Frank Luntz, a master manipulator of language who helped create the rhetoric that conservatives used throughout the 1990s, is now offering Republicans advice on how to talk about health care reform.
First, they must embrace the idea: “You simply MUST be vocally and passionately on the side of REFORM,” Luntz advises in a confidential 26-page report that Politico.com obtained from Capitol Hill Republicans.
Most Americans want health care reform, and so Republicans should forget about simply opposing President Obama on this issue. But they can redefine what reform means, says Luntz, author of Words that Work: It’s Not What You Say, It’s What People Hear.
The title is a nearly perfect definition of how Conservatives use words to mislead. Luntz shows no respect for language. For example, he takes credit for renaming the “inheritance tax” the “death tax.” In truth, people who die are not taxed. The heirs to America’s biggest fortunes find their windfall trimmed if an estate exceeds $3.5 million ($7 million for a couple). This is a tax on the legacy—i.e., an “inheritance tax.” (Note: in 2009, only 6,200 estates will be affected.)
When it comes to redefining healthcare reform, Luntz suggests that Republicans refer to Obama’s proposal as a “Washington takeover” of health care, and insist that patients will have to “stand in line” with “Washington bureaucrats in charge of healthcare.”
Here, Luntz recommends telling bald-faced lies. Nothing in the president’s healthcare initiative implies a “takeover.” President Obama has made it extremely clear, again and again, that Americans who have insurance can keep that insurance—with no government interference. Or, if they choose, they can pick another insurance plan from the private sector. Finally, the government may offer a public-sector insurance plan as an alternative to private sector insurance—no one would be forced into a public sector plan. The only major change under Obama’s proposal: if you cannot afford insurance, the government will give you a subsidy to help you purchase it, whatever plan you pick. Does that sound like a takeover?
Luntz recommends fear-mongering by using the phrase “It could lead to . . .” Here are some arguments that Luntz calls "clear winners”
“It could lead to the government setting standards of care, instead of doctors who really know what’s best.”
“It could lead to the government rationing care, making people stand in line and denying treatment like they do in other countries with national healthcare.”
Here the speaker neatly avoids having to offer any evidence. He is not saying that Obama has proposed letting the government set standards or ration care. He is just saying that reform “could” put us on a slippery slope, planting images in the reader’s mind without really claiming that they are true. As Luntz puts it “It’s not what you say; it’s what people hear.”
“Politicians,” “Bureaucrats,” and “Washington”
Luntz advises against talking about the need for “free market competition.”
Perhaps he realizes that most Americans recognize that health care little to do with a free market where sellers compete for customers. Eighty percent of our health care dollars are spent when patients are very sick, they don’t have the luxury of shopping around, and bartering. A patient not likely to tell surgeon A, “if you can’t give me a better price, I’ll go to surgeon B.” The truth is, the patient isn’t looking for the cheapest surgeon; he’s looking for the best surgeon, just as he is looking for the best medication, the best hospital.
So Luntz says, forget about “the free market”: “Stop talking economic theory and start personalizing the impact of a government takeover of healthcare.” There’s that buzz-word again, “takeover.” No one in Washington is talking about having the government take over the hospitals, or put doctors on the government’s payroll. But Luntz knows that you tell a Big Lie, and repeat it over and over again, a certain number of people will believe it.
Telling “the Big Lie (German: Große Lüge) is a propaganda technique defined by Adolf Hitler in his 1925 autobiography Mein Kampf. It’s a lie so "colossal" that no one would believe that someone "could have the impudence to distort the truth so infamously.”
Hitler describes how it works: “In the big lie there is always a certain force of credibility; because the broad masses of a nation are always more easily corrupted in the deeper strata of their emotional nature . . . ; and thus in the primitive simplicity of their minds they more readily fall victims to the big lie than the small lie, since they themselves often tell small lies in little matters but would be ashamed to resort to large-scale falsehoods.” Thus, while people might be skeptical about a small lie, they will think that there must be some truth to the notion if a Republicans says that reform equals a takeover.
Reinforce the idea, says Luntz, by using words like “bureaucrats,” “ politicians” and “Washington.” Personalize the message by making your audience feel vulnerable: “people are deathly afraid that a government takeover will lower their quality of care – so they are extremely receptive to the anti-Washington approach.”
