Seven years of studying journalism on both the undergraduate and graduate levels led me to the conclusion that the proper role of the media in today's society was best summed up in a 1950s play, which observed that journalism exists to "comfort the afflicted and afflict the comfortable."
Certainly, the news media often comfort the afflicted through a relentless pursuit of information and justice. Conversely, the comfortable are rightly afflicted when the media serve as watchdogs over governments or institutions that badly need watching.
Between these noble ends, however, lies a great divide where one is never sure just who the media are comforting through their affliction of others.
For years, our nation's hospitals served as a foil for media thrashing, comedians' jokes and politicians' scorn. Lately, however, it has become fashionable to shift our collective attention away from the true providers of care toward strange new beasts called HMOs. With their public presence and indisputable importance, HMOs make easy media targets (See related stories, pages 36 and 48).
The horror stories about managed care roll off the presses: HMOs sacrifice quality for cost. They discharge patients from the hospital much too quickly. They delay enrollees' access to the medical specialists they need. They interfere with a doctors' practice of medicine and relationships with patients. Their top executives flourish in a world of exorbitant compensation structures. In short, they are a poisonous menace to society.
Yet study after study by independent sources conclude that more than 93% of the people enrolled in HMOs like them, would recommend them and, if given a choice, would join again. Where are the stories about these folks?
Why don't we hear about those millions of Americans who now have access to a healthcare system from which they were previously disenfranchised? Or about how HMOs have dramatically increased prenatal education, lowered infant mortality rates, elevated percentages of children's immunizations, taken the lead in promoting mammograms, detected illnesses that otherwise would have gone unnoticed, and have established barometers of quality measurement and healthcare consistency heretofore unmatched?
Clearly there dwells a great inconsistency between what the public is saying and what the media are reporting. But why?
It's the media's fault. The same journalism training that taught me about comfort and affliction also left me with the understanding that news is the fusion of the unique, timely and dramatic. Success stories of the 93% of HMO enrollees who remain satisfied don't often meet those criteria. But while that may be an excuse for the media paying so much attention to the other 7%, it provides no justification for simply poor reporting.
Late last year, a Los Angeles television station spent a full week promoting an upcoming segment on its evening news titled "HMOs Exposed." The headline implied the investigative report would deal with the HMO industry as a whole or, at the very least, with multiple HMOs.
Instead, the piece featured only one organization that, it turned out, was not an HMO at all, but rather an independent physician group and its reinsurance program. This misrepresentation was not only hazardous to a public greatly in need of assistance in understanding the changing healthcare system, but reflected poorly on both the station's and the reporter's integrity and concern for accuracy.
Unfortunately, this isn't an isolated incident. Shockingly few journalists grasp as fully as necessary the social, moral and economic issues surrounding this changing industry, including the ability to clearly differentiate between HMOs, physician groups, hospitals and other facets of the healthcare system.
It's the healthcare industry's fault. If journalists lack appropriate knowledge, the healthcare industry must confess to not taking adequate time to work with local reporters in helping them understand the complex issues involved. In addition, the industry has done a poor job in coming together with one voice to address the healthcare challenges facing our nation.
Doctors, hospitals, home health agencies, skilled-nursing facilities, outpatient clinics and others-together with HMOs, PPOs and other financing mechanisms-are all part of the healthcare solution, not the problem, but only if they can work harmoniously to set a sensible and morally sound healthcare direction. The industry becomes easy prey when it's engaged in internal bickering. It's time to return to the roots of public purpose over private gain.
It's the HMOs' fault. For years, the HMO industry has focused far too much public attention solely on managed care's cost savings. But cost savings result from the larger good of keeping people healthy and out of the hospital. Instead of following the dollar and/or being passive in telling its story, the HMO industry should be trumpeting its contributions while aggressively leading a discussion about such concepts as value and quality. If HMOs can't add value, they serve no purpose at all.
HMOs have, in fact, added tremendous value through accepting a far greater sense of accountability and responsibility than was ever shared under the indemnity environment. In that world of yesteryear, how many people held their traditional insurance carrier accountable if they waited too long for a doctor's appointment, found the office staff less than pleasant, or didn't feel they were receiving the attention needed?
The answer is nobody. Yet we routinely challenge and criticize an HMO if the same unfortunate experiences occur.
It's the HMOs themselves that accept and expect this accountability. They set the performance standards and contract with physicians and hospitals to deliver care to their enrollees. As a result, when customers enroll in an HMO, they don't just sign up for the marketing, customer service, claims processing and other behind-the-scenes services an HMO brings. They are really signing up for the entire package, including physicians and hospitals. They generally make no distinction between what is part of the HMO itself and what is essentially a contracted service.
What consumers want is the right care at the right place at the right time, and for the right price. Too much care is as wrong as not enough care. Extended hospital stays when they are no longer necessary benefit no one. Managed care understands this and more. HMOs emerged and prospered because they responded to a demonstrated demand.
Certainly, managed care is no panacea. HMOs still have miles to go and promises to keep. But, hopefully, along that journey there will be an increased understanding that the goals of media and health plans are much more in harmony than in discord, and that "comforting the afflicted" is a responsibility these two institutions rightfully cherish with equal passion.
Goldberg is senior vice president of communications and marketing for CareAmerica, an HMO based in Woodland Hills, Calif.