What Happened?

“What we have here is a failure to communicate.”

“The Captain” as played by Strother Martin, Cool Hand Luke, 1967

So how did we get here, Captain? How, after coming to within a millimeter of plugging the leaky ship we call health care, are we now on the verge of the vessel rolling on its side and sinking into an inky sea of name calling and recriminations?

The short answer to “what happened,” of course is Massachusetts. The searing incompetence of Martha Coakley’s senate campaign, a White House political office snoozing at the switch and the genial allure of Scott Brown in the Bay State has made for some very unpleasant mathematics in the Senate.

But more important, by January 1 the public—both in Massachusetts and nationally—had become squirmy to the idea of reforming such a large part of the national economy. While no one poll is Delphic, the sum of polling data suggested that roughly half of Americans had serious doubts about where reform was going.

Two years ago the public was overwhelmingly supportive of a major health care overhaul. A Kaiser Family Foundation/Harvard School of Public Health survey then found that 59 percent of the public supported a universal requirement for families to have insurance and for companies to supply it.

By last summer—just six month ago—public support was still high, while organizations from the American Academy of Family Physicians to labor unions to the pharmaceutical industry both supported reform and opened their checkbooks to lobby their support.

What went wrong was that the administration and the moderates and progressives in congress lost control of the communications war and ever since have been on the defensive.

There was a lot for everyone in the legislation: closing the Medicare drug “doughnut hole,” guaranteeing insurance even if you’ve lost your job and taking steps to moderate health costs. But by its very nature health reform is complex and not very sound bite friendly. The reformers message veered from “health care reform” to “health insurance reform.” No Democrat could convincingly describe how reform would save taxpayers money nor guarantee that taxes would not go up. There was no antidote to the accusation that support from Louisiana and Nebraska were paid for with special earmarks.

Meanwhile, opponents solemnly warned of socialized medicine, death panels, and gutted Medicare. The hostiles played on the understandable concern about the rising cost of government and that no one really understood how much reform would cost us.

In a politically charged environment, the simple message always trumps the complex. Isn’t that the first law of political pr?

What President Obama and his allies failed to do was to boil down reform messaging to the key points that the majority of Americans would like—that it is linked to economic survival, that it would create greater security and that many benefits, such as guaranteed coverage would start the moment the legislation was signed.

The Social Security Act is a massive, jargon-ridden document, yet everyone understands and embraces its basic elements. The President had the opportunity to position health care legislation similarly, but failed to.

Here’s good news if you believe in reform: When you divide health care reform into individual elements the public even now supports it. A Kaiser Family Foundation survey released last Friday confirms this:

“The January Kaiser Health Tracking Poll, conducted before the Massachusetts Senate vote, finds opinion is divided when it comes to the hotly debated legislation, with 42 percent supporting the proposals in the Congress, 41 percent opposing them and 16 percent withholding judgment. However, a different and more positive picture emerged when we examined the public’s awareness of, and reactions to, major provisions included in the bills…

“For example, after hearing that tax credits would be available to small businesses that want to offer coverage to their employees, 73 percent said it made them more supportive of the legislation. Sixty-seven percent said they were more supportive when they heard that the legislation included health insurance exchanges, and 63 percent felt that way after being told that people could no longer be denied coverage because of pre-existing conditions. Sixty percent were more supportive after hearing that the legislation would help close the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medicines.”

Clearly the Dems bollixed the message.

Where do we go from here? At best it will be months before a new legislative roadmap is drawn. With any luck, the administration and its allies will pair and trim the proposal in a way that will get it back on track with some Republican support. But will not have all of the elements needed to completely right our health care boat and in the meantime millions of Americans will be at risk of losing health coverage and at risk of economic ruin. Conservatives haven’t so much won as the public has lost.

(This note was published earlier this week on Jack O’Dwyer’s Web site. Thank you, Jack.)

The Worst...

The Worst Public Relations Ideas

I can’t resist highlighting some of the worst health care public ideas that have ever cross my ears. Some of these were included in proposals in which I had a hand, so I am not an innocent, snickering bystander. But some I vetoed before they were offered up to clients. Thank God.

The point is that “creativity” is not an exercise in coming up with the most outlandish gimmick, but ideas that advance brand goals. As Benton & Bowles used to say, “if it doesn’t sell, it isn’t creative.”

Can you add to this list? Let me know.

Hummers for Heroes. A large pharmaceutical company wanted recommendations for its AIDS/HIV franchise. One tactical solution, “Hummers for Heroes” was to give away Hummers, those icons of 20^th century excess, to AIDS clinical thought leaders. Just nice gifts for all their hard work. Oy. That one got nixed before the client got his eyes on it.

