America’s health care system is far from perfect. It’s complicated. It’s expensive. It’s broken in many ways. So why aren’t more people talking about it? Evan Smith of The Texas Tribune joined us in the latest Blue Promise to discuss how public dialogue helps frame public policy.
[DAN]: America’s health care system is far from perfect. It’s complicated. It’s expensive. It’s broken in many ways. So why aren’t there more people talking about it? Tune in to this blue promise to hear how public dialogue helps frame public policy around healthcare.
[DAN]: Thanks for tuning in to Blue Promise, I'm Dr. Dan McCoy and I'm the president of Blue Cross and Blue Shield of Texas. We're filming today in Austin Texas in our office just across the street from The Capitol and we have a very special guest today CEO co-founder of the Texas Tribune Evan Smith. Thanks for joining us.
[EVAN]: Oh I'm so happy to be here. Thank you very much for having me.
[DAN]: Well before we get started tell people a little bit about the Texas Tribune.
[EVAN]: We're 10 years in business, doctor, which is amazing to think about we've been together talking about the world at the Capitol in the world and Texas for a long time it's hard to imagine it's 10 years as of this November we started because there was not enough coverage of public policy including health care policy and politics in Texas the number of reporters at the Capitol and around Texas is significantly down from what it was a generation ago the number of news organizations is down from what it was a generation ago. And yet the challenges we face as a state are more not fewer. They're more complex not less population's growing. And we made a decision to start the Tribune as a way to provide people with a reliable nonpartisan source of information that would allow them to be good citizens to know about the challenges that we face as a state and then as citizens to take ownership over those challenges because the public has largely for many years been checked out in Texas and the public absolutely needs to step up and check in.
[DAN]: Well I remember you've always been in evangelism, evangelist around kind of helping people engage in that dialogue. I remember the first time you shared this vision with me it was 10 years ago we met after work for a drink and honestly I thought you might be a little crazy.
[EVAN]: I thought.
[DAN]: It turned out like you thought it would turn out?
[EVAN]: I know no one is more surprised than I am after ten years that we've been successful on the fourth day that the Tribune was in business. That would've been about November the 6th of '09 I went home and my wife said "how's it going?" And I said "I think I may have to get a job." I'm really not sure this is going to work because look what we have built is something that does not and did not exist then does not exist now. We have raised 72 million dollars in 10 years to fund the operations of a serious public service journalism organization of a public interest newsroom from wealthy individuals and regular folks from institutional philanthropy foundations and corporate underwriters. This is something that we had no idea at the beginning would take hold. We had no idea that a business model would be as successful and as sustainable over the long term as it has proven to be. We had no idea that we would become a best practices laboratory for journalism all over the country where people are looking to us to develop the way to innovate and iterate and transform journalism and then they go back to their communities and they start versions of the Texas Tribune in Nevada or Mississippi or Northern California or New York City. We had no idea that we would change the way behavior is conducted at The Capitol where for a long time there was no accountability. Elected officials could do one thing one day and the exact opposite the next day promised to vote one way one day and then vote the opposite way the next day. We now have reporters on everybody at the Capitol at all times. We're keeping a watchful eye over people in power and taxpayer funded institutions without regard to party or partisanship or ideology. And I think that's the difference maker right there Doc is that it is nonpartisan journalism down the middle solves the riddle in tennis in journalism and in life.
[DAN]: Also, I would throw something at you, initially when you started it. When you start thinking about starting a news agency ten years ago.
[DAN]: When most formal news agencies, no offense, were either consolidating going bankrupt.
[EVAN]: Oh hell, none taken. Are you kidding me? That's exactly...
[DAN]: People looked and said this is kind of crazy but you did have a very interesting philosophy and the philosophy was people needed to know.
[DAN]: Things were happening that people needed to know.
