How to Market Healthcare Reform

| Tue Jul. 21, 2009 10:11 AM PDT

As the healthcare debate plays out, we're all getting to see in real time the fundamental political contradictions that make it so hard to get anything done.  The big lesson learned from the Clinton debacle of 1994 is that people who currently have insurance from their employer don't want it touched.  Ditto for senior citizens covered by Medicare.  So Democrats are making sure they aren't touched: in fact, they're repeating like a mantra that if you like the insurance you have now, you can keep it.  No one's going to take it away.  No one's going to so much as look at it crosseyed.

Fine.  But two-thirds of the country already has health insurance through their employer and another big chunk are on Medicare.  If these aren't going to be touched, then why should they care about healthcare reform?  In particular why should they be willing to pay higher taxes for something that won't help them out in any way?

No reason, really.  So instead Dems are promising to increase "access" and cut costs.  The former is basically welfare and gets only anemic support.  The latter is not only unproven, but doesn't do much to excite most people anyway.  Sure, they'd like it if their copays went down, but mainly they just want healthcare and they don't care how much it costs.  Mickey Kaus comments:

1) As is so often the case, overpolling seems to blame....I suspect [Obama aides] saw what they wanted — and they wanted to focus on costs. It's possible to take polls that show something very different2) Is "access" the right word to test-as opposed to "security"? "Access" makes it sound as if you are focusing on the problem of the uninsured — i.e. charity, to many middle class Americans — as opposed to security for everyone. If they polled "access," that may have stacked the deck from the start; 3) "Maybe" they "overcorrected from the Clinton model"? Maybe?

I sympathize with the Obama folks.  How do you promise to leave most people alone and also convince them to support major change?  It's a tough nut.  And putting aside whether the Obama team overcorrected or not, it's still true that "security" didn't get the job done for Clinton.  So what's the answer?  In a nutshell, fearmongering.  Like so:

Rather than overall cost....the selling point of national healthcare is freedom from the endlessly gnawing problems of our current jury rigged system. For example: HMOs that make it hard to see a specialist. High and rising copayments. Fear of losing coverage if you lose your job. Long waits for non-urgent care. New (and usually worse) healthcare coverage every time your HR department is told to find a cheaper plan.

And more: Small businesses that have a hard time attracting good employees because they can't afford to offer health coverage. Big business that are on the verge of bankruptcy because of skyrocketing health costs. Lack of choice in physicians because you're limited to whichever medical groups have signed contracts with your company's insurance carrier. Losing your longtime family doctor because your company switches insurance carriers and you can only see doctors on your new carrier's approved list.

And yet more: Fear that preexisting conditions won't be covered if you take a new job. The risk of financial ruin if someone in your family has a truly catastrophic illness. Crowded emergency rooms that have essentially become clinics of last resort for the poor. Being forced to go on strike year after year because your employer relentlessly tries to gut your healthcare benefits every time your union contract gets renegotiated. 43 million people who lack health coverage of any kind.

Reducing healthcare costs ought to be a goal of any national healthcare plan, and a truly national plan is probably the only way we'll ever accomplish that. But that's not the way to sell it. Freedom from fear, freedom from pain, and freedom of choice are the ways to sell it.

Fine.  I'm cheating.  That was me a couple of years ago.  But I still think it's the right sales pitch.  And even if it's not as highminded as Obama might like, it has the virtue of being true.  For most people, healthcare reform isn't so much about insuring their health now as it is about insuring their health tomorrow.  If they understood just how precarious that is, they'd be a lot more enthusiastic about healthcare reform today.

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Kevin Drum is a political blogger for Mother Jones. For more of his stories, click here.

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Comments

Perfect

Brilliant. I don't know how anyone but Senators could be totally at peace with their situation -- losing their job, not having something covered, etc., etc.

True, but....

Not to sound too anti-democratic or anything, but who cares? The dems have 60 votes in the Senate and control the House. Screw the polling, just pass a decent bill.