Skeletons Out of the Closet. We were asked to develop a proposal for launching a new anti-coagulation drug to prevent deep vein thrombosis. One of our strategy expertettes said, “Lets fill the seats at the American College of Cardiology meeting with skeletons.” Huh? She admitted the client wouldn’t agree to it, but said it would demonstrate our creativity. Okay, you’re asking what do skeletons have to do with DVT, or why would ACC allow a stunt. So did we.

Wii Rock. Holding Nintendo Wii tournaments at senior centers to raise awareness of stroke prevention and that new anti-thrombin drug. Hey, that might have been fun.

Bling. Then there was the suggestion to give Alzheimer’s disease patients specially designed jewelry. “Everyone loves a little bling,” said the VP leading the pitch. This one made it to the presentation, but the client was more interested in why we forgot to include nurses and social workers as stakeholders.

Eight is Enough. Any recommendation using Florence Henderson (beyond the first seven times she was included in a proposal).

Tune In, Drop Out. Then there was the recommendation to use Timothy Leary as a spokesman for a pharmaceutical product. No, we weren’t on acid when that one was thought up.

Public Relations 3.0?

P

ublic relations may be yet redefined in the ‘10s as the management of conversations not simply between a company or organization and its stakeholders, but the management of conversations between stakeholders. This constitutes the third step in PR’s evolution.

The early twentieth century view of public relations was not terribly audience friendly. Social scientists such Harold Lasswell, PR pioneer Edward Bernays and journalist cum commentator Walter Lippmann believed democracies should be equipped with muscular propaganda bureaus to help inform and guide the unwashed public. A good examination of this concept is found in an unlikely source, John M. Barry’s book about the 1918 influenza pandemic, The Great Influenza. According to Barry, Lippmann called “society too big, too complex” for the typical citizen, since most citizens were “mentally children or barbarians.” Under the influence of Lippmann and his acolytes, President Wilson created a Committee on Public Information to artfully guide the public’s opinion towards the Great War.

That was PR 1.0. The more enlightened view of the PR arts, which came into focus later in the twentieth century, was “the engineering of consent.” Or as the Public Relations Society of America says, PR ‘helps an organization and its publics adapt mutually to each other.” A variation on this theme that I’ve used for years is that public relations is the creation and management of dialogue between an organization and its stakeholders or audiences.

The central theme here is that public relations must encourage a company to not just communicate to audiences (whether shareholders, customers, government) but to carefully listen to what these audiences are saying about the it and factor this intelligence into both its communications and policies.

Bravo. This makes a lot of sense as far as it goes. But it doesn’t go far enough. As everyone knows, today every individual is to some extent a megaphone or cub reporter. Trust in traditional news outlets is low (just see the always thoughtful Edelman Trust Barometer reports) but faith in outside experts such as physicians or academics is high and trust in individuals “just like me” is sky high.

What this means is that PR 3.0 is not just managing dialogue between the organization and its publics, but managing dialogue between its publics. Not simply arranging for key opinion leader Dr. Jones to talk to the news media about a new treatment for high blood pressure, but fostering talk between Mrs. Smith and Miss Riley about the treatment.

This obviously isn’t easy, and many clients, such as biopharmaceutical companies, shiver at the thought of spreading seeds of dialogue that can’t be recalled or controlled. But the green sprouts of this approach are seen in buzz marketing and our cautious outreach to interested bloggers. In the future we will see more examples of encouraging consumers to “talk among themselves” such as offering disease education videos on company Web sites not just for viewers, but for viewers to pass along to a friend or relative who is interested.

In our strategic approaches to public relations planning, lets remember that we need not simply find ways to communicate our messages, but find ways to encourage others to talk about our brands to their friends, relatives and colleagues.

Sleeping Easier While Facing Pharma PR Challenges

I wrote this a year an a half ago for a public relations journal; the editor asked "what keeps you up at night. It seems as current today as when I wrote it. (I am still not sure whether this blog is going to focus on professional or personal matters; but it seems a lot safer--for now--to cover professional PR matters.

What keeps you up at night? As an agency executive practicing in the health care arena, you recognize that this is an epochal time and perhaps the first time in the brief history of marketing-oriented pharmaceutical PR that forces outside our control threaten the core of our business. How we individually and as an industry respond over the next year or two may very well determine the future growth and prosperity of pharmaceutical public relations.

