It’s easy now for the coverage of health care to slip into the tried and true—horse race accounts of who’s up or down in the government’s health care pecking order; stories that quote officials using the press to send signals to other officials; profiles of movers and shakers and wannabe movers and shakers. But the real stories of why reform is necessary still need telling, and the Philadelphia Inquirer, in a throwback to its glory days, has been running a series that shows why too many people get lost in America’s dysfunctional health system. For months, we at CJR have been urging the press to talk about real people and how candidates’ proposals would affect them. In other words, move away from all the wonk talk. That’s just what the Inky has done.
So far there have been nine stories detailing what happens to plain, everyday people who get sick. There is the home care worker whose wages are so low she can afford neither insurance nor her own medical care when she is ill. There is the transplant patient who ran out of coverage to pay for anti-rejection drugs because Medicare stopped paying for them. When that happened, she cut down on the dosage for the medicine she still had, taking a chance with her life. There is the forty-one-year-old man who suffers from Hodgkin’s lymphoma and eventually lost his job because the cancer treatments made him so ill he could not work. When he lost his job, he lost his income and his insurance. Medical bills mounted. There is the sixty-two-year-old man who used too many bad drugs early in life, and has had lots of health problems as a result. His employer dropped him from the small group policy because his ailments were raising the cost of premiums for other employees.
The series shows that the American health care system works well for those who are insured, never get sick, and never use their coverage. But once someone falls outside those parameters, it’s Patient Beware. Running through all these stories are several threads—the discontinuity of care, the inequity inherent in the system, the callousness of health care providers, the capitalist objectives of American medical care. In Monday’s installment, readers learned that the sixty-two-year-old man who lost his insurance struggled to get care for a broken arm and was told “you can’t come here” when he called a private medical practice that works with self-paying patients. He didn’t have the $600 that the practice required for the consultation. A woman with a huge pelvic tumor got the medical runaround. The paper said she went to the emergency room, where she was referred to a city clinic and back to a state welfare office and then sent her home. She had no insurance.
The stories are structured as a narrative about the people involved and what happened to them. There’s not a lot of explanation about the whys and wherefores. That’s good, because it keeps the stories moving and keeps readers’ attention, which we all know is in short supply these days—although in a few spots more explanation might have helped. Science and health editor Karl Stark says that the “talking head commentary” has been moved online. “The aim is to humanize, not bludgeon with analysis,” Stark said. Apparently, readers in Philly are reading. There were 46,000 web hits for one story and people are calling wanting to tell their own stories. The paper has tapped a raw nerve among the electorate. Call this citizen journalism, if you will. The paper may tell fifteen to twenty-five stories before concluding the series.
The trick, however, will be to put those twenty-five people inside the various health reform ideas that will be bandied about in the coming year. How will those people fare under a vision of reform advanced by the insurance companies, the American Medical Association, the hospitals, the pols, and others who think they have the secret sauce for a revamped system? Will each of those profiled by the Inquirer be helped by reform, or will they still fall through the cracks? Those stories have been lacking in the coverage so far, and we challenge the Inquirer to move its series to another level of reporting when the real debate begins.Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.