Unfortunately, Misinformation Rules

Let me say from the start (and most of you who have been following this blog already know) I’m not a big fan of the Affordable Care Act/Obamacare. It’s too big for what we need right now, too expensive for where we are, and doesn’t address many of the fundamental flaws we have with the health care system in this country.

But, you should also know I am a huge fan of reforming the health care system - we all know it needs to

happen. Like it or not, the ACA is the option we have to work with right now- at least the only one that is not simply rhetoric or political talking points.

In my Health Care Politics and Policy class each quarter I challenge my students to interview 5 people to determine what they know about health care and health care reform as a learning project. Without exception, they return to the class absolutely amazed with how little most people know- but have strong opinions anyway. For most of us who have been following health care reform over the years, this is no surprise. The reality is most people have no clue of how health care works or what the Affordable Care Act is all about. But they are very quick to take a firm stance even when they know nothing about it.

From the beginning, the supporters of the ACA have done a terrible job educating the public about what health care reform is all about and why it is necessary. They have been afraid to talk about it because, quite simply, many don’t understand it themselves.

At the same time, those opposing the ACA (even though they have no suggestions or plans of their own) are spreading some pretty unbelievable stories and misinformation. And it’s only getting worse as time goes on.

Here are some of the good ones:

• The ACA provides free health care to illegal aliens
• The ACA will allow the government to decide when to stop providing medical care to the elderly
• The ACA requires everyone to be implanted with microchips
• The ACA will allow forced home inspections by government agents

 It is estimated that over $400 million is being spent to discredit the ACA and more money and energy is being poured into trying to get it repealed. The Americans for Prosperity launched a website for consumers www.obamacareriskfactors.com that stretches the limits of truth and fiction.

Individuals are growing increasingly confused by it all and believe the misinformation being circulated because their political views override their ability to critically think, research, and form an objective opinion of their own about the single most important social and economic issue facing our country.

From the beginning, the Affordable Care Act should have been looked at as a starting-point instead of a final solution. There are many things in the Act that can and should be fixed if we simply had the political ability to do so. The American public needs to be better informed to voice an educated opinion politicians need to listen to.  Until that happens, many will continue to believe the misinformation being spread by both sides and base their views on the political messages they are being fed instead of forming an opinion that makes sense for the country.

 In the meantime,  we’ll continue to fight between ourselves as we deal with an expensive, inefficient, and unfair health care system that will only continue to deplete the resources of the economic foundation of this country.

Obamacare is the target right now. If those fighting the law have a better idea- There are many who would like to hear it.

Paul Bunyan and Babe Miss The Point

As predicted, the federal money being spent to market the health care exchanges is really flying out the door. Last Thursday the Department of Health and Human Services awarded another $60 million in grants to organization for the health care “navigators” who are supposed to help educate and enroll individuals in the exchanges.

The advertising campaigns for the exchanges in several states are also starting their kick-offs (remember, we’re supposed to be ready to go on October 1). The marketing theme for Connect for Health Colorado focuses on the benefits of the lower prices that are supposed to occur when health plans compete.  Oregonians are using folk music in their ads (Long Live Oregonians) to promote the CoverOregon exchange . And, only in Minnesota would we use Paul Bunyan to promote the MNSure health insurance exchange with the message “Land of 10,000 Reasons to Get Health Insurance” (not sure of the real message on this one).

Obamacare (or whatever you want to call it) has a serious branding problem. The Republicans still want to kill it and the Democrats don’t seem to want to fix it. Consumers are left in the middle not knowing what it really is and generally confused. These campaigns are going to need to break through a lot of political clutter.

Most of the statistics out there indicate that well over 70% of the population still doesn’t know what the health insurance exchange idea is all about. So, raising the awareness is an important first step. That’s what these advertising campaigns are supposed to do, and we’re spending a ton of money doing it.

Unfortunately, the real key to success of the whole Obamacare effort is to finally get individuals engaged in their health and the health care system- and being engaged is much more than just buying health insurance on an exchange. Engaged means being involved and aware of the bigger issue and aware of the reasons the health insurance exchange was created in the first place. It’s going to require some basic education about where we are in health care, what needs to happen to fix it, and what role each individual is being asked to play. We’re totally missing the boat on that one.

While the goal of these marketing campaigns is to raise the awareness and get as many people as possible to sign-up the real challenge is going to be what we do with them after they are in. The health care system is not being fixed, it will just have more people in it.

I don’t think Paul and Babe or the navigators will have very much to say about that.

Is Obamacare Crashing?

Since March 23, 2010 the country has been living in a constant psychotic state when it comes to reforming health care. While some have tried to implement the legislation and rules of the Affordable Care Act (Obamacare) others have religiously tried get rid of it altogether. Neither side has actually “won” as we have moved through the process but as a result we are now facing a health insurance market that doesn’t look anything like what those who supported the original legislation had hoped. It’s a mess.