Government regulation isn’t the bogyman, nor is the health care industry’s reputation. We’ve met those challenges before. The hurdles now facing us are unique and are outgrowths of a health care industry facing its own economic challenges. They include (1) increasing competition from other marketing disciplines, (2) clients’ drive for more accountability and efficiency and ironically, (3) consumers assuming more responsibility for health care decisions. Let me explain.

As everyone is aware, there is increasing pressure on advertising agencies and other communications disciplines to grow both their revenues and their margins. Faced with woes such as criticism of direct-to-consumer advertising, lack of new products to launch and skepticism about the objectivity of continuing medical education programs, ad agencies, medical education firms and others are looking at how they can create patient awareness of diseases and therapy alternatives using non-advertising channels. Their recommendations often look and feel a lot like those lodged in the public relations realm, if you accept that the main responsibility of PR is managing dialogue between a company and its publics.

One needs only to scan BrandWeek or Ad Age to see examples of advertising sidling up to social media channels such as Twitter and Facebook, tools that public relations also embraces. Ten years ago public relations agencies hoped they would control the development of Web sites. That was not to be, as very specialized agencies, often under the wing of ad agencies, seized that business sector. Could the time come when clients look to advertising agencies exclusively for social media, alliance building and loyalty management programs, relegating public relations to meat-and-potatoes media relations?

Under this scenario, public relations would not help set strategy or manage “the big picture.” This is a formula for industry commoditization, not growth.

Thinking about this, you toss fitfully, eyeing the alarm clock.

Related to the challenge coming from other disciplines is our client’s desire for accountability across each marketing engagement. We have beaten to death the observation that clients want to see greater return-on-investment. PR departments and their agencies are trying to address this; agencies in particular claim proprietary ways to measure campaign effectiveness and cost efficiency, each claiming that it has the loadstone. But until there are generally accepted industry standards for measurement, their claims will lack true stopping power. This is a lesson the advertising industry learned long ago.

Accountability also means clients are learning to be more strategic in their public relations spending. Some ask for holding company solutions, saying that they will award a global holding company their communications contracts, expecting that the brightest minds at the parent company level will manage their business. Great if you are Omnicom or WPP, not so good if you are a small independent shop. It’s also great if you have uncovered exactly how your holding company solution will offer the client greater service at less cost. But that’s not easy.

On the other extreme, clients also are recognizing that even the best agency is not best at everything, and they are parsing their business among generalist and specialty firms. So-and-so may be the agency of record, but another company that has built unique expertise in, say, reimbursement tactics will handle that job.

Many clients are zero-based budgeting their public relations accounts, saying, “never mind what we gave you last year, what is needed to do very specific tasks this year.” Starting from scratch can mean scratching for dimes.

Again, you stare at the ceiling, wondering if you can get by on just five hours sleep.

Finally, our clients recognize that economics is weighing very heavily on consumer choice. We all support greater consumer involvement with health care decision-making. However, as the price tag for wellness increases, consumer involvement will also mean sharing responsibility for the cost of care. We are already seeing insurance companies instituting multiple co-pay levels for medicines. You shell out $10.00 monthly for a generic remedy, perhaps $25.00 for one type of branded drug, and up to $45.00 for a super premium pill. Co-pays for new medications may zoom to $75.00 in the near future. As the patient pays more each month, will he or she be as receptive to traditional media placements or celebrity “endorsements?” I may adore Sally Field, but if I can get adequate treatment at a fraction of the cost of the drug she is promoting, her seal of approval will mean little to me.

Public relations—particularly health care agencies—needs to break out of its knee-jerk celebrity infatuation and focus more on the actual drivers of consumer behavior.

None of these issues need be fatal to public relations practitioners. They do mean, however, that challenges have to be addressed without business-as-usual solutions. They mean demonstrating how PR approaches communications problems in ways that smartly separate our discipline from advertising; they mean creating easily understood accountability systems and mean looking not simply at the traditional bag of PR tricks, but rather looking at what it will take to effectively convince patients and consumers to ask a question or take an action or for physicians to prescribe a brand. That’s a lot to think about but if you manage these risks, at night, you can sleep easier.

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The New Year...

So my friend Suzanne said I should start a blog. And why not? I started a family, a health care practice. This morning I started my car. What could be so daunting about a blog?

Suz said write about health care marketing, which I know a lot about. I'll try (though the recession has put me back a peg or two). My younger son said write about him. I'll try, but I'm not supposed to swear on the Web. My other son said talk about how difficult it is to live with a kid with bipolar disorder. I'll try that too, though that gets a little emotional. Politics? Sure, along with 10 billion other bloggers.

So stay tuned. We'll see what's interesting in the New Year.