Is The Obama Administration Blowing Health Care Due To Being Above Explaining It?

I read The Rude Pundit every once in a while as a kind of guilty pleasure.  Not so much the rudeness which is common as hydrogen but because he often makes points I haven't read anyone else saying or saying as succinctly.   His post last week about the potential for Affordable Health to help destroy the Republican right contained one passage, though, which made me go down memory lane.

As far as the GOP is concerned, the full implementation of the Affordable Care Act is their appointment with the executioner. That's why they have desperately attempted to defund, discredit, and disappear the thing. Forty votes to overturn it in the House. Threats in the Senate and House to hold the debt ceiling or the budget hostage if it's not defunded. A campaign of disinformation that has succeeded in making 44% of Americans unsure if it's still a law. 

And let's be honest here: The Obama administration and the AFA's supporters in Congress have totally fucked up in making people understand exactly what the hell the thing does, beyond easy shit like "No caps" or "Kids can stay on your insurance until 26." Transforming health care for tens of millions of Americans is a huge undertaking, made more complicated by the demands of asshole Republicans and assholier conservative Democrats, so of course it's gonna be hard to explain until it's in effect, no matter how many Katy Perry tweets or Bill Clinton speeches try to help. On October 1, the health insurance exchange opens and people can start shopping and discover for themselves that Obamacare won't rape their dogs, kill their parents, and eat their childrens' hearts while Kenyan drums beat savagely in the background.

Which, while it's not my style, says it about as emphatically as it will be put anywhere.  I'd say that the Obama administration is in serious danger of blowing it because they're either too snobbish to explain the program in language that can be understood often enough for it to be understood or, as I strongly suspect, they are so clueless about communicating with real people outside of the DC-Ivy League class that they don't really understand that it's even important to do that.  Sort of as a follow up to my post yesterday.

Why smart people do stupid things like that featured in one of my early blog posts when the same kind of thing was happening in one of those experiments in the 50 states that you're always hearing about, one of the alleged virtues of our rather awful federal system.   Then I attributed a lot of the problem surrounding Maine's experiment with providing full coverage to too many people wanting to sound like they were speaking West Wing talk.  And I think that kind of thing is still a big part of the problem.   Oddly, you'd think that Kathleen Sebelius, the former DEMOCRATIC governor of Kansas the quintessential puzzle of selling programs to people who need them, would have a clue about this.  That is until you see in her CV that she used to be the Insurance Commissioner of Kansas as well as being a state legislator before then.   I suspect that, as much as it may have counted as an asset in setting policy, it probably disabled her ability to talk to real people about health insurance.  But that's only a guess.

Here is what I wrote seven years ago as I was tearing my hair out while my Democratic Governor was in danger of blowing what should have been a spectacular asset both in terms of providing health care to people who couldn't afford it and in liberal politics in my state.

Saturday, May 27, 2006

WONKERESE, INADVISABLE OR JUST STUPID

Stay with me two paragraphs, that's all I'm asking. One of the most important and ambitious of those fabled experiments on the state level is in really bad trouble. Dirigo Health of Maine, a well planned try at providing affordable health insurance to the uninsured and the soon to be uninsured, is under full attack by the insurance industry and its Republican spearhead. Those who wax romantic about the states as test tubes always leave that part out. When progress is made in one of the fifty Petri dishes instead of all of them, it's easier for industry to kill the culture. And Maine is a mighty small dish.

For those who are already turning away, let me reassure you, this is not going into the details of Dirigo Health, though those aren't as complex as an income tax form. A lot of the trouble Dirigo is in comes from the same source as what plagues so much of the Democratic agenda. .

The explanations of Dirigo from its supporters are just awful. They are detailed, they are truthful, they mention all possible roadblocks and turns. They are delivered in so much insurance industry and policy jargon that not one in a thousand of those paying attention can understand what's being said.

John Baldacci, the incumbent Democratic Governor of Maine, has done some things I don't like at and has appointed some people I don't like but he hasn't been a really bad governor. For anyone who needs reminding, Jock McKernan, now better known as Mr. Olympia Snowe was the gold medal winner of bad governors. [Paul LePage, Baldacci's sucessor, has certainly demoted McKernan to second place.] But John Baldacci has appointed spokesmen for Dirigo who can't seem to get three words out not guaranteed to make eyes roll from Kittery to Fort Kent. The program is under attack from Republicans who have two things to say about it, "costs money", "socialized medicine". They just took out the talking points handed to Ronald Reagan in the 60s by the AMA and the insurance industry and are going to bury an experiment that has a real chance of doing it. A model for the nation.

For the Democratic Party in other states and on a national level, you've got bright people making the same STUPID mistake. I know they are brilliant with real degrees in real subjects from fine universities. I know they love the feel of those words coming out of their mouths with perfect diction. I know that if they close their eyes they see C. J. and Toby. But remember all of those plots where these brilliant, jargon fluent, policy wonks got into trouble when they tried to speak in public? There is a reason for that. It's because anyone who takes five minutes from their frantic schedule and looks knows that policy wonkery as public relations is guaranteed to do three things:

1. Confuse the public that would like the program if they understood it,
2. Embarrass them and make them hate you for it.
3. Provide the decisive opportunity for the lying servants of your enemies to master the debate.

For the love of Mike, stop it. You've got to use plain language, you've got to finish talking about step one before you jump to step 49 no matter how much of an inter-relationship there might be. Train two people on your staff to speak English on the subject, on that subject alone and let ONLY them talk on that subject to the public. Come up with simple accurate words and phrases to replace the industry terms that no one understands. If you want to know what those are ask the experts. The janitor, the lunch counter person, your doctor who has only been pretending to understand them all these years. Don't use the words the insurance industry invented to confuse their customers in the first place.

You have made a noble choice to serve the public. You have decided that the sacrifice is worth it. But if it is worth serving the people you should have enough regard for them to explain things. Getting them to understand isn't an exercise in vocabulary building. They've got all the words they want to know. Use those and show the world how smart you really are.

Update 2013:  Dirigo Health never lived up to its original potential.  What should have been an extremely popular program was always underfunded and its availability was limited.  What could have been a roaring success, once it was put into place, was constantly undermined and always widely misunderstood.  Here is what the Maine Government website says about it today.   Unless and until the Obama administration comes down from the Ivy Tower and explains the program in language people understand, it will always be a shadow of its potential and it will always be under attack, lies about it sold to the very people who would probably like much of it, and will wither and be in danger of blowing away.   Unless you've got designated spokesmen who are trained in explaining it, selling it to real people around the country in language they can understand, its failure will be due as much to administrative arrogance as to Republican-corporate lies.