Can the Media Derail Health Care Reform?

By now you’ve probably heard the calls for speedy action on health care reform during the Obama Administration’s first hundred days. Some prominent observers even say that the President-elect should get the ball rolling during “his first days in office” The possibility of imminent health care reform is certainly exciting, but a word of caution: just because some of us might be ready for health care reform doesn’t mean that the media is ready to cover it properly. And that could have important implications for how reform plays out.

Right now, health care reform is an abstract goal that everyone wants. Excitement and anticipation are high. But as the substantive process of health care reform gets underway, two things will happen: first, ideas will be crafted into policies—concrete plans of action and complex administrative measures—and second, politicians will become involved in the reform process. Policy can get pretty complicated; so the public will rely on the media to help it navigate the ins and outs of the issue. Once politics begins to shape policy discussions—that is, once politicians enter the picture—it’s all the more important to keep the focus on policy, because it’s at this point that policies have a real chance of being implemented. Americans should know their options.

Style Over Substance

Unfortunately, reporters aren’t health care policy experts. In fact, they rarely ever talk about the issue. In a December report, the Kaiser Family Foundation found that, out of 3,513 health news stories in newspapers, on TV and radio, and online between January 2007 and June 2008, health care policy comprised less than one percent of news stories and just 27.4 percent of health-focused stories. Instead of talking about issues like coverage, prescription drug care, costs, or public programs, the media prefers to report on specific diseases and conditions (cancer, diabetes, obesity and heart disease) and potential epidemics (contaminated food and water, vaccines, binge drinking). Together, these two topics comprised 72.6 percent of health coverage.

This is less than ideal. When Congress begins to talk about health reform in earnest, the important news that will affect all of us will be about policy and institutional changes. The media needs to be good at covering this stuff—yet as the Kaiser report shows, news casters, reporters, and editors have very little experience (or interest) in discussing such issues. Worse, history shows that when health care reform efforts are actually underway, the media ignores policy in favor of more sensational stories.

During Bill Clinton’s efforts at health care reform in the 1990s, for example, media reports disproportionately focused on politics rather than policy. In their 1998 book Politics, Power, and Policymaking: The Case of Health Care Reform in the 1990s, Missouri State professors Mark Rushefsky and Kant Patel found that that in 1993 and 1994—the height of public debate over Clinton’s plan—the New York Times reported just 257 stories about policy considerations (proposed reforms and solutions, analyses of options) and a whopping 549 on politics (personalities, disagreement, partisanship). When the nation’s health care system was at stake, spats received more coverage than substance.

More bad news: when policy was in fact being changed, the media was nowhere to be found because this process wasn’t politically dramatic. In 1995 and 1996, at the behest of President Clinton, Congress actually passed incremental health care reform. These changes included a limitation on insurers’ ability to exclude patients on the grounds of preexisting conditions and greater protections for HMO patients. But because these reforms didn’t involve public name-calling and proceeded through conventional legislative processes, the media all but ignored them. Rushefsky and Patel found that in 1993-94 major TV networks did a total of 583 stories on health care in their evening broadcasts; in 1995-96, this number dropped to a mere 93. The Times also reported 284 percent fewer health care stories during this period than it did in 1993-94, when conservatives were at the Clintons’ throats over “HillaryCare” (a term that perfectly exemplifies how letting personalities trump policy can derail reform). When progress was actually being made, the media was nowhere to be found. Real change was, in the words of Rushefksy and Patel, too “dry and lengthy.”

History Repeats Itself? 

Unfortunately, today’s health care reform isn’t going to be any more titillating. Comparative-effectiveness research hasn’t become any simpler to explain, reimbursement practices are no less tedious to analyze, and the trade-offs that will be necessary to contain costs no less complicated.  Any way you slice it, health care policy is tough stuff, and the media doesn’t seem all that ready, or willing, to cover it appropriately. If we’re not careful, once health care reform gets underway we may again see the media turn to its favorite sport—calling the political horse race.

Indeed, there are already some troubling parallels between the ‘90s and today’s health care landscape. In the late 1990s decade, health care reform only became big news after underdog Senate candidate Howard Wofford won Pennsylvania’s Senate seat with an unexpected 55 percent of the votes—on a platform of national health insurance. The health care reform story started with politics first, and policy second.