Like you said, most Americans really don't have a pressing reason to change, so you're never going to get strong support for a massive healthcare system, but they also won't have a reason to be angry when universal healthcare passes either since most people won't even notice the difference.

If healthcare fails, it's the Dems who will get the blame once again. All we're facing now is a power grab by the "centrists", and the Nelson-Lieberman crowd isn't going to be swayed by polling swings. Edging the poll numbers up by fear-mongering is nice and all, but it's really completely beside the point right now. Either the Dems hammer down and get something done, or they hand the Republicans the first victory in their comeback campaign.

Very nice.

"Freedom from fear, freedom from pain, and freedom of choice are the ways to sell it."

I might also add - "...my opponents are attempting to derail the legislation from their customary Fear-Lined Bunker...aren't you sick of that? Governing from a position of fear got us: the Iraq war, Gitmo, rendition, illegal wiretaps and more. Aren't you sick of being ruled by fear? Haven't you had enough?"

Is it fearmongering if it's

Is it fearmongering if it's true? I love my employer, but I hate the fact I am afraid I will never get health coverage if I were to go somewhere else. And if I am laid off in this environment, where will I get health coverage for myself or my kids?

Anyway, I do love my employer. Absolutely fantastic company and the greatest boss ever.

What's really notable about

What's really notable about your 1997 column is how much easier to the comments were, and how many more people participated....

People who have employer-provided healthcare...

...may not agree with the prevailing assumption that they want to keep the current arrangement.

Case in point: I have very good, affordable healthcare on paper, but have had to go to the mat several times during the past year to get my insurer to pay what their policy says they should pay for. In the most recent case, they finally did pay, but only after 8 months of haranguing.

I'd rather have a plan that does what it promises, so my wife and I can spend our scarce free time on things that matter to us. And if it's a public plan, we're fine with that.

Hope you've sent a copy of

Hope you've sent a copy of that to Max Baucus and his howling pack of Blue Dogs!

If you have to work that

If you have to work that hard to sell the American public on a specific proposed government program, then it's most likely a program that shouldn't be undertaken in the first place.

This isn't just "a specific proposed government program"

...it's a MAJOR change to the nation's infrastructure. It takes work! Guess we shouldn't have gone to the moon, either?

health care

Another tack is essentially a kind of Consumers' Reports argument. We are paying a ton of money compared to other industrialized democracies and getting in terms of most generally recognized measures really crappy results.

Virtually all Americans do

Virtually all Americans do indeed have a pressing need for change. They will lose that insurance they love so much if they lose a job. They won't get hired again by a corporation because the company has no idea how much their benefits will cost, and is at a competitive disadvantage for bearing the brunt of health insurance obligations for the whole country. Individuals need a backstop even if they have insurance they like, and they need a workplace where companies aren't trying their damnedest not to hire them.

Is this so friggin' hard to understand? If the government removed the worst fears of a worst-case scenario for everyone, the positive benefits in national confidence and reducing the administrative waste in the insurance system would be enormous.

Great piece!

tagged as: 

This is the best public piece I have seen on the subject. Could we put together a bill that includes portability, a plain vanilla health insurance requirement for every insurer to sell, regulations over costs, and a viable alternative to medical litigation?

Kevin, Don't Negotiate Against Yourself

All I can say is that people who are opposed to health care are going to deserve what they are going to get if health care reform fails.

Because the status quo sucks - and it is falling apart.

Most people don't care what it costs?

What planet are you living on? That's absolutely crazy. People with insurance are suspicious of health care reform because they're afraid -- and the Republicans keep saying -- it's going to cost them *more* for the same crappy coverage.

I agree your selling points are more effective, but it's not because people don't care how much it costs, it's because they simply don't trust assurances that it won't end up costing them more, when so many can barely afford their coverage now. Have you ever looked into what people pay for family insurance coverage in this country, even with an employer contribution? It's absolute murder, and the premiums keep going up by leaps and bounds every year.

