Aug
14
2009

Trudy Lieberman on healthcare reform, Gary Schwitzer on health news study

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This week on CounterSpin: Healthcare reform is still the top political story of the moment. But the coverage seems to have gone from bad to worse, with noisy town hall meetings standing in the way of any coherent discussion of the dysfunctional healthcare system in this country, and what can be done about it. Trudy Lieberman has been watching healthcare coverage for Columbia Journalism Review; she'll join us to talk about what she's found.

Also on CounterSpin today: An ongoing review of network morning news coverage of health issues finds a dangerous pattern of coverage providing faulty information, hyping medical products and drugs, and generally badly serving the public. We’ll talk to Gary Scwhitzer, professor of journalism at the University of Minnesota, and the leader of the research team about unhealthy morning news coverage.

Links:

Health Care Homework for the L.A. Times: How Does the Canadian Medical System Actually Work?, by Trudy Lieberman (CJR.org, 8/4/09)

Network TV Morning Health News Segments May Be Harmful to Your Health, by Gary Scwhitzer (HealthNewsReview.org, 8/3/09)

FULL TRANSCRIPT

All that's coming up, but first we'll take a look back at the week's press.

--One article of faith in the corporate media is that best solution to our healthcare problem lies the political center. And the pundits who advance this argument take it to its logical conclusion: Obama needs to get to the middle by distancing himself from the left. On the roundtable segment on ABC's This Week on August 9, host George Stephanopoulos wondered if Obama would accept a watered-down bill and break with what he called the "Howard Dean wing of the party." This notion was seconded by Cokie Roberts, with right-wing columnist Peggy Noonan chiming in to say, "Maybe it would be good for the President if the left got absolutely furious about something."

Well that's the media's standing advice to Democratic politicians: make the left mad, and you win. And what the pundits consider "left" is usually pretty telling. Washington Post reporter Dan Balz spelled that out on August 12, writing that the so-called public option "is dear to the left in the Democratic Party." Thus, if Obama and the Democrats ditch the public option, he's gonna get somewhere: "Some of his staunchest allies believe that course would be prudent and might change the dynamic of the debate in the administration's favor." This is the typical corporate media formulation; this public option idea is very left-wing. But that's not so. Despite a media discussion that muddies up the issues and favors shouting over substance, polls still show the public is generally supportive of the public option. So when the media suggest that the Democrats ditch the idea, what they're really saying is that they should reject something the public wants. How that is politically smart is hard to figure.

--One thing mostly missing from the media coverage of healthcare reform is simple fact-checking; if Sarah Palin says Obama is setting up "death panels," the media should say that's a lie. So USA Today decided to check some of the healthcare rhetoric on August 12; but they focused solely on Barack Obama. Under the headline "Some of Obama's Assertions Debatable," the paper compiled a remarkably weak case. Their first bullet point: Obama says that if you like your health plan, you can keep it. Not exactly, says the paper: the non-partisan Congressional Budget Office estimated that 10 million workers could lose employer-provided benefits and would have to find other insurance." This is a popular talking point among Republicans, but it's not clear where it comes from. The CBO did report that 10 million people, under one scenario, would choose coverage under the so-called public option; that's very different from losing your health insurance. Obama also pointed out that the Medicare Advantage program gives billions of dollars to private insurers to cover people who could be covered under Medicare for less. USA Today's response was to quote someone from the insurance industry saying they perform a valuable service, which doesn't exactly rebut the idea that the program wastes money.

USA Today even flagged Obama for saying there are no death panels in the works; his offense, apparently, was naming the Republican senator who wrote the language in one of the bills that has been widely misrepresented. That Republican senator objected to being singled out, but it's not clear what was wrong with Obama's statement. We're all for reporters fact checking politicians, but USA Today's attempt was way off the mark.

