The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Health Care Reform 2009 and the Danger of News Cycles

Posted by Alan on July 23, 2009

The campaign for health care reform is making a lot of people nervous. Every day the media is reporting on a crippling blow President Barack Obama’s reform effort has suffered or on the inevitability of passage. It’s like watching an episode of 24 or Lost every episode (or news cycle, as the case may be) a new cliff hanger. The television shows are obviously fictional. The drama of the health care reform debate is, at times, equally manufactured. And even when the situation is real, the situation is neither definitive nor long lasting.

However you get your news, the situation is pretty much the same. Every news cycle there’s some make-or-break event that requires breathless analysis. The reality is not every meeting, vote or comment is of momentous importance. It may be interesting. It may be informative. But it momentous events are few and far between. Which poses a problem for the media because they live or die on excitement.

The reason is that the need of the media to capture attention of a large audience outweighs its sincere desire to educate and/or influence that audience. The news media is a business. Like all businesses (even non-profits) it must generate revenue. For the media this means selling advertisements.  Most reporters and pundits have a want to educate and inform. Some seek merely to entertain or inflame. All of them, however, have a need to bring an audience to their advertisers. This means the stories they put forward need to excite their audiences enough so they can be exposed to the advertising that creates the revenue the media owners expect. (In this admittedly cynical view, the reporters and pundits are the equivalent of the brokers – it all begins with a sale).

In-depth stories examining the subtleties of a complicated issue like health care reform are not very exciting to a broad audience. Further, most reporters and pundits lack the expertise to examine the subtleties of health care reform. That’s not a put down as it’s not their fault. They need to be generalists and understanding health care requires specialized knowledge. Even those who truly understand the intricacies of the issue face a serious problem, especially on television: the need to break for commercials every few minutes. It’s tough to maintain a narrative when your presentation is constantly being interrupted to sell cars, prescription drugs or cleansers.

What does excite people is conflict. Which is why the media loves a good fight. Conflict requires good guys and bad guys, winners and losers. So instead of exploring the nuances of how a health insurance exchange might work (or what challenges it may face) or how the governments Medicare and Medicaid reimbursement policies increases the cost of private health insurance, the press focuses on the political maneuvering of the day. Broad statements by lawmakers go unchallenged because there’s simply not enough time (or expertise ) to challenge them. Instead, the best sound bites of the day are played and discussed in an echo chamber designed to amplify any conflict – or to create conflict where none exists.

I don’t blame the press. They have a job to do and, as I mentioned, most have a sincere desire to inform their audience as much as is possible given the restraints of their business. I do feel sorry for their audience. They can’t help but perceive the health care reform debate as a pitched battle between the forces of Light and Darkness with ultimate victory or defeat at risk each day. In short, they are exposed on a regular basis to a heightened version of reality intended to cause enough fear, relief, frustration, and elation to keep them paying attention through the commercials.

So, for example, President Barack Obama wanted each chamber of Congress to pass a bill so the two versions of reforms could be reconciled into a single bill and voted upon in the Fall. The Senate will not meet this deadline (the House probably won’t either, but they may). For the media this is great. Everyone understands due dates. Congress missed theirs so health care reform is in deep trouble and the President lost a major political battle.

Well, not quite. There’s still plenty of time to complete health care reform this year. And while the President may have missed a deadline, at the end of the day he will be judged by whether the status quo endures or not. It’s like owning stock. The price of the stock you own may change every day, but the only thing that matters is the price on the day you sell it. But the media can’t let this be known so every day’s stock price is of paramount importance..

Another example: three Congressional Committees have moved health care reform bills forward (an important milestone). Two Congressional Committees are still refining their proposals. Which ones are the most important? Given the hyperbole and attention showered on the versions that have already made it through a committee you’d be forgiven for assuming it’s the former. The odds are, however, that what emerges from the Senate Finance Committee and the House Energy and Commerce Committee are going to more closely reflect the final legislative package than anything already voted upon. The reason is that these committees are seeking to gain the support of moderates (both Democrats and Republicans) and those moderates are critical for passage.

Consider: Democrats have 60 votes in the Senate, but 18 of those are moderates. Without the support of at least eight of those moderates nothing passes in the Senate. (And this assumes only 50 votes will be needed. If 60 votes are required to move health care reform legislation through the Senate, which is more likely, then every one of those moderates needs to be brought on board).