The fear of losing health

The fear of losing health care coverage (due to job loss or EVIL insurance companies) is why health care reform does have a majority support in a country where health care costs are mostly invisible and the majority have health insurance.

Health care Vs. Illegal Immigration

The American people can never have affordable Health care, other than the wealthy, politicians, hospital staff, employer based and federal employees? In will not happen because the US taxpayers are--MANDATED--paying in-perpetuity--$billions--for the 20 million plus illegal immigrants and their families? Costs --NOTHING--to businesses that employ them. Learn about the costs, facts and the lies and propaganda passed around by Liberal-Socialist newspaper editors and even our own government. NUMBERSUSA for answers. SAY NO TO ANOTHER AMNESTY! SAY NO TO ANY PATH TO CITIZENSHIP. RESCIND THE INSTANT BIRTHRIGHT LAW. RESCIND ANY KIND OF BENEFITS TO THOSE WHO CANNOT PROVE THEIR CITIZENSHIP! WE MUST HAVE A PERMANENT E-VERIFY FOR EVERY US BUSINESS. NO TO IRREVERSIBLE OVERPOPULATION! ERUPT YOUR ANGER IN THE EAR OF YOUR Senator and Congressman today at 202-224-3121---BEFORE IT'S TOO LATE.

You forgot 'lower cost' and 'health care slavery'

You forgot 'lower cost' and getting out of 'health care slavery' which seems to be the real point. But those things can't be mentioned in the current political environment.

If the US can enact some decent health care reform then it is the first step in acting like the top 40 countries in the world and costs should eventually go down by at least 50%. Eventually the health-insurance industry will essentially be destroyed as a major economic player.

Then there is 'health care slavery' which these days depends upon having a job with a company that provides benefits. This slavery often inhibits social movement such as quitting jobs, setting up small companies, or getting married or divorced, all of which may depend on post transition health insurance.

Why do reform?

The cost of health care is rising faster than family incomes or inflation or the growth of GDP. It's takes money which might otherwise go to the financial industry for all it's gyrating nonsense. Pity the banker who has "his" money "stolen" by the health care/insurance industry. Worse yet, families don't get the money to pay their credit card bills and so the go bankrupt.

It's unsustainable on the family level or the national level.

How the reform might control costs?

The Exchange brings insurance offers together, so people can compare. It's the basis of a free market and competition.

The public option provides somewhere people can go when they dislike all the alternatives the private sector provides. If it doesn't exist all the private plans can screw you equally. The public option will create a standard of behavior towards the public that the private insurers will have to live up to.

Bringing everyone into plans the way insurance plans always do will spread the costs more than it currently does and thereby lower cost to each individual. It also ensures everyone can pay with insurance and therefore be able to get proper care from lower-cost points than only the ER room.

Insuring everyone will help everyone be healthier (more well) and more able to get back to the grindstone to produce more GDPs and that will make the financial industry and bankers wealthier. Isn't that what we all truly want?

Some of the reform does NOT revolve around the public option or insuring everyone. Some of the reform forces private insurers to behave better towards their customers. Therefore, even those people who won't ever see the public option will see improvements in relations with their own insurance co.

It's a good thing.

Fear is newly relevant

I appreciated the clip of Obama on this the other day, because it was fear mongering in a way I could relate to, although I wish it attacked the opposition more viciously. Recently a lot of Americans really have lost jobs, and hence coverage. And others have gone bankrupt, if not for health reasons, for reasons of income and real estate that at least make the prospect of bankruptcy feel personal. Thus, what Kevin a while back might have thought of as fear mongering, albeit effective fear mongering, is now nothing like Bush/Cheney on terrorism. To many if not most Americans, it's now reality.

That's one reason it's important to capitalize on the moment, rather than give into beltway or outright conservative talk of overreaching.