Similarly, it’s hard to imagine that we’d be hearing so much about reform today if Hillary Clinton hadn’t ran for president, thus feeding legions of political reporters a ready-made narrative of HillaryCare’s return. And do you really think we’d have seen a media debate about the importance of individual mandates if Hillary hadn’t made the issue a centerpiece of her political attacks on Barack Obama during the primaries?

To be fair, the media does cover health policy outside of campaigns. In fact, Kaiser found that the biggest individual health-related story was the fall 2007 Congressional battle over the State Children’s Health Insurance Program (SCHIP). And there has been some high-quality policy reporting in recent years, such as the New York Times’ “Fixing Medicare” and “The Evidence Gap” series of articles. Clearly, the media can write well about health care policy if it wants to; the question is, once health care reform becomes a political issue—and not just an intellectual policy discussion—can reporters stay focused? That’s not so clear. After all, though SCHIP received a lot of coverage, much of it focused on whether or not Democrats were “using kids as props,” and on the issue’s electoral resonance.  

You can already see some juicy political narratives emerging around Obama and health care—before he was even elected, Obama’s health care plan was being called “ObamaCare.” Currently, the media is focusing on health care reform as a bitter political fight while warning that the Obama story may turn out to be a case of ‘the bigger they are, the harder they fall.’ Indeed, the President-elect hasn’t even taken office and the media is already warning that “health care reform [is] up in the air” because “opposition likely will arise,” and that “Obama's bid for health care reform could sink or soar” (well, duh). Others warn of too-high expectations in order to set-up a dramatic arc of “euphoria” followed by “big disappointment,” and the “bursting [of] Obama’s balloons.”

Meanwhile, how many of these stories have spelled out, in detail, the rules of reform under Obama’s proposal? Relatively few (though you can learn about it here). 

There’s no question that health care reform won’t be easy; Obama definitely has his work cut out for him, and the public should know it. But already the media seems to be licking its chops at the political controversies it sees in the near future. Discussion of health care reform are already being wrapped in Obama’s political persona, with reports cautioning that partisanship may slay the Uniter and that the Chosen One may come up short. If we’re seeing this sort of coverage now, you have to wonder if the media will have the wherewithal to focus on policy once health care reform becomes a long, procedural slog as legislators debate some of the 115 discrete options for reform that the Congressional Budget Office has recently outlined. 

But it’s important that the media rises to the occasion. As Rushefsky and Patel put it, “the mass media may not tell us what to think, but they are very successful in telling us what to think about.” News helps us figure out what’s important and what’s at stake. A dearth of good policy stories will mean that the public isn’t understanding the challenges, trade-offs, compromises, etc. that really shapes health care. The public will misunderstand the terms of the debate as purely a clash of parties and personality—as a question of whether “ObamaCare” will succeed, instead of story about structural changes and policy choices that will affect all of us. We shouldn’t focus on how much we like or dislike the politicians involved in health care reform; the focus should be on the strengths and weaknesses of their proposals.

Unfortunately, as Health Affairs editor-in-chief Susan Dentzer notes in a new NEJM commentary, “journalists sometimes feel the need to play carnival barkers, hyping a story to draw attention to it.” But instead of constantly focusing on political soap operas, journalists should be “credible…communicators more interested in conveying clear… information,” and they should write stories that, “rather than being rendered in black and white, use all the grays on the palette to paint a comprehensive picture of inevitably complex realties.”

The Upside

So is there any chance that the media will in fact report such realities when it comes to health care reform? There are reasons to hope.  Both the NYT ‘s best work and the Wall Street Journal’s solid reporting on the health care industry offer models for other reporters. Many of these stories interweave policy analyses with accounts of personal, very human stories, proving that talking about policy doesn’t have to be boring. Better still, today’s reporters have unprecedented access to a wide range of health care policy experts who actually know what they’re talking about. Thanks to the Internet, people like Merril Goozner, Matthew Holt, Roy Poses, Kevin Pho, Bob Laszewski, and Ezra Klein (to name just a few) have a stronger voice than ever and they’re helping to shape the public debate. We also have folks like Gary Schwitzer at the University of Minnesota regularly reviewing media reports for accuracy and comprehensiveness (in fact, Schwitzer’s HealthNewsReview.org and its grading of medical health stories provides a good model for reviewing health care policy stories). In other words, it’s easier than ever for a reporter to write a good health care policy story, because there’s an organized community of people itching to help them.

