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

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 HealthNewsReview.org 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 HealthNewsReview.org 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.

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Comments (6)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Michael Getler

March 3, 2016 at 2:25 pm

Dear Ms. Lieberman, since my email exchanges with Dr. Adams have been “shared” with you and have come up in this article, I would like to point out that while the Pew poll cited was the one the NewsHour cited to me as support for Woodruff’s question, in those same emails to Dr. Adams, I also said to him that I had found other polls from my own research. I stated in my email to him that: “I’ve sent you, aside from the Pew poll, other material that I’ve come across, including the Politifact http://www.politifact.com/wisconsin/statements/2014/may/14/ralph-nader/70-years-most-americans-have-supported-single-paye/ which differs from your conclusions. I’ve also come across a Rasmussen poll http://www.rasmussenreports.com/public_content/archive/health_care_update_archive/april_2014/37_favor_single_payer_health_care_system which also differs, a historical look, done in 2001, that also differs http://content.healthaffairs.org/content/20/2/33.full, and a Gallup survey that seems also to show lack of majority support http://www.gallup.com/poll/186782/say-gov-ensure-healthcare-coverage.aspx? g_source=CATEGORY_HEALTHCARE&g_medium=topic&g_campaign=tiles.”
I also said: ” I am aware of the Kaiser Poll and the recent one by the Progressive Change Institute which, like your organization, supports single-payer.” I’m not saying who is right or wrong in this, only that there are differing polls feeding this argument.

Trudy Lieberman

March 4, 2016 at 8:36 am

Mr. Getler, thank you for your comments. As we both know, on this topic and on most others, there are lots of polls that show differing results,depending on how questions are ordered and phrased and yes, also on the political inclinations of the polling organization. We have only to look at this year’s political coverage to see that. The point of my commentary was to note this fact and try to bring some advice to journalists (and the public) for interpreting and understanding polls when news outlets and others use them. For that I turned to guidance from the respected Association of Health Care Journalists and the advice from Health News Review which has been working for a decade now to improve the coverage of medical stories. The same standards should be applied to health policy stories as well. In preparing stories, journalists need to look at as many polls as they can and try to understand them. They can either tell their audiences that varying polls exist and give a flavor of their findings, or do as Robert Blendon has suggested and use the most recent one because people’s opinions are volatile and change. Depending on their news outlet, perhaps journalists can do both. That is the fairest approach. As you noted in your e-mail exchange with PNHP, these issues will come up again, and I think it is all to the good we are having this discussion to present the fairest picture possible.

Rob Oliver MD

March 7, 2016 at 7:00 am

In contrast to the author’s contention, when people are explained the tradeoffs inherent with single payor as practiced elsewhere (less choice, waiting lists, overt/covert rationing, two tier systems emerging) support falls, particularly among people who were satisfied with their own plan currently. As noted, the results of polling vary with the way it’s asked, but the people most familiar with other systems know that the trade offs involved aren’t something Americans are culturally ready to accept at present.

    Ida Hellander

    March 7, 2016 at 12:25 pm

    Polls often do ask about “trade offs” (per Rob Oliver’s point) but they never ask about “trade ups”. How much would people’s support increase if they new that single payer would eliminate out-of-pocket costs? Reduce health care inflation? Allow free choice of provider? Eliminate the link between insurance and employment, ending “job lock”. Eliminate insurance company intrusion into what doctors you can see and treatments you can receive? Guarantee health coverage for life for the whole family? Eliminate hospital and doctor bills? Allow doctors to ask “what’s wrong” instead of “what insurance do you have?” etc. I suspect that if people were informed of just a few of the “trade ups” of single payer, support would be much higher.

      Aleta Kerrick

      March 7, 2016 at 4:25 pm

      Thank you, Ida, for pointing out the positives that too often get omitted when people talk about the consequences of a single-payer plan.

Jeanne Lenzer

March 7, 2016 at 7:12 am

Very thoughtful – and helpful – commentary, Trudy. I