The Uninsured Story Is Seldom Fully Told

For those of us in television news—as I am now after 20 years as a print journalist—the painful reality is that much of the real action takes place when the camera is turned off. This truth came home to me several years ago as I reported a story about the more than 40 million Americans without health insurance in a given year. As health correspondent for “The NewsHour with Jim Lehrer,” I had gone with my producer and camera crew to a public hospital serving the uninsured in the capital of a Midwestern state. While there, we taped some compelling footage, capturing scenes of undocumented immigrants, many from Mexico, working low-wage jobs in the city and fully We can’t but, somehow, we must. We have an obligation to throw into the sharpest possible relief the story of how the richest nation on earth systematically undermines the health and longevity of at least one in seven of its citizens.reliant on the free health care the hospital provided. We also learned that 500 employees of this hospital got all their health care provided there since, unbelievably enough, they, too, lacked health insurance.

But it was only when the taping was over, and our camera crew had packed up and gone, that we stumbled into an unforgettable moment in this national scandal.

We were saying our goodbyes to one of the hospital’s officials and complimenting her on the institution’s programs, when she blurted out some of her own anxieties and doubts. She pointed across the street to a private, nonprofit children’s hospital just steps away from her own public facility. She explained that under a deal with the private hospital, uninsured children with serious diseases such as cancer were treated there, with the public hospital paying the tab. But the arrangement had some quirks. For example, parents of kids with cancer and on chemotherapy first had to collect the plastic bags with the chemotherapy drugs at the pharmacy in the public hospital, where the drugs were given to them for free. Then—because no one in this jerry-rigged system apparently was willing or able to do so on their behalf—they had to carry the bags across the street to the private facility, so their children could be infused with the life-saving medication.

We listened, astounded, contemplating anew the unfathomable inequities of health care in America. Like anyone covering the field, I knew well that we’re the only industrialized nation that can’t see fit to insure everyone, even though we spend one-third more per capita on health than the next biggest spender, Switzerland. But the mental image of these parents having to ferry drugs to their own sick kids captured the wide gulf between the haves and the have-nots.

Admittedly, in this case the division was mostly symbolic, since the uninsured kids were probably getting great care and arguably their parents were only mildly inconvenienced. But the story was so compelling that we immediately pressed our source to tell it again, on the record and in front of the camera. She demurred, explaining that she would be fired if she spoke publicly about this embarrassment. And, in any case, our camera crew was gone. In television, where the visuals are critical, the verbal exchange alone was as good as useless.

We moved on to our next round of interviews.

Telling What It Means to Be Uninsured

I tell this tale now in the spirit of a confessional, for the sins of omission some of us have committed in covering the story of the uninsured. Clearly, my producer and I could have gone back to the hospital to find some affected parents and capture their tale on tape. But we didn’t. And therein lies a prime example of how we have failed to do our utmost to enable viewers and readers to understand what it means to be uninsured.

Whether in print or broadcast, it takes less effort to substitute easier types of reporting on the uninsured than to dig deep to show how the uninsured get second-rate, third-rate, or even zero care. Particularly for those of us Washington, D.C.-based reporters who focus on health policy—and we are the ones who do most of the reporting on the uninsured—it’s simpler to sit in the nation’s capital and phone up the “experts” for quotes than it is to get out in the trenches to capture actual health and economic consequences of people being uninsured. It has been said that social statistics are “human beings with the tears washed away.” Most of us have spent too much time repeating the statistics—nearly 42 million uninsured, roughly eight million of them children—and devoted too little time telling how it is the uninsured come to cry real tears.

This has not been for any lack of ability to find people who are uninsured; with so many millions of them around, that’s easy. A segment we did on The NewsHour in February 2002 about the Venice Family Clinic, a private, nonprofit community health clinic in Los Angeles county, California, offers an example.

