Q&A with Trudy Lieberman: Finding Local Stories in the Great Medicare Debate of 2011
When veteran health journalist Trudy Lieberman first started covering Medicare in 1988, federal lawmakers had just added prescription drug and catastrophic coverage to the popular health program for seniors – only to rescind both benefits a year later amid a political backlash.
Today, Medicare is once again a top news story as Republicans led by Rep. Paul Ryan propose a radical (but not novel) overhaul: new Medicare beneficiaries could select from a number of coverage options, and the government would provide vouchers to subsidize the cost of some of that coverage. The controversial proposal already is a key issue for Congressional races and the 2012 presidential election.
As Lieberman covers the latest national debate over Medicare's future, among other social issues, for the Columbia Journalism Review, she has been mulling how reporters outside Washington, DC, can report on Medicare in ways that truly will connect with their communities. We talked about this by phone recently, and our conversation has been edited for length and clarity.
Q: Why is it important for reporters to try to localize the current Medicare debate? It seems like such a Washington story right now.
A: This is a real bread and butter issue. It's not a boring health policy story. This is on the minds of everyone in every community. It's not just seniors who are worried; it's people in their 50s. It's possible that politicians will pull this off in five years, and people will have to assume a lot more of their health care expenses.
Q: What are the main issues in the current debate that you think are the most promising for local coverage?
A: We need to back up a bit. The basic problem that I see is that people don't understand Medicare. That includes people already on Medicare, people going on Medicare soon and the people who will need Medicare in the future.
It's a popular program, but the level of understanding of it is superficial at best. So when people hear that Ryan wants to cut Medicare, they get scared. The people on it know they're in trouble if they don't have it. They can't get medical care or drugs without it.
What are seniors really on the hook for? According to the Congressional Budget Office, today the average senior is paying 39 percent of their health expenses out of pocket, including deductibles. If Ryan's plan goes through, they'll pay 68 percent.
What's needed most are just plain primers right now. Forget the politics. I did "man on the street" interviews in Philadelphia, and one woman, who was 59, said, "I want to know how it's going to affect me. I hear about it on the radio but don't know how it's going to affect me." I think about this lady. The choices are too many and the information (for consumers) is imperfect, and sometimes downright bad.
Q: Where can reporters go to get the best information on Medicare?
A: Understanding how Medicare is financed is really crucial. That's where the rubber meets the road. The Kaiser Family Foundation has good Medicare information and Tricia Neuman there is good at explaining it simply. Bonnie Burns at HICAP in California is a gem. Marilyn Moon, formerly at the Urban Institute, is now at the American Institutes for Research. Bob Berenson at the Urban Institute – I did a Q&A with him (on health care costs).
Jeremy Engdahl-Johnson of Milliman, Inc., can put people in touch with actuaries who specialize in Medicare. They've got people who specialize in different regional markets. Most of what they'll tell you is off the record, but that's fine. At least you can understand the marketplace.
Reporters shouldn't be afraid of going off the record and getting background. When you need a quote, go get one from somewhere else.
Q: So once reporters have done the basic stories, where do they go next?
A: The first question I'd ask is, what does means testing for Medicare really mean? We're means testing Part D and Part B premiums already, and some people are starting to notice.
Are there price hikes in Medicare Advantage plans in your area? It's hard to say; it varies from plan to plan and region to region. I don't think premiums tell the whole story; reporters should focus on the total cost of the plan, including copays, deductibles and premiums. It's that mix that makes a plan a good deal or a bad one.
Some Medicare Advantage plans require step therapy, in which patients have to try a cheaper drug first. How is it working for patients? That's where you'd want to talk to some doctors.
Think about the coverage for people who are on Medicare and people are who are going to be on Medicare. What are their concerns? What help do they need, and not just during open enrollment in the fall?
Cherry picking: in a voucher system, people might try to leave Medicare, which could lead to an insurance death spiral for Medicare. Those are healthy people who you want to be in the risk pool. If they leave, then people left in the system are going to end up paying a lot of money. We see this to some extent in the individual (insurance) market today, where the only people left with certain kinds of policies, called "blocks of business" in the industry, are those who can't move.
Q: How can reporters connect with seniors in their communities?
A: One place reporters ought to go is to individual counseling sessions at local elder or aging information agencies and, in California, HICAP programs. Sit in on a session and hear what ordinary people are going through financially. That is one place in most localities where reporters can find out what people on the ground are going through. I remember meeting a woman at a senior center in Monterey (Calif.) – she was telling me she'd had breast cancer long before the Part D drug benefit. It was so profound to hear the struggles she was going through to try to get well because she was old and didn't have the money to pay for the tamoxifen she needed.
I would ask, can I visit people in their homes? I often had sales agents come in (to seniors' homes) and listen to sales pitches. That was so interesting. Being in someone's home and going through their budget with them, you can see what their problems are and why they're worried about Medicare, because if Medicare goes, they go, they know that.
Q: What other advice would you give reporters trying to localize stories about Medicare?
A: There's no substitute for talking to people on the street. I think we as journalists have moved away from that for a whole variety of reasons. It's so much easier to do research on the Internet. That's fine for basics but that kind of research often misses the story.
We don't have the time we once did. But go do it in small chunks, at lunch hour or an hour after work. Then, when you hear something, bounce it off the experts.
For me, being a good journalist means you're always on call to spot a story. There's no shortcut.