--Under the headline "Analysts Expect Long-Term, Costly U.S. Campaign in Afghanistan," the Washington Post's Walter Pincus wrote August 9 that "military experts are warning that the United States is taking on security and political commitments that will last at least a decade and a cost that will probably eclipse that of the Iraq War."

What follows is about what you'd expect: Various pro-war analysts giving their views on how best to wage war there. But perhaps the most telling part comes early on, when Pincus writes: "Military experts insist that the additional resources are necessary. But many, including some advising [Gen. Stanley] McChrystal, say they fear the public has not been made aware of the significant commitments that come with Washington's new policies."

Well the public is aware of the Afghan War, of course, and they don't like it, according to the most recent polling. So official Washington has to present escalation and extension of that war as a simple matter of fact, not something the public can debate or really do anything about. And stories like this, that evince some concerns about the war's means but not its ends, play a part. It's difficult to imagine a piece in the Post that one-sidedly detailed the arguments of those opposed to escalating the war in Afghanistan; though looking at the polls you'd think such a piece would reflect the views of much of the public.

--CNN president Jon Klein has ordered his producers to avoid booking radio talkshow hosts as guests. The practice of booking talk jocks to discuss national and international affairs on television, while common, is puzzling to many because such hosts often have no relevant expertise. And so, for instance, Rush Limbaugh appeared on Nightline to discuss such matters as global warming and the so-called Watergate scandal, two subjects about which his ignorance had already been well demonstrated.

In making the announcement CNN's Klein also said "Complex issues require world class reporting," and he explained that talk radio hosts often add to the noise and are "all too predictable." So why did CNN use them for so long? Have they become even more noisy and predictable in recent days? And how exactly does CNN square this policy with, say, the presence of Lou Dobbs, who is nothing if not predictable in his relentless tirades about immigration.

So radio yakkers are apparently gone from CNN; meanwhile, the New York Times has said goodbye to conservative actor, ad pitchman, and writer Ben Stein. It turns out you can't be a television pitch man for a fly-by-night credit reporting company and keep your New York Times business column. The Times cut Stein loose over his association with FreeScore.com, described by Reuters reporter Felix Salmon as "a sleazy company which exists only to extract large sums of money from those who can least afford it."

Stein's previous television pitching for eye drops and other consumer products were apparently okay. It's good to learn that the Times has some standards.

--And finally, sorting through the mountains of falsehood that conservative media outlets have produced on the subject of universal healthcare systems around the world, perhaps none is funnier or more pathetic than what the far right financial newspaper Investor's Business Daily published on July 31. Editorializing against Britain's National Health Service, the paper explained, "People such as scientist Stephen Hawking wouldn't have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

Hawking, as many CounterSpin listeners will know, is British and has lived in the UK his entire life. What's more, when informed of the Investor's Business Daily's claim that he would be left to die under the British system, Hawking told the Daily Telegraph, "I wouldn't be here today if it were not for the NHS...I have received a large amount of high-quality treatment without which I would not have survived."

Following the public airing of this embarrassing error, Investors Business Daily ran an editors note: "This version corrects the original editorial which implied that physicist Stephen Hawking, a professor at the University of Cambridge, did not live in the UK." That was it. Nothing correcting the paper's suggestion that the British National Health Service leaves people to die.

TRUDY LIEBERMAN

CounterSpin: Two weeks ago, it would be fair to say the media coverage of the health care debate wasn't very informative, focusing more on Beltway strategy and who's up/who's down punditry. Then, somehow, things seemed to get worse. Raucus town hall meetings have practically sucked up all the oxygen over the past week, with chatter about death panels and mandatory euthanasia. This too shall pass, one can only hope, but looking at the big picture, where are we in the healthcare reform discussion? And are some of these troubles caused by where this conversation started in the first place?

Joining us now is Trudy Lieberman. She directs the Health and Medical Reporting Program in the Graduate School of Journalism at City University of New York, and she's a contributing editor at the Columbia Journalism Review.

Trudy Lieberman, welcome back to CounterSpin!

