Names Matter: Patient Protection & Affordable Care Act versus ObamaCare

When I was studying for my MBA in marketing, I had a thoughtful professor, John Philip Jones, a career advertising agency veteran, who wrote one of the earliest books on branding: "What's in a Name". The answer, I learned, is a lot!

Case Study: The Patriot Act

"The Patriot Act", sound Constitutional? Protective? Patriotic? Simple and clear? Easy to understand? Or, does it sound of questionable Constitutionality? Takes away some of our right? Deceptive name? Too good to be true? 

"The Patriot Act", that's an easy one, a no-brainer, especially if you just got attacked on American soil ... and a major population center and national landmark city at that ... the first attack on American soil in 60 years ... you haven't really read all of the details in the actual legislation of the Patriot Act BUT it's been quickly and nearly unanimously passed by both houses of Congress, and signed by the President.












Did you know that "The Patriot Act" is a nickname? 

What if President Bush and Congress promoted "The Patriot Act" by its originally introduced to Congress name ... its real name ... as listed on the official government documents with the Library of Congress,  "Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act of 2001"? 

The law's real name is not too inspiring but it more accurately describes the law's provisions. And that could be controversial. 

Perhaps, if President Bush and Congress stuck with the original name "Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act", then then The Patriot Act would have raised the public awareness, concern, and contentious debate among Americans about its Constitutionality.

But no. President Bush and Congress  went with that new promotional name ... wrapped it in the American flag ... The Patriot Act. 

What a perfect name for a law that limits the interpretation of our rights in our Constitution's Bill of Rights! I believe that this is why President Bush and Congressional leaders knew that this law would be controversial, so they wrapped it in the American flag with the name The Patriot Act.

I do not intend here to condemn or assert opinion about The Patriot Act. It's just an example highlighting the importance of law's name. Government leaders select a name for bills that will build awareness and support or suppress opposition and inquiry. 

Here are some other examples: A name like Patriot Act is quite different from a name like Medicare or Gulf of Tonkin Resolution. It's more like Social Security or American Recovery & Reinvestment Act.

Be aware: Every major legislation, especially those that are cornerstones or controversial, are carefully named to establish them as cornerstones and influence the controversy.

Case in Point: The Patient Protection & Affordable Care Act vs Obamacare


... now ... as the American Health Care Marketplace and our feelings about economic security are changing ...















Please, close your eyes and Picture Patient Protection & Affordable Care Act and tell me ... tell yourself ... what this name is trying to say.

... clear your palette ...  

Please, Picture Obamacare and then tell me out loud what this name is trying to say. 

... clear your palette ...

Match these words and phrases to either the name -- Patient Protection & Affordable Care Act or Obamacare: 

• Government run

• No waiting period for pre-existing conditions

• Partisan, political

• No lifetime maximum on coverage

• Selfish

• Premiums prices don't go up so much

• Regulations

• Legitimately, as in passed by Congress, signed into law by President, affirmed by Supreme Court

• Not legitimate, Unconstitutional

• Social safety net, like Medicare and Social Security

• Temporary, political

• Permanent, enduring

• Something I want

• Something more I have to do, tolerate

• Fair, consistent with our rights as citizens

• Unfair, tramples our rights as citizens

• American democracy in action

• American government dictatorship, not democracy

• Good

• Bad

• Right

• Wrong

• I'm for it

• I'm against it

By now you must be getting my point. If not then read "Words that Work" by Frank Luntz because political consultants have been driving the talking points ... and names of Congressional and stat legislative bills since at least the early 1990's. 

The decision by Republicans to label the Patient Protection & Affordable Care Act as Obamacare as a purposeful, pejorative. Republicans and Democrats even argued about whether the term Obamacare could be used communications sent (free) through Congressional franking privilege. And, the bipartisan Franking Commission ruled that Republicans could NOT use it in franked mail. 

Republicans taunted Democrats, daring them to promote the Patient Protection & Affordable Care Act as Obamacare. But most Congressional Democrats saw this for what it is, and opposed its use. Unfortunately, after a while, President Obama adopted the label, perhaps he thought by giving it the context that "Obama cares" he could derail, if not hijack and redirect, the Republican initiative. 

It looks like the Republicans have been successful in getting most media and citizens to adopt the Obamacare label. Democrats fought and won the backstage franking battle but have not fought for the widespread adoption of Patient Protection & Affordable Care Act ... a consequential missed opportunity.

"A rose by another name" ... Kentucky presents an interesting example

Kentucky set up its own exchange for the Patient Protection & Affordable Care Act BUT DID NOT NAME IT anything similar to the PPACA or Obamacare. Instead, they named it with a local, statewide program name of Kynect (sounds like connect) ... and it's been very, very popular!!

News reports that Kentucky residents love Obamacare ... the Patient Protection & Affordable Care Act ... by another name. This rose by another name appears to smell even sweeter.

Nearly 20% ... one out of five ... uninsured Kentucky residents have already signed up for it and, among them, 40% of the enrolled residents are in the highly desireable young and healthy demographic group!!

Names matter. Evaluate the Patient Protection & Affordability Act with this in mind.

Republican Governors' Hippocracy on ObamaCare Medicaid Expansion

In total, only 12 of the 27 Republican state governors have outright rejected any form of participating in an ObamaCare approved Medicaid expansion. That means that 15 of the 27 either have committed to participation or remain undecided.

Specifically, accoding to research by The Advisory Board (30-year consulting company):

Fully 11 of the 27 Republican governors deciding to take ObamaCare's additional Medicaid federal funds and 4 are undecided officially at this point.

Of these 11 Republican governors who definitely will participate in the program, 8 plan to participate with the Medicaid expansion program as-is and 3 support some alternative versions of the plan specifics (which is permitted under ObamaCare if approved by CMS). 

