On the passing of Geroge McGovern---

The 1972 campaign, quixotic as it was, taught me the skills to be a reasonably decent public relations guy, and for that, coupled with the idealism of the age, a bevy of still close friends, and many, many memories make me to grateful to this iconic American leader.

Governor Romney on Health Care

Romney comments on his version of health reform in last week’s New England Journal of Medicine. 

http://www.nejm.org/doi/full/10.1056/NEJMp1211516?query=TOC.    Physicians must be disappointed he’s so facile, like he’s talking to an American Legion post.

Lots has been written generally about the Romney-Ryan jihad against the Affordable Care Act, but what is offered in its stead?  A lot, actually, if you visit the Romney website (http://www.mittromney.com/issues/health-care).   The problem is, most of his proposals nip around the edges of what’s needed in health care reform,  and only offer decades-old Republican chestnuts that will not cut costs and do nothing to lend a hand to the millions of Americans, around 47 million it seems, that do not have access to health plans.

Here’s what in the Romney toolkit, with,  of course, comments by moi.

•    Block grant Medicaid and other payments to states—

      Block grants surely mean rationing. I thought Republicans hated that. 

       

•    Limit federal standards and requirements on both private insurance and Medicaid coverage—

      Doesn’t this mean “race to the bottom?”  If the government does not establish standards, insurance

      companies are free to establish restrictive policies and coverage that wouldn’t include Band-Aids.

•    Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies

To date exchanges haven’t been very successful where they have been tried.  Just what do they have in mind when they talk about public-private partnerships?   Would these be any cheaper and more effective than the current system?

•    Ensure flexibility to help the chronically ill, including high-risk pools, reinsurance, and risk adjustment

Guys, it’s pretty well established that high-risk pools have not worked.   One can participate, but the costs are extraordinary.  How is this helpful?

•    Offer innovation grants to explore non-litigation alternatives to dispute resolution

Who is this helping?  Certainly not patients.   But fine, let’s see the meat on the bones of this old GOP principle.

•    Cap non-economic damages in medical malpractice lawsuits

Same as above.

•    Empower individuals and small businesses to form purchasing pools

This actually isn’t a bad idea.   There’s no reason organizations cannot do this now.  What Romney needs to do, however, is demonstrate how he’d be willing to actually encourage purchasing pools.   And what they’d cost.

•    Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage

Well, duh.  This is one of the central goals of the ACA.   Glad to know the Reps are on board.   The problem of course, is that if the ACA is repealed, Congress would be glaceriously slow in adding a benefit such as this to whatever bill they try to replace the ACA with.   It may be years before this common-sense provision is restored.   Further, the good governor means to cover people who have previously enjoyed insurance.  If you haven’t for a time, tough luck.

•    Facilitate IT interoperability.

Sure.  Why not?   Everyone in on board with this.

•    End tax discrimination against the individual purchase of insurance

I drink to this.   But would the COST of such coverage be unavoidably high?

•    Allow consumers to purchase insurance across state lines

What is it about state lines that enamors the GOP?   Will it mean that insurance companies will relocate to states with the least restrictive laws for them?

•    Unshackle HSAs by allowing funds to be used for insurance premiums

I thought we weren’t going to talk about “shackles” anymore?    In any event, how does this save money for the consumer and the health care system?

•    Promote "co-insurance" products

Okay, I give up.   What are these?

•    Promote alternatives to "fee for service"

Fine and dandy.   But the ACA makes very specific recommendations in its 2,000 pages about how this is to be accomplished.   Is Romney going to throw out what’s already in place, replacing it with who-knows-what?

·   Encourage "Consumer Reports"-type ratings of alternative insurance plans

Why not rating all health plans.    Oh, doesn’t Consumer Reports and other organizations already do this?

Repealing Obama Care. A Few Questions First

A Few Questions Re “Repealing Obama Care”

When Mitt Romney says that he will “repeal Obamacare in his first day in office,” do folks realize that he’d be throwing out item after item that the largest percentage of Americans support and that positively impact their lives?  

Would older people happily return to “the donut hole,” that would cost many of them up to $1,500 a year in added drug costs?  

Are kids and their parents willing to toss overboard the provision allowing adult children to remain on their parents’ health plan until age 26?   

People who have diabetes, cancer, who have suffered heard attacks or who are infected with HIV, are they receptive to allowing insurance companies to preclude them because of their “prior conditions?” 

Finally, the Act helps drive down costs—which Republicans and everyone else should embrace—through prevention programs and better understanding of health outcomes.   All in favor of losing that raise their hand.

Republicans say that they will reinstate portions of the Act that they don’t find objectionable—such as prohibiting exclusion due to existing conditions.   But health reform took the two years to enact (or decades, depending on how polemic you want to be).  Is there any assurance that the Reps could reinstate the goodies anytime soon?  Not likely.

Organized Medicine and The Affordable Care Act

Organized Medicine and The Affordable Care Act

Thursday Daniel Henninger, editorial writer for The Wall Street Journal wrote that doctors will be the losers with the Affordable Care Act.   Further, “The Affordable Care Act will damage that most crucial of all life relationships, that between an ill person and his physician.”

