Healthcare

Measuring Healthcare

Date: March 29, 2010
Author: Bob Griendling
Categories: CNN, Healthcare, Polls

As I reported last week, the level of displeasure over the recently passed healthcare reform legislation is often overstated.  The impetus for that post was the CNN/Opinion Research poll of last week.

There’s another CNN/OR poll this week.  Here again is a key data point.

"Thinking about the health care bill that Congress passed this week, which of the following statements best describes your view of what Congress should do in the future? Congress should leave the bill as it is. Congress should make additional changes to increase the government’s involvement in the nation’s health care system. Congress should repeal most of the major provisions in that bill and replace them with a completely different set of proposals." Options rotated

Leave as is……………………………….23%

Increase govt. involvement…..27%

Repeal and replace………………..47%

Unsure……………………………………..3%

So 50% like it or want more govt. involvement.

Another question:

"Which of the following statements best describes your views about the health care bill that Congress passed this week? You approve of the bill becoming law and have no reservations about it. You approve of the bill becoming law but you think it did not go far enough. You disapprove of the bill becoming law but you support a few of its proposals. You disapprove of the bill becoming law and oppose all of its proposals."

Approve, no reservations………………….15%

Didn’t go far enough………………………….27%

Disapprove, but support some of it….31%

Oppose all of it……………………………………25%

Unsure………………………………………………….1%

So 74% like at least some of the reform.

Here’s the way the CNN’s polling director interprets the poll.

The 47 percent who favor "repeal and replace" is significantly lower than the 56 percent who say they disapprove of the bill’s passage last week.

"That’s because opposition to the new law comes in many different forms and not all of them benefit the GOP," says CNN Polling Director Keating Holland. "Some Americans continue to say that they disapprove of the bill because they want even more government involvement in health care than the bill created. Only a quarter are against the entire bill; one in three support at least a few proposals in the new law. [Emphasis added] And a handful of Americans appear to dislike the bill but don’t want Congress to spend any more time on health care."

When will the press get it?

Cross posted on Commonwealth Commonsense.

The Power of Three

Date: March 29, 2010
Author: Bob Griendling
Categories: Healthcare, Protests, Right-wing echo chamber, Washington Post

The Washington Post covered a protest over the weekend outside the home of Rep. Steve Driehaus (D-Ohio). 

They showed up to decry the freshman congressman’s vote for the overhaul, standing in the chilling rain most of the afternoon Sunday holding signs that read: "Driehaus Voted to Destroy Our Children’s Future" and "Remember in November."

How big a story is this?

Sunday’s gathering, which never included more than three people at a time [Emphasis added], was anchored by Jim Berns, a libertarian who has run for Driehaus’s seat three times and for the state legislature 10 times. He wore a suit and waved at the congressman’s neighbors — a couple of whom greeted him with a middle finger, others with a thumbs-up.

What do you think the likelihood is of The Post covering a three-person protest in favor of healthcare?

Asleep at the Printing Press

Date: March 26, 2010
Author: Bob Griendling
Categories: Healthcare, Washington Post

While The Washington Post—and most other major papers—were writing stories about the to and fro comments, slanders, strategizing and complaining of the politicians considering healthcare, it missed something.

Whenever a newspaper uses the term “little noticed” in a story after a piece of legislation was passed, it’s a tacit admission that it didn’t do a very good job of informing its readers.

A little-noticed provision of the health legislation has rescued federal support for a controversial form of sex education: teaching youths to remain virgins until marriage.

The legislation restores $250 million over five years for states to sponsor programs aimed at preventing pregnancy and sexually transmitted diseases by focusing exclusively on encouraging children and adolescents to avoid sex. The funding provides at least a partial reprieve for the approach, which faced losing all federal support under President Obama’s first two budgets.

Not everyone is thrilled.

"To spend a quarter-billion dollars on abstinence-only-until-marriage programs that have already been proven to fail is reckless and irresponsible," said James Wagoner of Advocates for Youth, a Washington group. "When on top of that you add the fact that this puts the health and lives of young people at risk, this becomes outrageous."

