A New Strategy for Selling Health Care

By now, most of us can agree that Democrats have largely failed to use health care reform as a political boost. The new law remains unpopular with half or more of the U.S. population and it will be one of several critical issues in the upcoming mid-term elections, particularly in districts where freshman, Blue Dog or vulnerable Democrats voted in favor of the Patient Protection and Affordable Care Act.

The law did pass, by the way. Apparently, a lot of voters don’t know this. Ben Smith of Politico got word of what was presented today on a conference call organized by FamiliesUSA, a powerful and well-funded grassroots group that advocated for reform and will provide support for messaging about the law as its implemented. A PowerPoint presentation discussed on the call led Smith to rightly note that a messaging shift on health reform is underway.

The PowerPoint slides were put together by a group called the Herndon Alliance, which does opinion research and counts as “partners” high-profile pro-reform groups like SEIU, AARP and the Center for American Progress. A spokesman for FamiliesUSA did not want to comment on the content of the presentation – which amounts to a back-stage pass to pro-reform messaging strategy – and said FamiliesUSA was not involved in assembling the presentation, merely that FamiliesUSA “provided Herndon the platform to present this information.”

In the presentation, which can be found on the Herndon Alliance web site, pro-reform advocates are advised to “avoid overheated rhetoric,” keep it simple and talk about the law as something that can be improved upon. It also acknowledges what now seems obvious: “Straightforward ‘policy’ defenses fail to be moving voters’ opinion about the law.”

Surprisingly, the presentation says that voters need to be reminded that the health reform bill actually passed the Congress and is now law. It says many “non-college educated women” and Latinos, in particular, don’t realize this. The really interesting material, however, can be found in a much longer Herndon document, also available online.

This document – based on focus groups – asserts, “Those not aware that it passed have among the lowest resistance to repeal. They don’t realize any changes have been made, so there is nothing to defend or hold onto.” Another section says “Advocates had hoped that the poor economy would make it a good time for reform, but actually people think it’s a bad time.” Some parts of the new law will impose a tax on Americans making more than $200,000 per year. According to the longer presentation, this fact is worth touting: “Voters respond positively to the wealthy paying more…

Another section:

Use a transition message to meet them where they are and relax their defenses. Even low information voters have been exposed to a lot of
negative messages about health care reform, and they generally start from a position of apprehensiveness, fear, and doubt. Advocates should not be
afraid to concede that the law is not perfect, or “not the law any of us would have written.” This helps make any message to follow more relatable and
credible. Follow-up with a positive statement like “but it does some good things…” and briefly describe the key provisions described above.

In this context, voters what to move on and improve the law rather than repeal it. The language of “improve” works better than “fix,” “repair,” or “innovate” because it is positive and forward-looking.

The longer version of the material includes lot more fascinating information, like that AARP has lost a lot of credibility as a trusted source, bashing insurance companies doesn’t really work anymore and elderly men are more skeptical of reform than elderly women.

The shorter PowerPoint presentation also includes a helpful of “Don’t”s:

-assume public knows the health reform law passed or if they know it passed understand how it will affect them;
-list benefits outside of any personal context;
-barrage voters with a long list of benefits;
-use complex language or insider jargon;
-use heated political rhetoric or congratulatory language;
-say the law will reduce costs and deficit

This last one is curious. Democrats worked hard to get a favorable score on the legislation from the Congressional Budget Office, figuring a big selling point of the law would be that it reduces the deficit. This part of the sales pitch is apparently not as helpful as they predicted.

None of the material in either Herndon document is earth-shattering. It’s no secret that a lot of voters don’t know what’s in the law or how it will affect them. Everyone knows that seniors are worried about Medicare cuts. That a presentation like this exists is also not noteworthy. (Check out this anti-reform messaging memo from last year.) What’s significant here is that the Democrats’ messaging strategy on health care so far has been basically a waste of time and there’s a sizable effort underway among advocacy groups to salvage that effort, change strategies and possibly win over some more voters between now and the November mid-terms.

Related Topics: AARP, center for american progress, familiesUSA, Health Care, health reform, herndon, medicare, SEIU, Uncategorized
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  • gysgt213

    “By now, most of us can agree that Democrats have largely failed”
    .
    By now we can agree that the democrats have failed to stand for and articulate for their beliefs on a entire host of issues.
    .
    Instead what they have done is attempted compromise with people who have no intention of compromise and have expressly said they have not intention of compromise. As a result they have produced bill and laws that are watered down to the point of being ineffective and for the most part paper tigers and at worse worthless.
    .
    Let the flaming and burning of me begin.

