Personal Health

[Part Two] Empty Talk Express: The Problems with McCain's Health Care Plan

McCain touts his health plan as a boon for consumers. But real-world data shows that buying health care is not the same as buying an iPod.
This is the second entry in a series examining John McCain's health proposals and how they have been covered in the press. Read Part I here.

The sound bite you hear most often from John McCain about his health care proposals is that he wants to put families in charge of medical decision making. In "Straight Talk on Health System Reform -- 'A Call to Action'", a document published on his Web site, McCain says "the key to health care reform is to restore control to the patients themselves." At first glance, it's hard to argue with that premise, and so the sound bite sounds good. It plays well in Peoria, as Richard Nixon's operatives used to say. But what's under the hood here? If putting patients in charge is the cornerstone of McCain's health initiatives, shouldn't the media have been evaluating his premise?

The truth is they've been MIA on this one. There's been virtually no examination of what McCain means by his lofty sound bite, and how that sound bite squares with reality. He has used it to imply that government bureaucrats should not be in charge of health care, forgetting that managed care organizations now make many decisions about what treatments people get and who gives them. Last April, when he announced his health care plan, stories like the one in USA Today's On Politics blog quoted him saying: "My approach to transforming health care is to put families in charge." Since then, the topic has scarcely surfaced, giving more credence to McCain's Great Escape from press scrutiny.

One story that did appear comes from the Cybercast News Service (, an online news service whose parent organization is the Media Research Center, which specializes in media criticism with a right wing point of view. The Center's chairman, L. Brent Bozell, has long been active in conservative Republican politics. The news service's Web site says that is "an effort to provide an alternative news source that would cover stories that are subject to the bias of omission and report on other news subject to bias by commission." Its mission is also "to fairly present all legitimate sides of a story and debunk popular, albeit incorrect myths about cultural and policy issues."

Of course, what's legitimate to the Center may not seem that way to another observer. But a recent news service story, headlined "McCain: Health Care Choice for People," gave a pretty fair nuts-and-bolts description of the highlights of McCain's proposal, and even included comments from a spokesperson from "the liberal Center for American Progress Action Fund." The end of the story featured a familiar McRefrain: "families should be in charge of their health care dollars and have more control of care." The kicker amplified the point, noting that McCain would use competition to improve the quality of health insurance and impart greater variety to better match people's needs.

The story's last few paragraphs provided a perfect opportunity for to make the connection between family decision-making practices and the consumer health information business -- a mushrooming industry searching for keys to the kingdom of health care consumerism. The story, like all the others that mentioned McCain's emphasis on family decision-making, didn't make the link. Too bad -- a very good story lies therein.

If health care competition is to work, shoppers need information -- good information that will help them pick an insurance policy, doctor, hospital, or whatever. Then, there must be an incentive for shoppers to act on this information, instead of just sticking with their default options. Finally, the theory must work in practice -- prices go down and quality goes up because people choose the best options for them. But real-world data indicates that buying health care may not be the same as buying an iPod, and that the empty talk about putting families in charge of their health care decisions may be just that -- empty talk.

A few weeks ago, reported on a poll done late last year by the California Health Care Foundation, a health care philanthropic organization based in Oakland. The poll showed that, although 80 percent of adult Californians use the Internet to find health information, only 22 percent looked at sites that rated physicians -- and only 2 percent changed doctors based on the information displayed on those sites. The numbers were similar for online ratings of hospitals and health plans: about 25 percent of those surveyed looked at ratings, with only 1 percent making a change.

The survey didn't try to explain why the numbers are so low. It may be that people are more comfortable making these decisions based on word-of-mouth recommendations; perhaps they are just plain confused by the number of sites and don't know whom to trust. The federal Agency for Health Care Research and Quality (AHRQ) found twelve rating schemes for physicians, twenty-six for medical groups, eighty-one for hospitals, and eighty-six for health plans -- numbers daunting for even the savviest consumer. They raise the question whether such data can ever influence family decision making in health care.

A study I did a few years ago, also with the California Health Care Foundation, offers another cautionary tale about McCain's focus on competition in health insurance. We rated Medicare HMOs in California and found that one health plan offered a terrific drug benefit. Later reports we did showed that the plan no longer provided its great drug coverage. What it now offered was the same mediocre benefit its competition was selling. Being wise consumers, seniors chose the plan with the best drug coverage, but too many people with high drug needs and costs blew the plan's bottom line, so it simply reduced coverage. In insurance jargon, the health plan was "selected against," and it adjusted its policies accordingly. Some enterprising journalists need to tell us how McCain's call for competition in health insurance will deal with that.
Trudy Lieberman directs the health and medical reporting program in the graduate school of journalism at City University of New York, and is a longtime contributing editor to Columbia Journalism Review.
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Election 2018