During President George W. Bush’s administration, abstinence programs received more than $100 million a year directly in federal funding and about $50 million each year in federal money funneled through the states. But the effort came under mounting criticism when independent evaluations concluded that the approach was ineffective and evidence began to emerge that the long decline in teen pregnancies was reversing.

This should be embarrassing—for The Post.

Healthcare Without the Pols

Date: March 24, 2010
Author: Bob Griendling
Categories: Good idea, Healthcare, NY Times

Here’s how to write a story about healthcare.  No quotes from politicians.  No anecdotes to prove a point.  Just useful facts.

For all the political and economic uncertainties about health reform, at least one thing seems clear: The bill that President Obama signed on Tuesday is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.

…The bill is the most sweeping piece of federal legislation since Medicare was passed in 1965. It aims to smooth out one of the roughest edges in American society — the inability of many people to afford medical care after they lose a job or get sick. And it would do so in large measure by taxing the rich.

A big chunk of the money to pay for the bill comes from lifting payroll taxes on households making more than $250,000. On average, the annual tax bill for households making more than $1 million a year will rise by $46,000 in 2013, according to the Tax Policy Center, a Washington research group. Another major piece of financing would cut Medicare subsidies for private insurers, ultimately affecting their executives and shareholders.

The benefits, meanwhile, flow mostly to households making less than four times the poverty level — $88,200 for a family of four people. Those without insurance in this group will become eligible to receive subsidies or to join Medicaid. (Many of the poor are already covered by Medicaid.) Insurance costs are also likely to drop for higher-income workers at small companies.

Finally, the bill will also reduce a different kind of inequality. In the broadest sense, insurance is meant to spread the costs of an individual’s misfortune — illness, death, fire, flood — across society. Since the late 1970s, though, the share of Americans with health insurance has shrunk. As a result, the gap between the economic well-being of the sick and the healthy has been growing, at virtually every level of the income distribution.

The health reform bill will reverse that trend. By 2019, 95 percent of people are projected to be covered, up from 85 percent today (and about 90 percent in the late 1970s). Even affluent families ineligible for subsidies will benefit if they lose their insurance, by being able to buy a plan that can no longer charge more for pre-existing conditions. In effect, healthy families will be picking up most of the bill — and their insurance will be somewhat more expensive than it otherwise would have been.

…Since 1980, median real household income has risen less than 15 percent. The only period of strong middle-class income growth during this time came in the mid- and late 1990s, which by coincidence was also the one time when taxes on the affluent were rising.

For most of the last three decades, tax rates for the wealthy have been falling, while their pretax pay has been rising rapidly. Real incomes at the 99.99th percentile have jumped more than 300 percent since 1980. At the 99th percentile — about $300,000 today — real pay has roughly doubled.

The laissez-faire revolution that Mr. Reagan started did not cause these trends. But its policies — tax cuts, light regulation, a patchwork safety net — have contributed to them.

I left in the hyperlinks in the story.  They are good sources.

Cross posted on Commonwealth Commonsense.

Support for Healthcare Downplayed by Media

Date: March 24, 2010
Author: Bob Griendling
Categories: Healthcare, Polls, Washington Post

As I reported yesterday, the press is tending to underplay the actual support for healthcare reform.  If I were asked in a poll if I support the bill that was passed, I would have said no because it doesn’t go far enough.  The CNN/Opinion Research poll conducted during the weekend showed that when you combine those who supported the legislation signed by the president yesterday and those who opposed it because it did not go far enough, 52% of Americans support the bill and/or even greater reform.

Today in The Washington Post, reporter Scott Wilson again mischaracterizes the level of support for reform.

In staging such a high-profile event, the Obama administration was helping to make health-care reform something for Democrats to run on in the midterm elections this fall, despite the fact that a majority of the electorate opposes it, according to opinion polls conducted before the vote. Rarely, if ever, have such events been as raucous as the ceremony-turned-political rally that rocked the ornate East Room for just over half an hour.

Looking at the healthcare polls on PollingReport.com, few of them ask whether opposition is based on the idea that the current bill or general principles about reform don’t go far enough.  But I found two that did.

