The Fake News in Healthcare

I grew up in the pre-cable TV, social media era when our national and international news came from ABC, NBC or CBS and local from newspapers and radio. We trusted them, especially Walter Cronkite, the CBS Evening News anchor from 1962 to 1981.

Polls in the 60s and 70s ranked him as the “most trusted man in America.” His reporting of the John F. Kennedy, Martin Luther King and John Lennon assassinations, battlefield reports from Vietnam and coverage of the Iran hostage crisis and space program firmly positioned him as my generation’s news icon. He closed each telecast with “that’s the way it is” and we believed him.

Today, it’s hard for the public to know who to believe, especially about healthcare. There are more than 20 TV news networks, each with its own slant. National newspapers like the Washington Post, New York Times, Wall Street Journal and USA Today and news syndicates like the Associated Press, Bloomberg, Reuters and others filter our news and add depth to coverage. And social media are changing the news coverage game in politics, healthcare and every industry.

Case in point: As fallout from the August 19 showdown between white Supremacists and protestors in Charlottesville continued last week, CNN’s Alisyn Camerota hosted a focus group of sympathizers to ascertain their perspectives. Asked where they get their information, their message was clear: ‘media coverage is biased so they depend on their own social media to stay abreast.’ 

Data from Pew and Gallup confirm this view: the internet is playing a bigger role as a source for the public’s news as the public’s trust and confidence in traditional news sources slips. In fact, comparing journalists to healthcare providers as a trusted source is no contest: Gallup’s tracking surveys have consistently shown health professions among the most trusted and news providers among the least.

Coverage of healthcare is tough. I have written a weekly missive since 2006. I have tried to be objective and fact-based. I have been criticized by some for being liberal and others too conservative. I have had two death threats along the way and occasional requests to re-publish The Keckley Report in traditional news outlets. So, how the public learns about the healthcare system, its players, issues, regulations and trends hits close to home.

I’m especially keen to understand the data upon which the public views are based and how ‘fake news’ impacts our public diet of healthcare news consumption.  In reality, healthcare is not high on the public’s list of issues they’re thirsting to be informed. Say it ain’t so! It’s 17% of our GDP, 10% of household discretionary spending, and the issue state and federal politico’s boviate about ad nauseum and folks aren’t standing in line to understand it. Why not?

Most Americans trust their doctors and nurses for information about their medical condition and appropriate treatment when they need it. We collectively assume “they” will tell us everything we need to know when the time comes we need it. Information from social media and word of mouth with friends and family augment their directives, but rarely play a primary source role except in cases of complex diseases or circumstances where consumers are activated to seek answers for themselves. Publicly accessible resources, like Up-to-Date, Web MD, Cochrane Collaborative and others that provide evidence about the efficacy and effectiveness for specific treatments are virtually unknown to consumers. And the public trusts what our providers have to say, even if it’s inaccurate.

Most Americans don’t understand our health system. Public understanding of how our system compares and contrasts to others in terms of structure, outcomes, funding, and access is woefully nil. It lends to ‘fake news’ on all sides of issues. We understand our insurance coverage: the co-pays, deductibles and access to providers are the tangibles that get our attention but far less about how insurers evaluate what’s covered or denied and why. For our citizens who lack insurance, they understand the patchwork of public clinics, hospital emergency rooms and government programs as their safety net with confidence their costs will be covered by someone else. And the majority are resigned to the belief that the ‘system’ is big, expensive and too complicated to be understood so why bother. That makes fertile ground for fake news about our system!

Most Americans have strong opinions about the healthcare system based on personal experiences. In social services research, the strength of an individual’s opinion on a matter is linked to their underlying beliefs. Beliefs about healthcare for most Americans are not data-driven; they’re based on personal experiences. And for the majority of Americans, those experiences are negative: satisfaction with physicians is slipping. Trust in private insurers and drug companies is eroding. We know it’s taking more money from our household budgets often without warning. And we’re divided as a nation in our views about reforming the system based on those experiences. Thus, public opinion about the Affordable Care Act has remained virtually unchanged since passage in 2010: in Kaiser’s latest polling, 52% believe it’s a needed change to increase access to insurance for those without, 39% think it a costly overreach by the federal government, and the rest are unsure. But few have read the law. Fake news about the ACA has been constant since its passage in 2010, and is likely to continue.

As the Senate Health, Education, Labor and Pensions Committee begins hearings next week to avert a meltdown in the individual insurance market, it would be an opportune time for our policymakers to broaden that discussion. The bigger issue is the public’s ignorance about our system’s long-term sustainability and its performance, good and bad. Efforts toward transparency might chip away at the public’s lack of information, but it’s a war on misinformation and lack of public understanding about our system that needs urgent attention lest fake news be our source of truth.

As Walter Cronkite said: “that’s the way it is.”

Paul