Monday, June 15, 2009

President Obama's Speech to the AMA: Masterful, Necessary and Insufficient

The Disease Management Care Blog tuned into online C-Span and watched a part of President Obama's 56 minute speech to the American Medical Association's Chicago House of Delegates' meeting. It was quite the tour du force for a politician espousing greater government involvement in health care to an organization that has always been hostile to the idea. Unable to believe that the AMA interrupted the speech repeatedly with occasionally robust applause (though there was one episode of booing), the DMCB went back and listened again.

It's heard all these arguments before, but found how they were packaged was simply masterful.

What is the template for such a speech? The DMCB kept notes and has outlined them for you below, just in case you're ever called upon to enter a room full of doctors that are reluctant to go along with your brilliant plans. As a medical director, the DMCB has been down that road and wishes it had President Obama's rhetorical skills in past encounters, when the physicians, after listening closely with sketpical frowns and crossed arms, told it to get lost:

Open with vague descriptions of a better future rising out of the ashes of the current adversity. Bond listeners to you by noting their assistance is needed. Be a supplicant: modesty looks good and builds rapport.

Quote some telling and heart breaking anedotes: patients with cancer, doctors with hassles, small businesses with layoffs. Reach for big anecdotes if you can: automobile bankruptcies, the national debt and, what the heck, global warming if you can get away with it.

Call your listeners to action by saying that doing nothing is not an option. Costs will spiral upward, taxes will go up, budgets will be cut. The Huns are almost on the beaches of Dunkirk, now is the time to man the ramparts.

Recognize the fear and challenge listeners to take action under your confident leadership. Give examples of that leadership and take credit for anything you can. Anything.

Repeatedly commend the audience for their courage, good will and intelligence. Disarm them by thanking them for being so smart.

Remind listeners that, while big change is coming, their core issues will not have to be compromised. You're only fixing what needs to be fixed. It's OK to use terms like "hundreds of thousands" or "tens of billions" here.

Leverage the idea that, aside from a few Luddites, "everyone" agrees with your points of view. Cast your perspectives in the most reasonable way possible. Look affably mainstream.

Repeatedly remind the audience of how your plans will make life better for them.

Describe your plans with opening softballs (EHRs, prevention, Dartmouth Atlas) that you already know they agree with and lead them slowly to your more controversial points of view.

Repeatedly commend the audience for their selflessness, dedication and sacrifice. Disarm them by thanking them for being so unselfish. In fact, you'll eventually be able to say that their higher calling obviously makes them willing to forgo any economic rewards - and they won't boo at that.

Open your more controversial proposals with the options that are most likely to be supported thanks to your audiences' economic self interests. Yes, it may be more work but more work means more compensation.

Your audience is now ready: hit them with the items that they may not cooperate with. Now is not the time to let up! Sprinkle in more anecdotes that demonstrate why your ideas warrant their support.

Repeatedly recognize your audience wants to do what's right and that they have great expertise. Disarm them by recognizing that they are the trustworthy experts.

There is always something your audience wants. Don't give it to them (and expect the boos now), but now is the time to give something close to it in exchange for their support. Explain why your compromise bauble is a) is still worth having and b) is better than nothing at all.

Repeatedly commend the audience for their helpfulness and assistance. Disarm them by thanking them for their help. Admit that we're all in this together.

Point out that you recognize the core values of your audience.

By now, close to 40 minutes have elapsed. Attention is waning. Now is a good time to raise additional controversial recommendations.

Recast any disagreement as 'healthy debate' and 'legitimate concerns' that you 'welcome.' If there were prior mistakes, point out that you're not responsible... for any of them. Now is a good time to good-cop-bad-cop: mention that you're shielding your audience from others that are more radical than you are.

Identify a common enemy. Take sides with your audience against that enemy. Be firm. Look resolute.

Bring up the example, if you have one, of a family member or close friend, that would have done better if your ideas had been adopted years ago.

Your audience is more tired now. You can quote any economic statistics you like at this point. They are more likely to be believed.

Wrap up: unless you agree NOW this deal with disappear faster than primary care physicians taking Medicare.

No doubt the President will get good grades for this speech. However, the DMCB has a caution for the Administration. With time, it learned, on its own with lots of trial and error, to use many of the approaches mentioned above. As a result, it often also achieved the verbal support of its audiences. Weeks or months later, that support often waned unless there was continuous dialogue, feedback, reaching out and more face-to-face visits.

Mr. Obama has given a necessary speech, but he and his advisors need to know that it was far from sufficient. There is still some way to go.

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