[Note: updates below]
It was like two hospital ships passing in the night.
On Sunday, the Star Tribune published reporter Chen May Yee’s 1,300-word examination of Massachusetts’ health insurance mandate, similar to a proposal President Obama supports and Gov. Tim Pawlenty attacks.
The same day, the Washington Post ran a 2,300-word demystification of Minnesota’s holiest of medical holies, headlined “Is the Mayo Clinic a Model Or a Mirage? Jury Is Still Out.”
Both stories demonstrated ambition — the financially troubled Strib unleashing its travel budget for a national story, and the Post pointedly questioning an institution that has taken a forceful health care reform lobbying role.
But why did it take an out-of-town paper to weigh our sacred cow?
Here’s the basic boildown of the Post’s take on Mayo’s integrated-care model:
Few dispute the prowess of Mayo, which brings in $9 billion in revenue a year and hosts 250 surgeries a day. But a battle is underway among health-care experts and lawmakers over whether its success can be so easily replicated. Before embracing a fundamentally new approach to health care, dissenting experts and lawmakers say, Congress should scrutinize the assumption that a Mayo-type model is the answer.
They point out that Mayo’s patients are wealthier, healthier and less racially diverse than those elsewhere in the country. It has few poor patients. It limits the number of procedures it performs per patient, but the rates it charges private insurers and self-paying patients is higher than average, allowing it to thrive despite the lower Medicare spending cited by its supporters.
Armed with their new stature, officials from Mayo and a handful of similar facilities have become determined lobbyists in their own right. They are pushing for an overhaul of Medicare that would reward cost-effective hospitals and doctors, while punishing others.
But if the Mayo model is, in fact, difficult for even the most dutiful hospitals elsewhere to mimic, such an overhaul could set up many providers nationwide for failure — and a big loss of funds.
It’s sometimes easier to criticize from a thousand miles away. And readers who think the Strib has been a Mayo cheerleader are right — though the record is more complicated than that.
Surprisingly (at least to me), the Strib’s health team hasn’t really covered the clinic’s political efforts, an assessment health team editor Dave Hage confirms.
[Update: Hage and I talked this afternoon, and he asked me to reprint verbatim the first paragraph of the two-paragraph email he sent. It read: “The short answer is that, in my team’s coverage of the health care debate, we haven’t done a story on Mayo — favorable or skeptical.” The second paragraph is from the original story.]
“We’ve written about HealthPartners (is it the model for a ‘health care co-op’’?) and UnitedHealth (what’s the role for private insurers in an overhauled system?) but we haven’t done a Mayo story,” Hage says. “We’re trying to pick off stories that illuminate specific items in the House and Senate bills — e.g., the public option, the individual mandate, savings in Medicare.”
It’s a real missed opportunity that the Strib hasn’t done extensive reportage on Mayo’s ultra-high-profile advocacy. [Update #2: Hage notes that Yee wrote about the clinic’s financial difficulties in March, and about its then-nascent lobbying push in 2007.] Neither has the rival Pioneer Press, which has focused on east-metro health systems likely to fly below national reporters’ radar.
(My guess is local providers don’t mind Mayo being the nail that sticks up nationally.)
Mayo’s real cheerleader at the Strib is editorial writer Jill Burcum, who has written several pieces praising the clinic’s “advocacy for payment reform and individual mandates, as well as its staunch opposition to a public plan based on a government-run, price-controlled, Medicare-like insurance model.”
Burcum’s advocacy is hardly beyond the pale. She writes for the editorial page, after all, where you get to have opinions. Plenty of health care journalists have praised Mayo’s system of salaried docs and fully coordinated care, including New Yorker surgeon-writer Atul Gawande, currently being touted as Ted Kennedy’s interim U.S. Senate replacement.
Mayo’s — and Burcum’s — advocacy for “payment reform” is broadly embraced in Minnesota, where, parochially, it favors lower-reimbursement areas like ours and could deflate costly national misincentives. And while I personally favor a public option (you can’t mandate insurance without real administrative-cost competition), it shouldn’t surprise anyone that the Strib editorialists don’t bang that particular drum.
To her credit, Burcum referenced the Washington Post story Monday, at least online, noting it raised fair questions, though I think she mischaracterizes critics as primarily single-payer believers. The Post’s sources are broader than that.
Given Mayo’s political influence, the Post check-and-balance deserves wider local play than a link from startribune.com. At the very least, Strib (and PiPress) should republish it in their national sections, and perhaps some local reporter can give us her or his take soon.