Activating the Rural Voice on Health Care Reform

April 1, 2009 – Lyons, NebraskaPresented by Herndon Alliance

* develop strong rural messaging

* activate the rural voice

* connect with the public, media, policy makers

* help define the system change/health reform debate

* help move health reform

Historically, opponents to health reform have had more success communicating with the public than proponents.

“Good communication requires conviction and authenticity;

being a walking dictionary is optional.”

Drilling for Oil

Responsible Energy Exploration

Connecting on health reform?

Almost 50 million people are uninsured; but 95% of the voting public is insured.

People think about health care through a very personal prism.

Best way to connect: through values + beliefs

Values on health care

Personal—affordable, sustainableChoice + control—doctor/patient

relationship, qualityPeace of mind + securityPersonal + shared responsibility

Barriers that stop the conversation

Higher costs, lower quality (scarcity)Economic downturnPerceived lack of responsibility and/or

fairnessCynicism for government & bureaucracyFear of losing what you have

Words that Work

Our Old Words

Quality affordable health care

American solutions

Choice of public or private

Choice and control

Security and peace of mind

Fair rules

Universal health care

Canadian style health care

Medicare for All

Competition

Government health care for all

Regulations

Sliding scale

Prevention

Guaranteed

Government as watchdog

Affordable health plans

Smart investment in the future

Free

Wellness

Required

Public/Government health care

Basic health care

Inexpensive

Words that Work

Our Old Words

It’s not just words. . .

Start the conversation where people are

Values + beliefs outweigh facts

Anger motivates us—fear shuts us down

Proactive positive messages that:•Build on high-order themes•Create a unified voice•Point to a narrative of a better future

Health care reform BIG themes

My budget

My family

My health

My job

Peace of mind

What about me?

People will agree that “other people” should have health care, but real support is always weighed against personal impact.

Messaging: personal

“It’s not right that hard-working American families are struggling to afford health care. People shouldn’t have to choose between filling a prescription or filling up at the gas station. Our leaders need to make health care more affordable for everyone before our costs rise even higher.”

A core American value, helps make the case for guaranteed health care and system change

Basic human right

Fairness

Personal + shared responsibility

We are all in this together.

Responsibility

Public leaders set and enforce fair rules, but do not “provide” the service.

Government as Watchdog + Guardian

Health is a basic component. The flaws of the health care system are a basic economic obstacle to:

Providing for my family

Affording our own home

Putting our kids through college

Starting my own business

American Dream

Opportunities + Challenges

A 2009 Kaiser Family Foundation tracking poll, states

that 38% of Americans think they will be better off if major health reform legislation is enacted. According to Drew Altman, CEO of the Foundation, if that number goes up, we will win health reform. If that number stays stagnant or goes down, we will not.

We need good answers to the question what will health care reform do for me?

In talking about health care reform and system change, message around the value of reform for the

insured + underinsured + uninsured

Messaging:Value of reform for the

insured + underinsured + uninsured

Affordable choices you can count on

If you like your health care—you can keep it

No more insurance company abuses

Supporting your doctor + you We can’t afford to wait

Challenging issues can be opportunities too!

Cost of Doing Nothing

System Change

Government Role

Choice of a Public Health Insurance Plan

Powerful CODN arguments

Wages stagnant Costs rising Insurance company CEO’s make in a day

what working people make in a year

Remember— Understand the ‘macro’ but feel the

‘personal’ and speak about health reform as part of our economic recovery/protection (affordability)

Messaging:CODN (1)

Health care is the top personal economic issue facing Americans. The majority of voters feel the economic challenges facing us make it urgent to reform health care.

Messaging:CODN (2)

Unsustainable. . . projections for what will happen to the cost of health care are motivators for change NOW.

Nebraska data

$4,445 - Cost per uninsured today Poor health and shorter life $ .75 B lost/yr (to the state economy) 1.29% as a share of GDP

ESI 2006-2016 $10,777/family to $22,975/family 22% to 42% of average family income Average deductible in NE will increase

about 38% between 2006 ($1,325) and 2016 ($2,120)

New America Foundation, 2008

Messaging:CODN (3)

Voters angry with greedy profits of insurance companies + CEO salaries.