A Ipsos/McClatchy poll in late February found that overall 41% supported “health care reform proposals presently being discussed" and 47% opposed them.  The poll then asked those who “opposed” the proposals, “Is that because you favor health care reform overall but think the current proposals don’t go far enough to reform health care; OR you oppose health care reform overall and think the current proposals go too far in reforming health care?"  The result:  37% said they favored reform but that the current proposal didn’t go far enough, meaning another 17% actually support greater reform.  The overall support for reform, then, is 58%. 

In a CBS poll in early January, 57% of respondents said the “changes to the healthcare system under consideration in Congress” either were about right or “don’t go far enough.”  When asked about the proposals to “regulate the health insurance industry,” 61% said they were about right or didn’t go far enough.

Electorally, I can’t imagine that those who are disappointed that reform hasn’t gone “far enough” or isn’t “liberal enough” would vote for Republicans in 2010 based on their opposition to reform.  They may stay home because they are disappointed with Democrats, but they won’t be GOP voters.

If you like, write Post reporter Wilson (wilsons@washpost.com) and ask that he not mischaracterize the public’s opinion of healthcare reform.

Cross posted on News Commonsense.

Support for Healthcare Downplayed by Media

Date: March 24, 2010
Author: Bob Griendling
Categories: Healthcare, Polls, Washington Post

As I reported yesterday, the press is tending to underplay the actual support for healthcare reform.  If I were asked in a poll if I support the bill that was passed, I would have said no because it doesn’t go far enough.  The CNN/Opinion Research poll conducted during the weekend showed that when you combine those who supported the legislation signed by the president yesterday and those who opposed it because it did not go far enough, 52% of Americans support the bill and/or even greater reform.

Today in The Washington Post, reporter Scott Wilson again mischaracterizes the level of support for reform.

In staging such a high-profile event, the Obama administration was helping to make health-care reform something for Democrats to run on in the midterm elections this fall, despite the fact that a majority of the electorate opposes it, according to opinion polls conducted before the vote. Rarely, if ever, have such events been as raucous as the ceremony-turned-political rally that rocked the ornate East Room for just over half an hour.

Looking at the healthcare polls on PollingReport.com, few of them ask whether opposition is based on the idea that the current bill or general principles about reform don’t go far enough.  But I found two that did.

A Ipsos/McClatchy poll in late February found that overall 41% supported “health care reform proposals presently being discussed" and 47% opposed them.  The poll then asked those who “opposed” the proposals, “Is that because you favor health care reform overall but think the current proposals don’t go far enough to reform health care; OR you oppose health care reform overall and think the current proposals go too far in reforming health care?"  The result:  37% said they favored reform but that the current proposal didn’t go far enough, meaning another 17% actually support greater reform.  The overall support for reform, then, is 58%. 

In a CBS poll in early January, 57% of respondents said the “changes to the healthcare system under consideration in Congress” either were about right or “don’t go far enough.”  When asked about the proposals to “regulate the health insurance industry,” 61% said they were about right or didn’t go far enough.

Electorally, I can’t imagine that those who are disappointed that reform hasn’t gone “far enough” or isn’t “liberal enough” would vote for Republicans in 2010 based on their opposition to reform.  They may stay home because they are disappointed with Democrats, but they won’t be GOP voters.

If you like, write Post reporter Wilson (wilsons@washpost.com) and ask that he not mischaracterize the public’s opinion of healthcare reform.

Cross posted on Commonwealth Commonsense.

Kudos to The Post

Date: March 23, 2010
Author: Bob Griendling
Categories: Good idea, Healthcare, Howard Kurtz, Student loans, Washington Post

I started this blog with the intention of both criticizing and praising journalism.  But being the curmudgeon I can often be, it’s been more negative.  So let me rectify that in a small way by commending three good articles.

Alec MacGillis of The Washington Post manages to write a story about healthcare reform with quoting a single politician, no small feat these days.  He tells us how the reform bill will impose new rules on insurers.

Yesterday in The Post, Daniel De Vine writes about the student loan program changes incorporated in the healthcare bill.  He manages to go six paragraphs at the top of the story giving us pertinent information of the problem and solution before allowing the politicians their say.

Legislation hailed by supporters as the most significant change to college student lending in a generation passed the House on Sunday night.

