By:

Dave Kingsley

    My last post laid the groundwork for ongoing blogging about and discussing the privatized, publicly funded U.S. medical care system with colleagues and anyone interested in that discussion.  I understand that it was a long post.  However, it is presented in chunks.  There is no necessity to read through the whole piece to take away the point I’m making:  the system is rigged on behalf of corporations and high net worth individuals at the expense of ordinary wage and salary workers.

    One might think that everyone knows that.  But we have no good studies of public opinion to inform us about exactly what “most” people believe.  My focus in the past few years has been increasingly on the long-term care/skilled nursing sector, i.e., nursing homes.  In addition to many dimensions of this Medicare/Medicaid funded system I have worked on – mostly financial – I have interacted with journalists on a consistent basis and have discussed what I perceive as pervasive substandard care with medical professionals and lay persons.

    I believe that a negative view of nursing home care is widespread.  Let’s face it, no one wants to end up in one.  However, I would hypothesize that a large proportion of the public is confused or ambivalent about, or even in some cases sympathetic with, the owners of facilities.  Trade associations and their lobbyists repeatedly spread a hardship narrative, claiming that corporations are operating on a razor thin margin and on the edge of bankruptcy. Major media outlets report on specific scandals and a small number of scandalous chains and their scurrilous activities.

    This industry narrative, and the political and media strategies it supports has been effective – even though it is based on falsehoods and misinformation.  Although my colleague Charlene Harrington and I have conducted an analysis 2020 financial reports submitted to the SEC by publicly listed corporations and concluded that they did quite well during COVID (Kingsley DE, Harrington C. COVID-19 had little financial impact on publicly traded nursing home companies. J Am Geriatr Soc. 2021;1–4. https://doi.org/10.1111/jgs.17288), there has been no call from any quarter for holding the industry accountable for the death of at least 140,000 patients.  Industry representatives have appeared on many major media outlets claiming that the government is at fault for not providing operators with sufficient resources.

    This is a falsehood.  But have we – advocates and scholars – failed to frame issues and develop a narrative and political/media strategy based on objective, evidence-based, information?  I think we have failed to do that.  Therefore, the public and the media are responding to a well-funded media and legislative presence of nursing home industry lobbyists such as Mark Parkinson, former governor of Kansas, and others who have been well received in legislatures and by major news sources.  The time has come for us to go on offense with our own knowledge-based narrative and legislative-media strategy.