A puzzle underlay the complaints about a health care story in May from Houston. The reporting seemed gullible, but wasn't. It was in the more recent objections over war reports from Gaza, however, that I finally saw the full outlines of the conundrum—one that has been long nipping at me. You can help.
The issue is one of style, but beware: occasional listeners amongst you may judge differently from diehard NPR fans.
The puzzle is when and how hosts and reporters should tell us that a report is part of a series, or that it features one viewpoint, and that other views will come in other stories. A corollary is when and how the journalists should tell us that claims in a report are incomplete.
Should the hosts and reporters be like those at PBS, for example, who may seem tiresome in repeating that other sides will come, or that we should go to the web site for more? Or should NPR hue to a belief, related to its famed ethic of storytelling, that we in the audience already know these things? We know that other days will bring other views, or that an interviewee is self-evidently crazy, spinning or being incomplete. We don't need to be told. We are part of the cognoscenti, the smart NPR in-crowd.
To be fair, NPR often does give on-air guidance. But I am regularly struck by how people who aren't steady listeners hear one story that purposefully focuses on one side of a conflict—or they hear an unchallenged statement by a protagonist who is interviewed—and conclude that these represent NPR's bias. That's why they don't listen, they say. Even when frequent followers hear something they deem objectionable, concerning a subject about which they are passionate—Gaza, for instance—they seem to complain more angrily when there is no on-air admission of a story's limits. This is less an issue among Web readers who can read related articles in one place. Radio stories are catch as catch can.
Is NPR losing trust and listeners as a result? Or is it the tiresome phrases that are a killer? This is a business riddle for NPR as much as an editorial that only you can best answer. I have seen no study on the predicament.
The Houston Obamacare story is illustrative.
"Frustrated By The Affordable Care Act, One Family Opts Out" was the web headline for a piece that aired on Morning Edition by Carrie Feibel, a science reporter from Houston Public Media as part of a reporting partnership among NPR, nearly 20 local public radio stations and Kaiser Health News.
Feibel told an anecdotal story of a Texas couple that was into the wife's third pregnancy when they signed up for health insurance under the federally facilitated marketplace. They went to 28 obstetric practices that were listed as part of the HMO plan and could not find one that would take them, or that worked with a hospital that would take their insurance, or would designate a single doctor to see them through the pregnancy. They finally quit the insurance program and paid a midwife for a vaginal delivery in a tub at home.
Nearly a dozen listeners, many of them medical professionals, complained. They said that the story was so unrepresentative and unconfirmed that the reporter may have been duped. Underlying their complaints was a question of why this couple, Rachel and Nick Robinson, was given more than four minutes on NPR's flagship morning show to tell what seemed to be a one-sided, suspiciously negative story.
Kevin Yellick of Minneapolis, Minn., for example, took aim at the main point:
The thrust of the story was Rachel Robinson's claim she could not find a doctor willing to take her ACA [Affordable Care Act] plan. But didn't it become a non-story when Louis Adams, the spokesman for Blue Cross Blue Shield of Texas, confirmed that most of the 28 providers would take her plan? Perhaps one of the parties in this matter is not telling the truth. Which one is it? We will never know because Ms. Feibel decided she did enough digging for one story. Ms. Feibel should have confirmed for her audience the veracity of the claims on both sides.
Robert Benner, a certified OB-GYN from Pittsfield, Mass., was, as you might expect, more doctor-ly:
There may be some frustrating obstacles inherent in the system, but she did herself no favor by waiting until 30 weeks to establish care. Even becoming pregnant without a plan for how to pay for a delivery seems unwise, when there are very effective methods for preventing or delaying this, but I will grant her the benefit of the doubt and assume she had an unfortunate contraceptive failure. She then sabotaged her cause further by turning up her nose at group practices, preferring a solo practitioner. For good reasons, both for the health of the patient and the doctor, these are vanishingly rare in the 21st century, at least in the Northeast, and I suspect, most regions. Deciding on a home delivery with a midwife was a completely irresponsible and potentially disastrous choice, given her history of two prior Cesarean deliveries. I have worked with midwives my entire career, and both of my own boys were delivered by a Certified Nurse Midwife, so I have no prejudice or animosity toward midwifery in general. That said, it is my opinion that no responsible practitioner would ever attempt a VBAC (vaginal birth after Cesarean) as a home delivery. I am relieved that both mother and baby survived this adventure....In summary, the ACA, as it is implemented in Texas may be a morass or not, but this was a poor illustration, as the patients willfully made choices against their own self-interest.
Michael Kenney of Easton, Penn., was especially critical:
What your broadcast failed to clarify is that "Obamacare" is a marketplace, giving consumers the chance to shop for affordable plans that meet their needs. It is not a care provider.....Your selection of this particular couple is suspect. They appear to be naïve about healthcare in general ("midwives are for crazy people"), and demographically unlikely to support the ACA. They chose a "Christian" healthcare plan (whatever "Christian" means in this case), and they live in Texas. I have to wonder how hard [Morning Edition] had to look to find a family to interview which was so unlikely to have anything positive to say about anything related to President Obama. I don't expect Fox News style bias when I listen to NPR. Please try harder to be truly fair and balanced.
The listener objections are understandable, given what was heard on air. But I wonder what the reaction would have been had these listeners been told two things: One, the story was just one in a series of stories on the anecdotal experiences of ordinary Americans with the new health care scheme. And, two, the reporter did in fact vet the couple and did toil with the question of confirming their experience with the 28 providers.
On the first point, you can go to the web site here to find anecdotal stories on other experiences, plus analyses and reports, that editors are weaving into what is meant to be an authoritative tapestry on the new health care program as it evolves, often differently in each state. Among the positive anecdotal stories, for example, are one from California and another from Oregon about how the new health insurance is helping aspiring entrepreneurs and would-be retirees quit their jobs and pursue new businesses, stimulating the economy as well as their personal lives.