The student aid initiative, which House Democrats attached to their final amendments to the health-care bill, would overhaul the student loan industry, eliminating a $60 billion program that supports private student loans with federal subsidies and replacing it with government lending to students. The House amendments will now go to the Senate.

By ending the subsidies and effectively eliminating the middleman, the student loan bill would generate $61 billion in savings over 10 years, according to the nonpartisan Congressional Budget Office.

Most of those savings, $36 billion, would go to Pell grants, funding an era of steady and predictable increases in the massive but underfunded federal aid program for needy students. Smaller portions would go toward reducing the deficit and to various Democratic priorities, including community colleges, historically black colleges and universities, and caps on loan payments.

The bill’s greatest impact would fall on the more than 6 million students who rely on Pell grants to finance their education. Pell, launched in 1973, once covered more than two-thirds of total costs at a public university. It now covers about one-third.

The student aid measure was initially framed as a boost to the Pell program. Now it is seen as its salvation. Democratic leaders say that without a massive infusion of cash, the maximum grant could be scaled back by more than half to $2,150 and at least 500,000 students could be dropped from the program.

The article devolves a bit when it allows a GOP opponent to deride the bill with a nonsensical quote.

"Instead of making student loans more affordable or preserving choice, competition and innovation in the loan program, Democrats are taking money from struggling students’ pockets to help pay for a government takeover of health care," said Rep. Brett Guthrie (Ky.), senior Republican on the House subcommittee that oversees higher education.

How the student program pays for healthcare reform escapes me.

And finally, a word of praise for Howard Kurtz, not one of my favorite Post writers.  But his story yesterday about news coverage of the healthcare fight stuck many of the cords I have in the past.

The conventional wisdom is that the press failed to educate the public about the bill’s sweeping changes, leaving much of America confused about just what it contained. That is largely a bum rap, [Ed. note:  I disagree] for the media churned out endless reams of data and analysis that were available to anyone who bothered to look.

As time went on, though, journalists became consumed by political process and Beltway politics [Ed. note:  Here’s where we agree], to the point that the substance of health-care reform was overwhelmed. Here the plea is guilty-with-an-explanation: The battle came down to whether the Senate could adopt changes by majority vote (reconciliation) and, until late Saturday, whether the House could approve the Senate measure without a recorded vote (deem and pass). With the bill’s fate hanging by these procedural threads, there was no way to avoid making that the overriding story.

Still, Kurtz can’t help defending his profession.

Journalists struggled to say exactly what was in health-care reform because as Obama allowed congressional leaders to take the lead, [Ed. note:  So it was Obama’s fault?] there were multiple versions floating around the Hill at any one time. Remember the months and column inches we wasted on Max Baucus and the Gang of Six, the Senate group that was going to hammer out a bipartisan compromise? That collapsed after many forests were sacrificed on its behalf.

When the polls turned against the president’s push, journalists did what they usually do in campaigns: beat up on those whose numbers are sagging. Stories shifted from preexisting conditions and individual mandates to whether Obama had staked his presidency on an overly ambitious scheme that Congress was unlikely to accept (and, inevitably, how much was Emanuel’s fault). From there it was a short jog to the rise of political polarization, the death of bipartisanship and the erosion of Obama’s influence — legitimate undertakings that again shoved the health-care arguments to the back of the bus.

One stellar moment for the press was the refusal to perpetuate the myth of "death panels." [Ed. Note: Oh really!?; the press was very slow to correct the lie] After Sarah Palin floated the idea that government commissions would decide which ailing patients deserved to be saved, journalists at The Washington Post, New York Times, CNN and ABC News, among others, said flatly that this was untrue.

But such black-and-white judgments were difficult with many of the provisions. How many people would defy the mandate to buy insurance? How much would a tax on "Cadillac" health plans raise? Would Congress have the stomach to deeply cut Medicare? How many people would be eligible for the much-ballyhooed public option? For that matter, what exactly is the difference between a public option and state-run insurance exchanges? [Ed. note:  Difficult to find, maybe, but educated guesses were available.]

Kurtz references a Columbia Journalism Review article that’s worth a read.

