently in the coming months. It may also point out the apparent limits of press coverage in reaching the public on such a complex story with so many players.

When told that critics think they are responsible for the public's confusion, Washington-based reporters who cover the health reform story will concede that there's some truth to the charge, but will quickly add that others must share the blame. Dana Priest of The Washington Post, for example, points to the White Houses's inability to get its message out. "They have bungled it in a lot of ways," she explains, listing the evidence: a messy leak of the president's proposal and the White House's subsequent refusal to discuss what it called a "preliminary" plan; the unwillingness of allies to offer unconditional support; and the administration's on-again off-again attempts to sell its plan in the face of the consistent efforts of well-financed special interest groups.

Ed Chen, health and science reporter for the Los Angeles Times, adds, "I have heard Hillary and everyone on down admit that they let the opponents and the Health Insurance Association of America dominate the debate."

Even Kathleen Hall Jamieson, dean of the Annenberg School for Communication of the University of Pennsylvania and a tough critic of health coverage, concedes that "the Clinton people didn't focus on their central provisions -- choice and universal coverage. They assumed the public knew too much. Those were bad assumptions." However, Jamieson doesn't think White House ineptitude relieves journalists of their responsibility to explain matters the White House itself has a hard time explaining.

Tom Hamburger, Washington bureau chief of the Minneapolis Star Tribune, sees the press's role this way: "This story is not about public relations machines; this is a public policy issue. It is the first or second-most important issue in the mind of the public, and we should take it apart. Anything less is an abrogation of our public duty."

Getting a grip on such a complicated story poses a daunting challenge for journalists. Ed Chen took a short leave last fall to finish a book on another topic; when he came back, he says, "I had trouble remembering the details of all the different plans and proposals. I can just imagine what it is like for the poor readers."

Priest acknowledges that explaining the president's plan is difficult for both the press and the administration because of its phenomenal complexity -- for example, its attempt to meld a "dynamic private sector" and "major government structures" into a new system. By definition, she says, the effects of this mixed model on individuals and families will be difficult to predict.

Moreover, real-life stories are subject to manipulation. "You can do what you want with personal stories," observes Newsweek economist Robert J. Samuelson. "If you write about a person who came down with liver cancer and was between jobs and didn't have any coverage, there is an unconscious bias in that kind of story for universal coverage."

Still, given the complexity of the subject, reallife stories are virtually indispensable. Tom Hamburger sees them as pillars of effective coverage. At his urging, his own paper, the Star Tribune, has taken an aggressive role -- some might call it an advocacy role -- in educating the local community. To prepare readers for town meetings across the state (set up by the paper in cooperation with the Minnesota Public Health Association), the Star Tribune produced a special thirty-six-page supplement on how health reform affects "real people." The paper also convened a televised debate on reform between the state's two senators -- Democrat Paul Wellstone, sponsor of the single-payer bill, and Republican David Durenberger, a co-sponsor of two market-oriented bills -- and Judith Feder, a Clinton administration health official. Consumer-oriented coverage also appears in The Washington Post's weekly question-and-answer column on health reform.

If the American people are to give their informed consent for a new health care system, the press must redouble its efforts during the coming period. Robert MacNeil, executive editor of The MacNeil/Lehrer NewsHour, who has anchored dozens of health reform discussions, likens reporting on health reform at this juncture to watching a juggler: "So many of the balls remain in the air. I think that people will concentrate again when they know that the balls are landing."

In the meantime, Kathleen Hall Jamieson urges journalists to return to some of the basic health reform stories that they did last year, because she believes most readers and viewers weren't paying attention and missed them. And attention must be paid, because, finally, health reform is a story about redefining what it means to be an American -- what and who our social contract includes and excludes -- in short, a story everyone can relate to in the most personal way.

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