In presenting the Houston story on the Robinson couple, host Steve Inskeep did make note at the end of the reporting partnership with Kaiser and local stations but made no mention of how the story fit into this overall content strategy. Christopher Turpin, the acting senior vice president for news, defended the omission in general, saying:
It would soon get pretty annoying for listeners if every interview came with that kind of small print. The important things are that interviews are rigorous, which implicitly or explicitly acknowledges the existence of other perspectives, and that we do genuinely seek out a wide range of views across time.
I personally agree with him, but then I am part of the NPR cognoscenti. Time is treasure on air and arguably the time saved by not giving contextual guidance goes into reporting the news. Perhaps some listener complaints just come with the territory, though the cost may be lost trust. Hosts, reporters and editors almost certainly get tired of repeating guidance and reminders, but their personal preferences—and mine—should have no bearing on what the practice should be. You and NPR management will have to decide what best serves and builds the audience.
As for the objections to the reporting on the Houston story itself, Gisèle Grayson, a senior producer on the science desk who manages the reporting collaboration and handled the Houston piece, took the time to send me a long explanation that some of you might find to be an interesting insight into the NPR reporting and editing process:
A major goal of this partnership with 18 station reporters is to bring our collective audiences as many points of view as we can. The perspective of a family disenchanted with their new health insurance is important, and one that has not received much coverage by NPR or other media.
The point of the story is to describe how the Robinsons experienced their new health plan. We chose a family who represents what we know to be true both from studies and from our extensive reporting about enrollees in Affordable Care Act insurance plans: that some people are frustrated with their health plans and have chosen not to continue paying for them. Because the Robinsons were not satisfied with their options, they dropped their plan.
Your main question is whether we verified the competing claims of the family and the doctors and/or insurer. Reporter Carrie Feibel found the Robinsons through a trusted source, and she took great pains to independently verify the family's circumstances. We debated whether calling the 28 providers with whom Robinson spoke would truly verify her claims, and we decided not to do so. A certain amount of "he said / she said" here is unavoidable since there is no way to recreate those conversations. Feibel would obviously identify herself upfront as a journalist in such a call, and a doctor's office telling a journalist whether they accept a certain plan does not verify what they said in an earlier conversation with a potential patient. This is a story about a family's expectations and experiences with the health care system, not establishing beyond the shadow of a doubt who said what to whom.
Furthermore, Robinson made her calls in January. Feibel reported this piece in late April/early May, so the doctors on her list may have, over the ensuing months, added the plan, dropped the plan, figured out that yes, they were indeed part of the plan (and our reporting shows many doctors were confused about whether they were participating in an exchange plan), or realized they may have given out inaccurate information. Therefore, it's likely that those late-spring responses would not replicate what Robinson heard months earlier.
We did ask BCBS [Blue Cross Blue Shield] for a response to her story and the spokesman and his team called the 28 practices. He said "most" providers he or his team contacted said they accepted the plan. Again, because of the several-month gap, circumstances may have changed. Doctors' offices also may respond differently to an insurance representative than to a woman in the late stages of pregnancy, who are sometimes not accepted as new patients by practices. We do not say Robinson had no access, we are saying she was unhappy with her options.
My response to the question about whether the family can be considered credible after waiting until 30 weeks to seek care is: yes. As the story makes clear, they were uninsured. Robinson started calling doctors as soon as the plan started – when she was 30 weeks pregnant. Regardless of whether one agrees with her and her family's medical choices, it's hard to see why that would lessen their credibility about what doctors' offices said to them.
The third issue you raise is about adding context about the medical risk of a VBAC [vaginal birth after cesarian] or the likelihood of seeing one doctor consistently. Medical and insurance decisions are choices that every person and family makes. We did mention a VBAC can be risky, but the story's purpose was not to evaluate the soundness of the Robinsons' birth plan. As far as the decision not to choose a group practice, again, that was Robinson's personal preference for her medical care.
NPR has reported hundreds of very good stories on the ACA's policies. Now that the exchanges are operating, we can enrich that policy coverage with stories of how real people are experiencing their new options. With this story, Carrie has brought a valuable perspective to our body of coverage.
The reporting behind the piece, in other words, was conscientious. One can disagree with the choices made by the Robinsons, but they were personal choices that legitimately reflect those made by many Americans confronting the new health care scheme. The reporter was justified in not trying to confirm what transpired with the 28 practitioners.
But this still leaves the question of whether the story might have been more convincing—and we in the audience might have been better served—if the reporting limitations and the story's relation to the larger strategy had been reported on air. It was arguably a legitimate judgment not to tell listeners that there was no way to truly confirm who was right between the Robinsons and the Blue Cross Blue Shield spokesperson. Journalists are forced to report she said/he said stuff all the time. In this case, however, as listener Yellick notes, this point was the crux of the story. It thus seems to me that an open admission of the limits of the reporting would have helped us in the audience understand the story for what it was—a single anecdotal insight into a very complex and politically controversial program.
I certainly think that Dr. Benner was right in wanting more context on how group practices work today and in addressing whether the Robinsons were realistic in their demand for a single doctor. This, too, cuts to the heart of the story, as the Robinsons said that they simply didn't like some of their 28 choices for that reason. How many? We in the audience who may be using the new system want to know what to expect and how we might maneuver through it. To be fair, however, Feibel did her reporting while the implementation was still in flux, and so what the Robinsons experienced then may not be applicable now. But even that limitation could have been stated on air, helping us trust the reporting.
But this is my sense. Ultimately, trust is in the eye—or the ear—of the beholder. You may feel differently. Please weigh in.
Editorial researcher Annie Johnson contributed to this article.