MediaWatch: October 1993

Janet Cooke Award: NBC's Jim Maceda Attacks Conservative "Myths" About Health Care

Correcting the Clintons' Critics

In the Reagan era, reporters applied a skeptical eye to the administration's legislative proposals. With a Democrat in the White House, that skepticism is being trained on the new administration's critics. For a one-sided exploration of the "myths" surrounding the Clinton health plan, NBC's Jim Maceda earned the October Janet Cooke Award.

On the September 22 Today, co-host Bryant Gumbel described Maceda's story as a look at "a few common misconceptions." But Maceda selected only one myth-buster: Dr. Arthur Caplan of the University of Minnesota, a liberal.

Asked why Caplan was the only expert, Maceda told MediaWatch: "It was done not as a news report, it was done as an essay. I had freedom to do what I wanted. It was a more subjective piece, and I tried to be thought-provoking, rather than simply informative ...[Caplan] happens to be one of the best I know to raise those issues. Obviously, he is a reform advocate, and I say that throughout." But Caplan was never identified as a liberal or "reform advocate" in the story, and NBC never told viewers that they were seeing an essay or commentary.

NBC's first "myth" was "The Family Doctor." This might be a surprise to millions of Americans who have one, but over video clips of the old TV shows Dr. Kildare and Marcus Welby, M.D., Maceda remarked: "The rock-solid father figure. Images of the family doctor we as a nation still cling to. Only the stuff of dreamy fiction, say health care advocates."

Caplan lectured: "That you and your doctor are going to go together as a team through the universe of health care, hand in hand, down some path that leads to a golden old age where you part company with a fond farewell to one another, and the only problem is, there are three or four insurance officials and government bureaucrats blocking the path. Marcus Welby left the health care system about 1945."

Maceda moved on to the choice "myth": "But many of us do have private doctors, even if they're not Marcus Welbys, they are our doctors. We chose them, right?"

On came Caplan: "I think I can nominate as the mother of all myths about American health care the idea that choice exists. What you've got is consumers who get no information about their doctor, about their hospital, about their hospice, about their mental health facility. They don't know whether it works or it doesn't work. They have no idea who is doing things to them, whether they're any good, what the costs are, what the prices are." Maceda added: "But that hasn't stopped the media blitz from health providers, insurance companies, warning us that reform could threaten our power to choose."

In other words, choice does not exist because people are too stupid to make choice a meaningful concept. MediaWatch asked Maceda how health care is different from say, auto repair, where consumers often don't know the competence of the mechanic who fixes their car. Maceda responded: "That's correct. That's the point...We don't have choices. We don't know most of the time. I can't tell you how many times I've gone to a doctor not knowing who he or she is, absolutely starting from scratch ...It happens all the time, and that's the point I think we needed to raise." By that standard, we should have socialized auto repair.

If Maceda had interviewed Michele Davis, an economist with Citizens for a Sound Economy, she would have offered another view: "President Clinton stated explicitly that reform should empower consumers -- not the government -- to make health care choices. But under the Clinton plan, the federal government would tell all Americans what health insurance benefits they must buy, where to buy them, and how much to pay for them. It's a restriction of choices."

Maceda then addressed the "Managed Care" myth: "Also looming, the specter of managed care, something good for those so-called socialist countries abroad, but surely not for us. But guess what? American health care is already largely managed...Managed care already works in ten states, and, the reformers insist, is saving money."

Misleading. Managed care, through health maintenance organizations (HMOs), does exist, but not top-down government- managed care. As for the declaration that managed care "already works," Michele Davis contended: "One survey of 17,000 patients showed that patients prefer fee-for-service medicine to HMOs in every category -- competence, personal qualities, waiting time, and explanations of their diagnosis." 

Maceda then took on the "myth" of "Rationed Care" under the Clinton plan: "In its attempt to economize on our health costs, will President Clinton's reform plan ration our health care?" Caplan declared: "It's not only a myth, it's propaganda. It's basically being used as a scare technique to frighten people out of wanting to change the health care system."

"Flat wrong," Michele Davis told MediaWatch. "With caps on insurance premiums, Clinton's health alliances will have to ration care. If costs grow 10 to 12 percent a year, and you could only raise premiums five percent -- at the same time that you're actually expanding the demand for care by covering the uninsured -- the only way they can survive is by restricting care."

Maceda's story muddied the point by insisting: "These doctors say rationing -- by ability to pay -- has been going on for decades." MediaWatch asked: would it be better or fairer for Americans of all incomes to be denied care? Maceda replied: "That's something I would have liked to go into if I had more time."

Maceda concluded: "Before Clinton gets the maximum bang out of health care's buck, he'll have to address all the lingering myths and fears, but none more than this one: that reform will mean giving up what we've already got."

Unknown. How can Maceda claim it's a "myth" that Americans will have to give up what they have when the Clinton plan hasn't been enacted yet? "I didn't say giving up something, I said giving up everything. If I recall, I said starting from scratch, losing all the good things." After MediaWatch read Maceda the transcript, he replied: "Okay, in context, giving up everything we've already got is what that means, giving up and going plunging into the unknown." Won't people have to give up what they have for the new plan? Maceda admitted: "Sure, people will have to sacrifice. Of course."

Maceda's "myths" weren't errors or falsehoods, but partisan attacks on the notion that conservative criticism matters. If the Clinton plan reduces the choice of doctors, then choice didn't exist; if it leads to government-managed care, people already have managed care; if it leads to system-wide rationing, rationing already exists. NBC shouldn't mislead viewers by pretending such a story is balanced news; it's liberal commentary.

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