CS: It’s been a big political issue in Britain lately. Essentially two things came together. There’s the fact that a lot of social care is underfunded and lots of people didn’t like that, and the fact that many people would find that if they had to go to a nursing home, they have to sell their home. What they wanted to pass onto their heirs would be gone very quickly. That kind of thing causes political waves in Britain.
TL: What happens in the US is that if a person goes to a nursing home, the spouse remains in the home. But after he or she dies, the home is fair game for Medicaid in something called “estate recovery.” Medicaid can come in and sell the house and use the proceeds to defray the costs of the owner’s nursing home stay that the state paid for.
CS: That’s interesting.
TL: That’s not very well known in the US, and you don’t hear many people talking about it. It’s a shame, really. We’re focused on bad nursing homes and have been for four decades now. So the stories you see—and some are legitimate stories—are about poor care given in nursing homes, and there’s a lot of it. But you don’t see a lot of reporting on the financial side of long-term care, and there should be.
Press coverage
TL: As we wrap up, let’s talk some about press coverage—especially about coverage of your reforms and ours.
CS: I think a lot of debate in Britain over our new health reforms was driven—sometimes for good, sometimes for bad—by the press coverage that the reforms got, and by the government’s presentations about reform. At first the government spun them as being a big, bold, radical proposal revolutionizing the NHS. In fact, they could have been easily spun as a cautious, evolutionary change from the approach being pursued by labor. Both are probably fair descriptions. They chose to sell it as a radical one and they very much later regretted that.
People didn’t want radical change in the NHS. The government hadn’t really talked about it before the election, so people were very suspicious and mistrusted the conservatives. That was a theme of a lot of press coverage.
TL: I covered the Affordable Care Act from the beginning, and constantly urged the media to explain what this act was all about, and that never happened. The lack of coverage partly explains why the Act is so unpopular today. People really didn’t know much about the individual mandate. It was never explained, nor was the issue of whether the subsidies people will get to buy coverage will be adequate. It’s a huge question—a very important political question, but it’s not being discussed.
CS: Do you blame the Obama administration for not finding the language or words or ability to sell that, or was it something to do with the media?
TL: It was both. The administration did not really articulate what they were doing, why they were doing it, and why it was necessary to have this kind of system. A lot of people thought we were getting something different—actually a national health system like you have. The Democrats said they had to pass a bill so people can find out what’s in it. That kind of tells you where they were at in terms of communicating what they had done.
The nature of the US media, to some extent, is to follow what the politicians are saying. So if the politicians are not explaining it, then they’re not explaining it either. There was a whole lot of education of the press done by liberal advocacy groups, which was helping to shape what was getting in the media. But they were not interested in talking much about the individual mandate either.
CS: I have a similar problem. It’s hard to look into a competing set of claims about what will happen in the future. You can’t go out and independently verify them because they haven’t happened yet. So how do you work out which one you give priority to?
TL: You really can’t. There’s a willingness on the part of the press to accept what they’re told, without weighing claims and seeing if one claim is more meritorious than another. We have this cult of balance, and it’s a problem.
In the US, you need to remember one thing; what was passed was basically a Republican plan. The ideas had been in the academic literature for years, and they were ideas Republicans would be totally comfortable with. But instead, the Republicans have run against their own plan, so to speak. And when the press fell down on the job of bringing the people along, it made it easy for Republicans to move on this strategy.
Amen to that. The lack of real, probing reporting on the health care act is a serious failure in the MSM. The fact that the enabling legislation effectively prevents the IRS from collecting the tax imposed when someone refuses to buy health insurance is almost totally ignored. There is no attempt to either explain this or to assess the potential impact on the costs of the program. If I were still an editor, I'd be angry if a reporter submitted to me the sort of lazy, "balanced" junk I regularly read in the press about the act.
#1 Posted by Tom Barry, CJR on Wed 10 Oct 2012 at 10:29 AM
Hope to hear more about this surprising info about how NICE advocates for rather than denies good care:
CS: It’s important to note that what NICE has done is make it more likely someone will get treatment, because you will often find a treatment NICE has approved that is in fact not given locally because of these rationing decisions by local health boards. They might say it’s too expensive, we don’t have the money here. But the fact that NICE exists and has said this is a cost-effective treatment means that people can say well, no, hang on a second. I should be getting that because it’s NICE-approved and therefore you should be giving it to me. It has given people the power to demand treatment that NICE has approved.
But NICE is not the same as IPAB (right?). And IPAB is the current focus for "death panel" fear mongering? Does IPAB have potential to evolve like NICE?
It's possible that most Americans know the most about European health care through through British TV & film---we might know the British system better than the others. I have wondered if Doc Martin is good or bad advertising for universal care, particularly because it focuses on a surgeon reluctantly practicing primary care and the doctor's office looks old and run down. But just recently William & Mary and Call the Midwife portray very engaging struggles to deliver care by very passionate, caring, and competent health professionals---who are not MDs. So we get mixed glimpses of British care---but very little about other countries. We probably have no other view of the French system than the death of Diana and in Michael Moore's Sicko. MM covered Canada but elsewhere very little about it. International Mystery on MHZ shows a little bit about some others, mostly Sweden but occasionally Germany, some Italian. So other than TV & film, we have few opportunities to learn (accurately or inaccurately) about other health systems.
Good info presented here. Hope to see/hear more about it.
#2 Posted by MB, CJR on Thu 11 Oct 2012 at 01:09 PM