'Medicare for All' vs. 'Government Plan': Nuance matters in coverage of health policy choices

By Trudy Lieberman
Health Review News, March 3, 2016

In late January, as Hillary Clinton and Bernie Sanders battled over a Medicare-for-all health system, PBS NewsHour co-anchor Judy Woodruff in a conversation with her guests David Brooks and Ruth Marcus posed this question: “Essentially the argument is whether you just wipe away what we have done and you go to a single-payer healthcare system, which most Americans say they don’t want, right, I mean..?” (Exchange takes place at 9:00 in the video.)

Neither guest responded to her point, although Marcus noted, “it really is this argument about practicality.” Brooks was silent. Nevertheless, viewers—I was one—might have been flummoxed by her question. I recalled a Kaiser Family Foundation poll a few weeks earlier in mid-December, which found that 58 percent of Americans favored the idea, including 34 percent indicating they strongly favored it. What gives here? Why did Woodruff make the comment and then fail to back it up with evidence?

Presumably she was looking for her guests, the apparent experts, to support (or perhaps challenge) her contention that most Americans want no part of a single-payer health system. But the fact that nobody chose to respond gave her comment an air of finality and truth — one that is all the more impactful given Woodruff’s considerable experience and authority as a journalist.

That perception prompted officials at Physicians for a National Health Program (PNHP), an advocacy group that has long pushed for single-payer, to contact Woodruff and PBS ombudsman Michael Getler about what it said was Woodruff’s “factual error.” In an email exchange that PNHP shared with me, the group cited a number of surveys, including the mid-December Kaiser poll, and pointed out that “surveys repeatedly show that an improved Medicare for All, single payer, is preferred by about two-thirds of the population.” A few days later Getler sent a letter to PNHP’s past president Dr. Garrett Adams identifying a Pew Research Center poll from June 2014 as the source for Woodruff’s assertion. According to Getler, the Pew poll asked respondents who said government does have a responsibility to ensure health coverage whether a mix of private payers and the government, or if the government alone should provide insurance.  The single-payer option was supported by 21 percent.

There were more emails to Getler with Adams arguing that the Pew poll was an outlier and offering more information about the wording of questions and noting the results of many polls suggesting that support for single-payer ranged from around 45 percent to more than 60 percent depending on how the questions were phrased and the choices given to respondents. In one response Getler acknowledged there are “dueling claims about this” that were “not likely to cause a NewsHour correction. I’m not an expert on polling but it is my sense and experience that Pew is widely viewed among experienced journalists as the very best and most authoritative polling outfit.” Finally, he said he had sent all the PNHP materials to the NewsHour.  “I think it is clear that the NewsHour does not believe a correction is called for and they are not going to do one. I have no power to make them do so and I’m not convinced that one is necessary either.”

I discussed all this with Dr. Robert Blendon, who runs the Harvard Program on Public Opinion and often works with news outlets. He said “journalists are supposed to use the most recent poll or the most recent poll conducted by their organization.  The latest poll is usually the most reliable.” Because people change their minds, the latest poll is usually the best gauge of what the public currently thinks. In the case of the NewsHour the most recent poll on January 22 when the broadcast aired was Kaiser’s mid-December poll, Blendon told me.

As for differing polls about support for single payer, he said polls since the time of Harry Truman show high initial support for single-payer, but when pollsters ask whether people would support such a plan if they had to pay more taxes, or would lose their doctors or list other possible consequences, support drops. “Most people say they support Medicare for all until you give them the specifics.” An AP poll released last week is a case in point.  PNHP challenged the results on its blog.

Those specifics can bias the answers, argues Kip Sullivan, a Minneapolis lawyer who works with PNHP. He explained that if a poll compares single payer to Medicare, it usually draws 65 percent approval. A poll that describes single-payer as a single “government plan,” or uses the term “single-payer” and doesn’t mention Medicare draws about a 55 percent approval rate. One that uses the term “single government plan” and asks about single-payer in a line-up of questions — that is, the questioner asks about other options along with single payer — gets only about 45 percent.

So what’s the lesson in all of this? I think you can find it in the framework that has created to help reporters better cover medical studies and which British journalist John Lister has adapted for reporting on health policy. In its tool kit warns against using a single source for a story, citing the principles of the Association of Health Care Journalists (AHCJ), which points out “most stories involve a degree of nuance and complexity that no single source could provide. Most one-source stories lack depth and meaning.”  Lister makes a similar point, urging reporters to ask whether the “story unnecessarily suggests a consensus in favor of the policy and ignore opposing views?” Although Woodruff’s comment to her panel of pundits perhaps can’t be held to the same standard as a complete news story, the principle still applies: Health policy news should reflect a diversity of views on the subject and not gloss over nuances — such as poll wording — that are critical to understanding the issues.

In his last e mail to PNHP Getler acknowledged that its exchange with the NewsHour had been helpful “and should the matter come up again, which I think is likely, perhaps they will remember your challenge and my calling it to their attention.” Getler is right. There will be more polls especially as other health policy topics like fixes for the Affordable Care Act, the high price of drugs, and premium support plans for Medicare make their way into the campaign rhetoric just as Medicare-for-all has. The temptation will be to use whatever poll fits your biases or those of your news outlet and grab the juiciest numbers to support them. Those who forget the advice from AHCJ or from John Lister urging journos to broaden their sources, look for diverse opinions, explain their meanings carefully, and consider conflicts of interest will, like PBS in this instance, do a disservice to their audiences.

Trudy Lieberman, a journalist for more than 40 years, is a contributing editor to the Columbia Journalism Review where she blogs about health care and retirement. Lieberman served five years as the president of the Association of Health Care Journalists and fourteen years on the board of directors. A longer bio of Lieberman appears here.