[EVAN]: Yeah this was always not about news it was about knowledge. It was not about journalism it was about information. I totally agree with you and it's about Texas and it's about our democracy. This is the part I'll tell you a story. So one of the early people we went to see to fund the Tribune somebody who we hoped would become a donor and has become a donor did at the time and has become one over time every single year is a biotech startup guy very very smart guy who has started three companies venture backed and has sold them all and gotten increasingly in a position to support good causes, let's just say, right over time. And so he was somebody I knew a little bit. My partner the venture capitalist John Thornton who at the time we started the Tribune he and I were going around to see various people in various cities to say we have this idea it's pretty audacious but we think we can provide more public interest journalism but we need support philanthropically to do this. We were traveling around to see various people well one time we land at the Four Seasons bar in Austin to see this biotech startup guy very smart guy who is pretty quiet. We sit down with him we meet for an hour he asked a couple of questions but really didn't do very much talking. We didn't have any sense of whether this interested him or not. And we talked a lot about of course what we were planning to do. And I had movie tickets for that night with my wife and at the hour mark. I needed to get up and leave and so I apologized. I said Listen I'm sorry to have to get up and go but we have movie tickets I appreciate you making time with us. I thought this was going nowhere. I stood up to shake his hand and he stood up to shake my hand and he said OK I'm in for a hundred. And there was a pause and I thought he was then going to say "dollars" and instead he said thousand. "Go save my democracy." That's what he said. That stuck with me. That was a real inflection point in the launch of the Tribune because I realized at that moment that this was really about our democracy not about journalism it's not about the news business it's not about trying to save the legacy news media it's about giving people the means to be more thoughtful and productive participants in our democracy by giving them as you said the information they need the knowledge they need to be better Texans and better Americans. When I realized it was about our democracy that's changed everything.
[DAN]: Well I have to tell you as a company we took the challenge, you, I don't know if you really understand the impact the Texas Tribune has had on us.
[EVAN]: Oh, go on tell. How long can we talk about we have three hours? Is this a three hour podcast? Go ahead.
[DAN]: I will tell you when three or four years ago we started looking around the state and realized there wasn't really a dialogue occurring around health care.
[DAN]: And a lot of the traditional players either dropped the ball or they hadn't moved into engaging these conversations through social media through town halls around the state. And so we then launched something we call the voice of Texas Health Care Initiative which one of them is Blue Promise which you're...
[DAN]: Participating on today and it's been exciting to see how people are becoming more knowledgeable about our issues which allows them to play a better part in that dialogue and decision making. What about the Texas Tribune? Have some success stories have come out of this you'd like to share?
[EVAN]: Well what I can tell you is that life is been for so many years of I've been on this earth about one way conversation and really in the last decade or more certainly in the time we've been in business it's become a two way conversation. The public wants to be brought into a conversation that they can participate in about the things that affect them. One of the things that I've been proudest that we've done over the years is forged a partnership with Blue Cross on events where we'll travel around to a big city or a small town with elected officials policymakers experts and we'll have a conversation about opioids or about mental health or about the gap in insurance coverage or about vaccines. You know we love to do conversations around different areas of health policy that affect real people. We go into communities and real people come out they listen to these people who are so well versed in this stuff smart about this stuff but then they want to ask questions themselves which of course they always get to do in the end. Blue Cross has been a leader maybe the leader in facilitating making it possible for us to travel around the state and do these conversations. So, that's a success story of sorts because I think you know but for the opportunity to talk about health care in places like Alpine, Houston, Abilene those communities would be poorer in knowledge and in informedness on, on those subjects. So I mean I think that's been a major component of our success. We do now between fifty and sixty in total events a year. So on average one a week or more per year and they're on a whole range of subjects. Course not all health care but a lot of them do touch on health care at least a little bit. And every time I'm with elected officials these days particularly after this eighty-fifth largest eighty-sixth pardon me legislative session and we talk about school finance reform which was a big component of the discussion of the agenda this last session and about property tax relief I remind elected officials whether it's in El Paso, Dallas, Austin, Houston, San Antonio. Every legislative session is the story of the work done. But it's also the story of the work not done and while public school finance and property tax got a lot of love from this legislature. Health care continues to be if not the largest percentage then darn near the largest percentage of the state all funds budget. And yet there was almost no discussion of health care during the session of a meaningful sort. As I was coming over here today, doctor, I saw that for the first time since the Affordable Care Act passed the uninsured rate in this country has started to tick back up for the first time. Last year the number of uninsured children specifically on the rolls that has started to go back up after a decade of that going down. What did our legislature do during this last session to address just those two challenges? The broad challenge of people not having access to coverage and specifically the most vulnerable people in our communities the uninsured children of Texas. What did the legislation do to address those things? Nothing. So one of the things I always say even in the events that are not specifically health care events is why didn't you talk more about health care. What did you do on health care? All around us are conservative states that have conservative state leaders who say we are acting on behalf of the conservative voters who elected us. We're not expanding Medicaid we're not looking at significant changes to health care but in those states the voters were able to get a Medicaid expansion on the ballot up or down and you know what they voted for it. So we assume that progress cannot be made in a conservative state with the conservative politics of the moment and maybe that's the case but it's worth having a conversation with elected officials about whether there is a another conversation to have than the one we've been having. Those events are the perfect venue to have that conversation and we appreciate the fact that you and others have made it possible.