In terms of politics, there’s also good reason to believe that we won’t see a total replay of the ‘90s. Back in 1993, conservatives were on the verge of a major revolution. The health care debate was just as much about Republicans’ newfound clout as it was about that particular battle. In contrast, today’s GOP is on the verge of dissolution, meaning that at least one high-drama political narrative is no longer relevant.

Another factor is that, for the most part, the American people want Obama to succeed. They want change, and health care reform is one of their top priorities. Yes, this confidence could mean that voters will be more easily let down when things don’t go as planned; but it could also mean that people are willing to give Obama the benefit of the doubt. If support for Obama remains high, two things are possible. First, opponents of reform may be quickly cowed, thus saving some of the political clashes that would distract the media; and/or second, the media may simply feel that it’s not good business to fan flames of controversy when the public is invested in success. Either way, public enthusiasm dulls the shock value of political sniping.

In the meantime, the health analysts of the wonk-world are going to have to speak out louder than ever and not be afraid of holding the media’s feet to the fire when it comes to policy issues. Media watchdog operations should make an effort to incorporate reviews of health care policy reporting in their work. Third party health care policy fact-checking is going to become more important than ever. Further, journalists who do know how to report on policy should lead seminars for those that don’t, and foundations and other organizations should be convening these sorts of events regularly. Our best bet is to put the media through a sort of health care policy boot camp, and soon. We want to do all we can to make sure that policy is in the front of reporters’ minds as health care reform plays out.

Granted, the media will never ignore a partisan dust-up, and the more political health care reform gets, the more this sort of popcorn fare becomes a possibility. But if the media draws attention away from policy when reform is underway, it obscures the issues at a most critical time: when policy is actually being made. Our goal as a civil society and, more fundamentally, as a group of people whose health care system may well be rebuilt, is to make sure that titillation doesn’t trump the issues.

Comments

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[J Maguire]

There are so many aspects of this plan that are continually overlooked by the politicians and the media though. The medical industry is wrought with overspending and has gone for too long without any regulation or oversight. There is very little coverage of the medical industry itself right now, all of the focus is being placed on coverage, when the debate should also literally be about care.

Private insurance companies are also a part of the problem, yes. When regarding health, private insurance never should have been allowed to be profitable business in the first place. For-profit insurance means requires a need to make money and inevitably that is going to affect the quality of the insurance that people are getting from the company. Companies don't want to spend money on an individual so they will take whatever measures necessary to ensure they don't have to. But the medical industry has been profiting all along as well. Procedural costs, visits, even x-rays cost varying amounts state to state, city to city and practitioners are being bounced around by pharmaceutical companies to try and make money while waiting a year or more for the insurance companies to pay up.
This may be why the US was ranked #37 according to the World Health Organization. http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,...
It is time for the entire industry to work as a single unit and break down the privatized barriers. Every doctor takes the Hippocratic Oath before receiving certification so when will the industry as a whole step forward and honor that oath?

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[JoelS]

Just wanted to let everyone know that Bill Moyers is covering a cool documentary on his show tonight called, "Money Driven Medicine". It should be really interesting!

http://www.pbs.org/moyers/journal/index-flash.html

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[Jennifer]

Let's not forget that every few years State Governments have tried and all FAILED at Universal Health Care Coverage:

Hillary Clinton started a National Single-Payer Plan. The first test run pilot was started in Tennessee in 1994 called TennCare; A few short years later it failed. But before it bankrupted the state TennCare also bankrupted hospitals and doctors who had to shut business down and move out of the state to start all over.

Universal Health Coverage for all children in Hawaii. Failed after 7 months.

San Francisco HR 676 Medicare for All - voted down because they new it would bankrupt the city.