System change: research findings

Widespread support for health system change—69% of voters want either a complete overhaul or major reform

Voters think about system change in personal terms

and consider how change will affect their relationship with their doctor—crucial to connect on system change in personal ways

We win the system change/ cost control/ improved efficiency/ comparative effectiveness arguments, even against potent attacks of ‘big government’ and ‘interfering with the doctor-patient relationship’

However, when these attacks don’t have push back voters do begin to develop doubts

How ‘insiders’ talk about system change

System is inefficient System is costly• System needs to improve quality outcomes System doesn’t have enough primary doctors System is inequitable (ex: rural vs. urban) 16-17% of GDP - huge concentrated industry System is unsustainable for the American economy System needs to align incentives System needs to remove waste System needs updated health information

technology

How ‘voters’ talk about system change—

through a personal lens

Health care is good if: • I have choice of doctors and plans• My doctor can do what is right for me• I can afford my health care• I can see my doctor when I need to

Any changes to the system should:• Help my doctors do their job and support

them in providing the best care for me• Simplify the system for both my doctors +

me

Americans want reform that brings about:

the best care for them + cost containment + affordable access

81% of voters are dissatisfied with the rising costs of their health care. 62% are concerned that all people have access to affordable care. We must not separate these system change issues.

System change supported by the public

• Payment reform • Reward doctors for providing quality care• Encourage prevention—provide incentives for people

to actively manage their health before they get sick• Allow professionals, other than doctors, to provide

more care to both free up doctors and help control costs

• Modernize the system with health information technology

• Institute comparative effectiveness reforms but without data replacing their doctor’s judgment

• Control overuse of the system

Messaging: system change

Greatest dissatisfaction among voters is with the rising costs of health care; want to contain costs while improving quality.

Farm and ranch familiesstruggle with health care costs

Often forced to buy insurance on the individual, non-group market—spending twice as much as group market ($11,200 vs. $5,600)

36% of farm and ranch families buy on the open market vs. 8% of American public

Spend more, coverage less

Threatens stability of family, viability of their business, the strength of the rural economy, and our nation’s rural heritage.

Robert Wood Johnson Foundation/Access Project, 2007

Opposition messaging on system change

The most effective opposition messages are ones that connect system change with interfering in the patient/doctor relationship and the quality of care we receive. We continue to win support, but we should be prepared with effective responses to the opposition.

Example of opposition message

“Forcing doctors to accept government mandated guidelines about treatments means putting government bureaucrats in charge of our health care, not our doctor. And pushing care down to lower level providers like nurses means we’ll get lower quality care from people with less training. This isn’t reform it’s a government takeover that will hurt patient care.”

Biggest challenge . . . . Positive role for government and a choice of a ‘public’ health insurance plan.

Messaging: positive role for government

Set and enforce fair rulesBe a watchdog

Government role under attack

Bureaucrats will decide your health care

Big government will get between you + your doctor

Evidence based care is centralized decision-making (un-American)

Public health insurance plan

Private choices only—15%

Public choice only—9%

Public and Private choices—73%

Messaging:choice of a public health

insurance planVoters want itChoicesGuaranteed back-upOn the side of small business, farmers,

and sole proprietorsIt already is working in 30 statesA 75-year old smokescreenA competitive market—increased

competition

Define positive role andpublic plan debate

The best defense is a good offense— proactive

Stay at a high level + avoid getting into details*

On side of voter

*Avoid getting into the details— DO NOT get sucked into debating the details of reform.

Avoid policy details and speak in the language of the kitchen table. Aim your messaging for the heart, not the head. If your message is not emotionally compelling, start again.

Kitchen table talk Relate health reform to the everyday life

of real people. How will it benefit the person in front of you? Will they have choice, affordability, peace of mind? Acknowledge they are hardworking and create jobs for others. Messenger: farmer, small business voice.

