The Madison Avenue Approach to Health Policy - The Health Care Blog


by John C. Goodman

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 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.

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