  • Paul-no not that one

    So the Democrats-with much handwringing and concessions-passed a bill with 0 republican votes that is so much less than half a loaf and they are having trouble selling it to the public?
    .
    About 14 months ago, back in the KT days, some of us said this was the dumbest combination of bad policy and bad politics. We were told that “this is all that can be passed and any Public Option was off the table”
    .
    Maybe the “professional left” was correct.
    .
    (Commented as an amateur)

  • nibblybits

    “Maybe the “professional left” was correct.”
    .
    And maybe they weren’t. It’s all in the implementation IMHO. I may be in the minority, but I’m pretty happy that the bill passed, imperfect as it may be. And by no means is this the last of it, only the first important step.

  • shepherdwong

    By now, most of us can agree that Democrats have largely failed to use health care reform as a political boost.
    .
    What you go on to show is not “that Democrats have largely failed to use health care reform as a political boost” but that they can’t use health care reform as a political boost because the public is so deeply misinformed, ignorant or confused about the legislation. Likewise this:

    This part of the sales pitch is apparently not as helpful as they predicted.

    and this:

    What’s significant here is that the Democrats’ messaging strategy on health care so far has been basically a waste of time.

    Again, if you’re going to do a story about public misunderstanding on HCR you can’t talk about the “failure” of Democrats to inform the public without even mentioning the massive disinformation campaign waged against HCR by the right-wing lie machine. If you do, you’ve only begun to tell the story and, in fact, botched it entirely. Since your coverage of the HCR debate was a cut above and that general stink doesn’t attach itself to you, could you please explain why you’ve left out the pivotal fact of the story you’re trying to tell? Are you afraid of FOX? Your editors? The truth? Inquiring minds…

  • gysgt213

    “It’s all in the implementation IMHO. I may be in the minority, but I’m pretty happy that the bill passed, imperfect as it may be.”
    .
    Why are you pretty happy the bill passed when we are in the same stituation we all were before? Nothing has changed we are stil beholden to the insurance companies. And those same insurance compaines will have a much easier time fighting any modifications to the status quo.

  • kevin

    I agree that the summer months of 2009 — when Baucus stupidly thought Enzi and Grassley would work with him in good faith, and when Reid was trying to court Snowe and Collins — was a pathetic mistake. The Democrats should have known better, and if they had, we could have avoided the fall’s drama of the Fox News Tea Party™ rollout and likely wound up with an even better bill.
    .
    That said, I’m with nibblybits — this is an achievement that has been part of the progressive agenda since Teddy Roosevelt and it’s an amazing accomplishment. Social Security was imperfect when it was passed, and improved upon later. Medicare and Medicaid too. So too with ACA.
    .
    The real issue here is — how do people not know this thing passed?! Much like the people who think Obama is some kind of secret Muslim, it seems we have here a case of the news media failing to do its job. Horribly.

  • http://erieangel.wordpress.com erieangel

    I’m with nibbly on this. As imperfect as the health care reform turned out to be, it is a major accomplishment that will be improved upon in coming years.
    .
    As for medicare and medicaid, I think we took a step backward when legislatures, in all their glory, turned those programs largely over to insurance companies, the thought had been to save money, but in the case of medicaid in PA, it costs the state much more to have every medicaid recipient on an HMO than it did to have the state welfare system to pay the medical providers directly.

  • earljr1

    You better believe this is going to be an issue, come November and rightly so. Passing this bill in its present form , could well be the catalyst in significant democratic losses and guess what, they deserve what they get. I have never seen a bill so poorly prepared and overly complicated. NO ONE knows the final cost to this thing, it will be a nightmare to manage and it will negatively impact our existing infrastructure to a point of breakdown in many area’s. Fully one half of my colleagues are threatening to stop accepting new medicare patients, as a way to protest its implementation. If this trend continues, this turkey will never get off the ground. If the medical community refuses to embrace it, then an overload of major proportions is in the making. Escalating premiums, long wait times for existing patients and good luck to the new patients in finding a doctor to accept you. Yes, indeed, this is a FINE mess you have gotten us into, Andy!

