Q &A with Susan Dentzer
Dissecting the media’s role in health care reform
Susan Dentzer is editor-in-chief of Health Affairs, the nation’s leading peer-reviewed journal of health policy thought and research. One of the nation’s most respected health and health policy journalists, Dentzer is an on-air analyst on health issues with the PBS NewsHour, for which she was on-air health correspondent before joining Health Affairs in 2009. She has also been a frequent guest and commentator on such National Public Radio shows at This American Life and The Diane Rehm Show as well as CNN and The McLaughlin Group. She is also an elected member of the Institute of Medicine and the Council on Foreign Relations.
Dentzer presented the Charles C. Leighton, MD, Memorial Lecture at Penn’s Leonard Davis Institute of Health Economics (LDI). Afterward, she talked with Zachary Meisel, MD, MPH, LDI Senior Fellow, Robert Wood Johnson Foundation Clinical Scholar and emergency physician at Penn.
Q: What is your perspective on how media coverage shaped health care reform?
A: The test to me was, did the media coverage make any difference? I believe it made almost no difference whatsoever.
From many polls, it was very clear the public was divided on health care reform well before any proposals emerged on Capitol Hill or from the administration. It is almost as if we live in a world now where, as the journalist Walter Lippman said, people have pictures in their heads. The American public has very firm pictures in its head about health care. Unfortunately those pictures are much skewed, in many instances bearing not a whole lot of resemblance to reality. But they’re also very fixed, and the ability of the news media to break through any of that is, I think, frankly low.
So up against all that, can news media coverage make any difference at all? Really, as sad as it is for me as a journalist to admit that, that is the fundamental question.
Q:Given that there are researchers or publishers, or journalists such as yours at Health Affairs that have access to evidence-based understanding and knowledge of health policy and health delivery, should they be engaged in framing the debate?
A: Yes, they can and they should be. Now will it make a difference? That is the key issue. Because another thing that we haven’t talked about is the political process, the role of money, the [U.S. Supreme Court’s] Citizens United decision, etc. So even in terms that making legislative policy involves any sort of enlightened analysis, decision-making and presentation of empirical data, does any of that matter up against much more fundamental forces like the representative who says, “I need to talk to these people because I depend on them to re-elect me”?
Stepping back, if you look at all the forces aligned against enlightened policy, you could look at the Affordable Care Act as an incredible success. It is rather amazing that it happened given all the forces at work against it. This is not the same thing as saying it’s a perfect law—far from it. But if you apply to it the test that at least much of the population appears to agree it would be better to have more of the American population have health insurance than not, we took a major step down that road, against all odds.
Q: Health Affairs has been credited with helping along some pieces of the legislation, such as accountable care organizations. Do you consider that a victory? Are there other pieces of the legislation that Health Affairs had a role in advocating and advancing?
A. I wouldn’t say that we advocate, but we certainly are a platform for “blue sky” thinking about the health care system. And we are nonpartisan. When discussions began to emerge about health care reform during the last presidential election, we opened our doors for people to begin to advance ideas.
At the time folks at the Dartmouth Institute and Brookings Institution, including Mark McLellan and others, essentially were coming back to an old notion, capitation, as well as organized care delivery systems, and paying on the basis of value. Their notion of pulling these concepts together into a new framework—everybody wanted to avoid the old framework of managed care—and tying it to the measurement of outcomes and a population health focus gave rise to the notion of accountable care organizations.
Q: Where have innovators and researchers failed in communicating some of these concepts?
A. For researchers, a very key point is to communicate as clearly as possible. This is a challenge every day for our authors at Health Affairs, and we are constantly working with them to try to make language as accessible as possible. Because if we’re going to break through and get the 23-year-old legislative aide on the Hill who has to analyze proposed legislation for his or her boss and even help write legislation, it’s critical that this information be understandable to that person.
That’s really a plea I would make with academic researchers who want to publish in Health Affairs: It’s not stooping below your level to put things in terms that are as clear as possible.
Q: How does Health Affairs measure its impact? Or is your mission focused on getting the best possible information out there and then leaving it up to other people to do with it what they will?
A: One measurement in our field is the so-called impact factor, which really is limited. It’s a measure of the average number of citations received per paper published during the two previous years. We look to that nonetheless in the absence of other metrics, and we have a high impact factor. We believe that much of the impact that we have is not measurable, but you feel it, in terms of the esteem policy makers and others hold for our journal.
We think we’re having an important role now as we continue to give organizations, health services researchers, and policy analysts a platform to refine these ideas. We’re publishing a lot now on what different models of affordable care organizations, or other health delivery system innovations, might look like or how they should be regulated. Or since we’re putting in place these new entities, and we have to make a lot of change fast, and particularly when we have a huge urgency attached to bending the cost curve fast, how do we break out of the traditional long cycle of testing out new ideas through demonstration projects that take several years to get going, followed by evaluations that take a year or more, followed by publication of results a year or two later?
Can Health Affairs be a force pushing more in the direction of rapid cycle innovation? If so, will we be able to measure the impact of that?
Will we be able to measure that? I don’t know, but I think down the road we will certainly know that we played a role.
Q: What would you say to researchers who want to publish in Health Affairs?
A: We welcome contributions from this community, and we are always testing the limits internally in our journal. Our slogan now is that we are at the intersection of health, health care and policy. At the moment we have a hard time drawing a line of what we would not publish because health reform is bringing a whole new set of issues onto our agenda.
So when in doubt send us an e-mail. I encourage our team at Health Affairs now to think very seriously about rejecting pieces out of hand versus coming back to potential authors and saying, “You know this might not quite work for us but did you think about maybe angling it this way?” We’re very eager to work with researchers and the academic community to expand our content, make it as compelling as possible and make our journal an even stronger force in the improvement of health, health care and health policy.