‘Main Street’ informed, skeptical on health reform
In her blog on CJR.org, AHCJ Immediate Past President Trudy Lieberman updates what is becoming an annual franchise: Her summer man-on-the-street column gauging popular opinion on health reform. Just like last year, Lieberman found her subjects on the streets of Columbia, Mo., a town that’s about as close to the (population) center of the United States as you can get.
The common thread? Missourians were pretty sure health care reform wasn’t all it was cracked up to be, but still weren’t willing to vote “yes” in the state’s referendum on opting out of the individual mandate.
Lieberman added a concrete dimension to her main street opinions by prying details on income and expenses from her sources, numbers and ideas which she then used to link their stories to the larger themes surrounding reform implementation.
Keep an eye out for part two of the column, which should be coming soon.
Article looks at evidence behind back surgery
Filed under: Conflicts of interest, Health care reform, Hot Health Headline
In the Star Tribune, Janet Moore seeks to counter aggressive spinal surgery with equally aggressive journalism. It’s a comprehensive take on a subject which journalists have been hammering away at piecemeal for some time now. Her anecdotes are strong, and her numbers doubly so. For example:
Photo by planetc1 via Flickr
Four out of five Americans will suffer from disabling back pain during their lifetimes, according to the National Institutes of Health. Spending on back care soared between 1997 and 2005, reaching $86 billion — just shy of what Americans spent battling cancer.
As those numbers have multiplied, so have questions about the more aggressive forms of back treatment. A 2008 study in the Journal of the American Medical Association, for example, noted that the increase in back-care spending occurred “without evidence of corresponding improvement” in patients’ health.
As Moore points out, this is a debate that will continue as health reform is implemented because the new legislation will “require doctors and hospitals to demonstrate that their services are cost-effective. In that vein, the New England HealthCare Institute estimates the United States could save roughly $1 billion a year by eliminating unnecessary back surgeries.”
Minnesota is home to Medtronic, a leading maker of devices used in spinal surgery. Medtronic has consultation arrangements with a number of doctors and some experts question whether that relationship has an effect on how many spinal surgeries are done. The head of the Association for Ethics in Spine Surgery, says these financial incentives create demand for certain brands of product.
It’s a lengthy piece, and the numbers are just one component. The whole package is definitely worth a read.
Related
How reform will affect America, group by group
Filed under: Health care reform, Health policy, Hot Health Headline, Studies
In Health Affairs (AHCJ members get free access), economist Joseph Newhouse considers how health care reform will affect four major groups. They’re summarized below.
- Uninsured or on Medicaid or CHIP (30 percent)
- Insured individually or through a small business (10 percent)
- Insured through a mid-size or large business (45 percent)
- Recipient of Medicare (15 percent)
Medicaid expansion and broader subsidies are “major gains.”
This group will undergo the most change, with the individual mandate expanding their ranks to as much as 50 million people (16 percent of Americans). Health reform should “repair” this now-broken sector of the market.
A wash, as an insurance tax is balanced out by a reduced need to cover uncompensated care for the uninsured.
Complicated. The doughnut hole will close, but future financing sources are murky. Newhouse goes pretty deep into just how murky.
His conclusion is relatively upbeat. Newhouse writes that while reform “addressed many issues in health care financing, it left many others unresolved.” The system will need to be revised and updated throughout the foreseeable future, Newhouse writes, and effective implementation will “require persistence for many years to come.”
New rules affect patients’ insurance appeals
Filed under: Health care reform, Health policy, Hot Health Headline
Kaiser Health News’ Phil Galewitz and Michelle Andrews have an update on health care reform implementation, pointing out that new rules will give consumers the right to appeal insurance denials, first directly to the insurer and then to review boards. The rule doesn’t break new ground in most states – only five lack such regulations, and existing plans are “grandfathered in” under the old rules – but it may bring order to a chaotic national patchwork on insurance appeals. The White House estimates that, by next year, the rules will benefit about 41 million Americans insured either through employers or through individual plans. The administration is pushing states to implement the new standards by next July.
The new regulations take effect for plan years starting Sept. 23. But they won’t automatically apply to residents in states that have existing external review laws until next July. That’s to give states time to adjust to the new standards.
If states fail to change their rules by next July, their residents will then be able to rely on the federal standards. But federal officials are still working out the details of how that would be done.
Read the HHS press release here.
AHCJ resources
- Reporting on health reform between now and 2014: Some top Washington, D.C.-based journalists discussed implementation deadlines, how to tie local issues to reform, Medicare reimbursement rates, what reporters should look for in their states and more. A recording and transcript of this briefing and a resource list are available.