We told the story of Eric Moore, a UCLA graduate and 30-year-old employee at a local tourism Web site who lost his job when the travel business plummeted after September 11th. Unable to afford a doctor’s visit, he deferred seeking care for leg pains until he collapsed one day on the street. Taken to the Venice Family Clinic, he was found to have a blood clot that had traveled from his leg to his lung and lodged there as a pulmonary embolism. He was transferred to a hospital; his subsequent three-day stay there cost him $16,000.

We also told the story of Beatriz Samayoa, a Guatemalan immigrant living in Los Angeles with legal residency status. She’d worked a succession of jobs until gaining one tending the linen service at a fancy beachfront hotel in Santa Monica. It was the first job she’d ever had with health insurance—and it, too, disappeared with the tourist slump after September 11th. She turned to the Venice clinic for treatment of depression and other ailments. Her teenage son, born in Guatemala, was unqualified for any state health coverage and was also treated there. Samayoa’s two younger children, born in the United States, were qualified for coverage under Medi-Cal, the state’s Medicaid program—illustrating how the crazily xenophobic premise of public health insurance creates haves and have-nots even within families.

How to Convey the Reality of the Uninsured

In addition to telling personal stories like this, many of us have tried to get across key truths about the uninsured. A 2000 survey we did in conjunction with our partner in The NewsHour’s health unit, the Henry J. Kaiser Family Foundation, showed that six out of 10 adult Americans falsely believe that most of the uninsured are jobless. In fact, as we’ve reported, eight out of 10 uninsured adults are in families where at least one other adult is working full time. Many Americans also believe that the uninsured suffer little in the way of health consequences, but we routinely cite a range of studies that clearly document the opposite. As the Institute of Medicine, a division of the independent National Academy of Sciences, noted in its 2002 report, “Care Without Coverage,” uninsured adults are less likely than those with health coverage to receive preventive and screening services, like mammograms and blood cholesterol checks; more likely to get substandard care for chronic conditions like diabetes; less likely to obtain services when they suffer trauma or heart attacks, and more likely to be diagnosed with cancers when they’re more advanced and less treatable.

So why do I still believe that we have failed to fully cover the story of the uninsured?

First, because we have not yet managed to fully penetrate the health system and serve as direct eyewitnesses to the precise ways in which the uninsured get short shrift. I recently spoke with a prominent emergency room specialist from one of the nation’s bestknown public hospitals and asked whether there were still widespread violations of federal “anti-dumping” legislation. This law in effect bars hospitals from transferring uninsured patients until they have been stabilized. “Of course there are lots of violations,” he replied. I asked him how we could show this, short of holing up incognito in a hospital for several days with a hidden camera. “You can’t,” he replied.

We can’t but, somehow, we must. We have an obligation to throw into the sharpest possible relief the story of how the richest nation on earth systematically undermines the health and longevity of at least one in seven of its citizens. This is not only true for television news—which nearly seven out of 10 American’s depend on as their primary source of information—but for print journalism as well. Yet I confess I have few practical ideas about how to do this. Should I persuade The NewsHour to let us use hidden cameras that are associated more with tabloid shows than with our typical “serious” approach? In an age of strict new federal privacy regulations governing health care, should print journalists work surreptitiously to obtain patient records demonstrating inadequate care, or encourage whistleblowers to come forward to provide us with other evidence?

Recently I met with a group of writers who script many of the popular TV dramas like “Law and Order” and “ER.” The Robert Wood Johnson Foundation, which has sponsored a national effort to raise awareness of the uninsured, had asked several of us familiar with the issues to brief the writers on how they could incorporate realistic plot lines about the uninsured into their shows. I joked that, unlike them, I’d been doing “reality TV,” covering our long-running national hit, “Who Wants to Get Health Insurance?” But I also told them that if they incorporated some of our plot lines about the uninsured into their shows, their dramas would probably do a better job of getting at the truth than my news segments on people without coverage ever could.

After all, in their end of television, unlike in mine, all the important stuff happens when the camera is turned on. We owe it to the uninsured to be able to say the same for journalism.

Susan Dentzer, a 1987 Nieman Fellow, is health correspondent with “The NewsHour with Jim Lehrer” on the Public Broadcasting Service.