The University Record, March 6, 2000

HMO panel sparks lively debate

By Kara Gavin
Health System Public Relations

No fistfights broke out, but there was plenty of half-joking name-calling—and serious debate—on both sides of the dais on Feb. 21, when a panel of reporters and health care professionals squared off at the U-M over the issue of how the media cover managed health care.

The four-hour forum, organized by the Michigan Journalism Fellows Program with the Health System, may have been the first of its kind in the nation, bringing together experts from all sides of the issue. Based on the lively dialogue among the participants and questions from the audience in the Michigan League ballroom, it was a welcome opportunity.

By the end of the afternoon, many of the panelists’ remarks echoed several common themes. On their part, many of the health care professionals argued that the media oversimplify and overdramatize the issues surrounding managed care and its impact on American health care. Meanwhile, the reporters felt they were doing pretty well at balancing the complexities of the topic with the constraints their editors and audiences impose.

“Our goal, with the U-M Health System, was to attract some of the top people in the country on managed care and how it’s covered, and to get them to talk to one another,” says Charles Eisendrath, director of the Journalism Fellows Program. “Several mentioned that there had never been such an effort, and I believe that’s true. I’m satisfied that several heard viewpoints that were new to them, and all of us came away with a sense of having been informed. Evaluations from the audience indicated that this was true generally, so I am most pleased.”

The panelists—jokingly dubbed the journalistic “hacks” and health expert “frauds” by Eisendrath to highlight the mistrust each side has for the other—spent much of the afternoon airing their grievances about the other side while largely defending their own professions.

The media sustained many of the verbal punches that were thrown, mainly for focusing on the pitiful stories of individual patients who claim HMOs harmed them, and not on larger medical, public policy and financial issues. This coverage of “bad news” and controversy, some said, overshadowed the “good news” of the cost savings, preventive treatment and coordinated treatment made possible by managed care.

Panelists also accused the media of demonizing managed care without casting a similarly critical eye at the costly “unmanaged” conventional care it is rapidly replacing. Susan Hershberg Adelman, a U-M surgeon and trustee of the American Medical Association, called for more detailed analyses of health policy issues like the Patients’ Bill of Rights.

But reporters such as Joanne Silberner of National Public Radio and Carolyn Clifford of Detroit’s WXYZ-TV responded with convincing arguments of their own. They explained that patient anecdotes are often necessary to attract the attention of listeners, viewers and readers. They and others also said that the short time or brief space allotted to their reports makes coverage of complex issues difficult, and that stories must often be cast in terms of “good versus evil” in order to get editors’ approval for air time or ink.

In their defense, some media panelists also cited a recent study that found that a large percentage of media coverage of managed care was in fact balanced. They reminded the panel and audience that the mainstream media’s mission is to seek the truth about an issue and inform the public, not to campaign for a cause.

The nation’s for-profit HMOs and other managed care organizations took it on the chin, too. Both reporters and those outside the insurance industry pointed out the importance of exposing instances in which care is denied or postponed, where data on long-term outcomes for managed care patients is lacking, or instances in which doctors are pressured to provide inadequate care in order to save money.

Others, like HMO-suing lawyer Richard Scruggs, discussed what some see as the conflict of interest inherent in companies that have a profit incentive to limit health care for their customers. And some reporters on the panel said HMOs are overreacting to a perceived media bias by limiting reporters’ access to their executives.

The discussion also touched on the larger issues surrounding managed care, including the accessibility of medical insurance and care, physician unionization to counter professional pressure from managed care, and government health resource allocation. Vermont Gov. Howard Dean talked about the hard choices he has made in finding money to fund health care coverage for all uninsured children in his state.

In all, the afternoon’s discussion seemed to increase each side’s awareness of the other’s complaints, constraints and complicating factors. It also provided a spotlight for the U-M’s health care resources—the non-profit M-CARE HMO, represented by executive director Zelda Geyer-Sylvia, and the entire Health System, represented by Gilbert S. Omenn, executive vice president for medical affairs.

Now, Eisendrath and the Fellows begin preparing for the next forum, on gun control, in the series sponsored by the W.K. Kellogg Foundation.