Play on their fears, Luntz recommends, by saying: “In countries with government run healthcare, politicians make YOUR healthcare decisions. THEY decide if you’ll get the procedure you need, or if you are disqualified because the treatment is too expensive or because you are too old. We can’t have that in America.” At this point in the discussion, Luntz is advising Republicans to slide over into make it seem a “given” that the president is proposing “government-run healthcare.” It is not something that “could” happen; it is something that will happen—unless Americans fight the bureaucrats.
“Nothing will anger Americans more than the chance that they will be denied the healthcare they need for whatever reason,” says Luntz. . . . “ So say it. ‘The plan put forward by the Democrats will deny people treatments they need and make them wait to get the treatments they are allowed to receive.’”
Go ahead and just say it. Don’t worry about the fact that it isn’t true. Drug-makers, device-makers and some conservatives have already twisted this administration’s plan to fund “comparative effectiveness” research by suggesting that somehow this will lead to denying patients Needed Care.
Nothing could be further from the truth. The goal of such research is to find the most effective treatment for patients who fit a particular medical profile. Up until now vested interests with a financial stake in the industry have done their best to block head-to-head comparisons of competing treatments. The Obama administration would change that by funding unbiased research that test new treatments to make sure that they are, indeed, more effective for all patients. If patients and physicians have better information about which treatments work for which patients, they can avoid unnecessary, unproven and overpriced products and procedures.
The goal of comparative effectiveness research is to protect patients from unnecessary risks while making sure that “the right patient gets the right care at the right time.” Clinical experience has shown, time and again, that the newest, most expensive most aggressive treatment is not necessarily better. Though it usually is the most expensive—and the most lucrative
As for the notion that “bureaucrats” or “politicians” will be making decisions about which treatments are most effective, this is yet another colossal fib. President Obama already has appointed a panel to prioritize comparative effectiveness research made up primarily of physicians, plus representative from Consumer’s Union, a public health expert and a patient’s advocate.
Does this sound lik
e a group that will deny patients treatments that they need?
What Liberals Can Learn From Conservative Rhetoric
Those who try to tell the truth understand what Alice learned in Wonderland: you must both “mean what you say” and “say what you mean.” Luntz, by contrast, is neither sincere nor clear. He knows full well that the White House has no plans to take over health care.. And the last thing politicians want to do is vote on what care people should and shouldn’t receive. But Luntz’ aim is to obfuscate, not to educate. He is teaching conservatives how to distort language in order to play on their listeners’ emotions.
In the past, some liberals have praised conservatives for learning how to “frame issues” in memorable catch phases that will appeal to the masses. They even have suggested that liberals should learn how to imitate the conservative’s rhetoric. But the truth is that such rhetoric reads like ad copy. It is brief, to the point, and aims to “sell” you on a point of view. It is not meant to provoke thought; it aims to close off thought: “No question, I should buy it.”
I would suggest that progressives who are even tempted by the idea of learning to “spin” like Karl Rove should read Mein Kampf. And then re-read Carroll’s Through the Looking Glass. Lewis Carroll was a master of what looked like “nonsense language,” but usually wasn’t. He understood that, as President Obama said more than once on the campaign trail, “words matter”—and what they mean matters more.
“When the facts are on your side, argue the facts. When the law is on your side, argue the law. When neither the facts or the law are on your side, pound the table and holler.”
Maggie-
Words are VERY important!
Here are my two phrases which the American public may NOT be ready for?
– “More is not always better in health care-sometimes more is outright dangerous”
– “Every single American deserves a dignified, pain free death”
Conversely maybe Americans ARE ready for those words?
Dr. Rick Lippin
Southampton,Pa
Luntz’ comments are not entirely inconsistent with those contained in the memo from Celinda Lake to the Democrats last fall. Seems to me there are a few basic truths here that go beyond rhetoric.
first is that the overwhelming majority of Americans — and an even bigger majority among the powerful — is quite satisfied with the care they’re receiving and don’t want to see that care compromised as part of an effort to provide care to those who are not currently adequately served.
a second is that the drive for efficiency via evidence based medicine will inevitably limit the choices now available to the providers who serve this majority. The fact that the public will be better served by such a change doesn’t mean folks will embrace it.
saying that the government isn’t going to tell providers what to do doesn’t resonate, partly because it isn’t true. at minimum, it is telling providers what not to do, or at least what it won’t pay for in the medicare program.
a third is that we already limit choices in a fashion that has broad public support. think of which drugs are allowed on the market or the options available for those with an IRA for retirement savings.
one of the challenges here lies in redefining and packaging the concept that some limits on choice are good and should be embraced, as a consumer protection element. actively discouraging docs from doing things that clearly don’t work (see IOM report) is as commendable as keeping ineffective drugs off the market.
for reasons I understand (they don’t want to challenge physicians) reformers have been slow to make this case. but make it they must if reforms are to go forward.