Trudy Lieberman: Thank you

CS: Well, I want to start, not with the town halls and all the noise, but with an article you wrote as the reform discussion got underway for CJR. One of the main assumptions of the early coverage was that Barack Obama studied the Clinton healthcare fiasco, and he was going to steer clear of that. We had a whole new plan, a whole new day. But you were pointing out that some of the things that have been covered as new and different this time around aren't new at all?

TL: Well, the ideas for reform have not changed a bit. In fact, we have pretty much foreclosed discussion of other countries' systems from the very beginning. At least in '93-'94 there was some discussion of that, at least in the beginning. But the ideas for reform, a public plan, an individual mandate, making employers pay a little bit, taxing insurance benefits from your employer; all these ideas have been around since the early '90s in one form or another. So the ideas have not changed at all, and the limits of the debate haven't changed. We still, in this country, want to entertain very narrow ideas and very narrow solutions to a very big problem.

CS: I was struck reading in the piece, you know, one of the features of the current coverage was the idea that the White House was bringing different forces together, a lot of industry representatives were agreeing to cost cutting and the like. And I was struck to read that that was exactly what was happening in the Clinton years as well.

TL: Exactly. What was different this time is that the press said it was different. Because there were cheerleaders for various groups; a lot of advocacy groups were going around talking to reporters saying all the stars are aligned this year, we're going to have health care reform, the Democrats are in power; and the special interests, the drug companies, the docs, the insurance companies, the biotech companies, and everybody else were very agreeable. Everybody was agreeing that we have to do something about the uninsured, this is just intolerable, we have to do something about these runaway healthcare costs, medical inflation, so there was agreement on very broad kinds of principles here. But that was the same case in '93-'94. One of the things that I was able to show and present in that article was that even some of the headlines and the leads of journalism stories were exactly the same as they were then, as they are now. And so what you had then and what you had now, at least in the early days, was the special interests coming together saying we have to do all this, and it's going to get done. But that was before we got into the details, and as soon as the details started coming out--first with all the different House committees working on this--it looked like there really wasn't that much agreement at all, and there still clearly is no agreement, and there's no consensus in this country about what to do. Which is sort of the way it was in '93-'94.

CS: Those details seem to be where the action is shifting, and you wrote a piece recently that got at this. Looking past all this fog about town halls and things, there is this interesting shift going on: Obama and the White House are talking about health insurance reform, not healthcare reform, and makes it sound like, and advocates of the White House approach are saying, we're really going to reform the insurance industry. So if that is what we're talking about then we're trying to figure out whether any of these bills are going to offer much in the way of consumer protection, checks on the insurance industry. You're saying that's were the action is. How is that going to play out? Is it backroom lobbying to change these bills that we're not going to notice?

TL: Yes, let me speak to that in a minute. The first thing that's happened, and I think this is very instructive for people, that during the campaign, the conversation's all about universal health care. Somehow, we were going to get everybody covered, and the general population kind of believed in their minds that we were going to get something sort of like the way they do it in the rest of the world, that everybody will automatically get coverage. It was never really explicitly said during that time period, that what they had in mind was trying to figure out a way to get private insurance to everybody. So universal coverage then sort of morphed into universal healthcare. Coverage and care have always been sort of fuzzy concepts that get intertwined. And then we've gone from healthcare reform to health insurance reform. And the first time I heard this and picked up on it was in Obama's speech a few weeks ago, and he made that very clear at the very beginning of the speech that this was all about health insurance reform, and now I believe has used that term several times since then. So it has shifted in conception from what might have been a universal health care or health insurance system to regulating the insurance companies more with various kinds of federal regulations. And I think that is where all of the action is going to be as this thing moves forward. And I think it's instructive to look at those eight things that he talks about: the eight consumer protections, and I'll just name a few of them. End discrimination for preexisting conditions, end gender discrimination, end lifetime caps on coverage, extend coverage to young adults, guarantee insurance renewal. All of this sounds good but as I wrote in CJR.org earlier this week, that many of these things are already being done, and the key will be how the lobbyists try to water all this down as it goes through the backroom deal making, which is legislation in this country.