In the House, Democrats will soon hold a 257-178 member majority (there’s one vacancy, so there are only 256 Democrats in the House today). It takes 218 votes to pass anything through the House. Without Republican support, the House Leadership can only afford to lose 39 members of their caucus. The moderate Blue Dog Coalition has at least 52 members. Do the math.

What all this means is that we have yet to see the two most meaningful health care reform bills yet. Which makes much of what’s being reported lately exciting, but ultimately, not as important as the media would have us believe. The day-to-day tumult is not what matters. Health care reform will be determined by the forces and dynamics that are not easy to explain. And they certainly don’t fit within commercials.


4 Responses to “Health Care Reform 2009 and the Danger of News Cycles”

  1. How do you afford health insurance? You get a good health insurance broker who works free of charge in the client’s behalf. I work with groups and individuals. Tomorrow I have a presentation to make to a group of 35 employees. I always present 3 options with varying degrees of benefits and costs in order to meet all types of family budgets. My goal is to provide a coverage solution for everyone.

    In group plan platforms, you have employee, employee + spouse, and employee + children. I haven a few families who have 1 child but yet on the group platform, they still get a family rate which is expensive to cover for just one child. What do I do? I offer them an individual option so that they can cover the child with the same benefits for about $60 a month instead of having to pay an extra $200 for the family rate under the group. This is what Health Insurance Brokers do for their clients. They seek to provide smart cost saving alternative solutions so that people can afford health insurance.

    We have a competitive marketplace, we have the solutions and we have licensed professional health insurance brokers that provide the best link to the public for cost saving decisions towards purchasing health insurance. If the health insurance exchange system replaces the broker’s wisdom then we are in a heap of trouble.

  2. Nosedoc said

    Because I am an ear, nose & throat specialist, last night’s unscripted aside by the President regarding the treatment of tonsillitis told me that he doesn’t have the slightest idea about how medicine is practiced, and where financial incentives and disincentives exist. Here’s the link:

    First of all, pediatricians don’t remove tonsils, ENT specialists do. The incentive to the pediatrician is to have that child return to his/her office with every sore throat, rather than to refer the patient to an ENT specialist. In fact, it is in the financial interest of the ENT doc to see that patient repeatedly in the office (at say $70-85 per visit) as well. An in-network tonsillectomy generally pays in the range of $250-350 for a one hour operation that has a 90-day global period (i.e., routine postop care is included for 3 months), and carries with it the risk of middle of the night postoperative bleeding in need of emergent attention. To me, if President Obama is so obviously ignorant about the cost-effectiveness of tonsillectomy for recurrent acute tonsillitis, and then be foolish enough to talk out of his back side about it, why should I or anyone else have any faith that this man is qualified to make sweeping changes in the health care system in an excessively rapid fashion?

    • Paul said

      Nosedoc, Now a days we are so busy trying to discredit anyone that supports healthcare reform we are missing the big picture. Do you agree we need to do something about this issue or is the system fine the way it is? What is your solution if you think there is a problem with our current system? How about we stop the hostility and arrogant bias attitudes and try to work together to solve the problem or would it be easier to just let people die that cannot afford expensive medical insurance to solve the problem.

      • Nosedoc said

        I believe, as do all of my colleagues, that we are working in a very complicated and very broken system. I further assert that there was nothing biased or arrogant about my post. I think most of the arrogance on this matter is coming from the President, Rahm Emmanuel, Katherine Sebelius and Nancy Pelosi. Most everyone else has their eyes and ears open on this issue, and is looking, as I am, to be involved in a process that will address the pathologies in our system in an orderly and pragmatic manner. As this wonderful blog has repeatedly stated, we need to get health care reform done right, not quickly. Our goal is to produce a health care system that provides the highest quality health care to all Americans while remaining fiscally sound, i.e., sustainable. Given that our only business model on which to base the public “option” is Medicare, and that Medicare is currently on course to be insolvent in 2017 or so, I think we have plenty of cause for concern about the areas in which the cost savings are to be obtained and what the economic fallout of this plan will be for the American public. Last night, the President said nothing to indicate any specifics on the 1000-or-so page plans currently before the House and Senate, and what he did say didn’t make any sense. I am not willing to follow President Obama or anyone else on blind faith, and neither should you, Paul.

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