This release is quite timely, no? I am sure many of you have seen this already, but what a shame if there is no public Medicare for all plan in the reform.
Bethesda, MD — Elderly Medicare beneficiaries are more satisfied with their health care, and experience fewer problems accessing and paying for care, than Americans with employer-sponsored insurance (ESI), according to a study by Commonwealth Fund researchers published today on the Health Affairs Web site. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.4.w521
Jim–
I actually had Celinda Lake in mind when I wrote this post.
For those who don’t know her, she’sa pollster who likes to do “focus groups”. And during the campaign she kept urging Democrats to “frame” issues the way the conservatives do–to use language to say the things people want to hear– rather than what they need to know. (Her biography states that she is particularly adept at “framing” issues for women voters. Translation: she knows how to play on the worst fears of soccer moms.)
Obama refused to follow her advice. He won, in large part, because people were very tired of lies. And they sensed he wasnt’ lying. He meant what he said and said what he meant–even if sometimes, it wasn’t very popular.
Unlike Stan Greenberg and Paul Begala– progressive pollsters who helped elect Clinton– Celina Lake is essentially an aamoral person who thinks that she is finding out what America thinks when she holds a focus group in
upper-middle class all-white suburbia.
While Greenberg and Begala care about right and wrong, Celinda Lake doesn’t.
I heard her speak at a conference where she said: “Don’t ever ask any American family to give up something for another American family. They won’t do it. This is not what Americans do.” (Here she was “framing” for those soccer Moms.)
Inspiring, yes? . She appeals to the worst side of the America character.
In fact, many American famlies do help others, particularly in poorer communities, where people regularly help each other out. In NYC, my husband and I regularly notice this: get a flat tire, need a jump start– 10 to 1, a black or Latino person will stop to help you. People in SUVs don’t.
(Might dent the SUV. )
In his inaugural speech, and in many speeches since then, President Obama has talked about hte need for eaach of us to sacrifice. To grow up. To put childish things away. To reocgnize that we are in this together and must help each other.
Jim– Government is not going to “control” what doctors do. It will provide guidelines. Intelligent doctors will appreciate this. It will provide financial incentives that steer docs and patients toward effective care.
You write: “lies in redefining and packaging the concept that some limits on choice are good and should be embraced, as a consumer protection element. actively discouraging docs from doing things that clearly don’t work (see IOM report) is as commendable as keeping ineffective drugs off the market.”
If an idea is true, one doesn’t need to “package it.” That’s the old-fashioned lanuage of Madison Avenue advertising. It’s the language of Steve Case, CEO of AOL> (Time Warner shareholders remember Steve case–he lied and lied and lied to persuade Time WArner management to buy AOL and pay 20 times what it was worth. When I interviewed him, Case said “It’s all about packaging,”
If you’re telling the truth, you don’t need to dress it up and put a bow on it. You just have to be very clear–and you have to be sincere.
Most people can sense when you’re not sincere. Most of the time Bush was sincere–dumb as dirt and pig-headed, but sincere. This helped him.
One can say: More care is not necessarily better care. Newer more expensive care is not necessarlly better. Medical reserach shows that when patients receive hte newest, most agressive care, often outcomes are worse.
This is because every treatment carries some risk. If you are overtreated, you are exposed to risk without benefit.
The governmetn is investing in head-to-head comparisons of treatments–that will be done by physicians who have no financial stake in the outcome–to find out which treatments work best for which people. Then they’ll let other doctors know what they have discovered by issuing guidelines (not rules) which show which treatments work best for patients who fit a particular medical profile.
No one will force doctors to follow those guidelines. In the UK doctors follow them about 89% of the time– which sounds about right. 11% of the time, it’s quite possible that there would be good reason to deviate from the guidelines because a particular patient has a unique set of problems.
Probably you don’t want to say that all at once. You need to lay it out piece by piece. But you do need to speak plain English. No slogans, no bumper stickers, no catchy phrases.
