Bruce Benidt
Jon Austin
tcarideo
Ellen Mrja
Mike Keliher
Joe LovelandA story in the StarTribune today made me think about how covering the health care debate the way we cover elections — as a horse race — results in such lame coverage and an electorate that knows very little about what’s truly going on.
The story is about a small young girl in Colorado who was denied coverage by UnitedHealth Group because she was too small. Pre-existing condition — smallness. She was otherwise healthy. The denial became a national story because the girl is cute and healthy. The story embarrassed UnitedHealth and the health insurance industry. More embarrassing for UnitedHealth, when the media spotlight shone on the little girl’s blue eyes, UnitedHealth decided yesterday that she could be covered after all — following additional review.
Telling the story of how our health care and health insurance systems work and don’t work in real people’s lives is what we need reporters to be doing today, and way too few are.
A paragraph in today’s Strib story makes me laugh and cry at the same time: “For UnitedHealth and its peers, the story could not have broken at a more pivotal time.” Because of the national debate on health care coverage, donchaknow.
“Broken”!?!?!?! “BROKEN”!?!?!?!?!
Like someone has to BREAK this story? That people are denied coverage? That when people get sick many of them lose coverage? That health insurance is too expensive for too many people? That more than 60% of personal bankruptcies are connected to medical expenses? That the system isn’t working?
Health care and insurance coverage stories are lying all over the place waiting to be picked up. Broken? Reporters have to jump over them so they don’t trip. But way more ink and airtime are spent covering the horse race — who’s ahead, who’s behind, what’s happening on the turn: Palin says there are death panels, Sen. X says Sen. Y is a toad, insurance companies are spending millions lobbying, right says left is commie on health care, Glenn Beck melts into sputtering protoplasm, blahblahblah.
Much easier for reporters to flock to Capitol Hill or the statehouse and get fed the latest “Dems call Repubs Heartless, Repubs call Dems whacko” story. Much harder — god it requires leaving the newsroom and doing research — to go find human beings and tell the stories of how our current system affects them and how proposed changes would affect them. Much harder to go inside UnitedHealth and look at how coverage decisions are made. Much harder to go inside the negotiations and see what the insurance companies are offering in terms of change, what kinds of proposals are on the table, and what they’d mean to poor, average, and wealthy Americans.
Newsrooms are sparsely populated these days due to layoffs and a limping industry, I know. But stories like Aislin’s are out there to be told — and that’s the job of journalism. The Strib has done some good stories — on local clinics that are providing better outcomes at lower costs, on reformers’ ideas, on individual families. But we need more — we need an ongoing series of clear, easy-to-read (no five-page “projects” please, only 12 people read those) illustrations of what’s working, what isn’t, and what change could do.
The more the health care coverage issue is illustrated with what’s happening in real people’s lives, the more we regular humans will understand how things work and don’t work — and what needs to be changed. The more the coverage is about process and jargon and who’s yelling at whom, the less we’ll understand and the less faith and hope we’ll have that anything can change.
BTW, from Examiner.com in LA: “The story has inspired a surge of Internet searches. After the segment aired on NBC, searches on young Aislin surged from zero into triple digits. United Health-Care is wisely responding to what could be a Public Relations crisis. In an article from Denver’s ABC affiliate, a company spokesperson for United Health-Care said the company’s height and weight requirements ‘are based on several medical sources, including the Centers for Disease Control, and are well within industry standards.’”
We need to know more about how decisions are made under the current system, who gets helped and who gets hurt. We need reporters in the field. In wars, the military, from Saigon to Baghdad I, wanted to keep reporters at HQ where military briefers could tell the reporters how the war is going. Only when the reporters — Halberstam, Sheehan, Browne, McEnroe — went out into the field did we start to really see how Vietnam and Iraq I were going. We need more reporters out in the health care trenches, interviewing the casualties, seeing the Zippo lighters ignite the thatch, to know what’s really going on.
– Bruce Benidt
Filed under: Communications, Crisis, Ethics, Journalism, Media, PR, Politics, Public relations | Tagged: health care coverage, pre-existing condition, UnitedHealth Group
Amen Brother Bruce. Great points.