- Covering high-risk insurance pools: The federal government and states are scrambling to create temporary high-risk pools for the medically uninsurable, as one of the first provisions of the Patient Protection and Affordable Care Act to go into effect. Apart from being a policy story, it’s of great interest to all your readers, viewers or listeners who have pre-existing conditions and are struggling to find coverage. Four reporters covering the topic have shared their story tips, suggestions and resources for AHCJ members.
- Health care reform has passed: What’s next? Four journalists on the front lines offer their advice and suggestions on what needs to be covered next, how it might affect local communities and how to approach this complex topic.
PEJ: Reform coverage centered on politics
Filed under: Government, Health care reform, Health journalism
Six basic facts about how the media handled coverage of health care reform have been distilled from a study of more than 5,500 health care stories in the mainstream media from June 2009 through March 2010.
A new report from the Pew Research Center’s Project for Excellence in Journalism finds that coverage was dominated by the politics of the debate and there was far less coverage of how the health care system works. Some other findings:
First, health care coverage followed a roller coaster trajectory, spiking dramatically at times and plunging at other points. And the media platforms best suited for ideological debate proved to be especially interested in the subject—particularly the liberal talk media. In the war of words over health care, however, the opposition seems to have prevailed, as their terms and ideas showed up far more often than the key ideas of supporters of the Democrats’ reform plans. The media also seemed to focus far more on the politics and the passions that drove the debate than the health care system it was trying to reform.
Finally, President Obama’s presence as a key figure in health care coverage vacillated markedly over the 10 months studied, lending credence to the idea that he did, at times, lose control of the narrative.
The report’s conclusion tells us that, in the heat of the battle, when politics became most partisan, the media focused on those aspects rather than the system. It points out that while some outlets did good work, “the public seemed consistently confused by the health care debate and had a difficult time sorting out fact from fiction.”
Blame aggressive treatment, tech for rising costs
Wholesome, clean-living and thrifty, Provo, Utah, has always been a Dartmouth Atlas darling. But in recent years, health costs in Provo – like those in similarly cheap markets nationwide – have risen faster than in the rest of the country. Kaiser Health News’ Jordan Rau takes a deeper look at the Utah college town in an effort to figure out why, despite recent efforts to bring everybody else down to Provo’s cost level, Provo seems to instead be climbing up to join its costlier cousins.
Provo, Utah (Photo by jpstanley via Flickr)
In Provo, the costs seem to come down to a few interlocking factors which should already be familiar to anyone who has investigated health care costs in the past. They include advancing technology and more aggressive treatment, all driven by an increase in the number of hospitals and clinics competing in the area. It’s a combination that’s looking increasing irresistible.
To some, it’s inevitable low cost areas such as Provo will catch up to their more expensive peers as a greater proportion of medical spending goes toward expensive machines and nursing salaries, which are rising, says Greg Poulson, senior vice president at Intermountain. Aggressive marketing of the latest technology also is making it more likely that patients everywhere are demanding the same novel treatments, even ones that aren’t proven to work better, Poulson says.
#AHCJ2010 early coverage roundup
Filed under: Government, Health care reform, Health journalism, Health policy, Hot Health Headline, Member news
Apart from the announcement of the FDA’s infusion pump regulation push, the biggest appearances out of Health Journalism 2010 in Chicago this week have been U.S. Department of of Health and Human Services Secretary Kathleen Sebelius and Thomas Frieden, director of the Centers for Disease Control and Prevention.
Landon Hall, of The Orange County Register, covered the Sebelius and Frieden appearances for AHCJ.
At Health Journalism 2010, Kathleen Sebelius talked about implementing health care reform. (Photo: Pia Christensen)Reuters’ Debra Sherman also covered both presentations.
Sebelius focused on insurers, especially those who deny coverage to those with a legal write to it, Sherman wrote. According to Sherman, “Sebelius… said to expect ‘hand-to-hand combat’ if insurers try to ‘drive patients out of plans.’”
Working from a broader perspective, New America Foundation’s Joanne Kenen wrote about how insurance fit into Sebelius’ larger task of implementing recently passed health care reform measures.
In his presentation, Frieden focused on smoking, which he called the leading preventable cause of death. Reuter’s Sherman again:
Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said that after years of steady declines in the nation’s smoking rates, progress has stalled over the last few years and that the agency was renewing its focus.
He said government stimulus funds would be used to increase anti-smoking efforts. He said the CDC would encourage states to implement anti-smoking strategies, such as education and media campaigns, smoke-free laws and higher cigarette prices.
In other AHCJ 2010 news, Dallas Morning News reporter Robert Garrett wrote that a “siege mentality was very much on display when a trio of hospital executives spoke this morning at an Association of Health Care Journalists conflab in Chicago.”
“We’re all scared to death by health care reform,” said Advocate Health Care president and CEO Jim Skogsbergh, who runs 13 hospitals in Illinois. “We know we’re going to get paid less.”
