What NBC Didn't Tell You About Health-Care Reform
NOVEMBER 01, 1994 by JANE M. ORIENT M.D.
Dr. Orient practices private medicine in Tucson. She is also Executive Director of the Association of American Physicians and Surgeons.
How much education will $2.5 million buy on prime-time network television? The NBC two- hour special “To Your Health,” aired June 21, promised to provide a “vigorous, energetic discussion” that would “speak clearly” about “the most complex issue in our lifetime.” The sponsor was the Robert Wood Johnson Foundation (RWJF), the nation’s second largest tax-exempt philanthropic organization.
RWJF has played a crucial role enabling the passage of health-care reform legislation in various states. Key members of the President’s Task Force on Health Care Reform also were funded by RWJF. (The secret war-room operation of the Task Force is being challenged in federal court as a government violation of the Sunshine laws, in the case of Association of American Physicians and Surgeons, et al., versus Hillary Rodham Clinton, et al.)
The sponsor’s role in the televised “town hall” was simply to provide money for education. NBC was responsible for the content of the program—except for choosing the general subject matter.
RWJF did not fund a program on rising illiteracy, declining morals, welfare-state failures, government corruption, or other pressing issues. Just coincidentally, the subject involves a mammoth piece of legislation that the Administration is desperate to pass—urgently, quickly, before potential patients find out what it will do to them. The star of the show was the foremost proponent of that legislation: Hillary Rodham Clinton.
The vigorously stage-managed presentation had some huge blind spots. The most important one was what health-care reform would do to the patients who told their sad stories to a national audience.
Naturally, the audience would assume that health-care reform is supposed to help people who have lost their insurance and come down with cancer.
The reformers stated their agenda, but you might not have understood: our current system has a sickness orientation. They want to change it to a health-care or wellness orientation.
What does this mean to a person who cannot benefit from a school-based clinic, a blood- pressure check, or a substance abuse program? What about that uninsured, wheelchair-bound man who was too ill to come into the auditorium?
A spokeswoman for the model Oregon rationing program, a featured panelist, could have told the audience what was in store for that man under her program. But she didn’t. And people like me, who provided “balance” by sitting in our assigned seats in the audience, were not allowed to ask her.
On the Oregon Prioritized List of Physical Health Services, “cancer with distant metastases” (the man had lung cancer that had spread to his brain) is number 672 out of about 700.
The man in the wheelchair was bald due to the chemotherapy he had received, albeit with a few weeks’ delay. According to the narrator, he had accumulated some $30,000 in medical bills, which probably will never be paid. (That’s about one percent of the cost of the television program. But don’t bother to apply to the RWJF for a grant. As a matter of policy, they do not help individuals.)
Under the Oregon plan, the man might have been in a coffin, but at least he would still have hair. His wife wouldn’t have medical bills to worry about—.although she might have less money because of being forced to pay premiums for the “health” plan.
The $30,000 that might have paid for this patient’s care would be allocated to things with a higher social priority: for example, sterilization operations (number 88-89); preventive services (141 and 174); abortions (279); and the bureaucratic infrastructure to enforce the priorities.
For its cynical (or unthinking) exploitation of human tragedy, NBC’s educational effort merits an “F.”
There were also other failings. The spec-tram of views was by no means complete.
The featured dissenters were zealous and disruptive advocates of a government takeover of insurance and medicine (the “ single-payer” system).
On the other side, small business executives spoke eloquently about the harmful effects of employer mandates. Unfortunately, some viewers might conclude that hardened businessmen were the only obstacle standing between health care and the poor. It is hard to find someone with the insight to say, “I lost my job because the government ruined my employer’s business, and now I’m on welfare.”
Senators Dole and Mitchell provided an appearance of bipartisan balance by sitting together on the stage and saying very little. Senator Mitchell spoke glowingly of the success of Medicare, despite its monstrous costs and NBC’s technically brilliant exhibition of its paperwork forest.
Absent from the discussion (save for the briefest mention of Medical Savings Accounts) was any proposal to replace the current system of prepaid consumption with economically sound insurance. No one spoke of the proven benefits of putting decisions—d money—back in the hands of patients, wresting it away from the new elite managerial class that has caused much of our current problem.
There is one way to defeat this idea, which can reduce costs while preserving freedom: keep it a secret.
After viewing the NBC program, on location and on television, I would revise my question:
How much propaganda value can $2.5 million in tax-exempt educational funding buy?