America wasn't built on the tradition of Universal Health Care. We are taught to work, make money, save and purchase health insurance, life insurance, etc. Every time a Democractic party attempts to create a Universal Health Care system (and they make it sound so good) the news and media rally around with 100% support and then when when it dies by lack of votes or truly bankrupts the state/city you don't hear anything about it again.

[Mr. H.L. Atkinson]

As a Candian observer who gets many U.S. tv channels on cable, I would urge Americans to read and trust Consumer Reports on the subject of health reform. Too often the mainstream media covers something complex with a festival of predictable vested interests shouting at each other.I did not appreciate or understand Canada's health care system or the Canada Health Act until I read a superb explanation of it in the September 1992 Consumer Reports. Please ignore the fronts for vested interests such as "Harry and Louise." And keep an eye on who is slipping money to politicians who seem opposed to real change.

[Damon Thompson]

Your assessment is, unfortunately, right on the money - and the money is the all too easy focus for health reform coverage. The media will likely focus on determining "who wins and who loses" in terms of taxes, coverage, and who pays what, how and for whom.

If we don't address the factors that are driving health costs ever upward - like the growing incidence of chronic disease - we won't reform anything; we'll simply put off a day of reckoning.

Unfortunately, prevention measures are too often dismissed as less serious matters than the way we treat illness once it is manifested.

[Charles Clark, Sr., M.D.]

Is is going to happen! For the first time in ages we have strong, courageous leaders who recognize the importance of the health care crisis and are readly to take action. I am very optimistic and most physicians in our system seem to be also.

Charles Clark,Sr., M.D.

www.charlesclarknovels.com

[jim jaffe]

fascinating from several perspectives, starting with the fact that the health journalists reaching the largest audiences -- folks like Robert Pear and Tim Johnson -- aren't mentioned at all.

why's there so little about health POLICY in the media? because folks don't care about it. editors know their audiences. would you be more likely to read a piece saying that there's a good chance you'll become blind or impotent by age 50 if you don't eat your carrots or a discussion of computerized medical records? the first may have a real impact on you. the second is tangential at best. editors are hired to make such distinctions.
at this point, specific plans are irrelevant, which is why the Clinton-Obama spat about "my plan covers more folks than yours" during the campaign was such an marginal sideshow.
in fact, before we can get to plans, there's a need for agreement on what the problem is. saying the current system is flawed ain't adequate. if the problem is coverage, that's simple, let's provide coverage for everyone. if the problem is something else, there's a need to define it.
politics is ultimately about people -- people with problems that need help and the people who try to craft solutions. cold, quiet discussions about policy don't cut it.

[Dr. Rick Lippin]

I agree that the mainstream media (MSM) reporting on health care policy lags way behind the best of the bloggers including this one. (HealthBeat)

It is very possible that the expertise in the MSM on Health Policy is not there in abundance?

The MSM does a reasonable job reporting on medical science reporting? Although even there I have my gripes especially as it relates to fomenting unnecesassry fear or even panic and the cruelty of reporting unfounded breakthrough cures.

see my blog at http://medicalcrises.blogspot.com/2007/11/medical-journalists-you-too-1st-do-no.html on this latter topic

Thanks

Dr. Rick Lippin
Southampton, Pa

[Harriette Seiler]

Good overview, Niko, and a cautionary tale against sins of commission (misinterpretation, sensationalism, or skimpy coverage) and sins of omission by the media. While many of the Obama-Daschle community forums have indicated strong support for a single payer plan, neither the Transition team nor the media have reported on that phenomenom. Coverage has focused on the tragic stories of persons victimized by our current system. But those very stories illustrate the need for a nonprofit, publicly funded system that covers everyone regardless of financial or health status. If you see or hear a mainstream media report stating that most of the attendees at Anytown's health care forum expressed their strong support for a single payer plan, please let me know.

[Jack Lohman]

Maggie, health care reform makes sense for the public, but not for the insurance industry. And they control not just the politicians but also many in the media. I've just posted some reasons why "Medicare-for-all is best corporate bailout" at http://tinyurl.com/9d6bx9 but it may not get the ear it deserves because of the moneyed interests. The solution hasn’t changed, but the politics must…

Jack Lohman