What I wish she had said… The challenge of really communicating about health care reform

June 7, 2010

The Detroit Regional Chamber of Commerce held its annual policy conference on Mackinac Island this past week. Health care reform was a topic of great interest to many of the attendees. In general, this group of 1,100 or so business leaders was either agnostic about the Patient Protection and Affordable Care Act or negative on it. Few had much knowledge of the details or clarity on what to expect – there was much confusion and an overarching view that there was just “too much government” in it.

Kathleen Sibelius, Secretary of U.S. Department of Health and Human Services, was the keynote speaker on Friday morning, June 4. This was a golden opportunity to really connect on the value of the Act to this largely skeptical but very influential audience.

So, did she? Unfortunately, no. What she did at the Mackinac conference is representative of what has been happening since health reform was passed into law earlier this year and why there has been no positive “bounce” for that passage. The problem with how communication has gone on health reform isn’t just the fact that there have been a lot of other critical issues since its passage – everything from the Gulf oil spill to the employment numbers – it’s really about a lack of a cohesive message that connects with consumers, business leaders, providers, and state policy makers about what health reform really is and what it can do for them.

Secretary Sibelius is clearly very competent and extremely knowledgeable. She demonstrated all of that on Mackinac Island. But, what she did in her speech was to describe the Act in its parts. By 15 minutes into her 45 minute talk (she took no questions), the audience had checked out – with most on their Blackberrys or reading the newspaper. She gave a list of some of the things in the Act and tried to say that it was important because otherwise, businesses in this country would not be competitive. But, she gave no overarching vision of the Act – no emotional punch about why it’s important and what will look different after it is fully implemented. And, she relied on a statement that everyone in Washington seems to think resonates outside the beltway: she talked about her latest trip to the Mayo clinic – something that actually doesn’t help many people relate to the promise of this law.

Why is it so hard to communicate the positives that are in this Act? Is it because it is 1,000 pages long? Is it because since it is dealing with one sixth of the economy, there are many different sections and aspects to it? Is it because there are so many details that the focus becomes on those rather than the whole?

It’s probably all of those things and also the fact that those in Washington have been so immersed in the ins and outs of the specifics, that they have lost sight of the fact that most of the country still just doesn’t get the over-arching premise of the Act.

The audience in Mackinac needed to hear this: the Act will reduce the number of uninsured – significantly. And, that’s important because the health of our citizens and productivity of our country is affected by not having insurance. The Act will provide financial support for millions of businesses in the country (small businesses – the engine of growth in this economy) to provide health insurance to their workers – thus, helping them attract and retain good employees, and immediately helping them to reduce their costs. Groups (employers and labor unions) that provide coverage to early retirees will get financial support to do so. The Act will help fix the broken individual market – making sure those who are sick are not excluded from coverage and helping to even out the risks and costs of coverage. Both individuals and businesses will be able to make more informed health insurance purchasing decisions because of this Act. And, the government role in all of these areas is essential to make them work. There are only limited ways to get to essentially universal coverage and there are problems and benefits associated with all of them. The approach embedded in PL 111-148 is actually one that was previously favored most by conservatives and is, in important ways the one that includes the least intrusive role for government. The Act includes a significant amount of state and local control and leaves many crucial decisions to providers of care, community groups, and state policy makers. And, the Act lays the ground work towards improving our health status, our health care work force, and the quality and efficiency of our medical care system in fundamental ways.

Many of those points were there in Secretary Sibelius’ speech – but they were there as trees and not the forest. She needed to give that big picture – and then fill it in some to help people see more concretely how the Act will benefit each segment represented in the room – business, consumers, state leaders and Michigan overall. And, then, she needed to take questions.