Death by a thousand anecdotes

What is the meaning of the "death by a thousand anecdotes" in the second paragraph of the following text:

The Public Backlash Was Mainly Physician and Media-Driven

To reverse the backlash, you have to understand it. Many observers of the battle over patient protection have assumed that public hostility to managed care ("they don't manage and they don't care") was a direct result of the bad experiences suffered by a swelling tide of health plan members. It is not so. While the end of the nineties certainly saw a dramatic increase in public hostility toward managed care and health insurance companies, with the "negative numbers" mounting annually from 1995 until 2000, this was not based on personal experiences. Paradoxically, during those years there was no increase in plan members' dissatisfaction with their own health plans. Most insured people (but by not an overwhelming majority) continued to rate their own plans favorably. From all the evidence we have seen, we believe that the backlash against managed care was mainly caused by physicians and the media, rather than by member dissatisfaction. Most physicians strongly dislike managed care and have told us that they have voiced their criticisms to their patients, and many patients told us that their doctors had bad things to say about managed care. Although some media reports the contrary, most patients trust their doctors as reliable sources of information about the health care system, so what physicians say can influence public opinion.

Furthermore, physicians were surely a major source of many of the horror stories about managed care that consumed the media from 1995 onwards, and physicians led the charge in lobbying the Congress for patient protection. Managed care has suffered "death by a thousand anecdotes." In an age of competitive mass media it was not difficult to find, among the many millions of members of managed care plans, real abuses where patients died or suffered because plans just said "no" to necessary care. The fact that fee-for-service insurance also had its own record of horror stories was forgotten or overlooked. The result, in the words of Professor Robert Blendon of Harvard, has been "policy-making by outlier" as if the horror stories were typical rather than exceptional.

Because mainly angry doctors and very negative media caused the managed care backlash, it can only be reversed by actions that address these causes. Managed care will only regain the public's confidence if it makes doctors less angry and gets better media coverage. Of course, improving the experiences of, and the services to, plan members is also an important part of this reversal—but it is only one part. The big picture is that managed care needs to:

rebuild its battered relationships with physicians
improve the quality of service to plan members
focus, in new and better ways, on improving quality of care (actually "managing care").

[David L.]

Firstly, do you understand what "managed care" is?
Doctors are forced to treat their patients along 'managed care' guidelines as set down by the health insurance companies, rather than being free to manage each individual patient according to their own medical wisdom and discretion. Treatment of any patient can have complications, and sometimes, can go terribly wrong. For example, a person being discharged from hospital to free up a bed for another patient, and the person dying within hours of being at home. This might then be regarded with hindsight as caused by too early a discharge forced by the need to follow 'managed care' guidelines (as no further hospital fees would be paid after that date by the insurance company). Such 'horror stories', reported by doctors and publicized in the media, damage the credibility of, and public's faith in, 'managed care' practices. Each of these 'horror stories' is one of the thousand and more anecdotes of medical 'mismanagement' that kills off faith in 'managed care', for the doctors and public alike.

[rewboss]

In debate, "anecdotal evidence" means a story used to prove a particular point. It's usually considered a logical fallacy: that is, it's not real proof.

For example, we all know that when you are trying to repair equipment that uses high-voltage electricity, you should switch off the electricity first, otherwise you risk getting an electric shock. But I might say, "Look, I managed to repair a TV set while it was still connected to the power, and I didn't get an electric shock." That's an anecdote, but it doesn't prove that not removing the power is safe; it might be that I was simply lucky.

In the article, the author is saying that all these stories about managed care are simply anecdotes, and are not evidence that managed care is a bad thing. However, because these anecdotes are widely reported (especially by doctors who didn't like the system), many people have come to believe that such incidents are the rule, rather than the exception. This gives them a false view of managed care.

The exact phrase is an allusion to a form of execution called "death by a thousand cuts" which, it is said, was used in China. Although most likely part urban legend, the story is that the convict was given small cuts until he or she died. The idea is that although a single anecdote isn't enough to make the idea of managed care unpopular, over time a series of anecdotes might add up to cause the "death" of managed care.