Costs will go up with

Costs will go up with government health care. Don't listen to a word liberals say. Costs in health care will always rise: technology and world trade can't reduce costs through cheaper labor and market competition, not like they do with cars or TVs. A doctor's time, in terms of price, stays pretty much the same. It seems more expensive because things like cars and TVs get cheaper.

Of course, costs are also rising because health care providers raise insurance premiums to make up the hits they take via Medicare/Medicaid. They lose money when they provide service through Medicare/Medicaid, so they make up the price elsewhere.

Things will only get worse when Obama promises lower costs: it will mean you get less advanced treatments, which are cheaper. You'll have to pay for any cutting edge treatments.

Still don't see that this

Still don't see that this marketing pitch has enough sizzle ... and it doesn't result in any real healthcare reform anyway. The sad truth is that we as a nation cannot afford the healthcare system we have ... and it becomes less affordable each year. Unless a healthcare reform plan addresses what we are going to curtail in terms of available services (every national health system in other countries does this type of rationing), it has not addressed the real problem. Talk about a difficult message to sell.

My prediction is that, as with his predecessors, this President will unfortunately not be able to change much with the healthcare system. I hope I'm wrong.

Fine arguments - except

Fine arguments - except there is virtually no guarantee that any of these problems will be solved by putting your faith in the plan from a government which continually says one thing but does another. Obama has lost his credibility with the common people. Hope and change mean nothing when all we see is a stimulus bill laden with pork projects and Obama still claims the "stimulus did its job" with unemployment reaching double digits.

Open your eyes

Look at the lesons of the failed TennCare system and Massachusetts current debacle of government run health care. They've just kicked 10,000 legal immigrants out of the MA system to save about $130 million, that should cover the deficit of just one hospital ( Boston Medical) that is suing the state.

also

"One major insurer, Harvard Pilgrim Health Care, reports that there has been a spurt in the number of people who buy coverage for a few months at a time, run up high medical bills, then dump the policy after the treatment is finished and the bills are paid by the insurer. The state tries to discourage that, but apparently the penalty for not having coverage is too low -- about $1,000 -- so people game the system."

The democrats are the party of promising people something for nothing, if Obama's health care system passes, they will certainly deliver and the American taxpayer will once again get the bill for wasteful, failing democratic vote-buying.

Do you really want the government of Fannie Mae to run a sub-prime healthcare system?

rational healthcare will be the death of us

I'm happy with my healthcare. I have a good personal relationship with my doctor. I don't want the same government bueaurcrat interferring with my relationship with my doctor. The same government bueaurcrat that wrecked a lot of 401K's. The same democrats frank, walters, dodd, schumer that caused the fannie and freedie debacle that has cost every single american $42,000 each in debt and more in lost 401K retirement dollars.

barac rational healthcare plan is in honor of ted kennedy. ted was the same person that left mary jo koppeeekki to die in her car. He didn't even assist her, leaving the scene. I definately don't want a ted kennedy rational healthcare plan because he doesn't even respect the dignity of human life.

also, who wants to call the government to ask if they can go to the doctor, or have a procedure done. the government practices reverse discrinimation - that is they put the least qualified person in the job because of their skin color and not grey matter. Let me asked you when is the last time you called your government and the token on the other end of the line said wait a minute i have to go ask you body to answer your question (because I'm a token and plain too dumb to answer it on my own).

The same democrats gorillic memo that keep FBI and CIA from sharing vital information that would have stopped 911. Do you want the same democrats that caused 3000 americans to die because they didn't share information having your medical records to share? I say hell no.

Here is the actual reality

Here is the actual reality --- Dems wouldn't have to worry about finding the right way to market the package if it sane and reasonable. Start by dropping the provision that govt will be innocent provider of competitive insurance... everybody knows its a wedge to get single-payer healthcare, yet all we hear is that the legislation boils down to a marketing problem.

Why not just simplify it and

Why not just simplify it and quote someone reputable, say the Mayo Clinic. Their headline today is,

"Mayo Clinic Blasts ObamaCare"

Ya, that will do. That will do nicely.

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