More than a month ago, the mainstream media’s coverage of health care reform turned sour. I’m not sure why, but that negativity has extended to the way the press is reporting on the president himself.
Today, the New York Times reported that a new poll reveals that “Americans are concerned that revamping the health care system would reduce the quality of their care, increase their out-of-pocket health costs and tax bills, and limit their options in choosing doctors, treatments and tests. The percentage who describe health care costs as a serious threat to the American economy — a central argument made by Mr. Obama — has dropped over the past month.”
I fear that the way the media has been reporting on reform has played a significant role in shaping the public’s perception of both the president and what some like to call “ObamaCare,” personalizing the issue, as if reform were merely the president’s favorite hobby-horse.
Begin with the coverage of health care reform. Over the past month,,Media Matters has done an excellent job of tracking how “the media continues to spread conservative misinformation on health care reform.” Here are just a few examples:
“Despite clear progress, media declare health care reform nearing "life support"
“On health care reform, networks highlight perceived setbacks far more than progress” July 22
“Politico ignores contradictions in calls by “moderates” for lower costs, limits on public plan” July 20
“CBS' Smith advanced falsehood that Dems are taxing small businesses to fund health bill” July 19
“NY Times ignores House health bill's exemption protecting small businesses”
“Wash. Post column cites inapplicable CBO assessment to claim public plan option has ‘huge cost, minor benefit’” July 07
“CNN.com joins Republican fear-mongering about Canadian-style health care” July 07
And I’m not even including the over-the-top distortions of the truth that have become regular fare on Fox News, and in the pages of some decidedly conservative newspapers.
The Press Fails to Analyze the Arguments
In light of the compromises that Senate Democrats are making, one could argue that the press was correct earlier this month, when it declaried that health care reform was headed for trouble. But I can’t help but wonder: to what degree did the headlines become a self-fulfilling prophecy?
Less than two weeks ago, it seemed that Senator Baucus’ political capital was falling, and that the Senate HELP committee bill, along with the House bill, might well define the terms for reform. But the media continued to “highlight setbacks far more than progress.”
Moreover, Media Matters is right in pointing out that the press failed to analyze the contradictions in the Blue Dog’s arguments as they simultaneously criticized progressive Democrats for creating reform bills that “did not include enough cost savings,” and at the same time, insist that any public plan should pay doctors and hospitals more than Medicare pays. The Blue Dogs seem to be winning on that last point (As I have explaind in the past, while the Blue Dogs press for across-the-board increases for all rural providers, the .House bill would hike Medicare payments for treatments that provide greater benefit to patients–including primary care–while lowrering very lucrative payments for some treatments that are far less effective.)
How then would the Blue Dogs save money? In the House, legislators have now agreed to reduce the federal subsidies designed to help lower-income families afford insurance. As I have pointed out in the past, if they are going to be able to afford mandated insurance, middle-income families also will need help from the government. And now it appears that the the subsidies may not be sufficient—certainly not if a family wants comprehensive insurance.
What I find most disappointing is that when the 1,018 page House Plan was made public, even progressive newspapers failed to give readers much-needed, solid information on the strengths of the plan. How many Americans know that, under the plan approved by three House committees: insurers would not be able to charge co-pays for preventive care—including eye and foot exams for diabetics; insurers would not be allowed to “cap” coverage, either annually, or over the course of a customer’s lifetime; adult children would be able to remain on their parents’ insurance plan through age 26, or that Medicare would pay doctors for the time that it takes to explain the continuum of end-of-life services available to critically ill patients, including palliative care and hospice care?
What all of this adds up to is security. No family would ever again go bankrupt because a child suffering from cancer had blown through their insurance plan’s life-time cap on reimbursements. No parent would have to worry that her twenty-something might be in a car accident—and then find himself in a situation where he received subpar care– because he didn’t have insurance. No one would have to fear watching a loved one die in screaming pain because the doctor never explained that “palliative care” was available. (Palliative care specialists are trained in the fine art of controlingl pain.They also counsel critically ill patients, explaining treatment options.)
“Either We’ll Have to Tax Health Care Insurance, Or Ration Care”—Not True
Last week, I attended a conference where Dr. Donald Berwick, founder of the Institute for Health Care Improvement, noted that: “Both politicians and the media have been stressing that health care reform is going to be very difficult. Either we are going to have to ration care” denying care to 80-year-olds “or we are going to have to tax employer-based insurance.”
