Challenges Of Covering Health Care Issues p.

By: Editorial Staff

SEVERAL RAY BRUNER Science Writing Award winners and other selected journalists recently participated in a roundtable discussion on "Challenges of Covering Health Care Issues." The discussion was sponsored by the American Public Health Association and supported by Lederle Laboratories, a division of American Cyanamid Co.
The moderator was Victor Cohn, a former writer and columnist at the Washington Post.
Participants included Susan Brink, U.S. News & World Report; Shari Roan, Los Angeles Times and a 1984 Bruner Award recipient; Ronnie Scheier, American Medical News and a 1981 Bruner Award recipient; Diana Sugg, Sacramento Bee and a 1993 Bruner Award winner; and Howard Wolinsky, Chicago Sun-Times, a 1975 Bruner Award winner.

Cohn: Health reform and the political process have been far afield for some, but by no means all, medical reporters. Are medical reporters now getting into the subject in full swing? Or is it being mainly left to the political reporters?
Brink: I don't know whether political reporters are learning more about medicine, but medical reporters are certainly learning a lot more about politics. In addition to going to hospitals and interviewing doctors, we're sitting in on committee meetings and legislative sessions and talking to politicians.
Roan: There are some stories every year that seem to call for massive planning and coordination and health care reform has been one of them. We've had a master plan, including political reporters, medical reporters and business reporters.
Cohn: A public radio reporter covering one of the White House's promotional events for its health care plan called it a "love fest." Are reporters covering reform being critical enough?
Roan: Reporters are trying to turn over every stone in the process of explaining the health care plan. It's time-consuming. It's a very complex plan. Initially, the coverage was quite optimistic. I think that reflected a general embracing of health care reform by the public as well as the bipartisan cooperation that surrounded the unveiling. But we have to continue to look at the plan very closely. I think we are starting to see more stories that are critical and are more probing than the first reports.
Wolinsky: I think "love fest" describes administration politics. Their goal is to get what they want. The National Public Radio reporter was responding to an assembly-line interview set up on the White House lawn, where they had all these radio talk shows. These radio talk-show hosts were happy to get the attention. They were almost willing victims being used by the White House.
Scheier: It's hardly been a "love fest" at our American Medical Association publication, even though we function editorially independent of the AMA. Though the AMA has put forth a health system reform plan for several years, medicine's inclination hasn't been to readily embrace the health care revolution.
We've focused on elucidating the reform of the health system already under way and bound to proceed, Bill Clinton notwithstanding, such things as the state reform initiative, vertical integration of the medical industry, the corporate experiments. And we're exploring the prospects under reform for patients not adequately served by the current system.
Cohn: We're being wooed by every special interest you can name. Are we lying down before any of these? Are some of them running away with the story, whether they're doctors, the AMA, hospitals, insurers, small business or others?
Sugg: As a new medical reporter, it's been difficult for me to sort out the different motives. For instance, in Sacramento, we have an extremely high population of people in managed care, about 80%. The public complains about the quality of care they are getting: they don't get enough time, they can't be referred to specialists, that sort of thing. On the surface, providers show their concern, but it's directly tied to how much money they make. It's been difficult to sort through these motives and find neutral sources, even in academia.
Brink: I remember talking to Senator Ted Kennedy, who has been in favor of a national health insurance plan for decades. He very honestly said, "The status quo isn't working. But I know politically a single-payer plan is not possible. So, I'm behind Clinton's plan: managed competition."
And I wonder if part of this "love fest" is . . . those of us who have been covering health care and reform efforts may have come to that same conclusion, that something has to be done.
Roan: I've been disappointed in the lack of attention paid to proponents of a single-payer plan. I really feel that discussion did not reach the public and that we really didn't do a good job of talking about other plans on the table before the Clinton plan was unveiled.
Cohn: According to a story in the New York Times, a reading of 10 major daily newspapers shows that news coverage has less on the way decisions might affect people and more on the policy battles, multimillion-dollar price tags and political speculation. Are we telling the stories of people affected by the present system, and are we looking at what might happen to people under different scenarios?
Sugg: My editor and I keep saying to each other, "What is this going to mean to people?" One of the problems I've had is that there are so many new initiatives in California, one where they're trying to push millions of MediCal (the equivalent of Medicaid) patients into managed care. There are a lot of issues, such as, "How are minority patients going to be treated in these big HMOs compared to their treatment in the community clinics they've been going to for years?" There is so much going on that I'm almost turning into the political reporter rather than having the time to go out in the field and talk to patients.
