Reporting on the Business of Health Care

As a reporter and editor, 1995 was a watershed year. While most of the press were still delivering parting shots to President Clinton’s health reform plans, I was given the opportunity to imagine (and plan for) what health care reporting might sound like for a national nightly business show on public radio. Our bureau, based at WGBH Radio in Boston, had received its first grant to develop timely stories on health care trends for “Marketplace,” a nightly public radio business news program. And it was an ideal time to be doing this. The proposed government fix to health care’s spiraling costs had been rejected, and this left the private sector in charge. Given these circumstances, it wasn’t difficult to produce a bountiful stream of story ideas, a stream that continues flowing strongly today.

Since 1995, our health desk has produced more than 1,500 stories, reporting on a plethora of health care news in the United States. Much of the news involves the major financial stakeholders in the health care system—insurers, hospitals, physicians, nurses, drug companies, government agencies, legislatures and consumers. In the beginning, I viewed our task as helping listeners better understand the inner workings of one-seventh of the U.S. economy by explaining the logic that underpinned the various strategies of participants. That approach worked well until internal contradictions in the health care industry foiled even its best-laid plans. It wasn’t long before managed care (or at least its mid-tolate 1990’s version) was criticized as an artificial, arbitrary and unpopular fix to the system’s problems. These contradictions made it difficult to tell the coherent story we had first imagined. In fact, the first rule of thumb when covering health care is to map out why the system behaves so irrationally.

Covering Health Care’s Convulsions

Our health desk team has shifted its focus to reporting more on the health system’s convulsions—the clash of competing interests; the rising costs and marketing of pharmaceuticals; the backlash against managed care; the see-saw of solvency and insolvency of many big time HMO’s and hospital chains; the difficult task of reducing medical errors, and the country’s appetite for high-tech and expensive health care. Major policy initiatives to cope with health care woes—involving the control of costs or caring for the uninsured— remain elusive, and our reporters work hard to also explain why.

Sticking with such vexing issues is a grinding commitment. Seasoned health reporters often wonder aloud why this constant state of confusion that we call a “system” never seems to improve. Can health care be profitable and serve the needs of our entire population? As a journalist, I don’t have to answer that question, but I have the ability to point listeners to experts who are struggling to come up with possible answers. Given the enormous range of people working on so many health care problems, this beat is a rich, exciting and suspenseful journey. This is true even on days when I wade through details of another survey or study. Plus, reporting for a business show hones one’s skill at finding the money—whether the issue is Medicare, menopause or the Onco mouse (a specially designed mouse to study potential cancer vaccines and treatments).

The business world also has a way of steaming ahead with innovations and inventions in health care despite inertia on the legislative policy front. The drug industry is always grist for interesting stories, but the past decade has also seen the introduction of incredible lifesaving products like the portable defibrillator, which people can learn to use. Business ingenuity is largely responsible for the explosion of health information via the Internet and for making health research more widely available. These are challenging pathways for reporters to explore.

Radio’s Unique Reporting

Other challenges seem unique to radio reporting on health care. As Boston bureau chief for “Marketplace” (a job now held by my successor, Helen Palmer), the dilemma has been how to explain complex developments in short, one-minute news spots or threeto- four-minute features, while maintaining the upbeat and stylish tone of a half-hour evening news show or snappy morning modules. “Marketplace” prides itself on being irreverent and clever. Covering health care can be deadly serious and rarely lends itself to that tongue-in-cheek approach.

As I’ve learned more about health care and am able to draw on information I have already assimilated, it’s gotten easier to reveal the ironies so endemic to our health care system. At times it’s hard not to be glib, a pitfall veteran health reporters have to be careful of. Listeners relate to our stories in very personal and often painful ways. To create our best work, we often depend on people who volunteer to share their own or a family member’s health care situation as the backbone of our story. I might believe that my story exemplifies the craft of great radio with its ability to distill gobbledygook health care data and wonkish speech. But for listeners— and readers—it’s almost always a personal connection that makes the story work for them.