“This just isn’t true,” Berwick told an audience who understood what he was saying. They had just spent the day discussing ten U.S. communities that have succeeded in reducing health care spending and improving the quality of care—without rationing and without taxing. “There is a third way,” Berwick declared, “reforming the health care system.”
This is just what the House bill would do, funding half of the needed savings by making structural changes in our bloated system while raising the other half with a modest tax increase for Americans at the very tip-top of the income ladder. I’ve written about the structural changes here , the tax hike for the top 1 percent here.
“What’s In It for My Family?”—The NYT Finally Gives a Fair Answer
Rather than offering accessible analysis of the text of the House bill, too many newspaper articles reverted to spreading fears in unsettling “What’s In It For Me?” stories like this one. This piece ends: “In recent weeks, polls have shown that a solid majority of Americans support the stated goals of health reform government-run insurance plan. Most want the uninsured to be covered and want the option of a government-run insurance plan. Yet the polls also show that people are worried about the package emerging from Congress.
“Maybe they have a point,” the writer added.
To its credit, on Sunday the New York Times finally ran an editorial headlined “Healthcare Reform and You” that tackled the question: “How does my family stand to benefit from health insurance reform?” and then answered it, showing how reform could help virtually every American family, even those who already have good group coverage.
The editorial does an excellent job of addressing fears that reform means we will all wind up paying more: “If President Obama and House Democratic leaders have their way, the entire tax burden would be dropped on families earning more than $250,000 or $350,000 or $1 million a year, depending on who’s talking.”
More importantly, the Times observes: "Many Americans reflexively reject the idea of any new taxes — especially to pay for others’ health insurance. They should remember that if this reform effort fails, there is little hope of reining in the relentless rise of health care costs. That means their own premiums and out-of-pocket medical expenses will continue to soar faster than their wages. And they will end up paying higher taxes anyway, to cover a swelling federal deficit driven by escalating Medicare and Medicaid costs.”
The editorial disposes of conservative fear-mongering about reform “rationing” care: “Critics have raised the specter that health care will be ‘rationed’ to save money. The truth is that health care is already rationed. No insurance, public or private, covers everything at any cost. That will not change any time soon.”
What will be different under heath-care reform, is that care would be rationed, not by for-profit insurance companies, but by physicians and other health experts looking at medical evidence to determine which treatments work best for particular patients. The “bills call for research and pilot programs to find ways to both control costs and improve patients’ care,” the Times explains.
“The bills would alter payment incentives in Medicare to reduce needless readmissions to hospitals, the Times' editorial continues. "They would promote comparative effectiveness research to determine which treatments are best but would not force doctors to use them."
The editors do acknowledge that not everyone will be happy. “Healthy young people who might prefer not to buy insurance at all will probably be forced to by a federal mandate.” But, “That is all to the good,” the Times argues. “When such people get into a bad accident or contract a serious illness, they often can’t pay the cost of their care, and the rest of us bear their burden.Moreover, conscripting healthy people into the insured pool would help reduce the premiums for sicker people.”
I would add that, under the House bill, insurers are allowed to charge older customers twice as much as they charge younger enrollees for the same plan–which means that, in effect, younger Americans will receive a 50 percent discount on their premiums.
The editorial dispels fears that seniors will be the losers, pointing out that Medicare beneficiaries will receive discounts on brand name drugs. The House plan also phases out the “doughnut hole” which forces seniors to begin paying the full cost of their drugs out of pocket once their insurer has paid out a certian amout..
The piece concludes: “The AARP, the main lobby for older Americans, has praised the emerging bills and thrown its weight behind the cause. All of this suggests to us that the great majority of Americans — those with insurance and those without — would benefit from health care reform.”
(Kudos also to the Washington Post which ran an article yesterday that included some helpful bullet points explaining provisions in the House plan.) I wish we had seen more pieces like this when the plan was first released.
The Press Waffles
Yet, after publishing an encouraging editorial on Sunday, yesterday the Times reverted to stirring up fears in a news story headlined: “Democrats Push Health Care Plan While Issuing Assurances on Medicare.”
The article itself is far from reassuring. It states: “Democrats in Congress plan to finance about half the cost of the legislation by squeezing savings from Medicare. The White House says benefits will not be cut and beneficiaries will not be hurt.”
That’s it—no explanation that Democrats would squeeze savings from Medicare by trying to eliminate ineffective care that provides no benefit for the patient in question. As a result, the White House assurance that “beneficiaries will not be hurt” sounds hollow.