  • nibblybits

    “…we are in the same situation we all were before? Nothing has changed…”
    Really? Because I don’t think 26 million more covered is anything to sneeze at. Also, the preexisting conditions or the young adults on parents’ coverage. And insurance exchanges for small businesses and individuals. That all sounds pretty good to me.
    .
    “we are still beholden to the insurance companies”
    So what? If the implementation works towards regulating the insurance companies like utilities, then I don’t have a problem with no public option, which IMO was a lame alternative to single payer anyway. In fact, I think no public option will result in tighter oversight of the private insurance companies, because there is no place for abused customers to flee. If you can move these companies to a model similar to utility regulation (whose saturation with customers is equivalent to a mandate) then it should lower the cost for everyone with insurance.
    .
    My point is that there are possibilities in the current law beyond easy labeling like ‘public option.’ It’s in the implementation. And then continuing to legislate fixes for the parts that don’t work.

  • stuartzechman

    nibblybits:
    .
    I’m wondering:
    .
    What do you imagine is wrong with our health care system, exactly?
    .
    What do you think the main, underlying problem is?

  • allthingsinaname

    I think it is a start. As this economy continues down hill, as businesses try to maximize profits, they will continue to erode their part in health care. Soon, I predict, people will come to the point that if they want health care they are going to have to purchase it on their own. You will see the shift then.
    .
    My employer is planning for 2012 to implement what they call the Consumer Defined Health Plan. Guess what that is.
    .
    First $750 out of pocket, then their $750, then ours the next $750 out of pocket then they pick up 90% after. But here is the kicker those two 750 include Doctor visits. That’s right, have the flu there goes $ 180 bucks for the doctor. This is for each person. Have kids…………………? Tough.
    .
    No we will get the public option, sooner rather than later. Some of the right wingers I work with are excited about the 26 year old thing, wait until this health plan is implemented, it will be the government gives and industry takes it away.

  • newfreedomblog

    The reasons this new law is so “misunderstood” and complicated is due to the fact our leadership by the Democrats, Nancy Pelosi, Harry Reid, and Barack Obama MADE it so complicated themselves. Nancy Pelosi said herself, “we’ll know what’s in the bill when we pass the bill”. Excuse me?
    .
    2700, that is two thousand, seven hundred PAGES of pure crap was writen for this bill. Many of the things sold as healthcare have virtually nothing to do with healthcare, and everything to do with bigger government and more controls.
    .
    This equates to the people as more big government programs which we all know are inefficient, wasteful with our tax dollars, and overall do nothing what-so-ever to curb the cost of healthcare.
    .
    We now risk rationing of healthcare on an unprecedented scale. Seniors are a major loser in this new law. Their benefits have been slashed by the billions, nearly 1/2 TRILLION dollars.
    .
    Businesses are tasked with more government red-tape, some of which for example are the 1099′s which a business must complete for any transaction over $600 dollars. Why was this even necessary? Who thought up this mess?
    .
    Yes, you can have your 26 or less year old on your policy.
    .
    Yes, you may get insurance not withstanding your pre-condition, but at what cost?
    .
    That’s it!!
    .
    For basically two protections we did not have before we see a mountain of new regulations and bureaucratic red tape.
    .
    Not a great deal at all. Once the cost of all of these regulations begin to take shape and form, people will quickly realize what a boondoggle the Democrats sold us all. I am convinced of that.

  • http://derekg.wordpress.com/ Derek

    If this thing is unpopular now imagine how bad it would be if the money saving public option had made it in? The professional left would likely be out there promoting it as well, which would make it even more unpopular.

  • kbanginmotown

    By now, most of us can agree that Democrats have largely failed to use health care reform as a political boost.

    I agree with this statement.
    .
    The Dems can get a political boost from HCR by either:
    (1) actively selling the benefits of HCR to America, or
    (2) reacting to GOP efforts to repeal HCR.
    .
    The Dems chose “Plan B” and they gained a few points in the weeks after HCR passage when many on the right were threatening to “opt out” of HCR.
    .
    The GOP wisely throttled back their repeal efforts, and now the Dems do not have an “A-Game” – a plan to actively sell and market HCR to the American People.
    .
    The Dems need to speak with a unified voice about HCR, just like they are doing with the “Ground-Zero Mosque”…oh, wait…

  • nflfoghorn

    “2700, that is two thousand, seven hundred PAGES of pure crap…”
    .
    Geez, Rustfree, that almost matches YOUR blog total!