Nobody should be surprised that there are going to need to be changes to what was originally written. The original legislation was much too complex, confusing, (and costly?) considering where the country was

positioned economically and politically. Unless the majority of Americans were on board, there is no way it was going to work.

The Treasury Department announced last week that they are pushing the employer requirement for providing health insurance (over 50 employees) until 2015. Additionally, the Department of Health and Human Services published rules that stated they were going to allow self-reporting of income information to determine insurance subsidies instead of verifying the information through the government.

Some believe this is the “beginning of the end” of Obamacare. (Republicans) Others view this as simply making the necessary changes to respond to the market realities. (Democrats/White House) Still others see these changes as the predictable outcome of creating something that was too big, too confusing, and too complex combined with poor implementation and terrible communication. (including me)

An opinion essay in the Wall Street Journal (Obamacare’s ‘Lair’ Subsidies; July 7, 2013) stated, “All of this fits with Obamacare’s entire bloody-minded history. Democrats were determined to make their rendeveous with the liberal destiny of government-run health care, so they imposed this debacle on the country on a partisan vote and despite public opposition.”

I don’t think it’s quite as bad as the Wall Street Journal describes it (and the position that Obamacare is “government-run” health care is a stretch) but  illustrates just how far apart the country continues to be when it comes to health care reform.

Many will continue to move forward to try to implement what was originally designed. Others will continue to oppose every aspect of the Affordable Care Act. At the same time, more changes to the original rules will likely occur and who knows what kind of health care system we’ll ultimately create- and at what cost?

In the meantime many individuals will have to continue to simply cope with the expensive and selective health system model we have today and try their best to understand the rules they are expected to follow. Citizens are going to need to be much more engaged in health care reform than they are today to break the political impasse. In the book Health Care Reform and American Politics; What Everyone Needs to Know, authors Lawrence Jacobs and Theda Skoopol summarize where we are; “We will continue to live in interesting times, where each citizen’s understanding, voice, and actions can make a difference.” 

Changes to the Affordable Care Act will continue to occur. The more individual citizens understand the basics of what is going on, the better the chances they will have to make a difference to influence the results.

Obamacare isn’t crashing, it’s just continuing to lose altitude due to economics and politics. Ultimately, it’s going to be up to the individual citizen to get health care reform on the right track again. As in the past, they will be forced to live with the results.  

Empowering Consumer Tribes In Health Care

We’ve been living with the Affordable Care Act for over three years now. The past three years were a perfect opportunity to educate the public about what health care reform actually is and the “value proposition” it provides. Most of the provisions of the ACA that will impact most Americans are just now coming up- and unfortunately, most of the American public has no clue. The value proposition and the roles of all the stakeholders in the new system were never clearly defined. We were too focused on fighting it rather than try to figure out the way to make sure it works.

“Consumer engagement” is another of the many buzzwords being thrown around in the new health care+

nomenclature. Engagement to health care is about getting people to do what health care wants them to do. In the current health care world, engagement is a transaction. Real engagement is about commitment and doing what is right.

Most of the general public agrees something needs to be done to fix the health care system in America. As we have been arguing for over 100 years the disagreement comes from how best to fix it.

 Consumer engagement is not just taking part in a transaction to participate in a wellness program because they are being paid or enrolling in the health insurance exchange to buy health insurance. Consumer engagement is about understanding that health care is now a social and economic issue in this country that needs to be addressed, and everyone needs to be on board to make it happen. Everyone.

With the lack of consumer trust in employers, government, and the health care system itself, individuals are looking for leadership to help guide them to do what they know needs to be done. In Seth Godin’s book, “Tribes,” he defines leadership as the ability to transform a “shared interest into a passionate goal and desire for change.” We have no leadership for the individual consumer in health care today. We simply have transaction managers. Transaction managers may do some things to get people to do what they want- but they won’t reach everyone that needs to be reached, and certainly won’t get individuals engaged.

Godin argues that good things happen when “tribes” have the leadership and shared vision to change the way things are. Crowds are simply tribes without a leader. Today, health care consumers are simply a large crowd seeking/begging for some leadership. When they get the leadership, many will become much more engaged than they are today.

Godin states, “The movement happens when people talk to one another, when ideas spread within the community, and most of all, when peer support leads people to do what they always knew was the right thing.”

Especially today, we need a consumer movement to begin in health care. Unfortunately, consumers are in dire need of a trusted leader they can rely on to share the vision, the goals, and the purpose of reforming our health care system- for everyone, not just a select few. When they have that leader, the movement will begin, and consumers will become engaged in the ways health care needs them to be engaged. They will change from a crowd to a tribe with a passionate vision for doing what is right.