[DAN]: I think what's interesting about those events Evan is that you clearly when you have them you educate the local audience you get local media attention. You'll learn some stories but it has to have a powerful effect on the editorial content of the Tribune. If you're talking in the Rio Grande Valley about border issues. It clearly has to come back and impact the people that are helping to frame the news.
[EVAN]: Well the first thing to know is that we consider our events to be journalism not that there's anything wrong with barbecue festivals and bridal shows and the sort of stuff that is typically put on by marketing departments of news or media organizations those have a place but our events from the very beginning very first event we did was in January of 2010 a couple of months after our launch with the then speaker of the House Joe Straus. Ever since that first event with Joe Straus all the way forward and up through today every one of our events has been an editorial event. They're editorial events so of course they have a connection back to our journalists. Now, do they necessarily produce stories on our site? We always publish the video. People can go back and watch the events if they're not there but do we necessarily publish stories? Not always. I would even say not often, but there are definitely times when we make news in those events.
[DAN]: I will tell you three years ago I would start to go out and give public events and one of the things I talked about were crazy billing stories.
[DAN]: So you know people would I would tell you, you know, we this is kind of the crazy billing story of the week. It's the three stitches sixty thousand dollar charge. And what was remarkable is that people would come up to me after the event and they would say "that happen to me." I mean "that happened to me." And it really started to kind of rain down on us that this was it. This was a state crisis.
[EVAN]: Yeah. And. But it's not just a state crisis. I mean I'd say that honestly it's a national crisis. I'm on the editorial advisory board of an organization called Kaiser Health News. This is a independent journalism organization that is an arm of the Kaiser Foundation and they have really been leaders in that specific story in talking about excessive medical billing and in partnership with NPR has often gotten stories on the air talking specifically about that issue. And you know what? Here's the thing about that kind of journalism. It takes a while. It's not always a first time or the second time or the third time but eventually it begins to penetrate the skulls of people in a capitol like ours or in an electorate like ours. Change happens from the ground up. It almost never happens from the top down. Real change. It is the public with pitchforks and torches marching on the capital when change happens. And so whether it's surprise building and the very specific case or a broader conversation about health care coverage and access to coverage and access to care because we have a dual problem in Texas we don't have enough coverage. We also don't have enough doctors enough medical facilities Texas among the many challenges we have in health care area. As you well know is that we have seen more rural hospitals close in Texas than any other state over the last decade. We have a genuine rural health care crisis. So it is the public getting activated and literally marching on the capital that gets action to take place. And it sometimes takes time for those things to penetrate the skulls of people in their busy lives. But it happens eventually it happens eventually.
[DAN]: Well we saw great success this session with Senate Bill 1264. And Kelly Hancock stepping in and putting a ban on surprise billing.
[DAN]: And actually Texas leading you know putting some protections in place against price gouging it always alarmed me that you could run away from a hurricane pull into a convenience store and purchase gasoline at ten or fifteen dollars a gallon. And the attorney general could act on that. But if you go into the emergency room in a medical emergency there's no protections for a consumer or a patient. So we did have some pretty cool legislation come out this session. We're hopeful that our work with Texas A&M on the partnership around rural health care and the moonshot.
[EVAN]: Yeah and Nancy Dickey at A&M is a particular leader on this and in fact one of the things we're going to do with the Texas Tribune Festival is have a conversation specifically around rural health. Sarah Jane Tribble from the aforementioned Kaiser Health News who has been a leader as much as they've let on the surprise building stuff, they've also led on their coverage of rural health around the country and she has been their principal reporter. She's coming in to lead a conversation that Nancy Dickey and a bunch of hospital folks from rural Texas are going to participate in.
[DAN]: Okay so these topics to me on health care I mean 'course I'm you know I lead a health care company.
[EVAN]: You're interested all the time the bomb.
[DAN]: I'm interested all the time but the question is why, what's the reason why we've seen a dwindling of the dialogue if you will in mainstream media and the conversation.
[EVAN]: Well I think that I don't want to speak for other news organizations having said that let me speak for other news organizations. I think that one of the challenges that the industry has right now is fewer resources to be deployed one editor of one big city newspaper in Texas recently said to me we used to be a newsroom of record. Now we're a newsroom of choice. The decline in the industry and the resources available human and financial have made it so that they can no longer cover everything they can only cover the things that they can cover and they can only cover the things that they elect to cover based on what they believe their readers want. And I will tell you as somebody who has spent 10 years and in fact all the years of Texas Monthly I'd say beyond those 10 years. Also in the serious journalism business. Sometimes the public wants serious journalism sometimes it knows it wants it. Sometimes it doesn't it know it wants it and sometimes it doesn't know it needs it. Sometimes in the journalism business you're in the business of giving people what they don't yet know they want or need. The easy answer is to never get to that point. The easy answer is to say well what they want is Dirk Nowitzki and Jose Altuve they want color weather maps and they want crime on your street and they want celebrities with six toes. You know they want stuff like that.
