The Message Is The Medium

GooznerEmory University psychologist and political consultant Drew Westen in the weekend Washington Post offers a troubling view of the public’s role in health care reform. While reform’s reality involves complicated technical issues like insurance exchanges, public plan governance, physician and hospital payments and who will pay higher taxes, the public’s understanding of these issues is virtually non-existent, Westen assumes.

Instead, public knowledge comes from a media environment where Republican consultants craft messages about a government takeover of health care and Democratic consultants (the author among them) promise a family doctor for everyone. Never mind that neither message even remotely resembles reality.

Nowhere in the article does Westen pay homage to the democratic ideal that an informed electorate has a role to play in policy debates like health care reform. Nor does he lament the passing of an informed electorate. Such statements used to be a staple in discussions about political messaging and the impact it was having on policy debates.

It hasn’t always been thus. I’ve been reading “Lords of Finance: The Bankers Who Broke the World” by Liaquat Ahamed, a former investment banker who spent the past ten years researching the errors made in the late 1920s and early 1930s that led to the Great Depression.

Near the end of the book, he recounts how President Roosevelt explained the bank holiday declared immediately after he took office. His first fireside chat carefully detailed for average Americans the complicated workings of banks that had forced his hand. The next day, folk humorist Will Rogers marveled at the speech’s clarity. In a letter to the New York Times, he wrote: “Our president took such a dry subject as banking . . . (and) made everybody understand it, even the bankers.”

Today, few media outlets even bother to explain the intricacies of policy choices. Politicians, the special interests and the communications experts who craft their messages can safety assume the public will have a poor grasp on reality. Marshall McLuhan has been turned on his head. The message is now the medium.

5 replies »

  1. With all due respect, Mr. Goozner, you are wrong both on form and on substance.
    To begin with, Westen’s article does not have to “pay homage” to the idea that an informed electorate plays a role in policy debates like health care reform; it presupposes it. That is precisely why he quotes political strategists like Luntz and Lake. Effective communication of complex ideas in simple, relatable terms influences the public’s attitudes and, consequently, their willingness to support (or not support) any of the multitude of health care reform plan variations currently being proffered.
    Second, while I agree that media outlets don’t bother to explain the intricacies of policy choices in the health care arena, the reason is hardly because they have been co-opted by opponents of change. On the contrary, a simple Google or Lexis/Nexis search will show that positive media coverage is overwhelmingly in favor of health care reform that ranges from the extreme (Obama/Kennedy-style approach) to the downright radical (single-payor) despite the fact that polls like the most recent Gallup Poll and Field Health Policy Survey consistently show that, while people voice concerns about the current health care system, only about 28% to 34% of the American public favor such government-dominated types of health care reform.
    Finally, regarding the substance of the argument, while polls consistently show that 83% to 86% of Americans believe they currently enjoy excellent or good health care, they also believe that it is too expensive and they are concerned that it might not be available to them when they really need it. It is in this area that the members of the “Third Estate” are really letting everyone down. Instead of informing the public, they most often pander to its fears to advance their own agendas.
    Perhaps the greatest flaw of our current employer-based system of health insurance is that it conceals the true cost of health care coverage from most of the public most of the time. Employees who see $100 or $200 taken from their paychecks to cover health coverage often believe that this represents the majority of the cost of the coverage they receive. It is only when they leave a job and receive a statement showing how much continuation will cost (often $1,000 or more each month for a family) that they realize how much of the cost their employer was paying.
    In addition, I have yet to see an article in the main stream press that deals with the pernicious effect of the government’s underfunding of public health programs (e.g., Medicare, Medicaid, SCHIP) which shifts approximately $200 billion to the public sector each year – and effectively doubles the rate of increase of private health insurance from the 6.1% (the 2007 Medical CPI) to over 10%. The effect is a hidden tax that is paid for through reduced corporate profits, increases in employee contributions and out-of-pocket expenses, and a reduction in take-home wages especially for low and moderate income workers.
    But rather than report that it is precisely these bloated and poorly structured public health plans that adversely impact private sector health care, they merely tow the Obama Administration’s line that for private sector health plans to avoid complete ruination they must be remade in the form of their corpulent government counterparts. So much for accuracy in media.
    And by the way, I’m getting just a little tired of people like Dr. Schimpff putting down the quality of health care here in the U.S. In point of fact, despite the skewed (and highly subjective) assessments of groups like the World Health Organization, the quality of health care provided here in the U.S. is far and away the best in the world.
    As even a mediocre statistician can tell you, the correct way to measure effectiveness is to look at outcomes and by this measure, the U.S. has no peer. Without getting into the particulars (although you can certainly Google them to your heart’s content), journals like The Lancet, The New England Journal of Medicine, and Health Affairs and numerous others have reported on studies showing that the U.S. leads the world in virtually all forms of cancer, heart conditions, organ transplants, communicable disease – and the results are not even close.
    So instead of complaining about public ignorance, media dereliction, or mischaracterizations of the health care we receive, how about we focus on what is really wrong with the system and fix it. That’s what health care reform should really be about!