Press coverage of the effort to reform health care has been largely incoherent to the man on the street. The three hundred or so posts I have written about health-care reform for CJR.org over the past two years tell the story of media coverage that failed to illuminate the crucial issues, quoted special interest groups and politicians without giving consumers enough information to judge if their claims were fact or fiction, did not dig deeply into the pros and cons of the proposals, and gave tons of ink and air time to the same handful of sources.

By now it’s a familiar critique—the press did not connect the dots, there were too many he said-she said stories, not enough analysis, and so on. And yet, after a decade in which the inadequacies of traditional press strategies—objectivity, top-down coverage, the primacy of the “scoop,” etc.—became ever more apparent to those of us who care about these things, those very strategies failed the country again on a story of monumental importance to every citizen.

Support for Healthcare Reform

Date: March 23, 2010
Author: Bob Griendling
Categories: Healthcare, Polls

Just heard the chattering on MSNBC between Chris Matthews and Patrick Buchanan.  They misrepresented the recent CNN/Opinion Research poll.  They focused on the top line:

As you may know, the U.S. House of Representatives and the U.S. Senate are trying to pass final
legislation that would make major changes in the country’s health care system. Based on what you
have read or heard about that legislation, do you generally favor it or generally oppose it?

Favor 39%
Oppose 59%
No opinion 2%

But the next question tells the real story:

(IF OPPOSE) Do you oppose that legislation because you think its approach toward health care is
too liberal, or because you think it is not liberal enough?
QUESTIONS 20 AND 21 COMBINED

Favor (from Question 20) 39%
Oppose, too liberal 43%
Oppose, not liberal enough 13%
No opinion 5%

So what you get is this:

52% support the bill or wish it went further in the direction the Democrats wanted, while 43% oppose it.

You can make an argument that the term “not liberal enough” leaves much to the imagination.  But I’ll bet most folks would include a public option or a single payer system within the “not liberal enough” definition.

Cross posted on News Commonsense.

UPDATE:  Looks like most people now like Obama’s plan.

Support for Healthcare Reform

Date: March 23, 2010
Author: Bob Griendling
Categories: Cable News, Chris Matthews, Healthcare, Polls

Just heard the chattering on MSNBC between Chris Matthews and Patrick Buchanan.  They misrepresented the recent CNN/Opinion Research poll.  They focused on the top line:

As you may know, the U.S. House of Representatives and the U.S. Senate are trying to pass final
legislation that would make major changes in the country’s health care system. Based on what you
have read or heard about that legislation, do you generally favor it or generally oppose it?

Favor 39%
Oppose 59%
No opinion 2%

But the next question tells the real story:

(IF OPPOSE) Do you oppose that legislation because you think its approach toward health care is
too liberal, or because you think it is not liberal enough?
QUESTIONS 20 AND 21 COMBINED

Favor (from Question 20) 39%
Oppose, too liberal 43%
Oppose, not liberal enough 13%
No opinion 5%

So what you get is this:

52% support the bill or wish it went further in the direction the Democrats wanted, while 43% oppose it.

You can make an argument that the term “not liberal enough” leaves much to the imagination.  But I’ll bet most folks would include a public option or a single payer system within the “not liberal enough” definition.

Cross posted on Commonwealth Commonsense.

A Big Idea

Date: February 26, 2010
Author: Bob Griendling
Categories: Democrats, GOP message, Healthcare, Message, Message Delivery, Obama

Congressional Republicans achieved a goal during yesterday’s healthcare summit. They shed their “party of no” label. They had ideas.

But Obama saw them and raised them one. He framed them as the party of small ideas while Democrats have a big idea. As in, we’re planning to fix healthcare instead of, as Sen. Tom Harkin said of the GOP plan, throw 10 feet of rope to a man drowning 50 feet from the boat—with a promise that at some later point, we’ll throw him a 20 foot rope.

The GOP did their homework well. As is usual the case, they were, in large part, more articulate than many of the Democrats, the president included. They had fire in their bellies and a list of facts and ideological bon mots. Even when they threw hanging curve balls, the Dems took called strikes. When I commented on that in a contemporaneous post yesterday, a friend also in my line of work called incredulous himself. The response to that oft charge of letting the government makes decisions instead of “the American people and their doctors” is, “Oh, if it were only so. Now it’s the insurance exec making millions of dollars a year who now gets to make that decision.”

