by Mike Huntington MD
1. Always bring the focus back to the principles of the best care for more people at the least cost. The current system even with recent federal and state programs do not honor these principles. There are countless potential off ramps into discussion of side issues such as government involvement, free enterprise, human rights, coverage of undocumented immigrants, and people who may seem undeserving of care and public resources etc. You can respond by saying most other developed countries have dealt with all of those questions and have not strayed from the main goal of achieving the best care for the most people the least cost. Sam suggests asking the question, “If we had a system that cost half of what our current system does and provided better care for more people, would you care that the system included…(pick one or more) undocumented immigrants, reproductive rights, government involvement, for-profit fee-for-service reimbursement, etc?” Very few people hold moral concepts that are in conflict with their income. The concept of the best care for the most people at the least cost addresses most listener’s self-interest of protecting his/her income. Upton Sinclair said, “It is difficult to get a man to understand something, when his salary depends on his not understanding it.” Those who now profiteer from our system most likely will never agree to the idea of best care for the most people at the least cost and you may not want to spend your time trying to persuade them.
2. Always attribute the highest motives to your listener. Avoid negating the other person’s point of view and avoid argument. If the other person is angry or upset, acknowledge that with a comment such as, "I really get the feeling that you are upset and that, e.g., you feel that a healthcare for all system would be unfair to you and certain ways. Am I understanding you correctly?" Sam suggested paraphrasing and even subtly overstating the person's concern to make it clear you are honoring that concern, e.g., "I sense that you might picture the medical clinics in town becoming overcrowded to the point where none of us will have access to good care." Camilo offered a useful analogy. Restaurants that offer "All-You-Can-Eat" buffets stay in business with prices people are willing to pay. They know that some people will indeed eat all they can while others will not. The restaurant chooses a price that allows them to make money regardless of how much their patrons eat. Single-payer systems do the same thing. Most people don't seek "all the healthcare they can receive" because that's not how they want to spend their time. But even in countries where the healthcare system encourages frequent visits to the doctor, overall cost can be kept low. Frequent contact with the doctor has side benefits of better preventive care and earlier care for developing health problems. Dr. Hsiao of Harvard, who did the feasibility study for Vermont’s single payer plan, said that in a single payer plan it is easier to spot the outliers or abusers of the system because everyone is in one system and the information is more readily available and no longer proprietary.
3. Research and know your audience as well as you can. Realize that listeners are likely to judge your proposal purely from a self-interest point of view. Larry says, "A fool tries to persuade me with his reasons. A wise person persuades me with my own." Find out what your listener is most concerned about and be sure he/she feels you have addressed that concern. In the process elicit stories from the other person that are persuasive for your point of view. If so far your listeners have been well served by the current health care system (either they have had good insurance or, more likely, they have not been ill or injured to find out how inadequate their insurance is) they may not be impressed by the concept of better care for more people for lower cost. But Hilary mentioned that she has been without health care insurance for extended periods of time and has always been in good health. She never seriously thought about the implications of being without health insurance until one day when she was descending from a climb on Mount Saint Helens. She slipped on a rock and could have fallen and seriously injured herself but regained her balance. In that moment she suddenly realized what might have happened had she suffered a serious injury. Her whole future may have changed to a life of indebtedness and poverty. She realized that many Americans feel they must play “Health Roulette” as they avoid healthcare because of costs.
4. Use your sense of humor to keep conversation easy and free-flowing. Stay respectful and calm. Will will will
5. Most questions boil down to a few categories of concern:
Q: "Government can't do it, is not up to the task."
A: We cannot expect private businesses to provide a public good. Government exists to make sure people get needed services that private business cannot afford to provide: public roads, bridges, public health services, public safety, public education. All other developed countries, as a matter of national security, have directed their governments to be sure that all people get the healthcare they need in a timely fashion. Private businesses (insurance, pharmaceutical, medical device, provider companies) have had over 100 years to prove whether they can provide the best care for the most people at the least cost. They cannot and should not be expected to do so.
Q: "I don't want a government-run healthcare system shoved down my throat, to get between me and my doctor."
A: We currently have privately-run system determining whether we get care and what type of care we get. We have little control over the private insurance systems that ration our care and spend our money in ways that stray far from providing the best care for the most people at the least cost. Most other developed countries have systems where there is much more freedom of choice of provider and services than we have in this country (and, as previously noted, at about half our per capita cost).
Q: "Who says those other countries have such great systems and less cost?"
A: Every credible institution that is ever studied this question: The Commonwealth Fund, The Organization for Economic Development and Cooperation (OECD), the World Health Organization (WHO), The Kaiser Family Foundation. Inger, who is from the Netherlands, reports how she would go to a doctor, get her care, and never have to think about a bill.
Q: "I don't want to pay for the healthcare of that person who doesn't take care of his/her body (smokes, eats, drinks too much)."
A: We all are already paying for these people when they get into trouble and come to the emergency room. If we deny them care and the support they need to correct those habits, we will continue to pay for them in the emergency room.
Q: "I don't want to pay for that free-rider. We all must earn what we would get."
A: In every society, workplace, or group, there will be people who seem to be doing less than their fair share. How much are we willing to punish ourselves in order to punish those who we think are not working hard enough? The administrative overhead of designating "deserving" and "undeserving" members of our society through our complex private insurance system adds an extra 15% of cost to our healthcare system and excludes and punishes those who indeed do at least their fair share and still cannot afford healthcare. You can reframe the questioners lament that he/she does not want to pay for “that freeloader”. You can say our premiums to the single-payer system, instead of buying healthcare for freeloaders, buys our guarantee of access to healthcare when we unexpectedly descend into illness or injury.
Q: "We can't afford it."
A: We can't afford not to adopt a much simpler and less costly system. Our current system is bankrupting us financially, psychologically, and physically.
Q: “Don’t the ACA and Oregon’s CCO’s take care of the problem?”
A: The Affordable Care Act does not correct the underlying problems of cost and coverage. The ACA will leave 30 million uninsured by 2023. It will leave the rest of us underinsured because the bronze-gold plans cover only 60-80% of healthcare costs. The healthcare reform adopted by Massachusetts in 2006, after which the ACA is modeled, has not controlled costs or the high medical bankruptcy rate (up 30% between 2007 and 2009: David U. Himmelstein, MD, et. al., City University of New York School of Public Health, New York).
Q: “Aren’t nonprofit insurance companies better than for-profit companies?”
A: No. They each must take in more money than they pay out and cannot stay solvent paying for comprehensive care for sick people. They therefore avoid those of us who need care and shift costs to competitors, the government, or individual Americans.