  • kbanginmotown

    @kevin:
    .
    “The real issue here is — how do people not know this thing passed?! Much like the people who think Obama is some kind of secret Muslim, it seems we have here a case of the news media failing to do its job. Horribly.”
    .
    Herein lies the problem: the Dems expect the MSM to push “good news” the way it pushes “bad news.” It doesn’t happen. (The GOP’s blockage of aid to 911 first-responders was a one-night news-blip; how long have we been discussing the GZM?)
    .
    The Dems need to actively market their successes, or else the GOP will, yet again, dictate how the scorecard is tallied in November…

  • bobell

    Somehow the following innocuous post (in response to earljr (4)) fell into moderation limbo. (Surely it couldn’t be that I used the word b!tch.) At the risk of having the same thing eventually posted twice, I thought I’d run an experiment and see what happened if I tried again. So here it is,exactly as originally submitted, except for the changed spelling of one word:
    .
    You’re absolutely right, earljr. What this country needs is a system where someone insures everyone and pays fair prices to doctors and other health-care workers for their services. I don’t care who that someone is, but the only someone I can think of with the power to pull that off is the federal government. If you can propose any other person or entity, feel free. But unless we get the whole system better organized, we are indeed destined for “Escalating premiums, long wait times for existing patients and good luck to the new patients in finding a doctor to accept you.” As a matter of fact, we seem to be there already.
    .
    Anyone can b!tch about things as they are. I don’t like the current system any more than you do, even with the changes made by the new legislation (although I think it will make things marginally — very marginally — better). Nor do I claim to be smart enough to fix ithings as they are, or even to come up with ideas for others to implement. I think we need a different system altogether (Medicare and the VA aside). My proposal goes by the name of “single payer.” What’s yours?

  • bobell

    HMMM. Maybe it was “b!tch.” Them Swamp-folk seem to have very delicate sensibilities.
    .
    How would they discuss actual she-dogs?

  • nibblybits

    What do you mean by “money-saving”? My understanding is that professional consensus was the public option would likely be *more* expensive than private insurance because the people who would access it are those kicked off private insurance for being too expensive (pre-existing conditions, too old, too sick, etc).

  • http://derekg.wordpress.com/ Derek

    I thought you had taken to simply insulting me?
    .
    The answer is competition and leveraged purchasing power.

  • nibblybits

    Stuart, it would take more room than allotted here for me to outline what I think is wrong with health care in this country, and my view is that of a layman and financial geek. What I can say is that insurance companies aren’t the only problem here. There are pressures all over including hospitals needing filled beds for solvency, the dependence on patented drugs and drug pricing, fee-for-service payment system, end of life care, overuse of expensive tests and equipment (motivated in part by *fear* of litigation, in part to generate fees), fraud, etc.
    .
    I do believe that short of single payer, moving insurance companies towards a non-profit model or a heavily regulated model in which profits are capped (like with utilities, as I mention above) would be a positive. Knowing many small business people and self-employed, I personally hate the employer-provided and subsidized insurance, and this new law does some to help that.
    .
    My point is that insurance options aren’t the only problem here. And in fact, that might be one of the easier fixes. My first choice as for many is single payer, but there are so many ways to improve the current situation short of that I don’t see why we don’t focus on what can be done.

  • nibblybits

    One thing about the public option: wouldn’t that be the biggest boon to private insurance companies’ profits? Wouldn’t having a government-backed public option allow insurance companies to kick out expensive and risky policies by pointing to the public option as a place for them to go? I was always wary about that.
    .
    I mean Medicare and Medicaid exist because they cover the people private insurance don’t want, so those people are subsidized by taxpayers instead. By conceding on the mandate, private insurance picks up all those new healthy customers (in theory) but they also must keep the chronic conditions and pre-existing illness. That’s the tradeoff.
    .
    The basic premise of insurance is pooling the sick with the healthy to bring down costs for all. If private insurance can kick out the sick then the taxpayers end up paying. Another case of privatizing profits and socializing losses — something I am completely against.

  • johnnyzts

    What can be expected of a bill that nobody read. Nancy Pelosi herself said we would have to wait until it was passed to find out what was in it. Medical prices are already going through the roof and it’s supposed to get better ? I doubt it. And the cry that something had to be done is correct but why in such a hurry? I still can’t figure that logic out. Our lawmakers should have taken the time and tried to educate the public on what was in the plan and how it will work. As it stands I don’t know much more now as I did when it passed.

  • nibblybits

    I never engaged in ad hominem with you, just your bad positions and ideas.
    .
    Please explain how a public option is competitive.

  • groenhagen2

    “Surprisingly, the presentation says that voters need to be reminded that the health reform bill actually passed the Congress and is now law. It says many “non-college educated women” and Latinos, in particular, don’t realize this.”