But the Dems warmed up a little by the late innings, both rhetorically and passionately. The best I heard all day was by Sen. Dick Durbin. After the two Republican doctors lorded their experience over the crowd, Durbin gave them the view from the street. He’s been a good old fashioned—and as the GOP would characterize, “ambulance chasing”—trial lawyer. He’s defended victims of medical malpractice and the doctors that perform it. And showing his summation skills, he spoke in smooth paragraphs.

As any good lawyer would, he eviscerated the “common knowledge.” Both the number and award amounts of medical malpractice have dropped precipitously over the years, not increased, he said. The number of paid malpractice claims decreased 50 percent in the last 20 years, and the amount of awards have dropped the same 50 percent in the last five years. Then, he played the jury’s heart strings by telling the story of a woman who went in to have a mole surgically removed only to have the oxygen ignite, scarring her face for life and submitting her to repeated operations.

“Her life will never be the same. And you are saying that this innocent woman is only entitled to $250,000 in pain and suffering. I don’t think it’s fair.”

Certainly, GOP Chairman Michael Steele could understand that, he who thinks one million dollars, after taxes, “is not a lot of money.” Two hundred fifty thousand isn’t even walking around money for the chairman.

CNN, probably taking a cue from, I believe it was, GOP Sen. Mitch McConnell that Republicans weren’t getting enough hot air time, tracked the minutes party representatives talked.

Democrats spoke for a total of 135 minutes while President Obama spoke for 122 minutes, for a total of 257 minutes. Republicans, meanwhile, spoke for just 111 minutes, about 30 percent of the total speaking time.

The president spent too many of his minutes hemming and hawing as he is wont to do in extemporaneous situations. He often starts off searching for words in bursts of disconnected phrases. But when he warms, he can cut you with a butter knife.

His summation, which started in that same hesitant fashion, got legs. He cut through the GOP apocalyptic rhetoric.

“I know that there’s been a discussion about whether a government should intrude in the insurance market. But it turns out, on things like capping out-of-pocket expenses or making sure that people are able to purchase insurance even if they’ve got a preexisting condition, overwhelmingly, people say the insurance market should be regulated.

And so one thing that I’d ask from my Republican friends is to look at the list of insurance reforms and make sure that those that you have not included in your plans, right now, are ones, in fact, that you don’t think the American people should get.”

He reminded our representatives that they should be willing to let the American people have the same insurance coverage they have. He deftly framed his solutions as market driven as Sam Walton. His comparison of a wide open insurance market left to the states with what happened in the credit card market was one people could easily understand. He cited new statistics demonstrating how Americans already have chosen the government as their main source of insurance because companies can’t offer it anymore. And he used a little humor to undercut GOP criticism of the bill’s length and make the point that small ideas won’t work.

“I did not propose and I don’t think any of the Democrats proposed something complicated just for the sake of being complicated. We’d love to have a five-page bill. It would save an awful lot of work.

The reason we didn’t do it is because it turns out that baby steps don’t get you to the place where people need to go. They need help right now. And so a step-by-step approach sounds good in theory, but the problem is, for example, we can’t solve the preexisting problem if we don’t do something about coverage.”

By this time, Obama has found his voice. He’s talking smoothly and minimizing the “hums” and “uhs.”

He then made the observation that I would have put a little differently, though his way sufficed. The Republicans think compromise is first, Dems put their ideas out there. Then Republicans put theirs. And then we all accept the GOP plan—lock, stock and barrel. Voila, bi-partisanship!

Finally, in music to the ears of those who thought he has no soul or fight in him,

“We cannot have another year-long debate about this. So the question that I’m going to ask myself and I ask of all of you is, is there enough serious effort that in a month’s time or a few weeks’ time or six weeks’ time we could actually resolve something?

And if we can’t, then I think we’ve got to go ahead and some make decisions, and then that’s what elections are for. We have honest disagreements about — about the vision for the country and we’ll go ahead and test those out over the next several months till November. All right?”

Yes, Mr. President, that’s all right.