Why ObamaCare Makes Sense: Some Different Facts About the Affordable Care Act

I support ObamaCare -- the Affordable Care Act -- because it reduces health care spending without reducing actual patient care and it provides health insurance coverage to include more than 30-million more Americans so that we near universal health insurance coverage. 

My support for ObamaCare is not ideological, it's practical. "This is not personal; it's business." And, healthcare reform clearly is an urgent priority. 

We all agree that the United States spends the largest share of the largest economy in the world on healthcare ... even more than other members of the Organization of Economic Cooperation and Development, a group of developed industrialized nations of which U.S. is a member. More than 10% of American citizens and permanent residents are uninsured.



(Above graphs compare U.S. healthcare spending versus the complete Organization for Economic Cooperation and Development ... of which the U.S. is a member)

Uncompensated Care: Health care for the uninsured and under-insured.


Currently, we pay for the health care of the non-insured and under-insured in our own higher health insurance premiums due to charity care at hospital emergency rooms and lost economic productivity.

In it's healthcare reporting, JustFacts.com : Uncompensated care spending amounted to 6% of hospitals' 2009 total costs. The U.S. Federal Reserve Bank estimated that, in a 2003 bulletin "Overview of Consumer Data and Credit Reporting", that 52% of all collections by agencies and creditors was for healthcare bills.

The 2008 Kaiser Family Foundation (www.kff.org) study "Covering the Uninsured: Key Facts" estimates spending on the uninsured was $57.4-billion -- of which $42.9-billion (or 75%) was paid by federal and state funds, mainly through Medicaid payments to hospitals, and that $14.5-billion (or 25%) was paid by private funds, mainly  physicians and hospitals, and that this $14.5-billion represented nearly 2% of the $829.9-billion spent by insurance plans. 

McKinsey & Company, a major consulting firm as published several research articles on the health care trends and technologies -- here now and emergent -- that support the premises of the Affordable Care Act on continual, significant cost savings through productivity and outcome savings. 

Industry association America's Health Insurance Plans (AHIP) reports that "A 2009 study by Families USA (a health care consumer group) found that uncompensated care costs in 2008 imposed a "hidden tax" on family health coverage of $1,017 (per family)."

The 2009 study goes on to say: "As more people join the ranks of the uninsured, the hidden health tax is growing,' said Ron Pollack, Executive Director of Families USA. “That tax hits America’s businesses and insured families hard in the pocketbook, and they therefore have a clear financial stake in expanding health coverage as part of health reform.”

Together, the point might be made that we already pay for uncompensated care -- health care for the uninsured -- through higher taxes and insurance premiums. Also, the current spending on health care for the uninsured is not cost-effective (inefficient) because it's so heavily weighted on hospital use for primary care and late-stage care for undetected & untreated care.

ObamaCare is not a government take-over of our health care system.

The Affordable Care Act actually is a boon to private insurance companies -- in terms of the numbers of paying insureds and in terms of more efficient application of the basic premise of insurance: Based on the statistical Law of Large Numbers, many people pay premiums so that those among them who happen to need expensive treatment will be able to afford it.

The Basic Premise of Insurance in Health Insurance.

During the Great Depression of the 1930's, physicians and hospitals suffered, as did American families, because most people could not afford to pay out-of-pocket for sick care treatments ... because of the depression. So, Blue Cross and Blue Shield were born: Originally, one for physician insurance and the other for hospital insurance. 

However, a comprehensive insurance system like the Affordable Care Act has to work fully in order to work efficiently ... as soon as possible. 

       

I question why the Obama Administration continually issues waivers and delays implementation of the Affordable Care Act. And this is the central issue of this post. 

Comparison of Implementation Time for ObamaCare vs. Y2K

Compare the ObamaCare situation to the challenge presented by Y2K -- just 15 years ago. every company had to change the dates part of every software from a 2-digit year to a 4-digit year by the year 2000 because, during the 1960's and 1970's, in order to be minimize development costs, software was programmed to accept the last 2 digits of the year and start again at 1900 ("00") after 1999 ("99"). Government feared nuclear launch glitches and companies feared erasing of all their records since 1900!!

Updating for Y2K became a high-profile only 2 years prior to the big day!! The big software investments and rush to prepare for Y2K began in earnest in 1998. 

                                                  

Changing the software for nearly every computer in America (perhaps the world) was achieved in just 2 years!!!!!!!!!!!!! 

Health insurers and employers have had 3-4 years to prepare software and decisions for implementation the Affordable Care Act ... Obamacare ... yet all businesses, worldwide, had 2 years to prepare software for Y2K. Even the governments, like our Defense Department, raised the Y2K issue in 1998 and their 1999 budget requests.    

The Y2K "bug" was a huge issue and challenge!! It dominated the news from 1998-2000. Jobs and spending to repair-prepare legacy systems directly boosted the economy. For example, even supermarkets, like Whole Foods, spent a fortune on it.

So why has 3+ years for health insurers and employers not been enough time for simple, available software programs to be implemented for Affordable Care Act ... Obamacare ... ??

Think about it. Personal health records and physician-hospital-insurer-employer electronic medical records (EMS software) have been around ... and booming businesses for several years!!! 

Healthcare providers have been living with the federal mandate to implement electronic medical records.

Since 2011, the federal government also has imposed penalties as of 2014 but also immediately offered financial incentives ... up to $44,000 for a family medical practice ... to help the millions of physician practices afford to implement "significant use" of electronic medical records EMR.

So what's the real problem?



My opinion

Rescind all of the waivers. The Affordable Care Act ... Obamacare ... should continue to implement as enacted.

by Steve Reichenstein