Media myths about universal health coverage
LAST WINTER'S FLU EPIDEMIC OVERWHELMED emergency rooms across North America. Patients trapped in uncomfortable conditions were forced to wait for long periods of time before finally getting treatment. It was an ugly situation and the American press dutifully reported the winding lines, the cold drafts, and the screaming drug addicts adjacent to the people suffering from the flu. But their reporting of the situation in Canada and the situation in the United States was dramatically different.
The three major reports on Canada, by The Washington Post, The New York Times, and ABC News, used the overcrowding problem as evidence that Canada's universal health insurance program was critically flawed. The problems of Canadian emergency rooms, in short, indicted Canada's medicare. The two major reports on the problem in the United States, by USA Today and Time magazine, did not, however, turn overcrowding in American ERs into an indictment of America's non-universal health insurance system.
This contrast in press coverage cannot be attributed to obviously better conditions in American emergency rooms. Emergency rooms in both the United States and Canada have come under increasing stress over the last decade and, although there's no rigorous data on ER overcrowding, the data we do have suggest conditions are as bad, if not worse, in the United States. What the disparity does reflect is a tendency among American reporters to state or imply that Canada's increasingly intense debate about its universal health insurance program is evidence that its program is in "crisis" and that universal, government-financed health insurance programs are bound to fail.
Breaking the News
The USA Today and Time articles presented vivid evidence that in parts of the United States the condition of the ER is already putting Americans at risk. Time reported that patients entering the Thunderbird Samaritan Medical Center near Phoenix last December waited "for up to six hours to see a doctor." In Los Angeles, "for nearly 10 days in December," according to USA Today, "60 of the [city's] 81 ERs were so full that hospital administrators asked to send ambulances elsewhere." The USA Today story quoted a Boston paramedic saying: "When we get to a hospital, we either have to wait with the patient on a stretcher or we are told on the radio, `No, you can't come to this hospital.'" The articles explicitly attributed some of the overcrowding directly to the flu epidemic.
The journalistic portrait of Canadian ERs was similarly and deservedly dire. But the conclusion drawn wasn't simply that some Canadian ERs could be overwhelmed by events like the flu epidemic. The three reports on Canadian ERs either ignored the flu or dismissed it as an excuse used by Canadian public officials trying to minimize "the crisis." The problem was really our northern neighbor's universal health insurance program.
Steven Pearlstein of The Washington Post quoted unnamed "experts" to the effect that Canada's system is doomed. "Most academic experts," wrote Pearlstein, "say that while more money might alleviate the shortage of advanced machinery, hospital beds, and medical school slots, it will only be a matter of time before the demand for medical services once again overtakes the willingness of voters to pay for it." Pearlstein then quoted a Canadian "professor of health administration" who claimed "the big problem" is that "Canada has un-managed care," implying that Canada could avoid the apocalypse predicted by Pearlstein if it would import the techniques of managed care from the United States.
What Pearlstein did not say is that Canada is spending far less of its national income on health care than the United States is, that polls indicate Canadian voters want to spend more money on health care, and that in all countries with national health-insurance programs, doctors and other health-care professionals justify their demands for medical care with claims of critical shortages--a tactic known as "orchestrated outrage." Under these circumstances it is easy to find an "expert" who claims to foresee catastrophe; pending disaster is a great way to justify increased funding.
James Brooke, covering the flu outbreak for The New York Times, asserted that "few Canadians would recommend their system as a model for export," citing a tangential poll that actually only suggested that Canadians wanted the government to make health care a "top priority," and ignoring other polls that show that the vast majority of Canadians support their national health-insurance program. Brooke seemed to argue that Canada's whole "system" stands indicted by the reported problems its ERs were having during a bad flu season, at a holiday period where staff falls as much as 30 percent according to studies cited by the Canadian Institute for Health Information.
Although Pearlstein and Brooke based their indictments of Canada's universal health insurance on "expert" and "popular" opinion, Deborah Amos of ABC News was not so cautious. In her Feb. 3 report from Toronto for ABC's evening news, Amos averred that the "problem [of ER overcrowding in Canada] goes back a decade to when the Canadian government ... recognized that universal care was inefficient and expensive" and drastically cut the Ontario healthcare budget. Amos offered no study and quoted no expert in support of this statement. This is not surprising because the portion of her statement in quotes is palpably false. Canadian "universal care" is not, by any reasonable comparative standard, "inefficient" and the "Canadian government" has never said or implied it was.
Like Pearlstein and Brooke, Amos forgot to place American and Canadian performance in a comparative context. She failed to tell her audience (or did not know) that Canada insured 100 percent of its citizens for $2,250 per person in 1998 while the United States expended $4,270 per person insuring only 84 percent of our citizens. This oversight was convenient. One would look rather foolish asserting that Canada's medical care costs half what ours does and insures everyone, but is, nonetheless, "inefficient"
The Pattern of Distortion
These three reports weren't the first time that American reporters gave slanted coverage of the Canadian health-care system. In fact, American media coverage of Canada has suffered from two defects for a long time: it is infrequent, and it is often biased. These two problems also, of course, overlap since infrequent coverage is frequently ill-informed.
Canadian medicare has from time to time popped into the American media consciousness, but with precious little background or continuity of coverage. In the early 1970s, for instance, Sen. Edward Kennedy led a posse of politicians and press north to observe the successes of universal health insurance. In 1975, a serious and sustained comparative book was published with the accurate and promising title: Canadian National Health Insurance: Lessons for the United States. An academic bestseller in Canada, the book never reached the American journalistic community. The brief upswing in coverage of Canada was followed by a harsh backlash and then, with the stagflation of the 1970s, the domestic policy frustrations of the Carter years, and the conservatism of the Reagan administrations, a long silence ensued. Americans might, by a majority, favor universal insurance and, as the polls showed in the late 1980s, overwhelmingly favor what they thought Canada had. But their preferences forced no action in Congress and consequently stirred little media interest.
In 1989, during a period of economic growth and amidst the new ideas that always come in with a change in presidential administration, there was the typical flurry of inquiring (and occasionally appreciative) television programs, newspaper features, and radio interviews about Canada's medicare. As before, these were soon followed by counter-stories fueled by the same interest groups that would scuttle the debate over President Clinton's health-care plan in 1993. Coverage slacked off after the counterattacks in both 1989 and 1992 and, by 1999, when the failings of the American health-care system began to reappear on our national political agenda, the journalistic community had again fallen out of touch with the Canadian situation. Thus, once again, they became easy prey for the special interest groups aligned against the Canadian system.
Bias
