Miscommunicating Health Reform

Anyone following the debate about health reform knows that the discourse has become increasingly uncivil.  While it is easy to blame those opposing the proposals being developed in Congress for this situation, supporters of the proposals have been validating their adversaires’ messages by repeating the misrepsentative labels in their rebuttals.

Specifically, critics of the overall proposal have mischaracterized a provision that would pay clinicians for discussing end of life care preferences with their patients enrolled in Medicare.  (See below for information about the provision.)  Unfortunately, in responding to these attacks, health reform supporters have repeated the false claims about the provision, (and the label “Death Panels”), and thus perpetuated the fear their opponents have created.

The problematic nature of the messaging by health reform proponents has even been highlighted by the newsamedian Jon Stewart, who noted on his Daily Show, “You know a sales pitch is in trouble when it starts with, ‘Look, you gotta trust me, we’re not going to kill your grandparents.'”

Using Campaign Strategies Against “Death Panels”
While the Administration has adopted a campaign-style strategy to support health reform, unfortunately, they haven’t also consistently applied campaign communications strategies  – particularly the rule about not naming your opponent, i.e. referring to that person as “my opponent” rather than by name, so that their name doesn’t get additional public or media exposure.  Therefore, saying “death panels” in explaining why they don’t exist  violates this rule because it helps perpetuate the label and provides the media with video of leading advocates uttering that phrase.  This perpetuates the opponents message, giving it longer and larger life, and preventing advocates from talking about the positive aspects of the proposals they support.

Power of Positive Messaging
A much better strategy is to describe the positive aspects of mischaracterized provisions without referring to the false label.  In this case, that would involve explaining that the allegedly controversial provision is an extension of – and an improvement upon – current Medicare law, and it is  designed to strengthen patient-physician relationships and communications.  (Current Medicare law* requires hospitals, nursing homes, hospice programs, home health agencies, and HMO’s to give adult individuals, at the time of admission or enrollment, information about living wills.**)  The proposed provision improves upon current law – which can be fulfilled by handing a person a stack of papers – because it would encourage clinicians to talk to their patients about their wishes involving serious medical problems BEFORE they occur.


* This part of Medicare law was created in 1990 as part of the Patient Self Determination Act –  which was included in the Omnibus Reconciliation Act of 1990.
** “Living wills” are also referred to as advanced directives or durable power of attorney for healthcare.  These documents express the individual’s preferences for certain types of health care interventions, and empower a person (or persons) to make decisions about their medical care should they be incapable of doing so themselves.


Summary of Section 1233 from HR 3200, “America’s Affordable Health Choices Act” (Full text of section available here.)

Sec. 1233. “Advance Care Planning Consultation.” Provides payment to clinicians for discussing with Medicare enrollees issues and their preferences – including the role of clinicians – related to life-sustaining treatment.  Payment will only be made for such consultations once very 5 years unless there is a significant change in the enrollees’ health. CMS will also modify the ‘Medicare & You’ handbook to incorporate information on end-of-life planning resources, and incorporate measures on advance care planning into the physician’s quality reporting initiative.

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