Some reformers having been saying just this: particularly Peter Orszag, Zeke Emmanuel, Uwe REinhardt, Jack Wennberg,
Bob Wacther (see his website), Don Berwick, Merrill Goozner, Shannon Browlee etc etc.
The folks raising large amounts of money for large conferences are less likely to say these things– they tend to listen to people like Celina Lake. If you sit in a meeting with these people and say “we need to talk about overtreatment” they, as Shannon Brownlee puts it, “look at you as if you’ve set your hair on fire.”
They say “Maggie, Shannon: we can’t tell people THAT. And, whatever you do, don’t talk about the Cost of care or how we’re gonig to Finance Reform. (A direct quote from a meeting I attended.)
These people think of themsleves as “political strategists”–quite distinct form the people who actually understand healthcare who I named above.
The “strategists” care only about “winning”. They think of politics as some sort of sporting event.
And they are so used tring to mainpulate the American public they don’t know any other way to talk to people. Essentially, they’re PR people.
But rather than assuming that the American public is cravenly selfish (as Lake does) or stupid (as the conservatives tend to) we have to assume and appeal to the more generous, intelligent side of the American characgter.
This is what Obama does. He doens’t talk down to us. And he is not afraid of upsetting us by admitting that we face hard times–and that we are all going to have to do whatever we can to help each other.
Btw the NBC nightly news with Brian Williams has started a series profiling people helping each other in signficant ways. The Obama administration is inspiring progamming that is very, very different from the fear-mongering and “shout televison” of
recent years.
It feels like Bill Moyers has a hand in shaping this series of NBC.
And then there is the fact that Rachel Maddow, an outspoken, very progressive, very intelligent lesbian woman has become a star of television commentary.. .
Times are changing. (Brian Williams, by the way is also sincere and clear.No razzle dazzle. He doesn’t “package” the news.
Sorry to go on at such length, but this really is about the old-fashioned values that Obama stands for. As I keep saying, we’re at a turning point in American history. We can afford to let go of some of the phoniness of the “Me Decade,” the “Greed Decade” and the disastrous fin-de-siecle 1990s.
When you are blinded by your support, you tend to forget (I won’t say lie) about your guy doing the same thing. He’s a politician and it is false to say he is above framing issues. The economy tanked and power tends to cycle when you have an unpopular president, that’s why he won, not that he was an incredible truthteller. In Fact, aome of the first things he has done in his presidency is frame issues. He scrapped “war on terror” for “overseas contingency plans”. His homeland secretary scrapped “terrorism” for “man made disaster”. Democratic Pollsters now exclusively use “climate change” not “global warming. They are already discussing scraping the term “cap and trade” for some other term. Just watch he won’t call it a tax on energy he will call it a “nonrefundable pollution fee”.
-The conservatives know they won’t stop him or his agenda, they are just setting themselves up with a clear distinction from those in power. That’s how you regain it. To deny it will happen is to ignore history. When reform is passed and its not gumdrop valleys and candycane forests, they make their move. The current system is unstustainable, but that is a hard thing to sell people on that have been paying into medicare for 40 years. When large majorities of the population are told no that never have been, there will be upheaval. The opposing party will capitalize on that, they always do. What he is proposing to do by expanding coverage universally and having zero effect on the insured is similar to moving a full swimming pool and not spilling a drop. Medicare recipients won’t have the same access, not when you add 47 million to the outpatient system. Some employers will say screw it and drop their plans, thus breaking the you get to keep your doctor and plan line. Both are inevitable and the party in power now “owns” it and warts and all with a Dem. Pres and Dem Congress. The 47 million instantly granted insurance has never been and never will be a reliable voting block
jenga–
Only 23% of Americans now identify themselves as
Republicans.
The Republican party is in trouble because it has been hijacked by a group of conservatives who have no compunction about lying.
It will take a lot of fresh blood to remake and reinvigorate the party.
Whatever language “Democratic pollsters” may use, Obama himself avoids the catch-phrases and bumper-sticker language.
It has been a very long time since we have had such an eloquent president.
As for healthcare reform–few people think it will be easy. But it is what the vast majority fo people want.
Clearly, you relish the idea tha reform will end in disaster. . .