Roan: There's really been an effort to describe how this enormously complex plan will affect people. We did a story looking at the Clinton plan's mental health benefit, and we talked to families who had people suffering mental illness about how they would fare. There's been a real attempt to bring it down to the individual reader. That is definitely what we in the media need to try to do.
Brink: I think the stories about how it's going to affect people are probably the most important. But it's a tough thing for readers. Friends are always telling me that they are just going to wait until a plan emerges, then they'll read the one definitive story that will tell them what it means.
Scheier: For us, possibly the biggest challenge is to draw physician attention to the system's most disadvantaged patients. They're largely cared for by the public health sector, while the vast majority of our readers are private-practice physicians.
Cohn: Are we doing a good job of explaining the complicated language of health care reform?
Wolinsky: Somebody on our staff mentioned a telephone poll where 70% of the people said they didn't really understand the debate. If that's true, then we're doing a pretty lousy job. And the language is complicated. For years, I had problems writing about HMOs, constantly having to explain them. Now we have all these other new terms: health alliances, global budgets.
Scheier: When we initiated market research several years ago, readers told us quite vehemently that they didn't understand the terminology we were using and that, frankly, they were getting indigestion from the alphabet soup. And these are doctors who are fairly sophisticated. If they couldn't keep up, it's got to be more difficult for patients.
We've addressed the problem in a variety of ways, such as redefining key terms using glossary boxes, simplifying our sentence structure, avoiding jargon and making generous use of charts and other visual displays. We also need to include details as we go along about the legislative process, how it works, updates on where the thing is along the way.
Cohn: What health care reform issues should we pay attention to as time passes?
Brink: I was in Oregon covering medicine in the early 1980s. Our human interest writing was not "miracle" oriented but instead examined a compelling case. For example, a six-year-old who was in a drowning accident seven years ago is still in a coma. He's not dead; he's not alive. His care costs a certain amount of money. By combining these kinds of stories with business and economics, we remind people that money is being spent here and not in another place. These examples encourage people to think about priorities without scaring them with the word "rationing."
Roan: As we move forward with reform, we need to look at what is happening and compare it to what was initially proposed. We have to ask, "Will people get the services and get them at the cost and quality that were promised?" One way to do that is to look at the details. Will a mammogram once every three years be adequate for most women? Will 30 psychotherapy visits be adequate to treat a child with attention deficit disorder?
Sugg: I need to look at things such as: What's going on in rural areas? What's the role of nurses, and how might that change in the future? What's going on in medical schools and residencies, and how might that change?
Wolinsky: I would do a story on alternative medicine. No matter what story you're doing, there's an economic and political component to it. If you think about that, you'll probably write about it.
Cohn: I've often been bothered by the fact that some medical reporters, and especially some who mainly cover the economics and politics, seldom and sometimes never see the process itself. They don't go to hospitals, intensive-care units, emergency rooms, clinics or doctors' offices to observe the process itself. When you do that, you hear and see things that often seem very different from the things you read about or hear about in an interview over the telephone. Does this bother anyone else? Can anything be done about it?
Roan: One of my responsibilities as a consumer health writer is to provide the consumer point of view. I try to interview as many real people, such as patients involved in the particular issue, as I do experts. I think something is definitely lost when you can't get on the scene and see things. It certainly makes for the most compelling reading.
Cohn: What do you think are some of the major stories in health and medicine other than health care reform?
Sugg: I think gene therapy is a big thing that we're going to have to look at. It doesn't just get to curing people, it gets to issues of what things we're going to cure and not cure.
Wolinsky: State by state, a closer look should be taken into some of these special interest groups that are lobbying in our state legislatures, the local medical societies or the state medical societies, chiropractors, all the special interests, just to see how involved they are in the political processes.
I'd like to see more done on the drug industry, which may be a villain. I think we should take a greater look at the insurance industry. Let's take a look at the boards of directors of some of these companies, some of the special interests that are interconnecting. I'd like to see more on tobacco.
Roan: I think a more sophisticated look at health and medicine by way of the behavioral sciences will be of great interest. People are seeking a better understanding of why people do what they do and how that affects their health.
Scheier: For physician readers, I'd like to see coverage of how disease perception and health promotion can be incorporated into practice ? something most physicians don't do.
I agree with Howard on tobacco, and I'd like to add environmental health hazards, AIDS and multiple drug-resistant TB. I'd also like to see many stories related to the future of children, where violence again comes into play, as well as teen pregnancy, drug abuse and especially poverty-related health problems that impede school performance and limit future economic opportunities.