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Missing the MSM

The Washington Post's media maven, Howard Kurtz, notes that the persistence of the "death panel" reports shows the infirmity of the mainstream media:

For once, mainstream journalists did not retreat to the studied neutrality of quoting dueling antagonists.They tried to perform last rites on the ludicrous claim about President Obama's death panels, telling Sarah Palin, in effect, you've got to quit making things up.But it didn't matter. The story refused to die.The crackling, often angry debate over health-care reform has severely tested the media's ability to untangle a story of immense complexity. In many ways, news organizations have risen to the occasion; in others they have become agents of distortion. But even when they report the facts, they have had trouble influencing public opinion.

And that goes for the MSM across the spectrum, as far right as National Review. Canary in the mine for political discourse? Or has it always been thus?

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Jon Stuart [actually Stewart] seemed to kick the story to death the other evening in his interview with the woman who started the fracas--Betsy McGaughy (former Lt. Governor [R] of New York). She was inept and inarticulate though making every effort to charm Stuart and the audience. A dumb blond who has risen above her level of competence????

I'm not buying Kurtz's claim -- the MSM has done its level best to debunk and dismiss the hysterical distortions of Palin et al.? It looks to me like the MSM has done its best to report on said distortions as if they deserved to be dignified with a response. Reporters may have been less "neutral" than usual, but they were still more "neutral" than the facts called for.

I thought neutrality had to do with positions with regards to the issues, not validating false claims by airing them as legitimate points. Isn't it the job of journalists to fact-check, and to relay the truth?

We have a document that is 1,000 pages, leaves out many details, and as a result, we have mass confusion. No surprise there.

I agree with Mr. Kurtz; the MSM has done what it can to correct or explain distortions in the case for national healthcare.However regarding all this, the MSM has two main problems:First The President strangely enough, took a conservative approach and did not submit to Congress, a health care reform plan of his own; "The Administration's Plan" or "The President's Plan". Instead he turned the whole matter over to Pelosi and Reid. Not only are those two characters notably unreliable, now there are several bills or versions of bills floating around, which is just more fodder for anti-reformers to grab onto and use. It is not possible to focus on (talk about) just one healthcare proposal. I think president Obama made a huge mistake here; he should not have trusted Congress with this important matter. At best they are not big thinkers; they necessarily tend to think mostly only of their districts. Also, being politicians and politics being politics, they have elections coming up, and obviously they would tend to care more about their own re-election than they do about Mr. Obama's. At worst, not a few members of Congress are flat-out megalomaniacal pigs at the trough. In any case, most are premadonnas of the first order who simply cannot be relied upon, and the President should have known this. I think he does now.Second - Frankly, for better or worse (does not matter, it is just a fact), the MSM does not have the credibility it once had. They have lost a huge amount of credibility over the last ten or fifteen years, during which time the cable news and the internet have gained as much ground.There are technical reasons in the world of TV and Internat, and there are reaosns of perception; the MSM has long been thought to tilt Left, but their role has diminished.Like many other businesses, for various reasons the MSM has been down-sized (some industries called that sort of thing right-sizing back in the 80's and 90's) and now, the MSM is simply doing what is left of its job.

Isn't it always about soundbites and hearing what one wants to hear. We are all prone to favor those who agree with us without regard to their criminal record etc. Seems like the bishops pick it up also. http://www.salon.com/opinion/feature/2009/08/24/healthcare/

"A dumb blond who has risen above her level of competence????"Sexist much?Betsy McGaughy, B.A., Vassar College; M.A., Ph.D., Columbia University, historian, author, lecturer, curator, etc., etc.

Bill, you may want to share this information with salon.com to clear up their confusion regarding the Bishops and Health Care reform: http://www.usccb.org/healthcare/and since it is a sign of intellectual laziness not to be informed, you should also share this site with salon.comhttp://www.usccb.org

And now -- thanks to Obsidian Wings -- I see today's Washington Post has an op-ed by noted health-care-policy expert Michael Steele reiterating the GOP's most dishonest talking points. (OK, the bill doesn't say "death panels," but there are lots of other ways to phrase the allegation that Democrats want to hurt old people for profit.) Does Kurtz really not see how the WP bears responsibility for helping to keep this nonsense alive?

Aren't the end-of-life consultations a (so to speak) dead letter? Believe I heard that it's been yanked from the Senate's bill?I watched the portion of Stewart's interview with McGaughy that aired on television (believe the whole thing is on Stewart's web site).McGaughy seemed to have a point to make, and seemed several times to be on the verge of making it. She just about got it out. Stewart interrupted her constantly and basically obstructed her ability to say her piece (although, in fairness, she was pretty disorganized). Stewart himself is not a neutral party - he is not far from being an administration shill, albeit a very entertaining one. The interview made for some highly watchable television, but the opportunity that was missed is the same one that the MSM seems to have missed: to explain *what is actually in the bill*, and to explain, in a non-partisan way, what it means. The stories I recall reading about the "death panels" seemed to follow this format: quote some snippets from Palin's blog; quote some administration spokespersons denying and ridiculing it; quote some political observers (usually not neutral themselves) as to what it means in the context of, Will the Bill Pass or Won't It. Conflict and a horse race, but little or no educating and informing the public. Perhaps, as Kurtz suggests, the bill is so complicated that it is beyond the ability of a news reporter to disentangle what it actually says. That would be a problem for the administration, as it seems that base fear and paranoia - for which understanding and enlightenment would be the panacea - are their chief foes in getting this legislation passed and signed into law.

Without getting into the specifics of this issue - to me it was political hyperbole not unlike some that progressives engage in all the time (e.g. the Patriot Act will have the FBI reviewing everyone's library records) - maybe it's finally a case of the Boy Who Cried Wolf.For years the MSM ha=s been carrying liberal water without question - how about these whopper - Bill Clinton in 1992 - "This is the worst economy since the Great Depression." Every Dem in the 1980's - "Ronald Reagan has slashed social welfare spending." In other words, they "set the record straight" when they want to and don't when they don't want to. That makes them irrelevant, even if they are right. At least when I see Fox News or read the WSJ they aren't hiding their perspective like the NYT or Kurtz's WP. You can't claim neutrality, practice partisanship, and complain when people can't tell the difference.

Jim Pauwels: "McGaughy seemed to have a point to make, and seemed several times to be on the verge of making it. She just about got it out.." So...exactly what was the point she was trying to make?

"Betsy McGaughy, B.A., Vassar College; M.A., Ph.D., Columbia University, historian, author, lecturer, curator, etc., etc."Her performance was not a credit to her degrees or her career: flapping her eyelashes, giggling, swinging her blonde bob, and flirting with the audience and doing her best with Jon Stewart. Perhaps sexist, but more like giving women policy makers a bad name.

Another WP columnist, Charles Krauthammer, offers, to my mind, an astute fair and balanced commentary on end-of-life counseling provisions in the health reform bills:So why get Medicare to pay the doctor to do the counseling? Because we know that if this white-coated authority whose chosen vocation is curing and healing is the one opening your mind to hospice and palliative care, we've nudged you ever so slightly toward letting go.It's not an outrage. It's surely not a death panel. But it is subtle pressure applied by society through your doctor. And when you include it in a health-care reform whose major objective is to bend the cost curve downward, you have to be a fool or a knave to deny that it's intended to gently point the patient in a certain direction, toward the corner of the sickroom where stands a ghostly figure, scythe in hand, offering release.http://www.washingtonpost.com/wp-dyn/content/article/2009/08/20/AR200908...

That so many people cling to belief in "death panels" on the Obama agenda--despite the fact they aren't there-- signals that the "Death Panels" must somehow "feel true" and serve a purpose for those who cannot let them go. The way to dissipate their illusion would seem to be to remove the fears that conjure the image of this "reality" up.In a strange way, Michael Steele may have hit upon one way to do this. His "dishonest talking points" identify some potent fears that should be put to rest. Of course the broad and sweeping reassurances he would demand (safely, as he won't have responsibility for guaranteeing their fulfillment) are something of a trap. But going to the Democratic health care proposals and reiterating what they don't say (Of course they don't, who would?) will never allay suspicions based-- not on paranoia but real life experience with government bureaucracy, insurance company doublespeak, and an awareness of the vulnerability of patients with terminal illnesses. Identifying specific widely held fears ( both rational and irrational) and neutralizing them, one by one, with realistic, honest, limited guarantees, perhaps framed in a something like Steele's bill of rights format might not be a bad idea at all. It won't be easy. As Charles MacKay said in "Extraordinary Popular Delusions and the Madness of Crowds" :"Of all the offspring of Time, Error is the most ancient, and is so old and familiar an acquaintance, that Truth, when discovered, comes upon most of us like an intruder, and meets the intruder's welcome."

OK - there are no "death panels," but why do the current proposals - Not only premit payment for "end-of'life" counseling but mandate its content - what other Medicare authorized "treatment" has its content mandated by Congress?Require a section on end-of-life issues like living wills in Medicare benficiary guidesInclude data collection requirements on end of life care counseling and outcomes?Like the Krauthammer column says - there is an implicit preference for end of life care that involves less treatment given the cost reduction emphasis of the bill. The idea that people don't know about their alternatives and don't consider end of life issues, or that physicians haven't been talking to their patients because they weren't reimbursed is just silly. Is the "death panel" talk hyperbole? Of course it is, but so it equating 47million uninsured with 45 million people who aren't getting health care.

"Soexactly what was the point she was trying to make?"From what I could follow ... it seems that Medicare scores doctors who accept Medicare patients (which seems like a good thing). She is claiming (I think) that the proposed legislation would require that the doctors report which patients, or perhaps how many patients, they've had an end-of-life consultation with, and this would become an component of the doctor's score.

Probably few of us know what this scoring business is all about. Anyone?

FWIW, I just spent too much time poking around on Google. It seems that HHS has a program called PQRI - Physician Quality Reporting Initiative. "The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered services furnished to Medicare beneficiaries during the second half of 2007 (the 2007 reporting period). CMS named this program the Physician Quality Reporting Initiative (PQRI)."http://www.cms.hhs.gov/PQRI/01_Overview.asp#TopOfPageUnder PQRI, the government measures physicians on 153 different variables. There is a listing of the 153 items, plus an additional 32 collected by various other sponsoring organizations that must piggyback on the process.http://www.cms.hhs.gov/PQRI/Downloads/2009_PQRI_MeasuresList_030409.pdfNot that I have any expertise in this, but it appears to me that item #47 on the list is very similar to what McGaughy was talking about. If so, then it's not an innovation of the health-care reform legislation currently under consideration.Perhaps someone more knowledgeable can confirm or correct.

NYT, WP, FBI are inelligible by now, but add the likes of MSM, PQRI, TRHCA, P.L and CMS and you have an alphabet soup enough to drive you bonkers. You can tell me that TRHCA means Tax Relief and Health Care Act == but what the hell does *that* mean?? Is it all just too complex to be thought about? Or are the politicians unwilling to come out from under their cover of code-speak to really communicate with us?

What the MSM and others with intelligence beyond the 1st grade level need to keep in mind is that (1) all there exists at this point is a House bill; (2) nothing final exists to represent the Senate's feeble efforts at a bill; (3) there still has to be reconciliation of the 2 proposals when that time comes.There is NO proposed ACTUAL agreed-to bill at this stage of the game that justifies knicker knotting by anyone.What there is is this: http://www.thonline.com/article.cfm?id=254207

Can't we get past the "this is too complicated for anyone to understand" comments?It may be that no congressman has read 1000 pages of a proposed bill, but it is more than likely that someone on each person's staff has either read or written those 1000 pages. And if 5 different committees are working on the same issue, each committee's staff has probably kept track of what the other's are doing. All of this has been done under the supervision of the congressional representatives, who made the critical decisions on what to include or exclude.This has probably been done with varying levels of competency and attention, and with varying levels of influence from lobbyists, but that is how a bill becomes a law. Someone on the hill has read these things, and if any capable people have been elected to Congress, they are aware of what is going on.

Thanks Jim Pauwels. Do you think Barbara might know?

Ms McGaughy apparently wanted to object to judging the implementation of Advance Care Directives, thinking that doctors would improve their PQRI if their patients' directives were followed. That may have been in the bill, or it may just have been her assumption about the data collection. The purpose of the physician's quality rating (PQRI) is to establish 'best' practices so that physicians with better outcomes are paid better. This gets tricky in the case of terminal patients, since concepts like 'cure', 'health' and 'survive' take on different meanings for them. In any event, she did come across as a dumb blonde, particularly when she could not find page 432 in her binder; it just looked silly.What should be highlighted here is the difficulty of Advance Directives. People need to be informed, but resist the needed imaginings. When my brother-in-law succumbed to lung cancer, I might have thought that no one should ever be put on a respirator; it prolonged his life in a painful way, forcing his body to fight against itself. Except that I had already seen my mother helped by a respirator to survive some transient episodes with a relatively clear mind and heart. It is easy to say "I never want to be put on a respirator", but that is not always the right decision. Sometimes, even often, the advance directive is not the appropriate response to the situation because the individual did not understand all the situations that could be covered. Physician consultations are needed so that people can be more aware of what could happen and make better decisions, but it is not easy to decide which physicians are doing a better job with those consultations.

The point that the doctor made on John Stewart's program was that, by her reading of the end of life provision, physicians were not only paid for recommending this as an option...but also by what percentage of patients actually used it. Stewart disagreed...but, remarkably, she was unable to provide the the text. Or even the page number at first. She was disorganized, but that doesn't mean she should be dismissed.For my money, I think the main confusion here is that we have switched talking about death panels...and started talking about the end of life provision in the bill...while still using the term 'death panels.' At worst, its a single doctor doing this...so why talk of 'panels'? The answer seems to be that this is what conservatives focused on when they were made fun of for using the term...Palin's blog entry being the the first example. They may or may not have a point about the end of life provisions (I haven't read the text)...but that wasn't the issue raised by death panels. What is lost is the very real fact that the public option and the expanded medicaid program will continue be forced to ration care by something other than a market. Thus there will be a 'panel' that will decide how to ration limited resources. This is being done right now in Medicaid and Medicare and will continue in the new plan if it is passed.

Conservative satirist P.J. ORourke finds comfort in government sluggishness:I myself could point out the absurdity of protestors' concerns about government euthanasia committees. Federal bureaucracy has never moved fast enough to get to the ill and elderly before natural causes do.http://www.weeklystandard.com/Content/Public/Articles/000/000/016/867ttd...

I'm trying to remember that golden age of enlightened news media influence that Howard Kurtz seems to recall. Can't remember it, though. Has anyone seen a news organization take advantage of this ongoing story to do some good coverage of issues involving palliative care?

Jim Rutenberg of the NYT does a rundown of many of these issues by focusing on the way that Palin, McGaughy & Co. have misread or misrepresented the views of one bioethicist. It's herehttp://www.nytimes.com/2009/08/25/health/policy/25zeke.html?_r=1The Times had this palliative care profile last week about a doctor, Sean O'Mahoney, for whom this is a speciality.http://www.nytimes.com/2009/08/20/health/20doctors.html

Like most things there is a grain of truth on all sides of the debateEnd of life care is an important consideration and everyone should have a living will. However, from the medical end the presumption of care should be on preserving life.However, we need to be much more accepting of the inevitability of death. ST. Benedict said look no further than the distance of your own grave.Buddhists have a meditation on meditating on your decaying body.All of this in not to be morbid but to place life in its proper perspective.Kruthaumer is correct but it is a half truth. With the amount of technology available today to preserve life, individuals do have to contemplate the quality of it.I am not saying these are easy decisions but the choice is increasingly, in our world. being placed in the individual's hands. Again, the Catholic community could help by discussing a theology of death by drawing on the mystics and saints who saw death as "not an end but a beginning". Incidentally my father's favourite part of the funeral liturgy. His death was quick and unexpected but the funeral, although we of course mourned, was uplifiting because of his faith.

FWIW, her name is spelled "McCaughey." I wouldn't want anyone to try Googling her and miss her long and award-winning history of spreading misinformation about health-care reform. (See here, for example.) Also, NB: she is a "doctor" in that she has a PhD in history.

"she did come across as a dumb blonde, particularly when she could not find page 432 in her binder"I think that 90% of what she hoped to accomplish happened when she lugged out that binder that was thicker than six stacked Manhattan phone books. The fumbling about, looking for page 432, was just more window dressing to make the point, 'This is a big, long, complicated, indecipherable piece of legislation.'

"Do you think Barbara might know?"I'm hoping that she and/or Unagidon are following the discussion and decide to comment.

Jim: The Manhattan phone book has gone the way of the dodo bird--or at least we haven't had one given us in years. Even so... that binder looked to be about half the size of the last phone book we have... Even so (again), I would think (but what do I know?) that a complicated matter such as h-c reform is going to produce a lengthy bill. Remeber last September when Hank Paulson showed up with a one-page description of the TARP asking for a gazillion dollars? People rightly protested. Did he ever add a few pages?

TPM has this up: "The evolution of the death panel meme"http://www.talkingpointsmemo.com/photofeatures/2009/08/the-evolution-of-...

On another thread Ms. Steinfels describes Hank Paulsen as "loose-minded". Splendid word! It equally well describes Ms. McCaughey. Not my idea of window-dressing. Not only was she not attractive, she was downright scary, given that she is supposed to be a conservative expert.

Another of McGaughy's poorly communicated points was that doctors would have a financial incentive to do end-of-life counseling with patients AND to see that patients adhered to the advance directives that they had drawn up as a result of the counseling. She implied patients would be pressured to forego treatment that they later regretted having rejected on their advance directive. The text of the House bill does or did contain language that the secretary of Health and Human Services was to develop a measure to be added to the Physician Quality Reporting Iniative indicating how many patients created end-of-life instructions and to what extent those instructions were adhered to. The language of the bill does NOT explicitly specify WHOSE adherence is to be measured.McGaughey judged that it was patient adherence to prior instructions, leaving the patient who had a change of mind vulnerable to physician pressure.I suggest it is likely that the author(s) of this section meant physician and/or hospital adherence to a patient's written instructions. I think this because there are findings in the biomedical ethics literature showing that health care workers and hospitals frequently do not follow advance directives after a patient becomes unable to voice her or his wishes. At present, advance directives are VERY likely to be ignored if the closest family members want treatment handled differently.Advance directives have serious limitations for the reasons mentioned by Jim McK. It is more important to execute an appropriate health care proxy. Barbara Andolsen

Re Paul Moses' question: Has anyone seen a news organization take advantage of this ongoing story to do some good coverage of issues involving palliative care?Yes, NPR's "Fresh Air" ran a discussion of palliative and end-of-life care some months back, when the health care bill was still in the talking stages. Transcript is here:http://www.npr.org/templates/transcript/transcript.php?storyId=102638208... broadcast networks have done a dreadful job covering the health care bill because they've focused more on the conflict surrounding the bill than on the impact the bill would have on the average American. There was some perfunctory debunking of the "death panel" rhetoric, but I haven't seen much substantive analysis except on "The News Hour," which has devoted a series of segments to the bill's content and its impact on everybody from the elderly to big insurance companies like Aetna.In my view, political bias isn't the problem with commercial network broadcasts; it's their focus on "freak" stories--waves that washed seven people out to sea in Maine, Michael Jackson's autopsy report, and big wildfires in California and Greece. Right now, they're trying to make a "freak" story out of the H1N1 flu by hyping up the number of possible deaths, hospitalizations, and the like without offering any context to temper the story. I truly wish I did not have to watch this stuff, but, sadly, it sorta goes with my job.

Another thing that has largely been lost in the discussion of death panels is from the 'what could they possibly have been thinking?' file. Whoever allowed the end of life provision to get into an early version of the bill has to be tone deaf with regard to how it would be used by conservatives...and how quickly such things can get out of control in the public's mind. Everyone knew that those who opposed the kind of reform favored by the President were going to attack via the 'government wants to kill grandma through rationing' approach...and this provision played right into their hands.

"One of the foremost advocates of expanding Medicare end-of-life planning coverage is Johnny Isakson, a Republican Senator from Georgia. He co-sponsored 2007's Medicare End-of-Life Planning Act and proposed an amendment similar to the House bill's Section 1233 during the Senate HELP Committee's mark-up of its health care bill."http://voices.washingtonpost.com/ezra-klein/2009/08/is_the_government_go...

Yet more evidence that conservatives really shouldn't be afraid of the idea of these kinds of provisions...though 'similar' is of course an important word to consider here given that the complaint that the doctor had on the Daily Show was based on a difficult reading of a complex issue. Happily for Senator Isakson, he was able to propose his amendment without having to think about selling it during a national discussion over health care reform. Unfortunately for Obama and like-minded people, whoever put the end of life provision in the current bill also apparently thought they didn't have to sell it during a national discussion over health care reform.

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About the Author

David Gibson is a national reporter for Religion News Service and author of The Coming Catholic Church (HarperOne) and The Rule of Benedict (HarperOne). He blogs at dotCommonweal.