A 2005 survey by the Kaiser Family Foundation found that twice as many people rely on the media for information about health care as rely on doctors or friends or family combined. In 2007, with health care a major issue in the presidential campaign, people will lean on the press even more. Covering the complexities of the health-care debate is not easy. How can journalists make them clear? For the first in a series of Q&As with accomplished journalists on the main domestic issues of the campaign, CJR spoke to Julie Rovner, who covers health policy for National Public Radio. She was interviewed by Trudy Lieberman, who directs the health and medicine reporting program at the City University of New York’s graduate school of journalism, and is a longtime contributing editor to CJR.
How do you contrast the public discussion of health care as we approach the 2008 election with the discussion in 1992?
During this last year, I’ve been walking around saying, “Wow. It’s 1991!” So much of it feels the same. You’ve got businesses complaining about health-care costs and a worried middle class. On the other hand, I think the big difference is this sort of cynical “been there, done that, didn’t work” feeling that wasn’t there in 1991. And the numbers have gotten so much bigger. We’ve gotten so many more zeros. The costs have gone up that much more. The number of uninsured has gone up that much more. The number of solutions we’ve tried and that have failed has gone up that much more.
Is the public less likely to be swayed by commercials, such as the famous “Harry and Louise” ads, which helped derail the Clinton health-care plan in 1993?
I don’t think they’re less susceptible. People don’t understand the health-care system, and I think that’s one of journalism’s big challenges.
Is the public likely to be influenced by the mantra that the U.S. has the best health-care system in the world? How should journalists put that phrase in perspective?
Every candidate is going to say it. To some extent, it’s true. There are a lot of things that the United States leads the world in—developing new technologies and treatments and drugs. And there are a lot of things that the United States lags behind in, like life expectancy, infant mortality, the number of uninsured people, and access to quality-of-care measures.
Is the public ready to embrace cost-containment, as the Canadians, Germans, and French have?
No. That’s what I’m sort of looking at—when I’m watching these presidential candidates, one of the things I’m trying to measure is which of them is actually ready to suggest that people might have to make sacrifices. I don’t see that yet. Right now they can all rattle off the easy answers: we’re going to improve information technology and we’re going to have electronic health records, and they’re going to save money. We all know the buzzwords, and they all know the buzzwords—their talking points. You need to drill down below that.
What do we really mean by the word “reform” in health care?
At NPR we’re not supposed to use the word “reform.” Reform is actually a word that has subjective meaning, and therefore, we really shouldn’t use it. Our Washington editor tries to ban it and fails most of the time. We don’t tend to reform things. We do tend to make smaller changes.
Candidates have already begun to use phrases like “No European-style rationing.” How should journalists put that in context?
Any health economist will point out that we in the U.S. currently ration health care, on the basis of economics. If you have insurance, you get more care than if you don’t. If you have money, you get more care than if you don’t. We ration care. We simply ration it economically, rather than by queuing. You don’t have to go very far to find someone to say that.
Are we beginning to have queuing? A recent story from Orlando told of women unable to get mammograms, particularly diagnostic mammograms. There are not enough services. Is that not queuing?
Yes. There are also geographic disparities. We are starting to get queuing because there are starting to be shortages. There are places where it’s difficult even for people with insurance to get primary-care doctors. People with insurance wait months now to get appointments, to see specialists, to get mammograms. We’re getting to the point where we have the worst of both worlds.