The Madison Avenue Approach to Health Policy
Can you sell health reform the way you sell toothpaste? Can you stop health reform the way you sell soap? A lot of people apparently believe so.
I would guess that in the 10 months leading up to the vote on the Affordable Care Act (ACA), proponents and opponents spent more than $200 million on TV, radio and newsprint advertisements.
These ads were produced by agencies that basically knew nothing about health care. The clients of these agencies were groups that often knew nothing about health care. The funding often came from donors who knew nothing about health care.
By “knew nothing” I mean they did not understand health care as a complex system. That means they had no idea how you could solve real problems — like controlling costs, raising quality and improving access to care. To add insult to injury, most of the people who engaged in the ad wars knew very little about what became known as “ObamaCare.”
But this lack of knowledge didn’t slow anyone down. The abiding sine qua non for ad wars is the conviction that facts, knowledge and truth are irrelevant. It is the belief that people can be manipulated and conned into believing that what’s good for them is bad and vice versa.
Did all this spending do any good? Did it change a mind? Did it cause a voter to make a phone call to a Member of Congress? How about a letter? An e-mail? A fax?
We will probably never know. But get ready for another onslaught. You may have already seen taxpayer-funded Andy Griffith TV commercials touting the benefits of the ACA for seniors, or the Andy Griffith PARADE magazine print ad. This follows on the heels of a taxpayer-funded, four-color mailer with much the same message, sent to everyone on Medicare.
That’s only the beginning. Groups sympathetic to the ACA plan to spend $125 million over the next five years on pro-ACA advertising.
The view that people cannot determine on their own whether something is good or bad for them and that they can be manipulated with “spin,” pervades the entire White House approach to this fall’s election. Part of the strategy is to tout the benefits of reform to all who will listen — any benefit, no matter how tenuous.
For example, last Thursday was rollout day for some of the benefits that materialized on the six-month anniversary of the ACA. “Starting Today, A Boost for Children’s Health Care,” blared the headline on a Kathleen Sebelius editorial in USA Today. Really? What health care? No pre-existing conditions limitations? Nowhere in the editorial did the Health and Human Services Secretary mention that all the major carriers have stopped selling child-only health insurance to prevent parents with sick children from doing the very thing Sebelius apparently wants them to be able to do — buy insurance after the fact. Free preventive care? Nowhere did the Secretary mention that this doesn’t apply to “grandfathered plans” and that almost everyone with private insurance is currently in a grandfathered plan!
This is like the airline that tells you about all the wonderful things you can do with your points before you discover they never apply to any flight you want to take at the time you want to take it. Does Kathleen Sebelius really think people aren’t going to figure this out?
An example of Madison Avenue tactics was the campaign to vilify health insurance companies even as the Obama administration was meeting behind closed doors with insurance industry executives to concoct the health bill! Writing in The Nation, Health Care for America Now (HCAN) executive Richard Kirsch explained “What Progressives Do Right to Win Healthcare.” Here are some excerpts, courtesy of Chris Jacobs:
We found that…we need to animate anger and hope as the antidote to the opposition’s main weapon, fear. We also found evidence — not surprisingly — that the popular target for anger was the insurance industry… The HCAN Organizing Committee wrote an 865-page campaign plan incorporating…a new round of public opinion research focused on generating anger at the health insurance industry…
Our tag-line was direct: “If the insurance companies win, we lose.” At the grassroots, we wrapped insurance company offices with yellow crime tape, with the words “It’s a crime to deny our care.” Two weeks before the bill passed, 5,000 activists staged a mass citizens’ arrest of health insurance executives when they met at the Ritz-Carlton in Washington.
Did any of these tactics work? A Gallup survey found that approval ratings for health maintenance organizations (HMOs) actually rose by one percentage point as the health care debate transpired over the past year, while Congress’ approval rating dropped six points.
The Madison Avenue approach to health policy (facts-don’t-matter-truth-doesn’t-matter-we’ll-vote-it-in-and-spin-our-way-to-victory-in-November) was endorsed by White House advisors, the American Enterprise Institute’s Norm Ornstein and the Brooking Institution’s Thomas Mann, and even Bill Clinton. (See the Politico article here.)
Pollsters Douglas Schoen and Pat Caddell were virtually alone in saying that all these advisors are wrong. The health care vote will be an “unmitigated disaster” for those who voted for the health care bill in November, they said. So far, Schoen and Caddell appear to be right.
In a future Alert I will explain what does work in communicating with voters about health care.
Excellent post. Hard to imagine people were willing to waste so much money.
John, here’s what you neglected to mention: If you don’t know anything about a subject, there is nothing left to do but turn to hype. People who take a Madison Ave approach to health policy do so because that is all they know.
Hate to be cynical, but I think what you have here is a perpetuating cycle. You begin with donors who want to spend money to advance a cause. Then you have agencies that only know how to create mindless ads. To complete the cycle, the agencies create ads that appeal to the donors (rather than to the people they are trying to influence).
It sort of reminds me of direct mail.
The House Majority Leader, Steny Hoyer, says we need to sell Obamacare the same way Coca Cola sells soda pop.
http://www.youtube.com/watch?v=iFPJj20yhAk
In the class Theories of Political Economy, my professor explained that all good despots have to create a scapegoat (or some type of problem) that they purport to solve.
Making insurance companies the enemy and the uninsured (or the sick) into victims is an attempt to reinforce the notion that Americans need protection from the insurance boogeyman. This is another example of political opportunism.
“No one ever went broke underestimating the intelligence of the American people.”
