So, Breitbart alerted us this weekend to a Writers Guild of America-East event in February, at which entertainment writers and other intellectual luminaries – including a communications professional from the Centers for Medicare and Medicaid Services – will meet to discuss the topic of “The Affordable Care Act: Comedy, Drama, and Reality – Portraying Obamacare in TV & Film.”
Yes, this workshop is about positioning Obamacare in entertainment narratives – series TV, movies – in order to embed themes about it in people’s minds. The federal government is involved. And, of course, money linked to George Soros is paying for at least part of this. Outrageous, right?
It is outrageous. But something even more outrageous has been going on for over a decade. Specifically, your tax dollars have been going to a program that’s funded by the U.S. federal government, and operates jointly with the Centers for Disease Control (CDC), to place themes in commercial entertainment: series TV and movies. That program is quietly involved with the February event to plot Obamacare promotion.
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In theory, the program’s purpose is to make experts available to the entertainment industry, so that when programming executives (those notorious moralists) get a burr under the saddle to preach to the public about health and environmental issues, they can do so as accurately as possible.
But what the taxpayer-funded CDC has posted on its website in the form of “tip sheets” looks an awful lot like content placement to me.
We’ll get to that in a minute. First, the organizational layout.
Organized to sell themes to you through the tube
The sponsor of the WGAE event on Obamacare is the Norman Lear Center, an endowment at the USC Annenberg School for Communication and Journalism. As the Matthew Vadum article (link above) points out, the Lear Center – and one of its bankrollers for the Obamacare-entertainment project, the California Endowment – have multiple ties to the Tides Foundation. (For more on the California Endowment, see here.)
But the Lear Center is also connected directly with the Centers for Disease Control, through Hollywood, Health & Society, a project whose origins trace to a 1998 CDC initiative to provide expertise on health-related matters to the entertainment industry (p. 3 at last link). The early CDC project, the Entertainment Education Initiative, began awarding CDC grants to the Norman Lear Center.
As Senator Tom Coburn (R-OK) noticed a few years later (in 2007), the CDC awarded the grants only to the Norman Lear Center. In 2001, the Hollywood, Health & Society project (HH&S) was created at the Lear Center, basically as the vehicle for spending the CDC grant money. A CDC executive, Vicki Beck – who had gone to the CDC in the 1990s after a number of years as a consultant in Hollywood – was named to head the new project. That seemed pretty darn cozy to Senator Coburn. But it’s a sideline to our story; some of Coburn’s other findings were of even greater interest.
The HH&S project operates on a special basis: its services are free to the entertainment industry. How does it manage that? Taxpayer money. The link above to the project’s website lists 13 major sponsors, four of which are federal agencies (the CDC, the Office of National Drug Control Policy, the Health Resources and Services Administration, and the Agency for Health Care Research and Quality). Hollywood, Health & Society puts it this way:
Core support for HH&S has been provided since 2001 by the Centers for Disease Control and Prevention.
HH&S offers a lengthy list of “shows we’ve worked with” on the taxpayer’s dime, from the soaps One Life to Live and General Hospital to sitcoms like 8 Simple Rules and The Office, and the prime-time dramas Mad Men, Elementary, West Wing, The Good Wife, and House.
Trying to determine exactly what the CDC has been spending in more recent years has become difficult, however, since Coburn went on the warpath about the project in 2007. His staff calculated that HH&S had spent about $6,000 in federal taxpayer money per episode to consult on 400-odd TV-program story lines from 2001 to 2007. Most of that funding came from the CDC; some came from other federal health agencies – and some of the CDC funding used was from the CDC’s counter-terrorism budget. (See pp. 9-12 of the Coburn document linked above.)
Themes on tap
Since 2007, the CDC and HH&S have become cagier about publicly posting information on the monetary aspect of their activities. Their relationship remains close, however, as is obvious from the links between the sites. The CDC, for example, provides a set of tip sheets which are collated in an HH&S document, hosted at the CDC website. The HH&S document describes the tip sheets thus:
Tip sheets contain easy-to use, credible information on pressing health issues and include information such as who’s at risk, typical symptoms, prevention messages and case examples.
Sample topics include “Food Desert,” “Health Care Fraud,” “Climate Change and Transportation,” and “The Medically Uninsured.” Click through to a tip sheet, and the information displayed is at the CDC website. Each tip sheet has the same format, concluding with a “case example,” which apparently is meant to suggest the basis of a story line. Some of them are just silly, like the meandering, wonkish case example at “Climate Change and Transportation”:
A building developer wants to design a unique community that supports smart growth and that doesn’t require the use of a car for every trip. He designs the community based on a grid of streets, sidewalks and pathways that encourage walking and bicycling. He locates office buildings, shops and public transportation within walking or biking distance of most homes. He also plans to build an elementary school in the community so children can walk to school instead of taking buses. The design of the streets and houses encourage walking; streets are narrow to slow traffic and make crossing easier. By making options like walking, biking and public transportation more accessible, the developer is enabling the community’s residents to choose less fuel intensive forms of transportation, and helping them to reduce their GHG emissions.
