Want to understand why American healthcare costs are so high? It has something to do with the fact that while everyone’s in favor of saving some taxpayer cash in theory, no one welcomes that budget adjustment or regulatory tweak in their own backyard. And when interest groups are fighting off rule changes that threaten their slice of the health spending pie, it doesn’t hurt that they can count on getting their message out there in the press. While some journalists have set their sights on the factors that keep prices high across the system, media coverage of particular regulatory battles tends to follow a familiar template: The squeaky wheel—that is, the special interest group who’s complaining loudest—gets the lead.
Both of these patterns, the political response and the media coverage of the response, have been on display following Medicare’s latest attempt to save some cash—upwards of a billion dollars over a five-year period, according to the federal Centers for Medicare & Medicaid Services (CMS), which administers the program—through various changes to Medicare Advantage and the Part D prescription drug benefit. From the start, coverage has been framed around opposition from key industry “stakeholders”—drug companies; pharmacies; pharmacy benefit managers; health plans; disease advocacy groups, which are often funded by Big Pharma; and the politicians who’ve listened to their pleas. An alternative frame—how the rules aim to address the high price of American healthcare and other problems—gets relegated to the bottom of the stories.
Reporters shouldn’t just accept the agency’s reasoning at face value, of course, and organized opposition to beat back a rule change is news. But given that controlling “entitlement” spending has been high on the political agenda for years now, and that the president’s new budget proposal asks for higher contributions from senior citizens to help shore up Medicare’s finances, a plan that aims to cut drug prices should get a full hearing—and the motives of the groups opposing it should draw scrutiny, too.
So far, that hasn’t really happened here. The first substantial coverage of the proposed rule change, from The Associated Press on Jan. 10, the day the proposal was published in the Federal Register, began:
WASHINGTON (AP) — In a move that some fear could compromise care for Medicare recipients, the Obama administration is proposing to remove special protections that guarantee seniors access to a wide selection of three types of prescription drugs.
Advocates for patients are sharply criticizing the idea, but the Medicare prescription benefit’s first administrator says greater availability of generic drugs nowadays may allow for some protections to be safely eased.
Scary! The main rationales for the change, cost savings and curbs on improper prescriptions, don’t even get mentioned until the sixth graf. That’s followed by a long discussion of criticisms by patient advocacy groups, a few grafs outlining the thinking of CMS, and a kicker from an industry analyst who raises patient-protection concerns again. Not mentioned at all: drug industry support for the National Alliance on Mental Illness and the National Kidney Foundation, the two patient advocacy groups quoted in the article.
In late February and early March, the opposition kicked up a notch. Members of Congress and a broad range of stakeholders started sending letters to CMS, and Jonathan Blum, an official at the center, was
Reporters who want to dig deeper into this story might look at Carey’s story and sidebar as a starting point. In the same vein, here is a brief summary of what Medicare has proposed and what the dispute is about: