Give context, not equal time, to anecdotes in coverage of health reform

Drew Altman, president of the Kaiser Family Foundation, in a recent Politico op-ed, shared some thoughts on challenges in covering of the roll out of the Affordable Care Act.

Three of his main points – understanding the health law is not just a Washington story, knowing what to cover and finding solid resources to get at the facts instead of contrived “balance” – are topics we try to address on Covering Health and on the AHCJ health reform core topic site. Balance is fine – fair and essential – in complex stories where there are many points of view, different ideologies, and legitimate questions about how the health law will unfold over time.

It’s not “balance” if there is clear, solid data on a specific topic, and another side gets equal time just because they don’t like it (or because your editor insists that it get equal time).  Knowing what’s in the law, what it does and what it doesn’t do, helps us report with authority and find that balance.

The aspect I want to address here, related to the “balance” question, is what Altman calls “judgment by anecdote.” Here’s what he’s worried about:

“Critics will feed reporters ACA horror stories and supporters will sell them success stories.

Every journalist will be able to find a bad ACA story or a good one.

When does “one” person’s experience represent “many,” or “most”? The gold standard is to take examples from a statistically representative group using a scientifically valid survey, but that’s just not going to happen very often with reporters working under deadlines.

Journalists will need to do interviews, check with experts, scrape together what early data exist and make judgment calls about whether the anecdote they have is an outlier or representative of broader experience.

Let’s say Bill Smith in Arkansas chains himself to the IRS building and refuses to pay his fine in protest of the law’s requirement that Americans buy health insurance, but that overall, the mandate works smoothly, as it has in Massachusetts. No doubt, Smith will be “breaking news” on your favorite cable channel. With complex stories like ACA, there is a temptation to cover only breaking news and not the broader story. These news judgments matter because powerful anecdotes stick in the public mind in ways statistics never will.”

All of us reporting on implementation of the Affordable Care Act already are dealing with this.  Haven’t we all heard anecdotes about people blaming higher health care costs on the health law, even though most of it’s not yet in effect and costs were rising long before the law was passed –  at an even faster rate. We’ve all heard anecdotes of people blaming gaps in coverage on the health law – even though generally there will be more benefits and consumer protections. And we’ve had an anecdote avalanche of businesses saying they are cutting back their work force because of the health law – even though the trend to more part-time workers has been going on for years. I don’t mean that the law isn’t a factor in workforce composition or certain industries and, for certain businesses, it is.

But all this shows the danger of reporting by warring anecdotes. You need context, knowledge and experts who can help you provide both.

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