[DAN]: They don't talk about surprise billing necessarily.
[EVAN]: Forget about surprise billing, they didn't want to about real health care that I won't talk about the fact that we don't have enough coverage of insurance coverage out in the world so that people are going to emergency rooms at county hospitals with primary care needs and you're driving up everybody else's property taxes because those uncompensated care costs are being passed along to everybody. They don't wanna talk about any of that stuff is the assumption or read any of that stuff and so it's an easy out for news organizations to say well nobody cares about this stuff. So we're going to stop covering it. Where in fact the inverse is true. Nobody cares about it because you stop covering it. What is the job of journalism? It's many things it's the search for the truth and tell people what you found it's to hold people in power and taxpayer funded institutions accountable regardless of party or partisanship or ideology. But it is also to tee up for people in their busy lives things important enough to stop and pay attention to. If we tee them up, can't guarantee that they're gonna stop and pay attention. But there's a pretty good chance. What I can't guarantee you is that if we don't tee them up they absolutely will not pay attention to them. So they've stopped covering that stuff. They in the broad sense not us because they think among other things we don't have the resources to do it. And the audience is not there. As opposed to, we have a fiduciary responsibility with the community we serve and we're going to report on this stuff because it's important enough. Even if he can't make a buck off of it and the audience will materialize because we covered.
[DAN]: Okay. Speaking of teeing up the Texas Tribune Festival is coming up.
[EVAN]: It is?
[DAN]: And you've got a pretty phenomenal lineup.
[EVAN]: I should have been working on this!
[DAN]: People need to know about. So tell us a little bit about what you've got lined up.
[EVAN]: So the first thing I'll tell you is last year we had the most speakers we've had in the last year was the eighth annual festival. This is the ninth this year. So last year at the eighth annual festival we had about 350 people speak over the three days which was the most people ever. This year four hundred and sixty plus.
[EVAN]: Speakers over the three days. Last year I think we had somewhere in the vicinity of one hundred hourlong sessions over those three days we're up over one hundred and twenty five hour long sessions. Keeps thing keeps growing. It's like a snowball rolling downhill it's gonna crush all of us by the time it gets down to our level. Huge names from both parties politically both at the national level and at the state level huge experts on policy across the board. A lot of people from the national press because we always love to have a bunch of programs on the state of the intersection and complicated relationship between the press and politics. Bunch presidential candidates a lot of people running for Congress in both parties. Sitting officials from both parties from other states former officials from both parties from other states. And then a very conscious focus on the big topics that our legislature health care of course education immigration transportation criminal justice ethics the economy energy but also on the future of urban Texas the future of rural Texas the intersection of technology policy and democracy. The 2020 election cycle will be a focus of course as it always is. A lot of conversations around race at the moment because that's a big narrative through line. So I mean I'm. I love it. But of course I would love it right? I mean that doesn't surprise anybody.
[DAN]: But it still sounds like a spectacular lineup.
[EVAN]: Well you know it's a big effort to put together it takes a village. As everything good does it takes more than one person. I work a lot on it. I make the invitations to just about every single speaker personally but there's a whole team of people who make this festival happen it happens because of them.
[DAN]: Well you're making an invitation for the public to join you today and so.
[EVAN]: I'd like I'd love it if the public would come. You've go to Festival.TexasTribune.org. There's a ticket price for everybody at every level. If you're a student or an educator you get a pretty deep discount if you're in working in government or you work in a nonprofit organization. There's a deep discount available even if you have to pay the full freight for it it's still a bargain. And we'll have we think maybe 10000 people badged to attend this festival which would be a huge increase over last year which was our largest year ever we had about 7300.
[DAN]: And that's great.
[EVAN]: Downtown Austin.
[DAN]: Well thank you so much for all the Texas Tribune does. Thanks for being here today.
[EVAN]: Oh it's my pleasure.
[DAN]: As a sponsor of the Texas Tribune Festival we'll be there hosting the Women at the Tribfest Meetup, right here in this room across from the state capital. You can come together with some of the top women shaping politics business technology and public policy. Get the full details at Festival.TexasTribune.org. We'll also be recording upcoming episodes of our podcast that weekend in front of a live private audience so be sure to subscribe to Blue Promise whenever you listen to podcasts. Thanks for tuning into this episode.
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