-HL Mencken
Not to mention the fact that these ads are so insulting to the intelligence of the voters.
“But this lack of knowledge didn’t slow anyone down. The abiding sine qua non for ad wars is the conviction that facts, knowledge and truth are irrelevant. It is the belief that people can be manipulated and conned into believing that what’s good for them is bad and vice versa”
Death Panels.
Steve
John,
Interesting article–I am resonably certain you could find such efforts at promotion on all sides of most issues in DC.
I understand you were not a supporter of the 2010 Healthcare Reform Legislation, but why not use your energy to make PPACA work for all the American people. It is Federal law. Instead, you appear to want to try to marginalize PPACA because you disagree with how it was promoted?
What do you propose? I can only guess you want to return to good old days where an American was only one chronic disease away from backruptcy.
Mr. Weintraub, Trying to make PPACA “work for all” would be tantamount to Ford Motor Company trying to make the Edsel a top seller.
I am curious though if someone could point out the number of specific cases of personal bankruptcy (out of 300 million Americans)caused by chronic disease. If that is not possible, then one might draw the same conclusion as John Goodman in that the impetus of this law was created by anecdotal hype and fear mongering instead of facts.
Philip,
We have never shied away from the tough task of reforming the system in a rational way.
A list of the changes that need to be made in ObamaCare are here: http://www.ncpathinktank.org/pdfs/What-Does-Health-Reform-Mean-for-You-A-Consumers-Guide.pdf#page=47
These reforms are based on the principles outlined here:
http://www.ncpathinktank.org/pdfs/040209_EC_gooman.pdf
Philip,
I just want to understand your train of thought. The bill allowed a number of benefits that had to be covered and that millions of uninsured are going to be giving benefits. At the same time this bill has no intention of controlling healthcare cost targeted at the hospitials, drug and any mention of tort reform. I have been in this business for over 20 years and I know if you don’t start controlling cost in those areas no health care act will ever work. The hospitials trend is almost 30% and every doctor that I know has had to practice defensive medicine so that they are not put out of business by the evil malpractice industry. Ill give you an example I had to take my son to the doctor last week for an ER visit total bill $7,500 for food poisoning and with PPO discounts still over $5,000!!. He was not admitted and was out in three hours. I agree that insurance companies are part of the problem but money defintely helped in how the bill was created. So until we control cost in those areas the healthcare act will never work, but if this fails which it will the democrats can than move to a government controlled system. So yes instead of an american being one chronic disease from bankruptcy how about we go with limited treatment and no alternative depending on the age of the American and the medical condition. On that note have a nice day oh one last thing go the HHS website and see who comes up when looking for health care coverage help yes thats right ‘Ehealthinsurance’ funny but I dont see anyone else now how did that happen!!!
David Conrad
This is how I advertised the tax-free MSA a long time ago.
http://www.save101.com/audio/wake_up.mp3
So David, I assume you believe in consumer directed healthcare and you’re more knowledgeable about the health care system than the ordinary person. When your son was being treated, why didn’t you first get competing bids for each test or treatment the physician recommended? Why didn’t you demand that the physician justify each individual step to keep the cost down?
I would rather be one chronic disease away from bankruptcy than one government decision away from what to do about my health. As I regularly ask my medical students “In regards to health care decisions: ‘What is the government most interested in?’ The answers always and unanimously come back: ‘The budget.’ “
With healthcare, people can determine whether something is good or bad. We’re talking about services like any other business. Quality is determined by the individual. Ads shouldn’t have as big of an influence b/c the average person knows whether it’s a good product.
To david’s example and art’s response…..
When someone is ill in an er, the physician really has no clue on what the cost is. He is focused on the patient’s medical needs and is not there to barter. I’ve worked many ER’s and there are lots of moving parts in each room.
I have had 2-3 patients in recent weeks with food poisoning. I treat them over the phone. Prescriptions are ready in 30 minutes or when they travel, they have their travel med kit and give me a call from whatever city or country they are in.
Sometimes your not close to medical care.
Cost of prescription: $25.00
Money saved by the insurance company (or take any payor) by patien not having to go to the ER: I guess $5000.00
Money made b/c your back to work sooner: patient dependent
Quality and service perception by the patient: priceless
art,
seeing that you advocate competitive bidding. If you or a loved one had chest pain, what in the world would you ask?
Service: Priceless
Well, Dr. Ewin, I know you promote “concierge” medical care that claims to provide better customer service, but I’ll tell you that I don’t want faster access to lower quality medical care. Your claim of how fast patients can get appointments or how quickly you return phone calls tells me nothing about how long it takes you to get a diagnosis right and how often you get it wrong. Not only that, I have no way to really know what your response time really is. Do you publish statistics how often patients get their preferred appointment time as opposed to their second or third choice? Do you publish statistics on how quickly you respond to phone calls? Do you provide a service level agreement?
If I had chest pain, the ability to get you to return a phone call in 15 or 20 minutes is worthless. I live in Manhattan, which has two of the finest cardiac hospitals in the country. I would call 911 which has a documented 7.5 minute response time to life threatening medical emergencies and get them to hustle me to the closer of the two.
I’ve read artk’s comment more than once, and still don’t know what he is trying to say.
Artk, of course you would go to the emergency room if you had a life threatening emergency. Where else would you go? But what if your problem were not life threatening? How long would you wait in a New York City emergency room before a doctor sees you? Wouldn’t a concierge doctor be preferable?
And why are you beating up on Dr. Ewin for not doing what no other doctor does instead of congratulating him for providing services that people want and cannot get in the bureaucratic third party payment system?
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