And I'll just give you a couple of examples: one of them says it would end gender discrimination. We all know that women are charged a lot more for health insurance than men, particularly in the individual market, and that's because women do file more claims, and a lot of those claims are pregnancy related, and childbirth and pregnancy cost a lot of money. So insurance companies are really not keen on covering pregnancy. So one thing to look for there is whether the insurance companies will say okay, we're going to end gender discrimination, which they've already said—but will they limit pregnancy coverage in these individual market policies? We've already seen them do that in California. So that is one of the things to watch for. And this other issue about ending discrimination for preexisting conditions. The industry has said they would do that as long as everybody in the country is required to have health insurance, because that makes the risk a little better, if you spread the risk. But what they will manage to do is retain something called age-based rating, which means the older you are, the more you're going to pay, particularly in this individual market, and if you pay more that becomes a proxy for discriminating because you have health problems. Most older people do have one sort of health problem or another, as opposed to younger people, so that does become a proxy for health underwriting. So there are several things like this that I believe will be watered down in the final analysis, leaving open the question, what kind of protection consumers really will have.

CS: I guess we can be hopeful that the media will shine a light on these backroom deals, and as the lobbyists weigh in. We have a little bit of time left and I wanted to ask you, maybe to end on a somewhat hopeful note, are there bright spots in the media coverage of this healthcare debate? Is anyone doing a good job?

TL: Every now and then I do see something really good. A year ago, NPR did a spectacular series on health care in five countries in Europe, and they did really good investigation and showed very clearly that people in those countries—France, Germany, the Netherlands, Switzerland, and the UK—were very, very happy with their coverage, and then they compared and contrasted it with someone in our country who had the same illness and showed the travails of getting care in the U.S. And then just this week, I found another excellent story, and this was in Business Week, and the reporters dug into the lobbying by United Health Care, which is the country's largest insurer. And I think that's very instructive about what kind of behind the scenes activities are going on by the lobbyists, and we should have more of those kind of stories.

CS: We've been speaking with Trudy Lieberman. She directs the Health and Medical Reporting Program in the Graduate School of Journalism at City University of New York. You can read her coverage of the media and healthcare reform at the Columbia Journalism Review's website, CJR.org.

Trudy Lieberman, thanks for joining us this week on CounterSpin!

TL: Thank you very much for having me.

GARY SCHWITZER

CounterSpin: How are network morning news shows doing in covering health issues? And what might that coverage tell us about their ability to cover the larger debate over healthcare reform? A team of University of Minnesota researchers studying the subject say they've found a dangerous pattern.

Gary Schwitzer is a professor of journalism at the University of Minnesota School of Journalism and Mass Communication, a veteran journalist specializing in healthcare issues, and the leader of the research team. He is also the publisher of HealthNewsReview.org, a website that weighs in regularly on healthcare journalism.

Gary Schwitzer, welcome to CounterSpin!

Gary Schwitzer: Well, thanks for having me.

CS: Well, tell us why this review is needed—and tell us, how do you do it?

GS: Well, it's needed because surveys consistently show that so many Americans get so much of their information about the healthcare system, or lack of a system, from news stories. As someone who came up through the ranks of newsroom healthcare journalism, I knew from my career what some of the weaknesses were, but I wanted to document it. You can't manage what you don't measure. I think data speaks very loudly and now after three-plus years of reviewing the work of more than 60 news organizations across the country, and having reviewed more than 840 stories, we have a very clear data-driven picture to hold up to editorial decision makers about what they're doing or what they're not doing to help American healthcare consumers and news consumers. How are these carried out? Well, as I said, we look at 60 leading news organizations, we apply ten standardized criteria to the review of every story, so this isn't just some subjective, off-the-cuff assessment that we like this or we didn't like it. We were really quite rigorous. And it's not just my opinion, there's a team of about 30 folks that we turn to on a rotating basis for these reviews, three different people review each story, so I think it is about as objective and about as pure and rigorous a process as you can have.