Then the Times repeats the conservative lie that healthcare reform will promote “euthanasia for the elderly”: “A provision of the House bill would provide Medicare coverage for the work of doctors who advise patients on life-sustaining treatment and “end-of-life services,” including hospice care. “Conservative groups have seized on this provision as evidence that the bill could encourage the rationing of health care. The Family Research Council, for example, said the bill would ‘limit end-of-life care.’ The House Republican leader, Representative John A. Boehner of Ohio, said, ‘This provision may start us down a treacherous path toward government-encouraged euthanasia.’”
Again, that’s it. No rebuttal. The article just moves on to another topic, without explaining that the House bill would pay doctors to explain palliative care to patients, making it clear that palliative care is all about giving patients options– by providing full infromatinon about the the benefits and side effects of various treatments. With that knoweldge, patients (or families) can play a role in deciding which treatments to pursue. Palliative care is not about abandoning hope. Patients continue to receive potentially life-prolonging treatments as long as they want them. Why didnn't the Times spell that out? It just takes two senteneces.
It’s one thing to tell both sides of the story, another to repeat canards without deconstructing them. I fact, even if a reporter tries to expose the lie, unless his argument is quite powerful, a phrase like “government-encouraged euthanasia” may well linger in the reader’s mind.
The Times' story ends by explaining that President Obama wants to “eliminate billions in unwarranted subsidies to insurance companies in the Medicare Advantage program” and then gives Robert E. Zirkelbach the final word. He is , spokesman for America’s Health Insurance Plans, a trade group for insurers. The Times tells us: "Zirkelbach says “that if Congress made those cuts, ‘beneficiaries would face higher premiums and reductions in benefits, and in some parts of the country, they might lose access to their Medicare Advantage plans.’ When Congress cut Medicare payments in the past, he said, insurers withdrew from some counties.”
Meanwhile the Washington Post, like the Times, continues to see-saw on reform, explaining it one day, slamming it the next day. Tuesday it published an Op-ed by CBO director Douglas Elmendorf’s mentor, Martin Feldstein. (I have written about Elmensdorf and Feldstein here. Feldstein’s piece is jam-packed with misinformation—and just plain silliness. Referring to the Dartmouth Research, Feldstein offers no argument, but simply writes: “I just don’t believe it.”
Oh, okay, I guess that settles that.
Clearly, an economist with no particular expertise in healthcare is in a better position to judge more than two decades of research done by physicians at Dartmouth than the thousands of physicians and medical researchers who have endorsed Dartmouths's findings. In the early 1990s, many in the medical community were still trying to poke holes in the Dartmouth research. That was nearly 20 years ago. Now, both the cognoscenti of medicine, and the mainstream press have reached a conclusion: Dr. Jack Wennberg and the Dartmouth team were right.
The only question that remains: what do we do about the waste in our system?
Many would argue that papers like the Washington Post should publish OP-eds by writers representing a wide spectrum of political views. I completely agree. But that doesn’t mean that a newspaper should publish Op-eds by people who know nothing about the subject that they are writing about.
“Pundits don’t have to be right about everything . . . They do, however, owe it to the public to make enough effort to get basic facts right . . . One possibility is that Feldstein really is that ignorant of the health-care basics; if so, he has no business writing an op-ed on the subject, just as he had no business writing an op-ed on climate change policy (Yes, I write about subjects on which I’m not an expert — but I do my homework first.)
“The alternative possibility is that Feldstein knew that he was saying something false, but did it anyway in the hope of scaring his readers.
Krugamn concluded: “I don’t know which is worse.”
The Media Turns on the President Himself
What is perhaps most troubling is that the negative spin is not confined to coverage of health care reform. At times, is seems that the mainstream media is turning on President Obama himself, in a free-floating critique that isn’t directly connected to the issues.
Here’s one small but telling example: In a story about the recent press conference where the President argued for health care reform, the New York Times wrote: “he sounded cerebral as he delved into policy specifics for nearly an hour and tried to link them to the concerns of ordinary Americans."
Yes, now, at long last, we have a “thinking president.” Health Care reform is a very complicated topic. The President was using his intelligence to describe reform—and the alternative—as clearly as possible. Yet the Times’ writer must know that in our society, “cerebral” is, without question, a pejorative term.