  2. I would certainly agree with Dr. Westen’s assessment of the public’s knowledge of healthcare policy issues – almost entirely non-existent with respect to key issues. Mixture of lack of interest for whatever reason and of the explicit intention of vested interests to keep the public as confused as possible
    I have heard both President Obama and Peter Orzag make straightforward comments about the true state of the healthcare system in the USA, but all directly involved legislators in Congress, not to mention any Republican politician, are only unwilling or perhaps unable – out of either intentional ignorance or knowing venality – to make any accurate statements of facts. It is truly astonishing that the key issues are completely ignored by all those involved while either pure nonsense or fringe issues receive all the attention.
    Essentially the same situation that has existed every time that healthcare policy issues are considered every 15 years or so. The one exception being the passage of the act creating Medicare in the Johnson Administration.

  3. You are correct that we seldom hear about the real or underlying issues that are broken in our delivery of medical care system in America. The media tends to overlook them or just does not understand them. The politicians skip over them. No one takes the time to give a straight forward yet simple explanation of the problems. The result is that we have a large number of misconceptions about our medial care delivery system and what needs to be done to improve [or “reform”] it.
    The first misconception is that we have he world’s best healthcare. That is simply not true. Health care access for all is very important and America is the only country in the developed world that has not figured it out. But there is more to reform than access – or should be. The second big misconception is about the reasons for the rise in costs. There are many reasons why medical care costs so much but at the top of the list is the high cost of caring for those with complex, chronic illnesses – diseases that tend to last a lifetime such as heart failure, chronic lung disease and diabetes with complications. Large numbers of these illnesses among the populace is a new phenomenon in America. These occur as the population ages [old parts wear out] and as we continue with our adverse behaviors such as poor nutrition, obesity, lack of exercise, stress and smoking. Not only are these expensive diseases to treat but our system of care delivery is not well coordinated leading to excess doctor visits, procedures, tests and hospitalizations. A good place to start would be to ensure care coordination for those with chronic disease and to improve our behaviors so that fewer of these illnesses occur into the future. But that leads to the third misconception – that we actually pay attention to preventive care. The truth is that we do not.
    So, health care reform needs to address four interrelated issues. Access for those without insurance. Increasing the numbers of primary care physicians to take care of those with new insurance and to give time to others for care coordination and preventive medicine. Meaningful healthcare reform must address the societal issues with incentives to change behaviors, probably through insurance premium incentives. Physicians need incentives to give good care coordination of complex chronic illnesses– they must become real orchestrators rather than interveners; and incentives to physicians to spend the time needed to assure real preventive care. Access without meaningful attention to improving quality while reducing costs will only mean more people are getting less than appropriate care. More at http://medicalmegatrends.blogspot.com

  4. Great report, Gooze.
    Kool aid is being produced and sold by a number of factions.
    Take, for instance, the HIT kool aid. It was brewed by HIMSS who allied with CITL to produce “research” and “opinion” that was served in crystal goblets to Congress, all the while CCHIT was assuring those drinkling it that it will not make them experience peristalsis in reverse.
    The media liked its color and only reported on how good it made every one feel.
    Then, they read about the letter to D. Blumenthal (below), the deaths in Sweden, the DOD’s HIT debacle, the UK’s HIT blunders, but still did not understand because the kool aid looks and tastes so good.
    Finally, the CDC recognizes the breadth of illness and decides to study the epidemiolgy of the kool aid pandemic. The FDA thought it tasted bitter and asks, why were we bypassed?