Hold on, Dan; not so fast.   Sure the Act is imperfect.  But if it is so deleterious to that crucial relationship, why is it that major medical societies have applauded the Supreme Court’s ruling?

Here’s a sampling of opinions by some of the nation’s top physician organizations:

Robert Block, MD, president of The American Academy of Pediatrics (AAP), said in a statement:

“Today, the Supreme Court upheld a law that invests in children’s health from the ground up.”    

“The Academy endorsed the Affordable Care Act because it addresses the same ‘A-B-C’ goals that are entrenched in our mission and in our 82 years of child health Advocacy: providing all children in this country with access to health care services, age-appropriate Benefits to meet their unique needs, and high-quality, affordable health care Coverage.”

Notes the American College of Physicians:

“The Supreme Court’s decision to uphold the Affordable Care Act (ACA) in its entirety is a victory for improving health care for all Americans.” 

“While the American College of Physicians (ACP) did not take a position on the constitutional issues before the court, we believe that the individual insurance mandate, combined with the ACA’s subsidies to buy qualified coverage through state marketplaces (exchanges), Medicaid expansion to more low-income persons, and consumer protections against insurance practices that deny or limit coverage, are the most effective ways to expand coverage to nearly all Americans. We are pleased that the Supreme Court’s ruling resolves the legal questions so that these and other reforms can go forward.

The American College of Cardiology’s president William Zoghbi, MD, wade in: 



“Now that the long-awaited Supreme Court decision on the Affordable Care Act is behind us, we can continue down the path to health care reform… “The ACC favors provisions in the law that support preventive care, access to care, elimination of waste, and a payment system that encourages quality. Hard work remains ahead before we arrive at a sustainable payment system that emphasizes value and a strong patient-doctor relationship.”
 

Said the American Academy of Family Physicians:

“By upholding the Affordable Care Act, the Supreme Court has ensured that Americans have access to affordable, sustainable health care coverage and that they receive high quality, coordinated and efficient care based on primary care. It is a future that family physicians happily anticipate.”

Women’s doctors also gave thumbs up:

“The American Congress of Obstetricians and Gynecologists (ACOG) applauds the US Supreme Court’s ruling today that affirms the constitutionality of the Patient Protection and Affordable Care Act (ACA)… “The Affordable Care Act helps ensure all Americans have access to affordable coverage with important consumer protections and benefits, including comprehensive maternity coverage and well-woman care,” said ACOG President James T. Breeden, MD. “We urge all states to act swiftly to implement these important access and coverage guarantees.”

The American Medical Association, which long ago fought tooth and nail again Medicare, also added its stamp of approval to the ACA:

“This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents' health insurance policies. The expanded health care coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive. The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans. 

It would have been useful if organized medicine had been more vocal over the past two years when willful misinformation about the ACA was as common as smog.   But at least now they are affirming their support.  Better late than never.

Michael Durand

Judging PRSSA

I had the privilege this weekend to be a judge in the Public Relations Society of America’s Bateman Case Study Competition, which is a annual contest judging programs developed by undergraduate public relations students from around the country.  Each participating university team is given a PR “problem” (usual a public service issue) and asked to develop and implement a campaign to address it.

I’ve got to say that while program quality varied, overall, the caliber of the student programs was super.  Many resembled professional social marketing campaigns such as Chicago’s 5,4,3,2,1 obesity campaign but several teams took really unique approaches.  One team identified the problem as physicians’ reluctance to talk to kids about their weight (a really great insight) and focused solely on physician education, including direct detailing of doctors.   Another team, from LSU not surprisingly, created a program steeped in the argot of Cajun culture that knocked my  socks off.   It was really great to see the energy, analytical skills and creativity of undergraduate public relations students.  They could hold their own in graduate classes any day!

Winners won’t be announced for a few months.

Michael

Why I love PR...

Earlier today I helped judge public relations campaigns for a major chapter of a major marketing communications association.   The quality of the entries I judged (I won’t say what category!) was better than in years past and several of the campaigns were outright brilliant.

However, not naming names, one campaign, bothered me so much that I thought it was close to PR malpractice.   The strategy and execution on this campaign were terrific, but when it came to reporting out the media results, my jaw simply dropped and I kept muttering, “this can’t be, this can’t be.”    The entry reported 11 million placements from Road Runner, 17 million on USAToday.com, 1.865 million placements from KSL.com and a herculean 150 million placements from Yahoo.

I know measurement of public relations results is a trick business, but come on, half the US population did not read an article about this campaign via Yahoo.

But it gets better.

To the right of the “circulation figures,” were reported “Publicity Values,” apparently the monetary value of the placements.   Without explaining their rationale, the authors reported the above-mentioned Yahoo article was worth $28,000 and the USAToday.com placement commanded a sticker-shocking $1 million.   The poor old KSL.com placement was worth only $230.73.  

Oh, six million impressions from CBS.com were worth $29.74.   I checked that twice.

So what the hell gives here?   Did the managing director, who signed the entry, not pay attention?  Does the agency think its clients won’t notice?  Or do they actually believe this garbage?   Public relations has a hard enough time managing credibility.  It doesn’t need to be subverted from the inside.