Sure, that’ll have them rolling the aisles. Maybe they can get Drew Carey for the building developer. But other case examples are clearly making an effort to cater to the story framework of a drama series like Gray’s Anatomy or Nurse Jackie. See the case examples for “The Medically Uninsured”:
1. A 40-year-old working single mom, with no health insurance through her employer and unable to afford health insurance for herself, is only able to take advantage of some of the free community health care services available to her: free screenings for high blood pressure, diabetes, and cholesterol. She has a family history of high blood pressure, high cholesterol, and type II diabetes. Her most recent screenings indicate she, too, is most likely suffering from type II diabetes along with high blood pressure and high cholesterol. She cannot afford the repeated visits to a doctor’s office or the medications necessary to treat her condition. The stress of the situation has caused her to have an apparent heart attack – landing her in the emergency room. She’s going to be okay for now, but the on-call physician tells her she will need to promptly begin treating her multiple conditions. She tells him she doesn’t have insurance and is terrified to think how she’s going to pay for treatment for the rest of her life. Starting in 2014, he will be able to refer her to the hospital’s financial counselor who informs her of some of the more economical plans that are available to folks just like her via the Health Insurance Marketplace. She cannot be denied coverage based on her pre-existing conditions, and she may also qualify for a sizeable subsidy.
2. A 28-year-old young man, still living at home with his parents and no longer covered under his parent’s health insurance policy, is returning home from his part-time job when he loses control of his motorcycle on a slippery road. He is rushed to the hospital unconscious with multiple fractures to his legs. To stabilize him, the medical staff places him into an induced coma. Despite wearing a helmet, he has suffered injuries to his head. The extent of the damage to his brain is unknown and he could be in intensive care for an extended period of time. The parents are terrified, but are partially relieved to know at least he’s still alive. They stay by his bedside every minute of every day for a week until he finally regains consciousness with no apparent brain injury. They are ecstatic to know he will most likely make a full recovery, but then realize they are saddled with a bill for over $100,000, as the auto policy for their son will only pay a portion of the total hospital bill. In 2014, the young man could have defrayed the costs for himself, or his parents, by purchasing a health care insurance plan that contained catastrophic coverage through the Health Insurance Marketplace. To assist with the cost of purchasing health care insurance, there are many financial assistance options for those that qualify.
What we note about both of these case examples is that they are deceptive and unrealistic. In neither case was the protagonist realistically condemned to a lack of medical care prior to 2014 and the onset of the Obamacare individual mandate.
The premise of the second case is so transparently deceptive as to be laughable: nothing was stopping a 28-year-old from getting his own health insurance prior to 2014, and in fact, it was cheaper for him to get it in 2013. The 40-year-old’s case was only slightly more complicated. It’s an outright lie to say that the only care she had access to before the Obamacare mandate kicked in was simple screenings in community clinics. She would have been a Medicaid patient prior to 2014 – and it is virtually 100% certain that she’s a Medicaid patient now. Medicaid patients have access to the kinds of diagnoses and treatments this fictional character probably needs; they had it both before and after 31 December 2013.
So our tax dollars are being spent on offering tip sheets to the entertainment industry with tendentiously falsified case examples. That’s not surprising, of course. But it is evidence of how we can expect the collaboration of government and the entertainment industry to continue going.
Case studies in government-collaborated theme-selling
Here are some case examples of a different kind: the histories of two actual story-line collaborations between HH&S-brokered government experts and entertainment-industry story writers. Both are troubling because they involve story lines that purport to highlight public health issues – but the stories can only manage to make them public health issues (or could only be made compelling, apparently) by introducing a crime element for which there is no real-world evidence or precedent – or without which there’s no public health “story.”
Numb3rs
The first example is from the GWU School of Public Health and Health Services peer-reviewed case study paper, linked above and here. It’s dated June 2007, and looks at the HH&S/government/industry collaboration on an episode of the TV series Numb3rs that dealt with organ donations and the shortage of organs available for transplant in the United States. The following excerpt is from pp. 7-8 (emphasis added):
HH&S … facilitated a telephone consultation between the [Numb3rs] writer and James Burdick, director of the HRSA Division of Transplantation, a transplant surgeon who has extensive knowledge about organ donation trends in the United States.
