An election post-mortem on Medicare coverage

Coverage? Yes. Guidance? Not so much

In mid-August, when Paul Ryan burst on the scene with his voucher scheme for Medicare, the 47-year old program suddenly became hot news. Until then, the media had paid scant attention to Medicare, except in the fall when they served up some “how-to” stories for choosing new Medicare Advantage plans. This time it was different. Ryan’s plans for transforming Medicare from social insurance into a private system thrust Medicare policy into sharp focus, for the public and the press.

On the political side, it looked like Medicare might be a winning issue for the Democrats for a while. Their pollsters advised them to talk about it. NPR even reported that the GOP was taking a “risk that Ryan may turn off an important voting bloc: senior citizens.” Indeed, polls showed that seniors didn’t like the idea of vouchers, a theme we picked up in our CJR Town Halls. One Missouri woman told us that Ryan “wants to do away with what we know Medicare to be. I’m not in favor of it at all.”

But then came October. A few days before the election, a Reuters /Ipsos poll discovered that voters over age 50 continued to prefer Mitt Romney, and liked his position on healthcare and Medicare better than Obama’s. Voters 65 and older “leaned heavily toward Romney throughout the campaign,” reported Politico, while The Hill concluded that Medicare, “once seen as the most potent weapon in House Democrats’ campaign arsenal, is turning out to be a dud.”

Which is fine, if the public fully understands the issues. But it is not clear at all that it did, or that the press helped.

Did the media muddy the public’s thinking about the program? Drew Altman, head of the Kaiser Family Foundation, answered that question with another question: Is the point of media coverage “to cover, inform, or educate?” Altman’s frame offers a useful X-ray for examining how the press performed and how, in the coming weeks, it might perform as Medicare (and its cousin, Medicaid) gets snarled in the coming debate over the fiscal cliff.

The press did cover the two central issues swirling around Medicare throughout the campaign—the idea of a voucher plan, supported by Romney and Ryan, and the question of whose plan really cut Medicare. Did Obama cut $716 billion from the program, as the GOP charged day after day? Or would Republicans cut it with their voucher arrangement, which would make beneficiaries pay some $6,000 more each year for their healthcare instead of the federal government picking up the tab, according to a study by the Congressional Budget Office.

Many press stories addressed those two claims. But they did so from a position so close that you couldn’t see the forest for the trees. Nobody seemed to step back and say what Medicare is, who gets it and how it works. Nobody explained that it is social insurance—one giant risk pool, in which everybody gets the same benefits—in which an 86-year old with heart and hip problems generally pays the same as a 66-year old brimming with health.

Reporting on Medicare has been different from Social Security coverage, which, as we wrote in April has been shaped by the elite media, which in turn has often climbed on board the train with deficit hawks, who are hawks are eager to cut the program in the name of fiscal austerity. When it came to Medicare, there was no organization like the Peter G. Peterson Foundation and others that Peterson or his foundation funded to spread his austerity message far and wide, and try to bring the press and policymakers along.

With Medicare, the media seemed freer to examine competing claims.Yet they tended to do that in their customary “balanced” fashion, with lots of he said/she said quotes, which often confused audiences more than it informed. When it came to vouchers, the media readily paired representatives of the Heritage Foundation—which introduced the press to the concept in the mid-1990s, and pushed hard for vouchers at the time—with spokespeople for groups that were more skeptical, thus fulfilling their goal of balance and equivalency, although sometimes a false equivalency.

In the end, seniors didn’t know who was really saving, cutting, slowing the growth, or strengthening Medicare. Many took comfort in the Romney refrain, “My plan makes no change whatsoever for seniors. None. Zero. Zip,” which was semi-true for current seniors, but dodged the fact that he would dramatically alter Medicare a few years down the road, which could indeed harm current seniors as the years went on, if many people chose to opt into a private plan, sending Medicare into a “death spiral.”

The result of this “balance” were stories like those we critiqued at the end of July, when Obama gave a talk in Florida about vouchers and Romney quickly followed up in a radio interview contradicting the president. We reported that New York Times coverage of the Florida visit gave readers dueling quotes from the candidates, plus a lot of filler that “added nothing to people’s understanding of the Medicare issue.” There were too many stories like that one.

On the “$716 billion cut” to Medicare—Romney’s charge—the press did inform the public but failed to educate it. As we and many others have written; The Affordable Care Act did reduce government payments to healthcare providers—mostly to hospitals, the result of a bargain between the hospitals and the administration. And it did cut the fat out of payments to Medicare Advantage plans that policy experts agreed wasted taxpayer dollars. Over time these cuts also may well cause some plans to eliminate some benefit frills, like gym memberships. But the ACA did not cut hospital and medical benefits, the guts of Medicare coverage. The cuts, according to the administration, were meant to slow the growth in Medicare spending and preserve the life of Medicare’s hospital trust fund. Beneficiaries did not comprehend that. Instead, they worried that they would not get medical care. The specter of rationing and death panels appeared once again, resurrected by health providers anxious about their incomes. Romney himself raised the issue in the first debate, claiming that 50 percent of doctors say they won’t take any more Medicare patients because of the Obama cut. To us, the figure sounded absurdly high, but the notion lived on.

Nuanced and lengthy pronouncements from the fact-checkers may also have muddied the waters, because their own evaluations of the claims were muddy. When PolitiFact rated a Ryan claim that Obama was really raiding Medicare as “mostly false,” and then rated the claim by a group opposing Medicare saying that Medicare ‘cuts’ in the healthcare law will hurt seniors as “barely true”—and later “mostly false”, when PolitiFact changed its naming scheme, what are seniors to think?

“The truth squads played right into the agenda of opponents of Medicare,” says Altman. “When you do that, you respond to the agenda set by politicians and they are very artful about it.” The challenge, he says, is to think about what needs to be covered and not just to check this fact or that.

In other words, did their coverage educate? Bonnie Burns, a policy specialist with California Health Advocates says, “no.” Medicare seniors, she said, still have no clue what Medicare Advantage plans are, even if they have one. Despite the zillions of words written about these plans, Burns says, many seniors still don’t understand that it is private insurance they have, not traditional Medicare, and insurance companies can do what they want when it comes to hiking rates and dropping coverage.

It’s not totally fair to blame the press for failing to educate voters about Medicare and the choices the candidates presented about the program. Politicians themselves share some of the blame. They have not done a good job explaining what Medicare is, and is not. Democrats never made the case that sometimes the government can do things better than the private market, says Nancy Altman, co-director of the advocacy group Social Security Works. Republicans never were pushed to make a case that the reverse is true when it comes for insurance for the elderly.

In September, WNYC, a New York public radio station, along with the Rutgers-Eagleton Poll, conducted a poll to see what New Jersey voters thought of healthcare. When voters were asked whom they trusted more in matters related to health insurance, 44 percent chose the private market; 35 percent said the government. But when they asked voters if they wanted to continue with the current government-provided Medicare system or move to a voucher plan, 69 percent preferred Medicare, with only 25 percent choosing the voucher system. Voters under 30 expressed similar preferences.

“Oh, how we are conflicted about healthcare,” WNYC’s premier talker, Brian Lehrer, told his listeners.

Indeed we are, and therein lies a tall task for the media—to dive into the education part of the beat, as implementation of healthcare reform and the fiscal cliff loom ahead.

Related stories:

Medicare and the $716 billion “cut”

Medicare: Paul Ryan and beyond

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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: , , , ,