Sunday, August 22, 2010

Fix the ACA

Perplexed by the lingering voter skepticism over the Affordable Care Act (ACA), the White House apparently commissioned a series of "focus group" surveys on the health reform. While this is probably only one of many voter sentiment studies being undertaken by our hyper-wired political class, this time seems different because it was placed in the public domain by Politico and, to the delight of a conservative/libertarian opposition, it purports to show an Administration in mid-term disarray.

The Disease Management Care Blog has a slightly different spin. When it reads the survey summary, it sees an underlying fundamental assumption by the authors and their audience that the key constituencies from the 2008 Obama landslide haven't been adequately educated about the merits of ACA. What's needed, therefore, is a messaging/outreach/marketing/awareness-building campaign for Medicare beneficiaries, moms, Latinos and persons under age 40 years that....

1. credibly showcases the parts of the ACA with greatest appeal (more healthcare providers, tax credits as well as fixes of pre-existing conditions and lifetime caps)....

2. subtly leverages populism (tax the rich)....

3. appeals to a patriotic sense of shared responsibility (i.e., the mandate)

4. uses real world anecdotes and "transition or bridge language"....

5. in a calm and rational tone, recognizes that no law, including the ACA, is perfect.


The DMCB has seen that hollow canard fall flat on its face countless times among its professional colleagues who, when confronted by the so-called solutions concocted by an all-knowing administrator-policymaker-political elite (such as RVUs, capitation, pay for performance, electronic records and the sustainable growth rate, to name a few) didn't suffer from a knowledge deficit. They were perfectly aware of the details. The "problem" was that they didn't believe in them.

And what do you know: this phenomenon is not limited to doctors.

Such are the optics of any expert elite who are unable to discern the thin line between being educated and being convinced. While the sheer complexity of health reform makes it hard to grasp, much of the opposition to the ACA is not the result of ignorant assumptions but fiscal, philosophical, economic and political rationales. Therefore, a marketing campaign is unequal to the voter discontent, the coming challenge of slimmer (or absent) Congressional majorities, fighting a constant rear-guard action over additional enabling legislation/regulatory language and "repeal the law" grandstanding. To even consider this kind of political gimmickry calls to mind a passage from the Fat Lady's favorite bedside reading:

"You will be ever hearing but never understanding; you will be ever seeing but never perceiving. For this people's heart has become calloused; they hardly hear with their ears, and they have closed their eyes."

The DMCB is not political consultant that runs focus groups, but it has some advice for the Administration. Open your eyes, your ears and your brains by looking inward and asking:

1. have you faced up to those parts of the ACA with greatest problems (the complexity, expansion of government, inability to control underlying cost inflation and deficit spending,)....

2. should you tack toward the political middle (a good start would be some aggressive cost cutting....)

3. if its time to accommodate your opponents

4. reduce the overlawyered and hyperanalytical approach to problem solving and

5. recognize that the ACA is far from perfect, that there is a commitment to fixing it and that no option is off the table.

In other words, co-opt 'em. "They" say repeal the ACA. The DMCB says the response should be to "fix it."

Fix the ACA.

Image from Wikipedia

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