It can sometimes be hard to use effectively this sometimes wonky language of policy experts. When such experts are given a microphone, they can be deadly dull. Only by working on this beat for a while does it become clear whose ideas are best read (by the reporter) and who will come across well over the air. And sometimes we have to keep some of the smartest people in the field to no more than 20 seconds. As for the health care world’s more dazzling speakers, we risk overusing them. What reporters yearn to develop is a deeper pool of talent to enliven ongoing debates and bring new ideas to the table. Finding fresh voices is one aspect of our work we need to do a better job with.

The sounds of health care are of course critical to radio journalism, but here, too, new challenges emerge. I have a stack of tapes of beeping heart monitors, crying newborns, ringing phones, doctors being paged, and busy corridors—vintage hospital sounds of not so long ago. Some remain relevant, but as health care becomes computerized and moves online, hospitals are far quieter places than they used to be. Relative quiet affords more comfortable environments for patients and improves the staff’s working environment, but it has made the work of radio journalists that much more difficult. Similarly, outpatient care and managing illnesses at home has yet to emerge as sound-rich material. We need to rethink and enlarge the scope of our audio palette to weave more sense of the ebb and flow and movement of health care delivery into our health care stories.

Discovering New Reporting Pathways

In my new role as senior health desk editor, I have new opportunities to produce more in-depth feature stories for public radio. And as I recently discovered, when health events strike close to home—as my aging father suffered a stroke and family members assumed new caregiving responsibilities—my work is an asset in navigating the system. I doubt nurses and doctors welcome my father’s pronouncement, “Did you know my daughter is a health care journalist?” but the introduction often elevates the conversation. At the same time, having a personal encounter with the health care system helps me create a rich bed of story ideas to be harvested in the future. Why does one nurse stop to visit with a patient while another does not? What is it about physical therapists that make them so encouraging? How are hospital patients informed when one of their suite-mates dies?

I also step back from my own reporting at times to track trends in health journalism. More time and space is now being devoted to covering developments in medical science. It is hard to resist describing the myriad ways in which genetic discoveries revolutionize health care, but unfortunately such an intense focus on this topic tends to drown out other reporting and ignore important issues: What is it like for patients and families to navigate and negotiate the health care system with so many new drugs, devices and genetic discoveries?

With threats of bioterrorism more real, our public health system is being “called up” to protect us in dramatic new ways. For example, the $1.1 billion dollars recently allocated to the Centers for Disease Control and Prevention to monitor and prepare for possible bioterrorist attacks is in stark contrast to shrinking government dollars elsewhere in the health care system, including public health. It’s going to be a challenge for health reporters— regardless of medium—to determine how to allocate resources to this story at the expense of covering other issues that might not seem as urgent. Reporters might not always get to make this call. Editors will, and they, too, will likely be under some pressure.

My hope is that health care reporting stay closely tied to the central purpose of health care—service to patients. With so many stakeholders and powerful forces intersecting throughout the system, it becomes harder for patients to be portrayed in our stories as anything more than victims or people being acted upon. Yet, whether disease, poor treatment, or one more medical bill suddenly overtakes a person’s life, no individual reacts the same way. This means we need to do a better job illustrating our story subject’s multidimensional character. And we need to find ways to integrate their opinions about the care they receive into our reports and not only focus attention on their particular illness. I don’t have answers about how to do all of this, but I know it is not enough to talk to patients only when they’re caught in the headlights of illness.

In the time I’ve been reporting on this beat, the nation and the health care beat have come full circle. The conversation is once again about double-digit health care inflation, about the dramatic climb in Americans without health insurance, a health care crisis, and the pluses and minuses associated with a single-payer system. Insurance executives are proclaiming American health care near collapse. The private sector’s solution, managed care, has been deemed a failure, so it will be looking for something new. Single-payer advocates and universal coverage proponents (some fearful of a major tax-supported financing scheme) might find common ground. And employees who are shouldering most of the increases in health insurance premiums might actually stop to listen to what health care reformers have to say.

Health care reporting takes on special significance during times like these. It’s a great responsibility and a privilege to cover issues in which so much is at stake.

Madge Kaplan is the senior health desk editor at WGBH Radio in Boston, Massachusetts.