So far, the rollout of the health exchanges—the heart of the Affordable Care Act (ACA)—has reminded me of the incompetence associated with the Bush II Administration. The interesting part of the Obama Administration's bungling of the rollout is that the mistakes have not been made now in the heat of the moment, but months ago when Barack Obama and his inner circle had time to think about it.
Waiting until the Supreme Court affirmed the ACA to begin writing the software and setting up the website was at the very least overly cautious. I would be among the ones who would call it gutless, because it was not in the best interest of the United States and its citizens to wait and the money saved would really have been a drop in the bucket in the current deficit. Far better it would have been if the Administration had given the tech folks the time to do more extensive testing of the system. We should note, however, that as with many large websites of private sector companies, it’s very possible that the health exchange website would have still encountered problems even with extra time.
It’s a shame, because the state exchanges are mostly working and it’s primarily the people in the Republican-controlled states who have to wait until the federal website is fixed to sign up for health insurance. Those are the same states in which the poor eligible for Medicaid coverage under the ACA won’t get coverage because their governors rejected the federally funded expansion of Medicaid in their states.
Perhaps more interesting to me is the mistake in messaging that the President made when it comes to the relatively small number of people who are losing their existing policies.
First the facts: ACA sets new standards for health insurance plans. Setting standards has been a government function since at least the Sumerians. It is the government that tells us how much an ounce must weigh and how much fat and extenders you can throw in and still call it “lean ground beef.” All indications are that in writing both the laws and the regulations, large health insurers had input into developing the new standards. The policies held by the 3 million who will have to change do not meet the basic standards established in the ACA. Many are lousy policies, not worth the paper upon which they’re printed.
What the President said—months ago—was that no one will lose their policies. What he should have said was that less than one percent of people would have to change policies because their policies were below the new standard. This more truthful statement would have set the bar of expectations at the appropriate level. Many of those who have to change policies would still be angry and frustrated, especially if they lived in Republican-controlled states and couldn’t get through on the federal website. But the President’s misstatement would not have provoked a scandal in the news media, nor would the rest of the public be up in arms.
Setting the expectations of the audience is one of the basic principles of communications. The operating theory is the idea of “relative deprivation,” which basically states that people get angrier at being deprived of something than at never having had it. Contrast the positive reaction if you promise someone $80 and you give her $90 to the negative reaction if you promise someone $110 and you give her $100 for doing the same job. The public was led to believe that no one would lose their policies and now feels the frustrations of relative deprivation.
When I conduct seminars on communications, I advise my students—mostly executives and professionals—to set the audience’s expectations at the very beginning of the interaction. For example, before you open the floor to questions at a meeting of many people, always say that individuals will have the chance to ask only one question and one quick follow-up question until everyone has had a chance to pose questions. Without setting that expectation, if someone tries to grab control of the meeting by barraging you with questions and long comments, the audience may think you’re trying to suppress discussion when you try to stop him. But if you have set expectations, when the demagogue tries to take control, the audience will be on your side and shout out, “Give someone else a turn.” I’ve seen both scenarios play out multiple times.
In a sense, the website snafu is also a failure to meet expectations. When an organization announces a website is up and running, the expectation is that it will work.
I’m fairly confident that the website will get fixed and that the health exchanges, new standards and other features of the new law will lead to many more Americans being covered by good health insurance plans, an improvement in the nation’s health and a decline in the cost of medical care. The Affordable Care Act will work, but it’s unfortunate that before it does, the Administration has to learn some basic lessons in setting expectations…and meeting them.