By the way, are those sapphire eyes a preexisting condition?
I believe they were achieved through approved use of medical marijuana.
[...] 2009-10-22T18:59:35 We need reporters in the health care trenches, not the horse race stands: [link to post] [...]
The part that pisses me off is that with journalists NOT doing these stories on their own, it comes down to partisans and those with vested interests to push things.
“Pivotal Time?”
It wouldn’t surprise me in the least if someone sat on the knowledge of this little girl’s case, and waited for the “right” moment to drop it in a journalist’s lap.
Don’t get me wrong, both sides do it, because with a contracted media timing does become a consideration.
But this is downright wrong, and a disservice to the family who needs the help. Insult to injury, salt on the wound.
Good post. I agree on telling individual’s stories, but I’m dismayed when the media only focuses on the outrage stories such as this an then extrapolates it out as an across the board failure of the system. Polls consisently show that people like the coverage they have (because government and businesses pay for most of it already), though they think the system needs to be reformed. For all the Evil Empire demonizing of the health insurance companies, does anyone think government will provide a plan with less red tape, less limits on coverage and less outright denials? We need a system where people have economic incentives (share in some costs) in order to choose wisely and providers have incentives to contain costs and be less fearful of being sued every time they perform a procedure. We can figure it out.
Mike:
there are already several government operated plans that seem to be very popular (not by any means perfect, but generally popular) with their various constituencies–the military health care system, medicare, and the VA system.
that said, I am generally in agreement with your comments and prescriptions for what we need in a health care system. I think that one of the problems we currently have is that some players in the system are too big and too powerful–and so there need to be easy options–easy ways for us (consumers) to change providers.insurers, etc., without penalties. While i would hate to see a government system as a sole or even dominant player, having a government run program as one option among many would seem to me to be an acceptable option that would have positive consequences for the system as a whole.
i agree with you that we can figure this out–I just hope that we are soon to be getting beyond the point where all of the opposition is of the “just say no” variety, and starts to play a constructive role. The recent vote by Senator Snowe, as well as the comments by Dole and Frist are hopeful signs to me.
This story wouldn’t be nearly as compelling if it was an abberation. Millions of Americans are uninsured, and the number is growing every year. Americans have lower satisfaction levels with our health system than other industrialized nations. Most everyone you talk to has a story of problems with the system. Given all of that, I’m not sure it’s fair to blame the media for fabricating or exagerating problems with the system. The stories are everywhere, and they are real.
Sure there are plenty of folks out there in dire circumstances, but there are plenty who like the coverage they have an want to keep it. What I’m saying is that going out to find people representing one side is dishonest journalism. I worked for plenty of editors who sent me out to “find real folks” that fit the story they wanted. When I came back with different views, I was told “that’s not the story I sent you out to do.” Millions are uninsured, but it doesn’t mean they aren’t getting care. Not having insurance and not getting care are two different matters.
Re: “does anyone think government will provide a plan with less red tape, less limits on coverage and less outright denials.”
Red tape data: “Medicare administrative overhead costs (2%) are well below the overhead of large companies that are self-insured (5-10%), health insurers offering coverage to small employers (25-27%), and individual insurance (40%).”
Satisfaction data (which presumably has a connection to the extent of coverage limits and denials): “According to a national CAHPS survey conducted by the Centers for Medicare and Medicaid Services in 2007, 56 percent of enrollees in traditional fee-for-service Medicare give their “health plan” a rating of 9 or 10 on a 0-10 scale. Similarly, 60 percent of seniors enrolled in Medicare Managed Care rated their plans a 9 or 10. But according to the CAHPS surveys compiled by HHS, only 40 percent of Americans enrolled in private health insurance gave their plans a 9 or 10 rating.”
That’s the figure Medicare reports; leaving out administrative costs associated with support services of the GSA, IRS and other entities. Add up all the costs, including those off the books, make an apples to apples comparison (very tough) and some studies have found the government average is closer to 8, while private insurance is 16 with the profit built in. Yes, the profit factor does have to enter into the equation in the private sector. However, how sustainable is a system that has an unfunded liability of some $65 trillion? In addition the GAO has cited Medicare for virtually “nonexistent financial controls” and has deemed it at high risk for fraud, waste and abuse every year since 1990. Also, a poll this past summer done by Kaiser, ABC and USA Today found 86 percent happy with their medical coverage, including 70 percent of the uninsured who reported they were getting health care and were happy with it. So we can always find stats to prove our point.