    “This document – based on focus groups – asserts, “Those not aware that it passed have among the lowest resistance to repeal.”

    Translation: If you’re educated, you’re more likely to support repeal.

  • http://derekg.wordpress.com/ Derek

    The CBO published a good report on how the addition of the public option lowered the costs of the health plan, if you are interested.

  • Ivy_B

    bobell, it is the lovely WordPress software that has the sensibilities. When they switched to it after the great pre-election Swamp crash, there was a great deal of working out that had to be done. KT carried the banner for us and worked very hard on our behalf with the High Sheriffs to make things better.
    .
    Some of us couldn’t get our original names back – you may have read about formerlyjames; others had their names blocked for a while because a forbidden word was in the middle of another, perfectly normal, word, for example grape_crush was blocked. That was the most challenging aspect in posting comments unless you were really good at anagrams.
    .
    At least now we mostly know the words that make WordPress fan its hanky. Happily they are mostly single words and much easier to deal with.

  • kevin

    No, actually, the study suggests exactly the opposite conclusion.
    .
    The report says that those not aware that it passed have “the lowest resistance to repeal” — that means they are the group that’s the most easily persuaded to support the idea of repeal.
    .
    Therefore: If you’re uneducated, you’re more likely to support repeal. Which makes sense, given how uneducated the Republican base is.

  • nibblybits

    Ok Derek, I’ve reviewed the different takes on the CBO scoring and this article seems to lay it out as clearly and succinctly as any.
    .
    http://www.nationaljournal.com/congressdaily/cda_20090925_6347.php
    .
    It says the savings come based on the assumption of pegging public option reimbursements to Medicare rates. However, if the government negotiates rates like private insurance does, then the savings would be much lower. In either case, it’s not a case of ‘increased competition’ and it does not address insurance company rates or profits. It only means the recipients of the reimbursements — hospitals and doctors — must take less…and ask more from private insurers to make up the difference. (Something they currently do for Medicare and Medicaid.)
    .
    This is obviously a much more complicated issue than can be addressed on a comments board. But what I’m getting at is that a ‘public option’ in and of itself is not, and never was, a silver bullet. I also think that the left’s oversized disappointment over its exclusion is based on a misunderstanding of that.
    .
    This law has lots of space for interpretation and the beginnings of change. Now it’s up to the administrators of the law to grab those opportunities.

  • http://forgottenlord.livejournal.com forgottenlord

    With idiots like Ben Nelson holding them down, I don’t feel the fault of the Democrats was trying to compromise. I feel they didn’t spend enough time selling the fact that they compromised again and again for Republicans, but that’s beside the point. The real problem is that Republicans drew a line in the sand, Democrats picked a halfway point, Republicans backed away from the line and Nelson et all took it over (amongst others).
    .
    That said, Democrats ended up being spineless. When Republicans backed away, Democrats should’ve been able to back away too, but they didn’t. Worse, Obama has a huge problem where he reveals his hand WAAAAAY too early – something he’s doing both domestically and internationally and often undermining his own play. Case and point: the public option. He showed that card as being in play in August. It was gone within a month and they had another 4 after that of fighting.

  • stuartzechman

    nibblybits:
    .
    Stuart, it would take more room than allotted here for me to outline what I think is wrong with health care in this country, and my view is that of a layman and financial geek.
    .
    That’s too bad, because that’s the very question I asked.
    .
    It’s unfortunate that you can’t put together a paragraph or two –or three, or four– that outlines what the problem with health care is in this country, because then we could see exactly how much we might expect a certain policy to go toward achieving a solution or solutions.
    .
    See, it really doesn’t mean anything concrete when a policy is defended in terms like “We’ve got a long way to go, but it’s a good start,” if we don’t know where the “long way to go” is even supposed to end up.
    .
    Instead of an explanation, that sort of policy defense looks very much like what’s proposed in the public relations/messaging conclusions reached by the study to which Kate Pickert helpfully links:

    Use a transition message to meet them where they are and relax their defenses. Even low information voters have been exposed to a lot of negative messages about health care reform, and they generally start from a position of apprehensiveness, fear, and doubt. Advocates should not be afraid to concede that the law is not perfect, or “not the law any of us would have written.” This helps make any message to follow more relatable and credible. Follow-up with a positive statement like “but it does some good things…” and briefly describe the key provisions described above.