I have been ranting and writing about excessive medical care for most of my 20 year career as a physician. I suspect that the money saved by eliminating unnecessary CAT scans alone could probably pay the premiums of the 46 million uninsured. Excessive medical care is drowning the system. http://mdwhistleblower.blogspot.com/2009/04/medicare-reform-will-raise-physician.html. I also support comparative effectiveness research (CER), but the stakeholders will either attack or defend the results and process depending on if the conclusions allign with their interests. I support CER, but I am uncertain it can survive politically. I don’t expect that major players in the medical arena will fall on their swords to serve the greater good. Many powerful interest groups correctly recognize that health care reform threatens their survival . They may feign support of the president, as they did this week, but I suspect that they have a very different strategy and agenda that they discuss in private. The public had better get itself informed now if they are to exert any influence on the process. After all, they stand to lose more than anyone if health care reform fails.
Michael K–
Welcome– and thanks for your comment.
I agree with all that you say, ecept I am more hoepful that CER will be
used, in a rational way, to control costs.
Take a look at the recent New Yorker article about Whte House Budget Director Peter Orszag. (I think it’s the most recent issue)
The article makes it clear that Orszag is probably the most influential person shaping Prsident Obama’s healthcare policy and that the Dartmout Reserach (the gold standard for evidence on overtreatment) stands at the very center of his vision for healthcare reform.
Orszag also is convinced (rightly I would say) that health care inflation has become an enormous threat to the economy, and must be reined in.
So while I agree that the industry is paying only lip service to the idea of
cost containment, neither the Obama aministration nor the CBO (which Orszag ran until he joined the White House) will accept any reform plan that doesnt’ cut overutilization.
And CBO will have to “score” any plan that Congress passes–which means CBO has to agree the savings are real.
We’ve never had a Whtie House budget director or a CBO that understood what’s worng with our health care system so completely and in such depth. And, the president trusts and respects Orszag
Of course the lobbyists will still have a great deal of influence over many Congressmen, but without serious cost-containtment, Medcare is in real trouble.
They can’t raise Medicare payroll txxes. And it would be politiclly impossible to cut Medicare benefits across the board.
They know that they must find savings from within Medicare by excising unnecessary treatments. No legislator wants to have it said that
Medicare began to go broke on his watch.
Last summer, to the surprise of many, Congress stooe up to the insurance lobby. I think that the majority may well stand up to lobbyists on using CER.
Cutting unnessary tests will mean changing liability laws and in view of the fact that the country is being run by attorney’s I’ll be surprised that change will be forthcoming.
Henry
And, one more comment. Quite the contrary, it is rational to ration care. Every country that has some form of national health care rations care because it is the only way you can control inflation thus the cost(s).
Wow, Maggie, you have some strong feelings about “framing”. Do you see any value at all to the work of George Lakoff? (Lakoff I understand to be a leader in the use of framing for progressive ends). I’ve been trying to learn more about framing and to put it to good use for humanitarian ends in my work as a social justice activist who focuses on healthcare reform (e.g. healthcare for people, not for profit). I’m also a community health nurse and nurse educator.
I don’t entirely agree with all you say, Maggie, in your criticism of framing but I do appreciate the admonishment for people, especially those who do public speaking on the health reform issue (as I do and have been doing for 20 years) to not blindly embrace all the talking points of the so-called PR political strategists, even if they do self-identify as progressive Democrats. I think sometimes they get too caught up in the whirl of the political spin-machine and lose touch with the real world…or is the spin-machine the real world of American politics these days. Are we the people largely shut out of the political and policymaking process?
Maybe because Maggie is a seasoned author/professional writer she has more of a comfort level using words and language. I think for many people the act of using language, spoken or written, to convey ideas clearly and succinctly is very very difficult. One risks losing the attention of an audience, or of simply confusing them rather than informing and engaging. That’s why honed PR skills and products can be reasonable and valuable tools (e.g. talking points, speech writers)–but only when this PR is based on the shared humanitarian values of the spokesperson or people (Obama or other progressive Dems).
The Herndon Alliance is a coaltion that formed over 3 years ago in part to harness the power of effective public communication around health reform issues. It’s founding was spearheaded by Dr Bob Crittendon, a primary care doc health reform activist who’d been a health policy staffer for a Washington state Legislator. Bob identified a need for the progressive health reform movement to have a more effective and cohesive vision and message to move reform forward. I’ve attended a number of the annual meetings in D.C. since I also see the communication piece as a real stumbling block for meaningful reform (but not as big an obstacle as corporate money’s excessive influence in American politics!!), plus I have family in DC to stay with for free…
Bob Crittendon and a handful of other self-identified progressives formed Herndon and they hired Celinda Lake and another PR messaging firm, Environics I think is the name, to do research and messaging. Much of it I agree with, but not all.