The consumer leaders to create the engaged tribe won’t come from government, or employers, or health insurance companies. They will come from within the existing crowed- we just need to find them and provide the tools they need to do what they do best- facilitate the change that is needed.

Boston Marathon 2013- When Health Care Works

When we’re constantly reminded of all the things wrong with our health care system it’s pretty easy to be critical of it. We hear about all of the unnecessary costs, the inefficiencies, the errors, and the waste and we start to envision a system that can’t seem to do anything right. It’s easy to be negative about health care today.

While the health care system itself may be broken, there are times we need to remember those who are called to work in this broken system and perform their tasks admirably under difficult (or almost impossible) conditions.

We need to remember the medical teams at Massachusetts General, Bringham and Women’s Hospital, , Massachusetts General, Boston Children’s Hospital, and Beth Israel Deaconess Health Center who were called to respond to the tragedy at the Boston Marathon last week. We need to remember their hours of tireless effort as they worked together to save lives, save limbs, and treat the injuries of over 200 Americans. They didn’t care about insurance coverage or the patient’s ability to pay for the care they were receiving. They could have cared less about Obamacare or the fees they would receive for their work- these heroes were focused on doing what they were trained to do, to help save lives.

As we move back into the never-ending debate about how to fix the health care system let’s also take some time to recognize and appreciate when things work well. The Boston health care community responded admirably and continues to care for those recovering from a senseless act of violence (including the one who created it). Their compassion, dedication, and commitment will continue to guide their actions and help the victims heal. The first priority is care for the patient. That is the essence of what our health care system should be all about.

The ACA: More Expensive Than We Think

The Affordable Care Act has turned three and it’s been a rough three years.


The law has plowed through a number of legal challenges (and more will come), survived numerous attempts of repeal, and continues to face a largely unsupportive public. Nobody said changing health care would be easy. It just seems it could have been accomplished in a different way.

To be fair, during the three years since it passed the law has accomplished a few of the things it set out to do. But the real challenges are yet to come- and the challenges are all going to be about the cost.

When this whole effort began in 2010, the CBO estimated that even with the costs associated with it, the ACA would still reduce the debt by $147 billion over 10 years. I always keep in mind when Medicare and Medicaid were enacted in 1965 both program blew through their budget projections within the first two years. Government numbers seem to be optimistic and many times they are wrong. The CBO numbers are likely to be optimistic as well.

The Society of Actuaries released a study estimating that the “cost of claims” (and insurance) as a result of the provisions required in the ACA will increase costs (on average) by 32% in the individual market. The actual results vary by state with Ohio and Wisconsin the “winners” with their costs increasing over 80%. On the other hand, New York and Massachusetts insurance costs in the individual market would decrease by over 10%. On average, however, the costs nationwide will increase 32%.

Now, this 32% increase is only applicable to the individual health insurance market. However, health insurance companies have already indicated the costs on the employer side are likely to increase as well. We’ll know more when they start delivering their 2014 renewals to employers in a few months.

The ACA has focused way too much on getting more people into a costly, inefficient system. It does very little to address the real problem. Unfortunately, unless something dramatic changes we’re going to be paying for it- and it’s going to cost a lot. We’d better be prepared.

State of the Union- The Gridlock Will Continue

The President’s State of the Union address and Marco Rubio’s response underscored the fundamental challenge our country faces today.  We will continue to struggle with finding the right “balance” between free-market and government sponsored solutions to dig us out of the economic mess we find ourselves in. Unfortunately, the two messages couldn’t have been more different.

President Obama’s message was filled with government programs designed to stimulate economic growth. He clearly believes increased government spending can dig us out of hole we’re in. He stated, “Deficit reduction alone is not an economic plan.” This may be true- but the deficit can’t be ignored. The interest payments we’re paying on the debt is becoming a larger component of the federal budget. If interest rates start to rise (and they will eventually) we could find ourselves in a bind that will be tough to get out. His overall package sounded very expensive.

Rubio countered with a smaller government and a deficit-reduction message.  He (and his colleagues) believe the increased spending and increased taxes will actually backfire and hurt the middle class. Unfortunately, he didn’t provide a lot of specifics on the programs he would recommend.

It was interesting to note that both Obama and Rubio agree on the primary issues facing the country- the economy, jobs, health care, and education. Their methods for addressing them are polar opposite and (as has been said many times before) the real answer is somewhere between the two.

Unfortunately, with the political picture we face today we are unlikely to come to some common-ground; and the gridlock concerning the economy (and health care) will continue while the debt and deficit will continue to grow. The State of the Union messages only reinforced this fact.