    I will say that we are in great agreement when you write
    insurance companies aren’t the only problem here. There are pressures all over including hospitals needing filled beds for solvency, the dependence on patented drugs and drug pricing, fee-for-service payment system, end of life care, overuse of expensive tests and equipment (motivated in part by *fear* of litigation, in part to generate fees), fraud, etc.
    No, private insurers and their practices, while significant, aren’t to account for even a majority of the problem with US health care. The problems you begin to list, though, can also be described in terms of categories of problems to be solved, so that one doesn’t need to spend a week listing them individually in their entirety. It’s like saying “insurance companies’ inefficiencies, market positions, state-sponsored roles and incentives,” instead of detailing all of those individual issues.
    .
    That brings us to your statements:
    .
    I do believe that short of single payer…” and “My first choice as for many is single payer…
    .
    Germany isn’t a single-payer system, and yet they have a better health care system then ours. France isn’t single-payer, and yet they have a better health-care system then ours. Britain isn’t single-payer –they have a completely socialized system– and their system is better in some respects than ours, worse in others.
    .
    In other words, Canada’s system isn’t the goal, nor should it be. We shouldn’t be judging our policy on the feasibility of it becoming single-payer in the future. We have many options and solution prospects in front of us…if we’re allowed to hear/talk about them.
    .
    So the current policy should not be evaluated on how much of a road map it is or isn’t to single-payer, nor how close or how far away single-payer might be.
    .
    The current policy should be evaluated on the basis of how far it goes in solving what the problem of health care is in the United States, no more and no less.
    .
    …As an aside, when you ask:
    .
    Wouldn’t having a government-backed public option allow insurance companies to kick out expensive and risky policies by pointing to the public option as a place for them to go?
    .
    , I think the answer is
    .
    Yes, unless we regulate private insurers such that this type of burden-shifting is prohibited, and the cost of health care is distributed more equitably, as befits privately owned public utilities, a role which giant private insurers most surely fulfill, given their anti-trust exemptions.

  • http://forgottenlord.livejournal.com forgottenlord

    Here’s my question: which would you rather have: this reform or nothing. Yes, it doesn’t fix the fundamental flaws, yes insurance companies are still a problem, yes the fact that health care costs twice as much in the US as it does anywhere else….
    .
    But does it not improve things? You’ve been fighting this battle for over 50 years. So instead of saying “thank you for finally passing something that helps a little”, you’re saying “it’s not enough”.
    .
    Their fault wasn’t for not passing enough but for failing to know how to play poker and not being able to back away (see 1.4). The only thing they might’ve been able to do that they didn’t do was play chicken with Ben Nelson, but considering the narrow margin it passed in the house with, I’m not sure they could’ve even done that. Well, that or actually, y’know, filibuster.

  • nibblybits

    “I also think that the left’s oversized disappointment over its exclusion is based on a misunderstanding of that.”
    .
    I want to edit this sentence to say that *I* don’t fully understand the left’s oversized disappointment over its exclusion. Not that they misunderstand anything. Poor wording.

  • stuartzechman

    which would you rather have: this reform or nothing
    .
    That’s somewhat like standing in front of a burning building with a fire extinguisher, and asking
    .
    Would you rather have this fire extinguisher or nothing?

  • http://forgottenlord.livejournal.com forgottenlord

    Ok, that’s a real nice way to blow the issue completely out of proportion. Are you seriously of the opinion that this bill does nothing of significant benefit?

  • stuartzechman

    Interesting how the conversation is shifting to

    Focus on how the law will end pre-existing condition exclusions for adults and children, provide small business tax credits to help them provide coverage for their employees, and force insurers to provide nocost coverage of preventive care. These are the core elements of the law that voters value, and they help turn skeptics into defenders of the law. Unless these provisions are spelled out, many voters will not realize these are a part of the health care law at all.

  • earljr1

    So you are advocating socialized medicine, bobell? My suggestion is to leave our health care system ALONE. The insurance industry is calling all of the shots now, why not start with regulating them? The American taxpayer already owns AIG, so why would this be hard to do? The vast majority of Americans are quite happy with their doctor and level of care they get. Our hospitals are first rate and the envy of the rest of the world, so why fix what ain’t broke? The number one complaint is about insurance methodology and pricing…this CAN be fixed if politicians were not beholden to the Insurance and Legal lobby. What happened to “change we can believe in”?