Oregonian re-injects meaning into reform clichés
Filed under: Health care reform, Hot Health Headline
The Oregonian’s Joe Rojas-Burke clearly has a keen eye for that special place at which jargon and cliché intersect, and his nifty health care glossary cuts right through it all to explain those terms like “bending the curve” and “diagnostic yield” that we’ve all heard so many times that they’ve lost whatever meaning, if any, that they originally had. Each definition reads like a mini-column, complete with links and context, that explains why these words and phrases are actually important.
Photo by Beverly & Pack via Flickr.Rojas-Burke tackles plenty of sophisticated concepts (scroll down to surrogate endpoint), but my favorite entry is one that goes back to basics and elegantly explains a fundamental dilemma behind rising health care costs.
Healthy — Medical technology is blurring the distinction between healthy and sick, as illustrated by a study in which 1,192 healthy women and men had their entire body scanned by X-ray computed tomography, or CT. Abnormalities showed up in 1,030 of them, nearly 90 percent, and doctors advised 37 percent of the patients to get further tests. An essayist writing in the Journal of the American Medical Association hit the nail on the head: “A colleague of mine recently asked a resident how he would define a well person. With no hesitation, the resident replied that a well person was merely someone who had not been thoroughly worked up.”
Cohn’s reform-minded blog comes to an end
Filed under: Health care reform, Health journalism
The New Republic’s Jonathan Cohn, an AHCJ member, announced Monday that he’s closing up shop at The Treatment, the “crusading” pro-health-care-reform blog he’s run since 2006. Cohn will keep blogging and writing for the magazine, but seems ready to close the reform chapter of his health care reporting and hang a big “mission accomplished” banner across the widely read blog.
Cohn used the occasion of this semi-farewell to reflect on the course journalism has taken during the reform debate, and to contrast it with prior experiences, most pointedly Clinton’s push for health care reform and his own magazine’s notorious role in the debate. In particular, Cohn considers the changes brought on by “new online media” and bloggers like himself and The Washington Post’s Ezra Klein, with whom Cohn says he collaborated as much as he competed.
In addition to The New York Times and CNN, there was the Huffington Post and Talking Points Memo. The change didn’t fully register with me until the night the House passed the Senate health care bill, clearing reform for presidential signature. Sitting up in the House media gallery, next to Politico’s Carrie Budoff Brown, I looked around at my colleagues—and realized how few of them would have been there last time around.
Was this a change for the better? I’m biased, obviously, but with some important caveats I think the answer is “yes.” We (i.e., the new online media) could generally channel policy expertise more quickly. And we could, in some cases, dispense with conventions of even-handedness—conventions that cynics had long ago learned to exploit for their own purposes.
Writing for CJR.org, AHCJ Immediate Past President Trudy Lieberman praised Cohn’s blog, but took the opportunity to remind journalists that, while a reform bill may have passed, that doesn’t mean there aren’t myriad issues related to its implementation that will need intense coverage and scrutiny in the coming years. She also talked to Cohn and found that he isn’t leaving the game entirely.
Cohn told me that when health reform was the political story of the day, the magazine “could afford to let me write on that subject exclusively and dedicate an entire blog to it. Now that it’s no longer topic A, it makes sense for me to write about some other things.” He said he will be doing just that. While the magazine is officially retiring The Treatment as a blog exclusively devoted to health care, Cohn and The New Republic are talking about creating a new blog that will include health care coverage.
Lieberman: Pollack wrong, reform coverage lacking
Filed under: Health care reform, Health journalism
Last week, Harold Pollack (bio), a University of Chicago professor who has been contributing to The New Republic’s The Treatment blog, recently referred to health care reform reporting as “the most careful, most thorough, and most effective reporting of any major story, ever.”
AHCJ Immediate Past President Trudy Lieberman took issue with that in a post on CJR.org.
Better coverage than the Vietnam War; the civil rights movement; the consumer movement? Really? In the case of the civil rights struggle, the press helped change the discourse; Americans began to view race in a new way, which led to the eventual passage of the Civil Rights Act. During the Vietnam War, the media effectively changed the public dialogue from a war we couldn’t lose to one we could not win. In the early days of the consumer movement, media coverage of Ralph Nader led Congress to enact significant consumer protections. Coverage of health reform has hardly risen to that level.
Lieberman writes that health care reform coverage failed because the public was inadequately educated on the finer points of reform efforts. Her evidence? That public opinion was roughly split on reform. Had reporting been better, Lieberman writes, public support levels would have been higher. She then brings up a number of issues she says were undercovered and uses examples to back them up.
For advice from Lieberman and three other journalists on the front lines on what needs to be covered next and how to approach this complex topic, see this special tip sheet.
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