We all benefit from the rural voice setting a higher frame

and/or rebutting attacksVision—the ‘value of reform’ from a rural

perspective

Fairness—need standards so all are treated fairly and with dignity

Real choices—importance of both public and private plans

Sustainability—improve the care people get AND control the costs

Questions & Commentswww.herndonalliance.org

sherry@herndonalliance.org

Messaging: personal

“It’s not right that hard-working American families are struggling to afford health care. People shouldn’t have to choose between filling a prescription or filling up at the gas station. Our leaders need to make health care more affordable for everyone before our costs rise even higher.”

Messaging:fairness

“Real reform means putting Americans back in control of their health care. We need better oversight and sensible rules to make sure that insurance companies provide fair and affordable coverage.”

Messaging: responsibility

“We need to make health care more affordable for everyone, and everyone needs to pay their fair share. We need solutions that work for families and businesses alike. But the insurance companies and the drug industry must be part of the solution—putting the well-being of patients before their skyrocketing profits.”

Messaging:government as watchdog

“We need leaders willing to take on insurance companies, by setting clear, high standards for what’s covered, preventing them from requiring patients to jump through hoops just to get insured, and saving billions by cutting administrative costs and moving to electronic medical records. If we stopped wasting doctors’ time with paperwork, they’d have more time for us and we wouldn’t have to worry about overloading our system.”

Messaging: American dream

“It’s time we got America back on track. And one of the best ways to help our economy is to fix our broken health care system. Making health care more affordable would put money back in our pockets so that we can send our kids to college or start that family business we’ve always dreamed about—that’s what America stands for.”

“When Wall Street collapsed, taxpayers footed a $700 billion bailout. But Main Street is hurting too. America’s working families are struggling to pay skyrocketing health care costs and premiums. Too many of us can no longer afford or have been denied coverage. Our economic recovery is tied to fixing our broken health system.”

Messaging:CODN (1)

“Our health care system is broken. America’s working families are struggling to pay skyrocketing health care costs. Too many of us either can no longer afford or have been denied coverage. The number of uninsured Americans keeps rising. And the staggering amount—$56 billion annually— of uncompensated care to the uninsured just increases the cost of health care and premiums for all of us. The current path is unsustainable and we’re all paying the price—we have to fix this problem now.”

Messaging:CODN (2)

Messaging:CODN (3)

“Main Street is hurting. America’s working families are struggling to pay skyrocketing health care costs and premiums, while their wages remain stagnant and their health benefits sliced. Too many of us can no longer afford or have been denied coverage. Meanwhile, the CEO of United Health Insurance was paid more than $350 Million in a single year and the industry’s profits keep soaring. Now is the time to stop the greed and take care of the health of all of us, not just the profits of insurance companies.”

Messaging: system change

“We need to make sure doctors have access to the latest research that compares the effectiveness of different treatments, such as comparing which drugs work best. This will help doctors and patients make more informed choices, rather than risk our receiving less effective treatments.”

Messaging: positive role for government

“Hardworking Americans need protection from insurance companies that increasingly deny us coverage for pre-existing conditions, change policies at whim, and raise our premiums whenever they want. We need an independent voice that is on our side, sets and enforces rules that are fair to our families, as well as businesses. We need a tough, fair and independent watchdog on our side.”

Messaging: public health insurance plan option

“It’s just wrong for people who work hard and pay taxes to go without affordable, quality health care. Too many middle class Americans are struggling to afford health care they can count on for themselves and their families. We need a public health insurance option as a guaranteed backup that will always be there to ensure quality affordable health care coverage is available no matter what happens. It would give millions of hard-working families peace of mind.”

Messaging:small business

“Small businesses are struggling with rising health care costs. That's a serious problem for all of us, because small businesses are the engine of job creation in America.”

“We’re strangling small businesses and American ingenuity, as people stay in so called “safe” jobs that have health care rather than doing what Americans have always done—start a business with a little capital, a lot of elbow grease, and a good idea.”

Messaging:small business

“We need tax breaks for small business to help them with health care costs. Tax breaks will lighten their load so they can get back to what they do best…create jobs in our hometowns.”

“Our health care crisis is bad for the economy and cripples the American dream of owning your own business. The success or failure of a business should depend on innovation and hard work – not the cost of health insurance.”