MediaWatch: September 1993

Networks Promote Government-Directed Systems, Obscure Cost, Quality

Prescribing Nationalized Health Care

Four years ago on NBC Nightly News, reporter Fred Briggs pushed for the Canadian health care system: "When a baby is born in Canada it's given a birthright denied to U.S. citizens -- free health care, a lifetime of preventive and corrective medicine without ever getting a bill from a doctor or a hospital."

With President Clinton about to unveil his health plan, MediaWatch set out to learn if Briggs' report was typical. Analysts identified 20 health stories, aired between January 1, 1990 and July 31, 1993 from morning and evening shows on NBC, CBS, ABC, and evening shows on CNN. The stories profiled government-run or mandated health systems in five countries (Canada, Germany, Britain, Japan and Sweden) and two states (Hawaii and the proposed single-payer Vermont plan).

MediaWatch determined that 70 percent of the stories were decisively positive; talking heads favoring government-run systems outnumbered opponents by two to one; and most stories called the other systems free or cheaper than the U.S. system.

Story Angle. Analysts timed the length of positive and negative statements in each story. Pieces with a disparity greater than 1.5 to one were categorized as either negative or positive. Stories closer than the ratio were considered neutral.

Of the 20 stories analyzed, 14 clearly shed a positive light on single-payer or state-mandated health insurance systems. Four were considered neutral, while only two qualified as negative. None included a mention of a market-oriented approach to health reform.

ABC's George Strait typified the positive assessments. He concluded a May 3, 1990 World News Tonight story: "Hawaii had to make hard political and business choices to become the only state in the union which assures everyone equal access to health care. It is a glimpse of what the rest of America could be if it chooses." Tom Fenton ended his April 5, 1993 CBS Evening News report: "As Americans search for a better system, the lesson from Germany is that private health care can be made available to everyone, provided all pay their fair share."

Soundbites. Proponents of government-directed systems outnumbered the opponents 72 to 36, a two-to-one talking head ratio including both "experts" and "the man on the street" interviews. Among stories classified as positive, the ratio jumped to five-to-one, including eight stories with no negative voices and two with only one dissenter.

Free? In 13 stories (65 percent), the reporter directly stated or indirectly implied that health care came at no cost. Paula Zahn introduced a 1990 This Morning piece on Britain by noting "Many countries have a different approach, making sure no one has to pay for health care." Jeff Levine's May 28, 1992 CNN Prime News piece followed suit: "About 3,000 patients a year visit this community health center in Toronto and no one has to pay a penny."

Even in neutral or negative stories this myth persisted. In the first of a two-partner on Britain, classified as neutral, Dr. Bob Arnot said on the July 16, 1990 CBS This Morning: "Since it began in 1948, the National Health Service has promised universal access at no charge." In the next day's story, classified as negative, Arnot quipped: "It's always free."

Of these 13 stories, only five mentioned a source of payment. Four of those five cited the source of revenue as "the government," and only three mentioned the word taxes. In only one, Tom Fenton's April 5, 1993 report on the CBS Evening News, was a direct tax, in this case the average 13 percent payroll tax placed on German workers, mentioned. Ironically, Fenton reported this just seconds after declaring: "Germans get full medical and dental care without ever seeing a bill."

Cheaper and More Efficient? In 14 of the 20 stories (70 percent), reporters claimed that health care in these alternative systems cost less than in the United States. In a May 26, 1992 CNN Prime News report, Jeff Levine asserted that in the U.S. "yearly medical costs run about $800 billion -- nearly 13 percent of Gross Domestic Product. In contrast, Canada commits about $2,000 per citizen -- that works out to about 9.5 percent of its GDP."

No story mentioned that per capita spending on health care in Canada, relative to the United States, remained unchanged at 75 percent of the U.S. level even after 20 years of national health insurance. As John Goodman of the National Center for Policy Analysis has pointed out, between 1967 and 1987 "real increases in health care spending per capita have been virtually the same in both countries."

Additionally, none of the stories mentioned the different accounting methods that skew the costs of health care. In Canada for example, the capital costs of health care, such as the building of hospitals, along with the cost of employee health benefits are part of the general costs of the Canadian government and are not counted as health care expenditures.

Just one story mentioned the indirect effects of mandated health. In a July 11 Evening News story this year on Hawaii, CBS reporter Bill Lagattuta observed: "Since state law requires companies to contribute for all who work at least 20 hours a week, some businesses are now limiting their workers to nineteen hours." Reporters didn't mention Hawaii's dropping wages, or the absence of job growth in western European countries.

Quality and Access? Fifteen of the 20 stories (75 percent) mentioned problems ranging from long waiting lines to shortages of hospital beds and medical technology. But these complaints were offset by qualifying remarks in 66 percent of those stories. On the May 28, 1992 CNN Prime News Jeff Levine opined, "High-tech procedures aren't as widely available here, as in the States, but Canadians point out that could be a plus." Bob Arnot echoed this aversion to technology in his July 16, 1990 report on Britain, declaring: "There's not the competitive pressure to have every new high-tech device in every hospital."

Similarly, after noting Canadian waiting lists and high tech equipment shortages in a 1992 Good Morning America piece, Greg Dobbs insisted: "But still, there seems to be less pressure on doctors to produce, and more time to simply practice medicine."

While some doctors may be pleased with these systems, only three stories pointed out that patients are not. CNN's Jeff Levine reported on May 29, 1993: "Some Canadians do cross over into the U.S. in search of medical care. In some cases, they're seeking high-tech treatments not readily available in Canada." Bob Arnot's 1990 CBS This Morning report outlined how centralized care inevitably leads to rationing: "British health care has become a two-tiered system, with money or connections you get to the head of the line, without them you wait. That fact is turning people sour."

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