‘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.
Reform may worsen ER crowding
Filed under: Health care reform, Health data, Health journalism, Health policy, Hospitals, Hot Health Headline, Member news, Studies
Associated Press medical reporter Carla K. Johnson has found that, contrary to common assumptions, emergency rooms could become even more crowded with the passage and implementation of health care reform. Popular wisdom has it that, with more access to insurance thus to primary care, folks will be less likely to go to the emergency room for minor complaints or to allow illness to progress to the point where an emergency visit is necessary. Johnson, an AHCJ board member, gives three big reasons why it’s not that simple:
- There are not (will not) be enough primary care physicians in America to deliver that preventative care.
- At present, the uninsured are no more likely to use the ER than patients with insurance coverage.
- “The biggest users of emergency rooms by far are Medicaid recipients,” Johnson writes. “And the new health insurance law will increase their ranks by about 16 million.”
ERs are crowded, Johnson writes, not only because of a lack of insurance but also because of obstacles inherent in their structure and mission, such as an aging population, more people with chronic illnesses, the closures of many ERs in the 1990s and the demand for beds for both emergency patients and patients scheduled for elective surgeries that bring more money.
AHCJ Immediate Past President Trudy Lieberman praised Johnson’s story and linked it to reporting by The Boston Globe on the impact of that state’s reform law upon emergency room use. So far, events in Massachusetts reinforce Johnson’s predictions.
The Boston Globe revisited Massachusetts’s ER conundrum last week, and reported pretty much what it did last year—that despite the state’s reform law, which mandated everyone have coverage beginning in July 2007, emergency room use is rising. Last year, the state’s Division of Health Care Finance and Policy cautioned that it was too early to draw any conclusions from the seven percent rise in ER visits between 2005 and 2007. Now the agency is saying that expanded coverage may be one reason for the 9 percent rise from 2004 to 2008. According to commissioner David Morales, many studies have shown that expanding coverage does not reduce emergency room visits. That’s because the uninsured “are not really responsible for significant ER use,” he told the Globe.
House nixes COBRA help, opens “jungle”
Filed under: Health care reform, Hot Health Headline
On Prepared Patient Forum, AHCJ Immediate Past President Trudy Lieberman examined the fallout of the Friday House vote to toss a proposed extension of COBRA subsidies through the end of the year. The Senate has yet to vote on the extension, which Lieberman says would cost about $8 billion.
The up-to-65-percent subsidy had already been extended four times since it first passes in 2009. Lieberman says that without this latest extension all the unemployed Americans who have been relying on COBRA will be forced to wade into what she called the “insurance market jungle” to get quotes on the unsubsidized market. Lieberman even did a bit of bushwhacking of her own, wading into the online insurance market to see just what consumers are up against.
Deconstructing a NYT op-ed in three acts
On April 17, New York Times‘ op-ed columnist Thomas Friedman wrote a column about globalization, international competition and entrepreneurship. Here, as anyone who has even held a newspaper with his column in it will know, he’s on all too familiar territory. It’s not until he steps over into uncritical praise of a medical device maker that Friedman starts stepping on land mines.
He profiles EndoStim, a company working on an implant to treat acid reflux. Friedman admits that he has “no idea if the product will succeed in the marketplace,” then the cheerleading begins.
EndoStim was inspired by Cuban and Indian immigrants to America and funded by St. Louis venture capitalists. Its prototype is being manufactured in Uruguay, with the help of Israeli engineers and constant feedback from doctors in India and Chile. Oh, and the C.E.O. is a South African, who was educated at the Sorbonne, but lives in Missouri and California, and his head office is basically a BlackBerry. While rescuing General Motors will save some old jobs, only by spawning thousands of EndoStims — thousands — will we generate the kind of good new jobs to keep raising our standard of living.
Journalist Merrill Goozner, of GoozNews fame, picked up on the story the next day and asked the world “Why Is Tom Friedman Championing Higher Health Care Costs?” Goozner effortlessly chronicles the marketing-driven history of acid reflux treatments, from Pepto-Bismol to Zantac to Prilosec to Nexium, each conveniently emerging as the patent to their predecessor expired, then puts EndoStim in its place at the end of the chain.
… instead of finally being out from beneath the wasted billions now being spent on brand name acid indigestion pills like Nexium, the health care system will be lined up to move onto the next chapter in the lengthening medical text for treating what for most people is a relatively minor and passing phenomenon.
In his final paragraph, Goozner gets to the heart of what Friedman’s vision of “thousands of EndoStims” really means for the U.S. economy.
Friedman is right. Endostim’s success will create “the best jobs - top management, marketing, design” at company headquarters. But let’s not forget that to create those jobs, the entire society through its collective health care system will have to pay an unnecessary tax, which burdens every other industry and shifts scarce societal resources away from potentially more useful activities.
