Saturday, February 15, 2014
ObamaCare: Narratives, Anecdotes, Horror Stories
Persons attempting to find a motive in this narrative will be persecuted; persons attempting to find a moral will be banned; persons to find a plot will be shot.
Mark Twain (1835-1910), The Adventures of HuckleBerry Finn
Whether ObamaCare succeeds or fails will depend on who can tell the best narrative, anecdote, or horror story on President Obama's "monumental achievement" – the administration or its critics.
Challenging Narrative To Tell
Putting together the best narrative is challenging. Drew Altman, head of the Kaiser Family Foundation notes that ObamaCare have sought to impose noble principles of social injustice, i.e., covering 15% of the uninsured, onto 85% of the insured. The imposition of these principles involves transfer payments, redistribution of wealth from Have’s to Have-Not’s, and leveling of government subsidies and social benefits with Have-Not winners and Have losers.
These two groups respond differently to different narratives These differences have created confusion because the uninsured and insured differ in their wants and needs.
No Single Narrative Works
In any case, no single narrative clearly explains the diverse interplay between the uninsured and insured, between those who pay and those who receive government subsidies, and between private businesses and individuals who must figure out how deductions, co-payments, adverse selection, and the death spiral interrelate.
President Obama Ineffective at Telling the Tale
President Obama has not been effective at telling the story or laying out the goals of ObamaCare , or interweaving the threads of the narrative. His constant improvisation and changing of ObamaCare rules to protect his fellow Democrats up for election in 2014 has not helped. Doing this on an ad lib basis, ignoring public disapproval, then rewriting the rules has added to the confusion.
Somewhere Along the Way
Somewhere along the way the intent of ObamaCare has gotten lost, that it is a social program to cover the uninsured, to give states help those with low and moderate income to purchase coverage, and to prevent insurers from denying coverage to those with pre-existing conditions (which includes about ½ of the American adult population). It’s a complicated narrative.
How Do You Tell the Story?
You tell it by telling personal anecdotes. Anecdotes are much easier to understand than policy debates.
There are anecdotes on both sides of the political aisle.
So far negative anecdotes on the affect of broken and deceptive Obama promises and negative consequences have gotten most of the attention in the media - “sticker shock” premiums and deductibles, inability to find a doctor, or one that will accept you, cancelled policies for cancer victims in the middle of their therapy being forced to find a new doctor, only to discover the best hospital to treat your disease is off limits for your insurance, or that healthcare.gov is not helpful or incomprehensible- adds salt on the wound of the botched narratives.
The Obama administration is fighting back with positive anecdotes about the poor and the near poor suddenly having affordable insurance, uninsured sick patients being saved by ObamaCare-approved health exchange policies, surges of IT experts making quick fixes of healthcare.gov and so forth. Peter Lee, the chief executive of CoveredCalifornia, California’s health exchange, has called these efforts “Salvation by anecdotes.”
Anecdotes Not Going Away
Anecdotes will not go away. The Hotair.com website has a campaign with this message “Tell us your ObamaCare story. What worries you about the ACA? How has your health been affected? How would you change the health system?” CBS News reports the White House is soliciting feel-good stories about ObamaCare’s benefits on its website. Politico reports the Obama administration is seeking to “flip the narrative” from negative to positive. Drew Altman, head of the Kaiser Family Foundation, and others say conservatives and the media at large, are preaching the gospel of “death by anecdote” or “death by a thousand cuts.” Sarah Kliff of the Washington Post talks belittlingly of the “Battle of Anecdotes.” Dana Millbank of that same paper scorns “Governing by Anecdote." Democratic strategist., Steve McMahon, observes “The bogeyman stories always seem to punch through.”
Anecdotes Add “Artistic Verisimilitude” to Narrative
If this anecdotal assault continues much longer, we will sooner or later be in our anecdotage, telling our grandchildren what ObamaCare was all about. But perhaps not, anecdotes tell compelling stories. Sir William Gilbert (1836-1911), author of Mikada, says anecdotes tell to the narrative of life anecdotes by adding add “corroborative detail, intended to give artistic verisimilitude to otherwise bald and unconvincing narrative.” I couldn’t have said it better myself.
Tweet: To many the overall ObamaCare narrative, its reason for being and continuing, has been unconvincing and is better told through personal anecdotes.
Posted by Richard L. Reece, MD at 2:17 PM
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