Could the Media Derail Health Care Reform?
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This article originally appeared on Health Beat.
By now you've probably heard the calls for speedy action on health care reform during the Obama administration's first 100 days. Some prominent observers even say that the president-elect should get the ball rolling during "his first days in office."
The possibility of imminent health care reform is certainly exciting, but a word of caution: just because some of us might be ready for health care reform doesn't mean that the media are ready to cover it properly. And that could have important implications for how reform plays out.
Right now, health care reform is an abstract goal that everyone wants -- excitement and anticipation are high. But as the substantive process of health care reform gets under way, two things will happen: first, ideas will be crafted into policies -- concrete plans of action and complex administrative measures, and second, politicians will become involved in the reform process. Policy can get pretty complicated; so the public will rely on the media to help it navigate the ins and outs of the issue. Once politics begins to shape policy discussions -- that is, once politicians enter the picture -- it's all the more important to keep the focus on policy, because it's at this point that policies have a real chance of being implemented. Americans should know their options.
Style Over Substance
Unfortunately, reporters aren't health care policy experts. In fact, they rarely ever talk about the issue. In a December report, the Kaiser Family Foundation found that, out of 3,513 health news stories in newspapers, on TV and radio, and online between January 2007 and June 2008, health care policy made up less than 1 percent of news stories and just 27.4 percent of health-focused stories. Instead of talking about issues like coverage, prescription-drug care, costs or public programs, the media prefer to report on specific diseases and conditions (cancer, diabetes, obesity and heart disease) and potential epidemics (contaminated food and water, vaccines, binge drinking). Together, these two topics made up 72.6 percent of health coverage.
This is less than ideal. When Congress begins to talk about health reform in earnest, the important news that will affect all of us will be about policy and institutional changes. The media need to be good at covering this stuff -- yet as the Kaiser report shows, newscasters, reporters and editors have very little experience (or interest) in discussing such issues. Worse, history shows that when health care reform efforts are actually under way, the media ignore policy in favor of more sensational stories.
During President Bill Clinton's efforts at health care reform in the 1990s, for example, media reports disproportionately focused on politics rather than policy. In their 1998 book Politics, Power, and Policymaking: The Case of Health Care Reform in the 1990s, Missouri State University professors Mark Rushefsky and Kant Patel found that that in 1993 and 1994 -- the height of public debate over Clinton's plan -- the New York Times reported just 257 stories about policy considerations (proposed reforms and solutions, analyses of options) and a whopping 549 on politics (personalities, disagreement, partisanship). When the nation's health care system was at stake, spats received more coverage than substance.
More bad news: When policy was in fact being changed, the media were nowhere to be found because this process wasn't politically dramatic. In 1995 and 1996, at the behest of Clinton, Congress actually passed incremental health care reform. These changes included a limitation on insurers' ability to exclude patients on the grounds of existing conditions and greater protections for HMO patients. But because these reforms didn't involve public name-calling and proceeded through conventional legislative processes, the media all but ignored them. Rushefsky and Patel found that in 1993-94, major TV networks did a total of 583 stories on health care in their evening broadcasts; in 1995-96, this number dropped to a mere 93. The Times also reported 284 fewer health care stories during this period than it did in 1993-94, when conservatives were at the Clintons' throats over "HillaryCare" (a term that perfectly exemplifies how letting personalities trump policy can derail reform). When progress was actually being made, the media were nowhere to be found. Real change was, in the words of Rushefsksy and Patel, too "dry and lengthy."
See more stories tagged with: media, health, obama, health care, health care reform, health policy
Niko Karvounis is a program officer with the Century Foundation in New York City, where he works on issues of socioeconomic inequality and health care. He is a regular contributor to Health Beat, the Foundation’s health care blog.
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