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?

As I explained at my own blog the other day, 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, the six-month anniversary of the ACA was rollout day for some of the benefits. “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 the future, I will explain what does work in communicating with voters about health care.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis.  He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system. Dr. Goodman’s Health Policy Blog is considered among the top conservative health care blogs on the internet where pro-free enterprise, private sector solutions to health care problems are discussed by top health policy experts from all sides of the political spectrum.

Spread the love

23 replies »

    ” .. Advertising agencies have decades of experience at selling ..”
    Wrong. Any publisher will tell you, if advertising was truly effective, they’d be billionaires.
    They are NOT. Advertising is NOT truly effective. It is more art than science.
    Every time the OweBama ilk wins, voters are brilliant. When they lose, the voters are morons.
    Gimme a friggin’ break. Look in the mirror — the problem is there.

  2. “How about we just vote for more inteligent and honest politicians?”
    This political system has always been the fault of voters, not candidates, but voters want their cake and be able to eat it too. They want low/no taxes but want the services and jobs/spending from other peoples taxes.
    Before we could even consider “intelligent” politicians we’d have to get their party to nominate them, that would mean candidates would have to buck party ideology and donors. In our state’s last governor’s election my wife voted for the Libertarian candidate (I can’t vote but agreed with her decision) because we thought neither Democrat or Republican was up to making the changes necessary and the Libertarian made a lot of sense on fixing the states budget. But he ended up getting only 6% of the vote because he didn’t have a well funded party machine and his solutions would have meant some pain for citizens to get this fixed. A level public campaign finance law would get more candidates with more ideas and beat this Tweedledee/Tweedledumb system that gives us the same mindsets every election cycle.

  3. How about we just vote for more inteligent and honest politicians?
    Congress passes a law that all bills must be read before being voted
    Must be posted in entireity with full language and no reference to material to be written later for 3 business days before vote can be held
    Require the rule writing take place before the bill is voted not after. It would greatly reduce the number of bills passed but I think most people would find that a good thing. We don’t need to dance around any more problems we need to solve them. An idiot is an idiot no matter how you finance his campaign.

  4. Nate, writing detailed and complicated laws is not what Congress does, hell they don’t even read the legislation before signing it many times. The law is passed for many political reasons, not the least of which is congressional back scratching, but politicians don’t have the time to debate, investigate, or fine tune legislation because they have to spend most of their time chasing political donations, especially congressmen with 2 year terms. Also many representatives will vote for a law to get favor from constituents then work dishonestly to weaken that law in the rules/regulations phase to appease their corporate/donor contributors. As well when laws are written the first thing that happens is corporate lawyers get to work looking for ways to beat the law. Want better (working) laws then get Washington off the donation drug addiction and support public financed elections – you’re paying for them anyway through the tax system. If we all agreed with your opinion of government no law would ever get written. The healthcare bill is the worst example of law writing, a desire to please everyone (especially donors) and not suffer any political pain, then ending up with a bill that won’t work without years of political fighting. The bill does at least provide insurance through subsidy to many more citizens, but I agree this bill will be expensive because no attempt was made at any meaningful costs cutting.

  5. i.e. here is something new i learned this week. If your insurance carrier denies your $20 claim to have your doctor trim your finger nails, you can request an external appeal costing them hundreds of dollars.
    using just a millogram of common sense what do you think that is going to lead to? What do you think that will do to insurance premiums…..

  6. bad news Margalit, I can. I’ll be lazy and take the easy one to disprove your thought.
    COBRA. Democrats threw it into the bill at the last minute, didn’t think it through, and didn’t even write out the law. Becuase it was vague and poor;ly written employers suffered 15 years of lawsuits trying to learn how to comply. Employers spent hundreds of millions on attorney fees, hundreds of millions more on judgements, and some were even forced out fo business and some had to drop insurance.
    Finally 5-8 years ago, DOL finally had a good idea and started releasing “model notices” basically instrustions what you had to do to comply with the law. Not perfect but they eliminate a ton of lawsuits.
    I can say without doubt we would have been better off had COBRA never passed, sadly not becuase what they tried to accomplish but because how they did it.
    This law is 100 times worse then COBRA how poorly written and thought out it was.

  7. Nate,
    Is there any evidence that things would have been better if all those things you mentioned were not enacted? Is it possible that without them things would be infinitely worse?
    I don’t know the answer, but I don’t think it is possible for you to substantiate your assertions either.

  8. I wish I could say your commentary is so hilarious, I&I, but, demeaning and belittling people who help people is just rude. I guess to you all doctors are Patch Adams in the end, eh?
    This posting resonated in me in reminding those who are objective and unbiased that this health care deform legislation is the joke, but again, no one will be laughing if it reaches full fruition.
    Well, I guess you are the exception. Ha, Ha.

    Back in the old days (1960s), Medicare was debated for EIGHT years. CBO’s estimate for Medicare was 12% of what Medicare is today (in nominal terms). Dang.
    OweBama and his thugs JET-RAMMED that 2,300-page piece of BS, in eighteen months.
    Why? Because they were really STEALING?
    Push people — they will push you back. Get used to it, MESS-iah. This isn’t Chicago — the race card ain’t as easily played.

    ” .. While I like many others have issues with parts of the health reform legislation, it’s a first step towards ..”
    OweBama (D) replacing Jimmy Carter (D) as the most INCOMPETENT U.S. president in the last 100 years.