The.Dictionary.com definition of the word is telling: “betraying or characterized by the use of the intellect rather than intuition or instinct: His is a cerebral music that leaves many people cold.” The American Heritage dictionary definition is even more damning:” to or requiring the use of the intellect; intellectual rather than emotional: "His approach is cerebral, analytical, cautious" Appealing to or requiring the use of the intellect; intellectual rather than emotional.”
The knock on Obama is that “he’s too intelligent”? Would we rather have a leader who appealed to our basest instincts and emotions? Didn’t we just see that movie? And this criticism of Obama is coming from the New York Times, supposedly the nation’s paper of record, a thinking-man’s newspaper.
Nevertehless, some observers suggest that the president also needs to reach out to people where they live—in their hearts, not in their heads. But today, the Washington Post criticized the President for trying to follow that advice. First, the Post quoted Obama pollster Joel Benenson saying: "I believe the more we know about underlying values and attitudes, and those deeply held attitudes that shape what people think, what they bring to the table, the more we can fine-tune a message. The more you understand what they are bringing to the table, the better you can connect with them."
"That's one of the things we are very conscious of," he aded, " really kind of using language that reflects the language that people actually use."
Then Washington Post staff writer Michael Shear felt a need to editorialize: “That admission opens Obama up to the charge of pandering, of telling people what they want to hear rather than what they need to hear.” Shear then turned to “Gail Gitcho, the press secretary for the Republican National Committee” to finish the job: Gitcho says the reliance on polling proves that Obama ‘is running a PR machine’ out of the Oval Office.” The headline on the story: “Poll Results Drive Rhetoric of Obama's Health-Care Message.”
Finally, of course, there is he press response to Gates-Gate. The president was surprised by the reaction, and I was too.
I wasn't 'shocked that the press blamed Havard professor Henry Louis Gates, Jr.. The media doesn't recognized distinguished scholars as national treasures, nor does it treat them with much respect. If anything, the fact that Gates was a "Harvard professor" hurt his case. . But I was caught off guard by the way reporters blamed President Obama for suggesting that the police acted "stupidly" when they arrested Gates in his own home– after they had determiend they he hadn't broken in and wasn't a burglar. Gates' only crime: being disrespectful to a police officer.
Consider what Washington Post columnist Chris Cillizza had to say about the incident : “the media swirl that has developed in the wake of Obama's comments last night reveals just how critical message discipline is when you sit in the White House. “The Administration wanted today's message to be about the urgent need for health care reform — but instead saw much of the coverage focused on whether Obama stepped too far out on a limb in his defense of Gates.
"Again, the long-term impact of the Gates story is minimal,” Cillizza added. “But, for every minute of press coverage it draws is a minute not being spent pushing the idea of the necessity of health care reform.”
Whoa . . . Anyone who has watched President Obama over the past fifteen months realizes that he does not need to be lectured about the need for “discipline.” This is not a man who lacks impulse control. Moreover, Cillizza, like many in the press, seems to be blaming Obama for the fact that the media was “distracted” from healthcare reform. The truth is that the president could only watch, as the media itself seized on a story with racial overtones, and ran with it.
Tuesday night, I happened to catch Cillizza on television, keeping the story going as he once again declared the president “wrong.”
When I think of the amount of ink that has been spent on Gates-Gate. . . Certainly the fact that African Americans are “profiled” is worth comment –as is the question of how a policeman should respond if a citizen who has not committed a crime shouts at him. (I tend to think the motto: “Sticks and Stones Will Break My Bones, But Names Will Never Hurt Me” should be posted in all police academies. But this is only a mother’s personal opinion.)
In any case,what is certain is that the the Gates-Gate story has gone on for far too long. In the meantime, as the Times noted today, most Americans seem to have forgotten that out-of-control health care spending represents “a serious threat to American economy.”
Perhaps the media might begin using some of the time and space that it has devoted Gates-Gates to analyze the impact that healthcare inflation has on our ecnomy. We need editorials and news stories that drive the point home: if health care spending continues to climb by 8 percent a year, not only does that guarantee that your health care costs will double in nine years, it also means that the deficit spiralls and other nations become increasingly skeptical about the dollar.
The cost of imports will climb, and at some point oil-producers will no longer price oil in dollars. If that happens, energy costs will skyrocket, and you can expect a decline in the U.S. standard of living. As for healthcare—without reform, in ten years only the wealthiest 5 percent of the nation will be able to afford decent care. The rest of us will be lucky if we have Medicaid.
If this sounds apocalyptic, ask yourself this: Two year ago did you think that we were heading toward the deepest recession/depression that this nation has seen in eighty years?