If Medicare is only twice as efficient as private insurance (highly disputed by many researchers, but for the sake of argument…), it’s still hard to embrace for-profit health insurance on the basis of efficiency.
The other big data point is that the private-heavy system in the U.S. spends more than any other UN member, but has higher infant mortality and lower life expectancy than any EU member. We spend way more and get way less than peer nations.
Given all of this, and the fact that private insurers will always be accountable to share holders who demand that they maximize the net profit, and I’m just not all that wild about keeping the whole thing in the hands of private insurers.
PM:
You’re right. The aformentioned programs seem to be quite popular. I have two concerns with the government option. One, they ought to be held to the same anti-trust laws that corporations are held to (lest they use the taxing power or endless mandates to undercut private insurance companies and kill competition. Second, government could foster competition and efficiency of pricing now by allowing people to shop for the best plans even with a government option. Part of the problem you identified is that the McCarran-Ferguson Act of 1945 empowers the states to regulate the business of insurance, which means I can’t buy insurance in other states; so a few big players dominate. Let’s have true competition. My preference: Offer a government option but make it means tested so that those who truly cannot afford insurance can get it. We do that with all kinds of other government benefits. A chunk of people in the 46 million without insurance fall into the middle class in terms of income but choose not to buy health insurance. Risk pools in both private and the public option would have to be large enough to overcome the adverse selection problem and participants should have to pay a portion of the costs to avoid the moral hazard conundrum.
Joe:
Private insurance is by no means efficient, but the idea that government insurance would be is well…..dubious at best. If people really believed it, government run health care would have passed a long time ago and Democrats wouldn’t be trying to convince the country. I know profit is a dirty word among the more liberal faction in the country, but as economists have discovered since Adam Smith, incentives matter. The idea that government is not immune to lining its own pockets and is free of phony accounting, bookkeeping and corruption is…….well dubious at best. While I was a journalist, I didn’t trust big power (business or government). My journalist friends seem to trust big government but not big business. In many respects, I don’t see the difference. Anyone who doesn’t think that political factions are beholden to those who supply them with money hasn’t seen sausage (I mean legislation) being made.
I would prefer that it not be means tested, and for the same reason that Social Security is not currently means tested–means testing would imply that this is a program exclusively for the poor, and there is generally little political support for programs that are directed at the poor in the US. You can read an excellent book on this topic by Theda Skocpol–Protecting Soldiers and Mothers– about how social security and its predecessors came into being. Her bottom line–in the US, we tend to divide people (particularly the poor and people in need) into 2 categories–the deserving and the undeserving (guess where “welfare queens” fall?). Almost every “handout” program tends, over time, to fall into the “undeserving” category. And lose its political support as a result, regardless of effectiveness, etc.
So i think it would be better to offer a public option that is strictly a bare bones option, but that anyone could buy into. I think that this would also be a good idea in that it would be a better way to attempt to contain the costs of a public option, and would cede the higher end, probably more lucrative arena to the private insurers (who could offer things like bariatric surgery coverage and charge for it, etc.)
As for your idea about allowing competition over state lines, I am all for that as well. I think that this is another area in which we have allowed government regulations to shield private interests from competition, to their benefit (and not to the benefit of consumers).
PM:
Good points.
Oh, and Joe, not even the administration bothers with that old saw anymore about life expectancy or infant mortality. As Dr. David Gratzer says, “infant mortality stats, like life expectency, reflect a mosaic of factors such as diet, marital status, druge use and cultural values (never mind differing definitions of infants where some countries don’t even count infant deaths if the baby is below a certain size). Judging American health care only by such statistics is like declaring Cuban democracy stronger than America’s based on voter turnout.”
We get a lot for our health care dollar considering women who get breast cancer in Europe are four times as likely to be diagnosed after the tumor has spread and are less likley to survive than women in the U.S. Cancer patients in the U.S. have markedly higher survival rates than their European counterparts. In fact, the U.S. beats every country in Europe in five year survival cancer rates.