  10. Bill,
    weren’t we suppose to be in a better place after Medicare
    MH Parity
    Small Group reform
    why is it every time Washington passes a bill promising a better place things get worse then people like you pop up to say its the first step to a better place. FYI you have been walking backwards for 45 years.
    Margalit I think you meant to say promising grandma wont lose thge shirt off her back when Democrats pass a bill that cuts off coverage after 60 days. I forget which democrats exactly said that but most of them sold it.

  11. The point that John is missing is that the status quo in health care, with declining access to care, escalating costs, and crowding out of other economic activity, prior to the passage of the Obama legislation IS NOT A SUSTAINABLE PATH for the US.
    As distasteful as many of us find it at times, our democratic system relies on elected officials to figure out how to govern us, including decisions about very complex vast economic and personal realms like health care.
    While I like many others have issues with parts of the health reform legislation, it’s a first step towards what is likely to be a long protracted and at times quite painful transition to get the US to a better place when it comes to our health care system.

  12. “Making one simple change to the payment system paying for access to instead of use of the health care system aligns these two primary motives that drive every decision in health care.”
    Jim, don’t we pay for access now, and isn’t the problem the access is too expensive and unsustainable? I guess a one sentence health care bill would have solved everything eh.

  13. “They are right that deceptions come from both sides, but that has more to do with competing agendas and the complexity of the issues.”
    The late Kurt Vonnegut: “if you cannot explain what you do to a 14-year-old, you are a fool.” (not an exact quote, but close enough)
    Mr. OweBama and his ilk JET-RAMMED through a 2,300-page load of BS into a sector that employs 10% of the USA, killing tens of millions of jobs in the process.
    He is a Harvard Law dodo and he will end as a Harvard Law dodo. His replacements will not be much better, but at least the damage will lessen. And the replacements can also be THROWN out, PDQ.

  14. They are right that deceptions come from both sides, but that has more to do with competing agendas and the complexity of the issues.
    By its nature advertising packages and oversimplifies. They wrap up complex issues with a nice bright red bow to make it pretty. Unfortunately we are informed based on our leanings. We want the “Right” to be self-serving or we want the “Left” to be humanitarian.
    One of the fundamentals of capitalism is that the selfishness, i.e. taking care of oneself first results in the public good. But I digress.
    Solving the health care problem and all of its complex issues can be wrapped up into one simple systemic problem. Align the financial motive with the caring motive and the invisible hand of capitalism takes over to ensure the public good. Every time in every way. Making one simple change to the payment system paying for access to instead of use of the health care system aligns these two primary motives that drive every decision in health care.
    You will never see the problem packaged and sold this way. Why because the so called “Right” is welfare for corporations (fascism) and the so-called left is welfare for the common man (socialism). Both do not work. We don’t need fascism and we don’t need socialism we need capitalism.

  15. Thought for a fleeting nano-second John that you were being non-partisan in this piece, but as usual you just say how “dishonest” the “left” is, trying to “Madison Avenue” us into thinking the “right” is “honest”.

    Mr. Goodman, lying is lying. Mr. OweBama is a Harvard Law grad from Al Capone-land who used to staple fliers on telephone poles. He’s going to be Diogenes?
    OK, here’s the bi-partisanship: Newt helped Slick Willie raise taxes. Before he dumped his second wife and Slick got Monica. Happy, MGA?
    And death panels? Of course not — and Fannie/Freddie, USPS, Medicare, Medicaid, and SocSec are solvent. Pigs will fly tonight, too.
    Communism failed. So will OweBama.

  17. Healthcare began as a service and became tainted along the way when greed entered the picture. When the opinions of stockholders ranked higher than doing what’s in the best interest of the patient, healthcare immediately lost it’s reputation as a service. So yes, it is a business at this point and serving the patient-aka-doing what is in the best interest of the patient-is a lost craft. Until pharmaceautical companies stop generating profits, until most healthcare sectors refuse to sell stock, and until honesty regarding medications, treatments and ailments themselves return to patient care, it is an impossible task to overhaul healthcare to actually benefit the patient. You can try to address one minute area, but the whole issue needs overhauling.

  18. hilarious that ExhaustedMD imagines Dr. Goodman is his/her ally in defense of his/her “calling”

  19. Amen! That is why those who are enlightened to the real truth to this intrusion need to continue speaking out and neutralize at the least this ongoing “hear the lie enough and it becomes the truth.”
    Health care is a business! Bah!!! Health care is a craft, a calling, that has business elements, but does not work under pure business guidelines. Other blog authors here seem to confuse the difference!!!

  20. “In the future, I will explain what does work in communicating with voters about health care.”
    Don’t we know already what works? Terrorizing folks with made-up Death Panels, Communist take over, $500 billion Medicare cuts until there are no doctors for older folks, the unwashed masses consuming all health care resources until nothing is left for hard-working Americans, Founding Fathers turning in their graves as the Constitution and your freedom to die of disease are being assaulted, name calling the President of the United States and anonymous financing for TV adds for all of the above.

  21. Advertising agencies have decades of experience at selling healthcare and other insurance, pharmaceuticals, political ideas, and that “warm-and-fuzzy” feeling inside.
    That said, I agree with you that none of these groups– the people creating the advertising, the politicians for and against reform, and the consumers– understood (or currently understand) the complexity of healthcare delivery, financing, costs, or the linkages between stakeholders. Check out the numerous articles on our blog and our website regarding healthcare reform and cost.
    Good post.
    Pamela J. Powers, MPH
    AJM Managing Editor

Leave a Reply

Your email address will not be published. Required fields are marked *