What we’re talking about when we talk about the cost of health care
So there are these three charts that have been bouncing around my head, mixed up in there with Baby Shark and the theme song for the Mickey Mouse Clubhouse (thanks, toddler).
They’re all equally catchy, but I think the charts in particular speak to a key opportunity and challenge that health care comms people run into in a way that neither Baby Shark or Mickey Mouse Clubhouse do (maybe I’ll come back to the discussion of how Mickey and the gang could leverage Toodles to optimize care delivery in another post).
Controlling health care costs is the most important thing
I was reading Dan Pfeiffer’s Substack “Message Box” the other day and in a post about political comms, it was a health care chart that jumped out at me.
Navigator Research asked a cross-section of voters about their opinion on the various accomplishments of the Biden Administration. Far and away the most popular policy win among the widest cross-section of voters wasn’t the massive investment in manufacturing jobs, the semiconductor renaissance propelled by the CHIPs Act, or the new roads and bridges coming from his bipartisan infrastructure investments.
It was lowering prescription drug costs for people on Medicare, and capping insulin at $35 a month for seniors. Health care costs — to most Americans — are the most important thing.
We have made amazing, historic progress to bring down health care costs
Then here is some really amazing news: we have made the most progress in controlling health care costs in generations. Looking at Medicare spending specifically, costs have flat-lined for more than a decade. The New York Times wrote about this amazing trend recently, with the fun and mysterious title: “no one is sure why.”
Actually, some people have some pretty compelling theories (like Dr. Zeke Emanuel on the payment reforms in the ACA specifically). But no matter what specifically caused it, this kind of spending control accounts for $3.9 trillion in savings for the federal government alone and probably much more if we had a sufficient tally of private health coverage. That’s a ton of health care cost control!
Unfortunately, when it comes to health care communications, it doesn’t really matter.
We have have not done nearly enough to bring down health care costs
The United States is as close as ever in its history to “universal coverage” where every person has health insurance that should help them access and afford care when they need it. Less than 1 in every 10 nonelderly Americans lack health coverage (elderly Americans, of course, have their own universal coverage through Medicare).
Yet half of every 10 Americans under the age of 65 say they have trouble affording health care. It’s even worse than that, though — half of American adults who aren’t on Medicare but have another source of health insurance still have trouble affording their health care costs.
(KFF, the artist formerly known as the Kaiser Family Foundation, has an excellent December brief on this)
Why so much negativity when we’ve made so much progress? It’s pretty simple — because the ways most people interact with the health care system have not gotten much cheaper. KFF pulls this out in their brief:
About four in ten insured adults worry about affording their monthly health insurance premium, and 48% worry about affording their deductible before health insurance kicks in.
KFF’s Larry Levitt highlighted this a few days ago with a classic “welcome to the new year!” tweet:
This is a very basic explanation for why so much of Democratic health care policymaking has shifted to some blunt tools to control costs (insulin price caps, tougher negotiation of drug prices, medical loss ratio for health insurance, etc.) And while the policymakers (or “nerds” as comms people call them) figure these pieces out, there’s an important role health care communicators need to play.
Don’t fall into the trap
This is a pretty common policy communication problem — the same term (“cost”) means two very different things for two different audiences. In this case, policymakers and health care experts often use “cost” to describe the cost of health care to individuals, states, the federal budget, etc. But to everyone else — voters especially — “cost” means simply “how much I spend on health care.” Health care comms professionals need to be hypervigilant for anyone using the wrong one for the wrong audience.
But there’s something even more dangerous about this discrepancy. I can hear my fellow progressive, policy-loving nerds saying — with an idealistic gleam in their eye — “well we have made historic progress in bringing down health care costs! We must educate the voters!”
This is a policy wonk trap waiting to be tripped.
As any communications professional will tell you, you are fighting an uphill battle if your goal is to “educate” an audience by directly contradicting a source of information they trust more. And there are few sources of information more trusted by voters than their own budget and their family’s. You’re not going to convince Americans that health care costs are coming down if the costs that they pay every month aren’t coming down.
Worse, by trying to insist that reality is different than what most Americans see, we risk feeding into a narrative that progressive policies don’t actually make a meaningful difference in people’s lives. “If a decade of incredible cost control doesn’t actually make my health care bills cheaper, what’s the point?” In our political system that is a little too frequently presenting us with the choice between liberal democracy and creeping autocracy, anything that discredits the small “d” democratic argument pushes us to a pretty perilous place.
Let’s be part of the solution. Progressive health care communicators need to focus on what matters to voters — tangible efforts and policies that bring down the costs that people actually pay for health care, like price limits on insulin, lower prescription drug costs, policies to reduce health insurance premiums, and stopping practices like surprise billing or other ways that shocking health care bills could end up in their mailbox.
In other words, talk about “costs” the same way that voters talk about them.
And then we’ll have time to think about all the the fun things we can talk about spending $3.9 trillion on.