This work includes a “Do’s and Don’t’s” word list to use when talking about national health reform, mostly so as to not activate people’s fears about making big changes. (the Repubs and Luntz have that covered already).
While I agree there are risks of taking talking points too far and dumbing down a topic, I also think some of the framing approach makes a lot of common sense. Obama did use some of the talking points that were developed and shared with him by Herndon Alliance and Celinda Lake, I believe.
For people who want to learn more about progressives’ efforts to use framing for meaningful health system reform you can look at Lakoff’s healthcare reform here
http://www.rockridgeinstitute.org/health.html
and at Herndon Alliance here
http://www.HerndonAlliance.org
Ann–
Ann–
Because I’m a writer, I know how powerful words are–and how they can be misused to manipulate people’s emotions–and to tell them what they want to hear, rather than what they need to know.
“Framing” goes back to the Madison Avenue ad language of the 1950s. See “The Man in the Grey Flannel Suit” (I think it was made into a movie with someone like Gregory Peck) and other novels and films that ultimately exposed how the language of ad campaigns was all about lying.
It was about “creating demand” by making people think that they needed things that they really didn’t need–leading to “compulsive consumption.”
John Kenneth Galbraith wrote about this.
In other words, ad language was often about planting ideas in people’s minds that Just Aren’t True.
Thanks for the links.
I have some problems with the advice for progressives.
Here is one example.
First, Herndon gives an example of a conservative message, and then advice on how to counter it:
Example of Conservative Message attacking reform: “We need to make health care more affordable, but trying to add 48 million uninsured
people to the system all at once with a big new government program is a recipe for
disaster. The new program will cost billions in taxes, hospitals and doctors will be even
more overloaded than they are now, we’ll have to wait weeks to get appointments, and
quality of care is bound to suffer. This approach punishes families and businesses who
are already working hard to pay for health care by adding billions in new taxes and
overloading the system.”
Henderon recommends:
When responding to attacks like the one above [progressivs should] incorporate the following points.
“More providers—Reform will mean that incentives are in place to encourage
more people to become doctors and nurses (especially in rural regions of the
country and areas of medicine most in demand), work in teams, and provide
the best care for you and your family.”
MY COMMENT This first piece of advice recommends telling people something that is NOT TRUE..
There are no plans to increase the total number of doctors. WE have too many specialists as it is—leading to overtreatment.
There are hopes of increasing the number of primary care docs and nurses, (at the same time there is talk of reducing the number of residency slots for dermatologists and orthopods), but even if we start today, it will be another 4-8 years before they even Begin to Come through the Pipeline.
The conservative attack is partially right: unless we think very carefully about how we are doing it, if we flood the marketplace with milions of uninsured people ALL AT ONCE–there will be very long waits. (IN Mass. many people have a very hard time finding a doctor.)
WE PROBABLY NEED TO SET UP COMMUNITY CLINICS STAFFED WITH PEOPLE WHO ARE NOT DOCTORS OR RNS doing many of the things that docs and nurses now do–getting the intitial information on the patient’s medical history, perhaps taking blood pressure etc. We’ll need people who can speak languages other than English staffing these clinics.
And docs in private practice may wel need to hire one or two lay assistants helping with many tasks.
This means that if you now have insurance, you’ll still be able to keep your plan and go to the doctor you know—but you may find that first you see a nurse or someone else who does routine things before your doctor comes into to talk to you.
If you’re not suffering from a serious chronic condition, your doctor may spend less time with you. But if you are suffering form a chronic condition that needs managing the goal is that he will have more time to talk to you (and will be paid for that time.)
All of this will require thought and planning. This is one reason why as Dr. Atul Gawande and others have said you can’t simply flip a switch and roll out univeresal coverage all at once.
Even if we do it right, there will be long lines and waits in some places. We’ll have to make changes as we go along.
We need to remember that while universal coverage will create more demand for primary care docs and nurses it will not create supply.–not for many years.
We need to deal with that– and uppper-middle class insured people who find themsleves in line will have to be patient and understand that this is part of the price we pay to live in a society where everyne has access to care.