CS: Well, zeroing in on the network morning show coverage, before we get down to individual cases, what are the big points you would want listeners to take away from your review of morning show coverage?

GS: Let the buyer beware. If it sounds too good to be true, it probably is. You're probably not going to hear a balanced presentation. You're probably going to hear more about the benefits of a new idea than you will hear about the harms. You'll probably—even in this era of healthcare reform discussion—you're probably not going to hear anything about costs of the terrific new idea being discussed, so we tell, especially lay audiences, that what you're getting is a kid in a candy store view of U.S. healthcare, where day in and day out everything is made to look terrific, risk-free, and without a price tag. And nothing could really be further from the truth.

CS: Well, give us some individual examples. What are the kinds of things you'd see, say on ABC's Good Morning America or one of the other network morning shows?

GS: Yeah, well, what we published recently, which is what caught your attention, was just a very simple little look back at what we've seen so far in 2009 on the ABC, CBS, and NBC morning shows. And, you know, maybe playing to a female demographic there are a terrific number of stories about weight loss and obesity. You know, stories that claim, and these are their terms, not mine, that there's a "silver bullet" for people wanting to drop a few pounds, that there is a "promising new drug" that could impact how to control obesity and diabetes, that there's a "super-shot" for weight loss. There are terms like "remarkable" and "exciting," yet without any data to back this up. There was a story about a young woman who, you know, maybe had a little bit of a bulge in her midriff, a few extra pounds, going in during her lunchtime to get liposuction. You know, I think it's time to ask viewers if that young woman were in your insurance pool, would you want your premiums to go up as a result of that procedure being used and covered by your insurance? But that's just it, we're not having enough of a discussion about how these news stories may be making the healthcare reform discussion impossible. Because they don't talk about evidence, they make everything look terrific, and now suddenly, if we have an evidence-based approach that says, you know, maybe we shouldn't be covering X, Y, or Z, it's going to be very easy for anti-reform forces to step up and say 'oh that's rationing.' No, I'm sorry, it's not rationing. It's a look at the evidence of how do the benefits stack up against the harms, what is this going to cost. We still have 16 percent of our population uninsured. We spend 16 percent of the GDP on healthcare—we don't have the outcomes to show for it, and yet we keep promoting "breakthroughs" and "miracles" and "silver bullets" and "super-shots" on the morning news programs.

CS: Now, the answer to this next question and final question might be obvious to close media watchers, but why does the coverage, why is the coverage like that? Why does it hype procedures and drugs and the latest thing?

GS: Because it's easy. It's easier to do that. It's easier to do that than to dig and then to have to analyze, and it's easier than, unfortunately, applying good, healthy, basic journalistic skepticism. But if that work isn't going to be invested, my stake in the ground is to say that perhaps more harm is being caused than good. And it would be better off for these news organizations not to report health news at all than to do it in the manner they're doing.

CS: Could it also have something to do with the sponsors?

GS: You know, as critical as I am, maybe I'm naive. I'd like to believe that's not the case. I do know that another factor, though, that I haven't discussed is that many news organizations are being asked to do more with less because of tough times in the news economy. But I have very little patience for that. We know that the Detroit automakers are in trouble with their product and their economy, but if you're in the market for a new car, that doesn't mean that you go into a showroom ready to accept a car whose rear axle falls off when you drive out of the showroom. News also is a product; and if the news economy is tough that doesn't mean that consumers should have a lower expectation of the quality of the product.

CS: We've been speaking with Gary Schwitzer, professor of journalism at the University of Minnesota. You can see the ongoing review of morning show health coverage at HealthNewsReview.org.

Gary Schwitzer, thanks again for joining us today on CounterSpin!

GS: Well, thanks for your interest.