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The Politics of Health Care

The Mainstream Media’s Uneven Treatment of U.S. Healthcare System Performance

Published August 17, 2015 9:25 AM by Silas Gossman

[Editor’s Note: this blog was originally written by Ken Perez, vice president of healthcare policy, Omnicell, Inc.]

With the U.S. presidential election campaign season in full swing and a number of polarizing candidates apparently gaining traction among sizable portions of the electorate, the longstanding issue of media bias has arisen once again. One need only watch the two leading cable news networks to wonder if they are covering developments on two different planets!

Media bias certainly exists in the political realm, but is it also at play in the coverage of the financial and clinical performance of the U.S. healthcare system?

In the March 4, 2013 issue of Time, Steven Brill, founder of Court TV and the American Lawyer, delivered a withering critique of America’s healthcare system in an article entitled, “Bitter Pill: How outrageous pricing and egregious profits are destroying our healthcare.” It was the cover article of the issue, and with more than 42,000 words, it was the longest in the history of the magazine. Brill reported, “In the U.S. people spend almost 20% of the gross domestic product on healthcare, compared with about half that in most developed countries. Yet in every measurable way, the results our healthcare system produces are no better and often worse than the outcomes in those countries.” In a subsequent article in the Jan. 19, 2015 issue of Time, Brill went on to describe the U.S. as having “a broken-down jalopy of a healthcare system.”

Brill’s “Bitter Pill” article garnered generous, positive coverage by CBS, the Commonwealth Club, the Huffington Post, the Los Angeles Times, National Public Radio, the New Yorker, the New York Times, and even Jon Stewart’s “The Daily Show.”

But how do the mainstream media cover good news about the U.S. healthcare system?

There is a recent case that answers that question. The July 28, 2015 issue of the Journal of the American Medical Association (JAMA) included an article, “Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013,” that shared the findings of a study of over 68 million Medicare fee-for-service and Medicare Advantage beneficiaries by a team of well-respected medical researchers from Yale and Harvard.

This lengthy, detailed, heavily footnoted and carefully written article reported the following encouraging findings:

-          All-cause mortality for all Medicare beneficiaries decreased from 5.30% in 1999 to 4.45% in 2013

-          The total number of hospitalizations per 100,000 person-years declined from 35,274 to 26,930 (for fee-for-service beneficiaries)

-          Mean inflation-adjusted inpatient expenditures dropped from $3,290 to $2,801

In other words, for the vast majority of American seniors, from 1999 to 2013, the healthcare system saved more lives and did so with fewer hospitalizations and at lower cost — not too shabby for a broken-down jalopy.

The researchers wisely offered a wide variety of possible reasons for these impressive gains, including healthier behaviors (e.g., increases in rates of exercise and decreases in rates of smoking), shifting lifetime exposures (e.g., younger seniors have benefited more from improvements in public health), technological advances (e.g., improved therapies) and other factors. The authors mentioned at the outset national efforts to improve the care of all patients across the study period, citing federal initiatives to improve the quality of healthcare dating from the early 1990s. Like an ocean liner, because of its size and staggering complexity, the U.S. healthcare system requires considerable time for it to change course.

The study’s results do lend support to the belief that the U.S. healthcare system can indeed “bend the cost curve,” even under the frequently criticized fee-for-service model. Interestingly, it should be noted that the biggest drop in the rate of hospitalizations (9%) during the period studied occurred in 2013, the first year of the Hospital Readmissions Reduction Program, which penalizes hospitals for excessive readmissions within 30 days after discharge.

Of course, these gains achieved under the fee-for-service system do not mean that the quality improvement and cost reduction initiatives in Medicare Advantage and Medicare’s accountable care organization programs, respectively, are unneeded — we can and must do better clinically and financially.

So what kind of media coverage has this study with encouraging news received? The last time I checked, while a number of the more serious healthcare industry publications had covered the JAMA article, not a single one of the mainstream media that covered Brill’s article had done so.

So what are we to conclude? Evidently, in the eyes of many mainstream media editors, the improved performance of the nation’s healthcare system doesn’t constitute much of a story and thus doesn’t merit coverage. Such unfair and unbalanced treatment is the bitter pill that good news about the U.S. healthcare system must swallow.    

posted by Silas Gossman


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