Tuesday, February 11, 2014

All in the Family

Even the best of families have skeletons: the uncle who had some shady business dealings, the cousin in drug rehab, brother with the messy divorce and custody fight, or the adult kids who are maxed out on their credit and behind in their mortgage payments but have to “keep up appearances” with their expensive suburban lifestyle.  When these things happen, there is a tendency to “keep it all in the family” –that is, don’t talk about things that might be embarrassing, because above all else, you have to keep up the image that all is fine and well. 

This especially is true if the family already feels it is under attack by others in the community that have made it clear that they don’t like them and don’t want them to succeed—so the last thing the family wants to do is add fuel to the fire.  It is true of historically persecuted ethnic groups: my Irish grandmother didn’t want anything bad said about the Irish (and her own immigrant family and believe me, there were plenty of skeletons in my ancestors’ closets!), because there were enough people already who wanted to keep the Irish down. 

And of course, there are things one shouldn’t talk about, because they are private and not anyone else’s business. 

All of this makes sense, except when it comes to things that are going to come out anyway, or are already well known—in those cases, denying reality isn’t going to help your case.

I may be stretching the analogy, but I think that is what is going on with many liberal (or progressive or just pragmatic) supporters of the Affordable Care Act.  They know that not everything is going well.  They know that not everyone is going to come out ahead.   They know not everyone can keep their own health plan.  They know that no one (not even the president of the United States) can guarantee that your own physician will be included in your new health plan.  They know some people will pay more for coverage. They know that there still are problems with the federal enrollment website.

But they don’t want to acknowledge these or other potential ACA shortcomings, because they don’t want to give away anything that opponents will use to help make the case that it isn’t working.  So they will talk among themselves about things that aren’t going so well with Obamacare—but not in public, everything must be kept inside the family of ACA supporters.

I understand the sentiment, because ACP supports the ACA, and we want to help ensure that it succeeds, not undermine it by saying critical things about it. 

But when the ACA’s progressive supporters aren’t willing to acknowledge problems and unintended shortcomings, they can come across as having a blind-eye to the legitimate problems some people are having.  It doesn’t help the ACA to cast a blind eye to the problems that people have had signing up.  It doesn’t help the ACA to cast a blind eye at the people who lost their current coverage and now have to pay more for it.  It doesn’t help the ACA to cast a blind eye at people who couldn’t keep their doctor because the only affordable plan they could find had a “narrow network.”   It doesn’t help the ACA to dismissively say “well, most people are better off” because of the ACA (even though, factually, most are) without acknowledging and empathizing with those who feel that they aren’t.

Casting a blind eye to the disruption caused by the ACA only appears to make you seem indifferent to the people who feel ill-served by it.  That isn’t any way to make any new friends for Obamacare.

Later today, Tuesday, the American College of Physicians will be releasing a progress report on the ACA’s implementation.  We will talk about the millions it is helping.  We will express our opinion that it is the right thing for the country. 

But we also will talk about things that have come up in its implementation that  are causing problems—especially the narrow health plan networks and restrictive formularies that are making it harder for people to continue to see the doctors they trust and the medications they need.  We will offer specific ideas to make improvements in how the ACA is being implemented, so that there doesn’t necessarily have to be a trade-off between getting health insurance and keeping your doctor.

Do we run the risk of adding fodder to the anti-Obamacare crowd?  Sure.  But I also think that there is no one in a better position to help improve the ACA than its supporters.  When the ACA’s opponents find fault with it, their motives are suspect because their single-minded objective is to discredit it and get it repealed. When ACA supporters point out things that aren’t quite right, it is to get them corrected so that the law works better for everyone, including those who now feel ill-served by it. 

If we really care about the ACA’s reputation, we can’t keep it all in the family when we know there are things about it that can be made better.

Today’s question: Do you think supporters of the ACA should talk about its shortcomings, even if that gives fuel to the law’s critics?


southern doc said...

"Today’s question: Do you think supporters of the ACA should talk about its shortcomings"

I think physicians today have so many more urgent issues facing them that it's kind of puzzling that the ACP is wasting time worrying about the ACA's reputation.

ryanjo said...

This post is so laughably one-sided compared to the prior one criticizing opponents of ACA, I almost don't know where to begin.

If the administration was really serious about changes to healthcare policy, Obama would be offering changes instead of deferring implementation piecemeal again and again to disguise failures. As long as the Ideologue-in Chief uses his office as a club to break his opponents, they will seek to sabotage ACA. It is the nature of the beast, a fact unappreciated by ACP leadership when they support government ownership of our profession.

Now we hear fawning praise of the SGR recession bill, as it provides a trivial pay increase and institutionalizes more erosion of physician autonomy. We don't even catch up to the 2% sequester reduction, which was just quietly extended to 2023. Did you miss that ACP, or did it just not look good in the newsletter?

Southern Belle Doc said...

My Momma taught me that just complaining about something without offering solutions or alternatives is never helpful for solving problems. The old proverb comes to mind, "Best to be quiet and thought a fool than confirm it by speaking of things you know nothing about." We as physicians must always make it a point to know as much as possible about the things directly affecting our patients health care.

Louisiana Doc said...

The powers that be in the ACP are as out of touch as those in the AMA, etc. They don't have any clue what working physicians are facing daily. They would spend their time applauding this laughable waste of money (how much spent to cover how many more?? -- billions to have essentially equal coverage) while as other posters have pointed out, we deal with actual problems (mostly caused by the government already -- regulations, paperwork, etc). When you get back to reality, we can have meaningful talk.

BDoherty said...
This comment has been removed by the author.
BDoherty said...

BDoherty has left a new comment on your post "All in the Family":

Hmmm. The so-called powers that be at ACP come from all types of practice. Many are in small independent practices. They live with all of the good and bad our system has to offer. They consider all viewpoints They develop policy based on evidence, not ideology, thru consensus. They believe that extending coverage to millions of uninsured is good for doctors and patients. They are on the right side of this epic battle to decide if the US will join the rest of the industrialized world in striving to universal coverage, an ethical, medical and moral imperative. I am proud to work with and advocate for them

Posted by BDoherty to The ACP Advocate Blog at February 20, 2014 at 11:01 PM

PCP said...

"They are on the right side of this epic battle to decide if the US will join the rest of the industrialized world in striving to universal coverage, an ethical, medical and moral imperative."

The arrogance and self certitude of this statement is unique to liberals. If the ACP stands on this, they cannot consider themselves apolitical.

Fiddler said...

I believe there is plenty of information about the ACA's shortcomings without it's supporters having to chime in. I actually think there has been only a small emphasis on the positive aspects of the bill, lets face it, good news never sells any advertising.