During the course of the consultation, Harden [the show’s writer] asked specific questions about “transplant tourists,” what happens to them in real life, and black markets for organs. The expert explained to the writer that no black market exists in the United States, and suggested that the episode instead emphasize the high demand for organ donations, since vulnerable populations in the US may be susceptible to myths and inaccurate portrayals associated with organ transplants in television media. The expert also explained important key messages about the topic, such as the overwhelming number of deaths in the country due to the shortage of organs, how the donor-recipient matching system works, and the system in which organs are tracked. …
The resulting storyline, “Harvest”, aired on January 27, 2006 and was one of the most popular episodes of the season, drawing 13.36 million viewers. As the writer originally planned, the storyline focused on a black market for organ donations set in the U.S. In the episode, through an underground, illegal connection, girls from India are flown to the U.S. and forced to become organ donors for wealthy Americans. Their organs are procured in a hotel basement, where the agents find that one girl had been murdered and all of her organs taken. Despite the inaccurate premise, this episode also provided considerable accurate information about the number of people on the transplant waiting list and the computer system for organ matching. In addition, the storyline concludes with an extensive discussion about the importance of organ donation around the detectives’ family dinner table. Through a warm and comedic scene, four of the characters who are already donors themselves convince a fifth character that he too should sign up to become an organ donor.
So at least there was a warm and comedic scene, to balance out the false depiction of a black market for human organs that’s getting Indian girls killed by evil Americans. While the GWU School study is at pains to point out that the lying narrative was the writer’s own idea, the upshot of the whole thing was still that a taxpayer-funded agency was involved in bringing a false narrative about a human-organs trade to the public.
The fact that there’s an ethical gray area in such fictional story-telling is why the U.S. federal government shouldn’t be anywhere near the process of story planning for the entertainment industry. Let Hollywood do the research for false story lines on its own dime. We out here in Boob-Tube Land are big boys and girls; it’s up to us to sort out truth from falsehood when we’re watching TV. But our tax money shouldn’t be spent on enabling such enterprises. It’s hard to think of anything, other than keeping state-security secrets, in which a government entity should knowingly participate when it could end up being implicated in a lie to the public.
Law & Order: SVU
The other case study, published in Public Health Reports in 2011, involves an episode of Law & Order: SVU from 2007. This next paragraph summarizes what was produced with HH&S-brokered collaboration (p. 152 of the periodical, or p. 3 of the PDF document; emphasis added):
With 13.45 million U.S. viewers, L&O: SVU was the 23rd most-watched network show in February 2007. An episode called “Loophole” was aired February 6, 2007. It began with detectives from the New York Police Department’s elite sex-crime unit receiving photographs of a little boy in his underwear. Initially assumed to be child pornography, the photographs turned out to be data from a chemical company’s test of an unregistered pesticide. The test involved spraying the pesticide in an apartment building; the boy developed “cancer in his blood” as a result of repeated exposure to the hazardous substance. A corrupt federal official character had been conducting sham plant inspections, and the detectives quickly uncovered evidence that incriminated the pesticide manufacturer. However, according to the storyline, there was a loophole in federal regulations that protected the company from prosecution and damage liability. Undaunted by their lack of firm regulatory ground, the detectives bluffed their way through a confrontation with the head of the company and he agreed to pay the child’s medical bills.
The government employees who consulted on this show provided information about the physiological impacts of toxins, and scientific questions like proving causal relationships. But notice, again, that in order to have a story, the L&O: SVU writers decided to incorporate a corrupt federal official into the plot, and posit a regulatory loophole that may or may not exist in the real world – plus, of course, have the chemical company “test an unregistered pesticide” on an apartment building (!), which certainly sounds nefarious but is hardly representative of a “public health hazard” that viewers have any reason to expect in their own lives.
This story isn’t actually about a public health hazard. It’s about a fictional weakness in government’s regulatory apparatus, and the fictional culpability that results. It’s not clear from the study whether there was ever a consultation with experts about that. But if there was, I’m thinking we should hold the consultation to the same standard I propose for public-health-issue consultations: that they not involve federal employees, working under the auspices of a government-industry partnership to promote themes and story lines.
If the producers of L&O: SVU want to make people think that we’re just one corrupt federal official away from an epidemic of chemical-induced blood cancers in our children, that’s between them, their audience, and their commercial sponsors. Knock yourselves out, dudes. But it can only open doors wider to corruption of multiple kinds, for federal agencies to get involved in such scare-mongering fiction – regardless of what their role is. Leave the taxpayer and the official stamp of government out of it. Period.
A few additional lines of text from the L&O: SVU study suggest a chilling view of how practitioners see “entertainment education,” and why we really need to keep government out of it. The study yielded this conclusion (p. 5 and p. 9 of the PDF document; emphasis added):
Among viewers of the show, those who felt transported by the narrative were more likely to have retained the undramatized symptom information, as well as to learn that children are more vulnerable to toxic exposures and to indicate that they would take action if they suspected a cluster of cases. …
From a theoretical perspective, the most interesting finding was that those who felt more transported by a video narrative were likely to have higher levels of knowledge. This may mean that they learned more from the show and were more primed for action. Future research should explore narrative factors that make all kinds of narratives more transporting.
Just what we need: government collaborating with the entertainment industry on narratives that will be “transporting” to us and “prime us for action.” And the good news is that we already have it.