Finally, Trudy Lieberman, AHCJ immediate past president, catches Goozner’s post and wades into the fray in her own column on cjr.org, writing that Friedman’s column was “essentially a puff piece for EndoStim.” Lieberman ties Goozner’s observations on EndoStim into his previous writings as well as her own, writing “there’s nothing in the new law that limits the use of the device only to patients with chronic disease who don’t respond to other, less costly treatments.”
I can see hospitals advertising: “Hey acid reflux sufferers come to us. Our surgeons know how to get that thing down your gut. They are the best in the world, and by the way, insurance will pay.”
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.
Lieberman to cover health care as CFAH fellow
Trudy Lieberman, contributing editor/columnist for Columbia Journalism Review, has been appointed a fellow at the Center for Advancing Health. Lieberman, AHCJ’s immediate past president, will contribute content to The Prepared Patient Forum, a Web site that will be launched next month to help consumers navigate the increasingly complex health care system.
Lieberman
Lieberman will focus on the topic of paying for health care, including Medicare, Medicaid, CHIP, commercial insurance policies, and other private sector ways to pay for care. She will follow the implementation of health insurance reform activities and help people learn how to use and benefit from options created by the newly passed legislation.
Lieberman will continue her CJR duties, which include blogging about journalism coverage of health issues. She was most recently director of the health and medical reporting program at the Graduate School of Journalism, City University of New York.
The Center for Advancing Health runs the Health Behavior News Service, intended to “translate complex scientific evidence into information that will ensure that each person can make good decisions about their health care.” CFAH is a independent nonprofit organization supported by a number of foundations.
Are insurers to blame for rising costs?
The San Francisco Chronicle’s Carolyn Lochhead and Victoria Colliver use the recent furor over insurer Anthem’s rate hikes to explore just how much of the blame for rising health care costs should be shouldered by insurers. The reporters find that, in the end, insurers are just another one of the cartels (others include device makers and providers) and operate inside the opaque world of medical pricing and snag hefty cuts for themselves. Lochead and Colliver put it thus:
While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.
Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.
The reporters write that, despite their best efforts, they weren’t able to get many folks on the record. When they did find someone who was willing to talk, it was often a source we’ve seen before in other cost stories. It’s a tough theme to get quotes on, as nobody wants to burn bridges with their professional suppliers and everybody’s got some sort of skin in the game. They did, however, manage to find a local source who offered an original and illuminating anecdote:
Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.
“But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200,” Bernstein said. “It’s ridiculous. There’s no open competition.”
(Hat tip to AHCJ Immediate Past President Trudy Lieberman, who wrote a column on CJR.org praising the Chronicle’s story.)
Lieberman: Media bought into heart docs’ fight
Filed under: Health care reform, Health journalism, Hot Health Headline
Using one-sided sentences published by newspapers nationwide as evidence, AHCJ Immediate Past President Trudy Lieberman takes her media peers to task on CJR.com for blindly advancing the agenda of the American College of Cardiology in their push against Medicare reimbursement cuts.
The ACC aggressively fought what Lieberman describes as “a new Medicare rule, which took effect January 1, that cut projected total revenues for cardiologists by 13 percent on average over four years while increasing the revenue of internists, family doctors, and general practitioners.” Lieberman writes that the rule change will effectively put more money toward much-needed primary care specializations and that it was widely mischaracterized in the press, thanks to ACC’s machinations. Lieberman:
… for the most part (news articles) passed along the cardiologists’ complaints, threats, and warnings without any hint that there was another side to the story. Between the slanted newspaper articles and audio news releases from the ACC, millions of Americans learned that the incomes of heart doctors, which can be upwards of $400,000, could take a hit.
Lieberman: Joe’s looking out for folks at home
Sen. Joe Lieberman (I-Conn.) has been a vocal burr in the saddle of the Democrat majority’s push for health care reform. Writing for CJR.org, Trudy Lieberman seeks to explain why Joe Lieberman has so vigorously opposed measures like the “public option” and the long-term care CLASS Act. Trudy Lieberman says the senator’s position would seem to have something to do with his constituent base.
Independent Sen. Joe Lieberman at the 2008 Republican National Convention. Photo by NewsHour via Flickr.
Joe Lieberman comes from Connecticut, and Hartford is America’s insurance capital. It’s home base to Aetna, one of the country’s largest health insurers and a huge lobbying force this year, not to mention some lesser carriers that dabble in the health insurance business.
Trudy then goes down Lieberman’s reform stances issue-by-issue, pointing out exactly how vested interests in his constituency could have influenced each one.
There certainly seems to be some data to back Trudy Lieberman’s insights. OpenSecrets.org shows that the “Finance, Insurance & Real Estate” sector has been the largest donor to the senator.
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
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