Yeah, but Europe has universal coverage.
While things are much better in Minnesota with our non-profit health plans and lower cost care, the U.S. system is a mess. Pick your measure. According to the Commonwealth Fund, a private, independent foundation, America spends a far higher percentage of GDP on health care than any other country, yet has worse ratings on quality, efficiency, access, safety, equity, and wait times. With the amount we spend, we should be first in all these categories, and we’re far from it. Our system is not performing well, and it needs more than a band-aid to cure what ails it.
Our for profit structure is part of the problem. Publicly traded plans with a shareholder mandate to maximize what they take in and minimize what they pay out are not doing well by many patients. Physicians with equity shares in diagnostic equipment have a profit motive to overuse it. Pharma companies with a shareholder mandate to maximize profits invest in drugs that are most profitable rather than the drugs that are most needed.
I’m no commie. I believe in the private sector is the best choice for delivering most goods and services. But its not working very well in the case of health care.
Mike, it’s great to have you here. Hope you come around more often.
Thanks, Joe. It is a nice site with a lot of good debate. You guys have me hooked on. I agree with you that government has a role in eduction and health care. Those two areas are too important to be left totally to the public or private sector.
Glad to hear it, Mike. Great stuff you’re bringing to the discussion.
The other thing I wish was a bigger part of national reform is encouragement of non-profit health plans. While non-orofit plans are not perfect either, the kind of non-profit health plans we have in Minnesota have much lower overhead costs than their for-profit cousins. They also have been much more effective in collaborating with each other and providers to imbed cost control and quality improvement into the process. Minnesota’s cost and quality controls are much better than the nation as a whole, and the rest of the nation has something to learn from us.
I know that sounds like hometown puffery, and I should disclose that I have had clients in this realm. But national experts will tell you that the quality, cost and access results produced by the Minnesota system are demonstrably better than the nation as a whole.
The profit incentive is the only reason we have the pacemaker, stents, neurostimulators, statins, aspirin, lysinopril, zoloft, albuterol, etc.
Even Viagra was a discovered as a drug Pfizer intended to be an anti-hypertensive.
Profit drives life-saving innovations unlike any other societal mechanism. To argue against this is to argue against medicine’s greatest breakthroughs.
Sure, and precisely why the pharmaceutical companies apparently spend far more on marketing than research. That doesn’t seem quite right. Does it? I mean they’re not selling the latest cut in blue jeans. Does profit for the pharma-company translate to the benefit of the consumer?
I agree that profit motive drives innovation in the pharma and device fields. We should continue to benefit from that while also regulating them to mitigate the downsides, such as
1) We need to make sure we incent those companies to seek less profitable, or unprofitable, treatments for orphan ailments.
2) We need to limit and/or disclose doc investments in new devices and drugs to guard against the reality or perception of doctor-driven conflicts of interest; and
3) We need to be careful about prematurely throwing money at buying new devices and drugs until and unless clinical data proves they are truly the best available treatment.
Again, I have no problem with for-profit pharma and device companies. But you do have to guard against the very real downsides of their for-profit structure.
Excellent and useful discussion. We’ve had two cases recently in Colorado, the “overweight” baby and the case that sparked this discussion. One question, what happens to the infant who is actually sick and the insurance company denies coverage?
I assume she is still treated and then no matter which way you slice it, we all pay for her care, as it should be…maybe she’ll grow up to cure the disease she suffers from.
Good point Mrs. But instead of getting lower cost preventative treatment from a primary care physician, the slim and fat babies will go to the emergency room to get more expensive and extensive treatment. The cost of the treatment will either a) put their parents in bankruptcy or b) be passed along to hospital patients in the form of higher prices.
This is what we in America call health care “cost containment.”
Only in the realm of healthcare is high demand a bad thing.
Why?
Because the patient is not the customer – insurers are.
Only if and when patients are in a position to spend their own resources (no intermediary) to purchase care directly from providers will you see costs come down and quality go up.
If we needed insurance to purchase mufflers for our cars, the cost would be $20K/muffler.