On the Health Policy Beat

With the Boston Globe’s Kay Lazar

As we head into a new presidential campaign with health care likely to be one of the defining issues, Campaign Desk thought it a good idea to talk to some health beat reporters who try to bring the story home to people in their communities. This new series will feature journalists who translate the political story into kitchen table terms while tossing other kinds of health reporting into their mix.

A couple months ago the RAND Corp. released one of the most important health policy studies to show up in a very long time. Using a large sample of more than 800,000 medical claims, the study demonstrated that high deductible health plans, which are seen by many experts as the way to control health care costs, deter people from getting medical treatment, even preventive care. The press missed the story big time. But not Boston Globe reporter Kay Lazar. As soon as the press release showed up on her computer, she was on the phone to RAND asking to talk to one of the researchers. “I hadn’t seen a whole lot of studies that measured the impact on real consumers,” she told me.

Since most of the policies sold through the Massachusetts Health Connector, the state’s insurance exchange, carry high deductibles, she wanted to know what the study meant for the state. The number of residents with these policies had nearly doubled, from about 50,000 people in 2009 to about 93,000 last year. “To me the story was a no-brainer,” she recalled. Still, she wondered if she if she had overblown the story since others didn’t pick it up: “Am I out of touch for not following the pack?” Clearly not. Her story connected with readers; plenty of them called to talk about their high-deductible insurance.

Lazar came to health reporting late in her career. Now age fifty-three, she has been at the Globe seven years after having worked at the Boston Herald, the Asbury Park Press, and the Philadelphia Inquirer. Until she was thirty-five, Lazar was a broadcast journo working as a writer/producer at CBS and ABC. At the Globe, she started covering municipalities, but found herself gravitating to health stories, which she thought were cool, like the one she wrote about hospitals trying to accommodate the needs of their patients who were immigrants. When the Globe’s health writer left, she got the job, and began climbing what she calls a “steep learning curve.”

“I wanted to inject more humanity into the beat,” she said. “I wanted to know how health policy was working for people.” One of her early pieces was about dental care for residents newly insured under the Massachusetts health reform law. “It has intrigued me that dental health is not considered health.”

Lazar seems to have learned quickly. Earlier this year, the Association of Health Care Journalists honored Lazar for beat reporting. One story her editors submitted described the overuse of anti-psychotic drugs in nursing homes; another revealed shortcomings of the Massachusetts reform law. Many residents were buying the required insurance only when they were sick and needed it, which meant higher premiums for everyone else. The state has now ended that practice.

Lazar is an old-fashioned reporter, using old-fashioned techniques that may seem quaint to newbie journos today. But to those schooled in the old ways, these techniques work, often producing stories that are far ahead of the pack. Sometimes Lazar sits in on meetings of the Health Connector board and attends insurance regulatory hearings to sniff out stories and understand how the state’s insurance law works. Last year she was the only reporter to attend a public hearing that Gov. Deval Patrick had called to find out why health insurance rate hikes were disproportionately hitting small businesses, a big problem in the state. She discovered that executives from the state’s largest hospitals were no-shows. To be exact, only two of the seventeen invited to testify had bothered to come. That made a dandy story a reporter could get only by observing that Boston hospital bigwigs were MIA.

“I get a lot of education at those meetings,” she told me. “They are great even if they don’t produce a story for the next day. They give an explanation of the bigger picture and they help you save string.” She’s not much into data, the currency of the realm for journalists today. The Globe, however, has been hammering the Centers for Medicare and Medicaid pretty hard for not releasing data on the use of antipsychotic drugs in nursing homes. Lazar doesn’t do much number crunching herself, and her work shows that you don’t always need zillions of databases to tell a good story.

Her beat includes health and aging, and stories about aging are a particular hit with her audience. Whether readers are looking for the press to tell them there really is a fountain of youth is hard to say, but Lazar told me “any time I write about anti-aging products, I hear from a lot of people.” Anything about Alzheimer’s disease, new research, and regulations about quality of care in nursing facilities or places where older people live are popular. One constraint of the section where aging stories appear is that they be focused more on consumers rather than the science of aging.

Stories about the affordability of health insurance and health care also resonate. That’s hardly surprising in a state whose insurance reforms became the template for federal reform. “When you can do a story that accurately and simply reflects what’s going on, it really touches a nerve,” she said.

How do you make an insurance story simple and interesting? “Honestly, I struggle all the time,” Lazar admitted. “I’ll talk to colleagues and explain it to them. If they look confused and their eyes glaze over, I know I haven’t gotten it yet. Just write the story as if you’re sitting around the bar talking.” More advice, I asked. Start writing the lede and the first graph in an e-mail. “Sometimes that gets you over the log jam.” Don’t be sheepish about asking for more explanations about how things work, and if you don’t understand keep asking. “Try not to get stuck in the weeds with jargon,” Lazar advised. “Get them to explain things in plain English. This is really a challenge.”

Covering Massachusetts health reform is not always easy, especially when public officials don’t want to talk. We talked about that problem, which all journalists have encountered, and specifically about getting information from the Health Connector. “There’s that tension and that’s not surprising,” she said, noting that good reporters try to find ways around government officials who stonewall. That’s a point that’s too often forgotten. Lazar says that she has learned that checking facts with government sources, though, can sometimes save you from making mistakes. That, too, seems old-fashioned in today’s hurried world of getting stuff up or out so fast the facts don’t always matter. Occasionally she e-mails sections of a story to an official at the Connector, asking him to check her facts. “He has saved me from some big mistakes,” she said.

What’s one health topic Lazar hasn’t tackled much “Medicare,” she answered without hesitating. “Every time I do a Medicare story my knees tremble.” Covering Medicare falls into a gray area, Lazar noted. Is it a Washington story or a local story? Sometimes news organizations are not so sure. All this points to the need for local reporters to pay more attention to Medicare. Campaign Desk hopes that Lazar will find the subject a little less daunting and create new ways to cover Medicare, leading the way for others on the beat.

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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. Tags: , , , , ,