  • afguy

    …it is a major accomplishment that will be improved upon in coming years.
    .
    nibbly & erieangel,
    .
    Gunny has a point – as of right now, nothing’s actually changed from a practical point of view. The good points of the law don’t really kick in for a few years and a lot of mischief can happen between now and then. (or, more accurately, a lot can NOT happen, such as your guaranteed improvements to the law as presently passed.)
    .
    Right now, the GOP is screaming and threatening to repeal ALL of the HCR law – LOUDLY. Let me give you a scenario that will fit right in with the present threats and the almost total lack of Dem courage being exhibited on virtually everything.
    .
    The GOP gains seats in the House and the Senate and threatens to repeal. The Dems, wanting to appear bi-partisan and save the HCR law, promise that, in return for the GOP dropping their challenge to the law, the “improvements” to the law that you want will be dropped or “delayed”. Or, better yet, funding for enforcement mechanisms that will cut costs or enable enforcement will be reduced or eliminated. Remember – the law can say a lot, but it’s not really the law until a judge or the SC says “pay up”. That’s what they have lobbyists and lawyers for.
    .
    Everyone gets what they want. The Dems get to keep their signature legislative accomplishment – HCR, and the GOP gets what they want – a law with nothing practical that will cut into the profits of the HC companies and nothing that will curb any of the real excesses in existence right now.
    .
    Everyone in Washington (and Wall Street) goes home happy – except you and me, though. We just wonder where the foreplay and the cigarette went. We understand we just got screwed.
    .
    Me, cynical about the improvements to HCR actually happening with the existing crowd in power?? You betcha!!

  • http://derekg.wordpress.com/ Derek

    “But what I’m getting at is that a ‘public option’ in and of itself is not, and never was, a silver bullet. I also think that the left’s oversized disappointment over its exclusion is based on a misunderstanding of that.”
    .
    I don’t recall the Left claiming it was a silver bullet. Single payer is what the Left really wants, The public option was a pathetic compromise. However, even it was too much for the centrists who run the party and never compromise on anything. If the public option isn’t such a big deal one wonders why they still insisted on keeping it out knowing the Left wanted some input to the policy. However, they won the day and in the next few elections one can only hope they get their reward.

  • nibblybits

    “See, it really doesn’t mean anything concrete when a policy is defended in terms like “We’ve got a long way to go, but it’s a good start,” if we don’t know where the “long way to go” is even supposed to end up.”
    .
    That’s not my quote (at least not on this thread) so I shouldn’t have to defend it.
    .
    “That brings us to your statements:
    “I do believe that short of single payer…” and “My first choice as for many is single payer…”"
    .
    I’m aware of those other systems, and I expressed my choice — single payer. But if that’s not an achievable reality in the near future, I think I articulated the idea of insurance companies regulated as utilities as an option that might work. Was I not clear about that?
    .
    “That’s somewhat like standing in front of a burning building with a fire extinguisher, and asking
    “Would you rather have this fire extinguisher or nothing?”"
    .
    Like forgottenlord, I find this analogy completely bizarre.

  • stuartzechman

    That’s not my quote (at least not on this thread) so I shouldn’t have to defend it.
    .
    Right. So you’re being willfully obtuse again.
    .
    How helpful.
    .
    When I said “terms like” ““We’ve got a long way to go, but it’s a good start,” that means terms like your quote “by no means is this the last of it, only the first important step.
    .
    See? Those statements are similar. Understand? They’re “like” each other.
    .
    Was I not clear about that?
    .
    No, you weren’t. You’re hardly clear when you step outside of certain familiar talking points, actually, as in when you actually try to articulate policy. Being simple isn’t the same as being clear.
    .
    So, when you say
    .
    I’m aware of those other systems, and I expressed my choice — single payer. But if that’s not an achievable reality in the near future, I think I articulated the idea of insurance companies regulated as utilities as an option that might work.
    .
    , that’s a very simple rendition of a complex solution to the problem of health care that comes across as incoherent, as if you haven’t thought about it a great deal, and have been concentrating on other things.
    .
    An example of that incoherence would be “as an option that might work.” It’s not clear at all what kind of solution that entails. Do you mean that the prices of insurance premiums would be fixed by local or state governments? If so, how would that solve the problem of rising health care prices?
    .
    If private premiums are regulated, then what will happen when the prices of medical care itself continues to rise? Do you not anticipate health care costs to continue their skyward rates?
    ,
    How will the regulation of private insurers –presumably on a state-by-state basis, as per your “as utilities”– decrease the cost of Medicare, Medicaid and other state and Federal health insurance programs? You do realize that these make up over forty percent of health care cost in the United States, right? So what’s your plan?
    .
    I realize that you haven’t committed to said utilities-sort-of private insurance regulation-maybe, you mentioned it as “an option that might work.” Perhaps that means you have some sort of plan b in mind, because it sounds like what you’ve proposed by itself stands just as good of a chance it might not work. You do have another policy proposal, don’t you? Something that you can articulate a little more clearly, perhaps?
    .
    I find this analogy completely bizarre.
    .
    That’s interesting.
    .
    The analogy “burning building” is meant to convey a situation that’s dangerous to the structure necessary to accommodate many people, and is visibly disastrous. It’s meant to convey urgency, because a structure in such a state of physical distress may be approaching a diminishing capability of being repaired.
    .
    So, when I say that the US health care system is like a burning building, I mean that the problems in evidence are indicative of a path to catastrophic failure.
    .
    That’s not just a scary story to tell, it’s based on evidence, amongst which is data from the US Dept of Health and Human Services:

    National Health Expenditure
    .
    # NHE grew 4.4% to $2.3 trillion in 2008, or $7,681 per person, and accounted for 16.2% of Gross Domestic Product (GDP).
    .
    # Medicare spending grew 8.6% to $469.2 billion in 2008, or 20 percent of total NHE.
    .
    # Medicaid spending grew 4.7% to $344.3 billion in 2008, or 15 percent of total NHE.
    .
    # Private spending grew 2.6% to $1.2 trillion in 2008, or 53 percent of total NHE.
    .
    Projected National Health Expenditure, 2009-2019:
    .
    * Growth in NHE is expected to increase 5.7 percent in 2009 and average 6.1 percent per year over the projection period (2009-2019).
    .
    * The health share of GDP is projected to reach 17.3 percent in 2009 and 19.3 percent by 2019.
    .
    * Medicare spending is projected to grow 8.1% in 2009 and average 6.9% per year over the projection period.
    .
    * Medicaid spending is projected to grow 9.9% in 2009 and average 7.9% per year over the projection period.
    .
    * Private spending is projected to grow 3.0% in 2009 and average 5.2% per year over the projection period.
    .
    * Spending on hospital services is projected to grow 5.9% in 2009 to $761 billion. Average growth of 6.1% per year is expected for the entire projection period.
    .
    * Spending on physician and clinical services is projected to grow 6.3% in 2009 to $528 billion. Average growth of 5.4% per year is expected for the entire projection period.
    .
    * Spending on prescription drugs is projected to grow 5.2% in 2009 to $246 billion. Average growth of 6.3% per year is expected for the entire projection period.
    .
    https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp

    So, when I say that the US health care system is like a burning building, it’s a way of analogizing a wildly unsustainable consumption. It’s a way of analogizing being on track to spending 20 percent of our nation’s wealth on health care in ten years. In comparison, other OECD nations will be spending a little more than half of that, if they do not introduce greater efficiencies into their systems. Germany, for example spends about 10 percent of GDP on health care (almost 7 percent less per year), but their growth rate is nothing like ours, meaning ours is skyrocketing.
    .
    If, in a relatively short period of time –9/11 til now, basically– we spend over a fifth of our nation’s wealth on health care goods and services –like hospital beds, drugs and laboratory tests– and not capital investment, or infrastructure, that’s bad. That’s catastrophically bad in both human and economic terms.
    .
    Is that burning building analogy still “bizarre” to you?
    .
    Do you get it now, or do you still insist on being obtuse?

  • nibblybits

    Tell you what, Stuart. If you have a problem with something that I said, then use my actual words instead of making up another sentence, sticking them in quotes and demanding that I defend it. Maybe then I would be less “obtuse” and you’d be a little more honest. Because frankly, while I do view this bill as an important first step, I have no idea if we have “a long way to go” (as those are your words, not mine.)
    .
    Second, I believe I am more than clear about regulating insurers as utilities in post 2.8 and my doubts about the public option in post 2.9. Perhaps in this you are the one being “obtuse.” If what you want is a project paper with step by step implementation, then feel free to commission me for my research and time.
    .
    Finally, your bizarre analogy. Still crazy exaggerated, but I appreciate that you added a cogent argument supporting why the health care bill needed to get passed now instead of trying to torpedo the whole thing when the public option wasn’t included. Which is what a lot of liberals wanted. Like you wanted. Your sense of urgency seems rather belied by your efforts to reject what ultimately passed. Or are you ready to defend how you preferred no fire extinguisher at all and just let the building burn to the ground?

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