Hendreon also says to tell people that reform will mean:
“Less paperwork—Simplifying the insurance process so doctors have more
time for you, and you have more time for your family and job.”
Again that just isn’t true. Reforomers may get insurers to make the paperwork more uniform (though if we have a wide variety of plans to choose from, each plan will have different paperwork).
And if we are going to use comparatve effectiveness reserach to contain costs, that will mean more paperwork in some areas.
For instance, Medicare is likely to begin requiring referrals before a patient can go for diagnostic testing (which is way overdone.)
If we have medical homes, this means patients will need referrals from their primary care doc for many things.
If we use comparative effectiveness reserach, this means a doctor will need to keep notes if he is deviating from guidelines for best practice, explaning why he is doing so–and fill out paperwork to explaing why the patient isn’t being charged a higher co-pay for the more expensive, less effective treatment.
In other words, cost-containment means “managing care.” Though, unlike the “managed care of the 1990s, in this case, the decisions will be made based on medical evidence rather than insurers’ desire for profits.
I would agree that progressves Should Not use the phrase “managed care” to explain this. The phrase has been contaminated by the insurance industry’s abuse of the idea in the 1990s.
We should talk aboout protecting patients by elminating wasteful, ineffective care.
Finally, in his speeches Obama constantly tells us what we don’t want to hear:
This will not be easy. There are no silver bullets.
EVERYONE WILL HAVE TO MAKE SACRIFICES.
This will be true of healht reform Probably American will have to wait longer for Elective Surgeries. (Note–they are elective, not necessary–you’re not going to be hurt by waiting.)
Americans are impatient. We want what we want NOW.
Obama is saying “grow up.
The time has come to put childish things away.”
And in fact, research tells us that in countries where patients wait longer before having elective surgery they have a chance to learn more about the risks and benefits. IF given the infromation they need to really make an “informed choice” (rather than pasively give “informed consent”) about 20% to 30% decide not to go ahead with the surgery.
This not only saves money–it spares patients from being talked into a surgery that they don’t really want or need–and which in many cases (much spine surgery) will do them no good.
If women have more time to get over the shock of finding out that that have breast cancer they are more likely to have a lumpectomy rather than a msstectomy. Survival rates are just as good–though with the lumpectomy, you may have to go back for further treatment in the future.
This is something to think over–after you have gotten past the panic.
No lines, immediate service–great feature at the car-wash, but in health care this is not always a good thing.
There are so many things we need to unlearn about healthcare.
It will be a difficult adjustment for many–we need to admit that–but the important thing is that we will know that all of us–you, me, our adult children, our neighbors– will be able to get healthcare.
Finally, on the idea that most people need tips from PR people on how to write persuasively:
When writing, don’t worry so much about maniuplating tne mind of your listener. Focus on saying what yoou know to be true, as clearly as possible, with evidence. That’s always the most persuasive writing.
Ann-(and everyone)–
ON Primary care practioners needing help from staff who are neither docs nor nurses (since there is and will continue to be a shortage of primary care docs and nurnes in the next 6-8 years):
To clarify: I am not suggesting that we need community clinics that are staffed only by laypeople.
I’m suggesting that since we don’t have enough primary care dcs and RNs (and won’t for many years–even if programs to attract more students and nursing schcool teachers work), we need to figure out how to use and train people who are not doctors and nurses to do many of the things that doctors and nurses do now–so that doctors and nurses can focus on
diagnosis, & chronic disease managment.
People who are not physicians or nurses (but perhaps have training as social workers, drug counselors, or in other realted fields) might well be able to do much of the counseling on preventive care for healthy people, plus counseling those suffering from addictions–and talking to the “worrie well” –who want more time with the doctor but, in his estimation, really don’t need it. (But they do need reassurance. A trained layperson could provide that, after the doctor had done an initial evaluation).
Also, when I suggest that primary care practioners in private practice may need to hire more lay people to do some of these things, I am assuming that primary care doctors will be paid more to manage chronic diseases (paid for the time they spend talking to and listening to patients, in person, by phone, by e-mail and talking to patients in groups (ie. diabetics.)
That extra pay needs to be enough to allow them to a) hire an extra person as neede, b) have more time to spend with patients who truly need chronic disease management, and c)wind up with an income that rewards them for choosing a very demanding job.