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Benjamin W. Heineman, Jr.
Legal Scholar

Benjamin W. Heineman, Jr.

Business ethics expert; senior fellow at Harvard’s schools of law and government; former General Counsel for General Electric; former assistant secretary for policy at the U.S. Department of Health, Education and Welfare (now Health and Human Services.)

The Power of the Personal Story

As with his off-handed comments at a Marin County fund-raiser during the campaign that people suffering economic dislocation turned to guns and religion, President Obama's remarks about Professor Gates and Sergeant Crowley showed an unusual and surprising insensitivity to the political power of the personal story--in this case the negative power.

The deeper leadership question behind the incident is how the president and other top government officials can use the power of such stories affirmatively to support complex policy prescriptions.

People have almost completely forgotten that President Obama' self-declared goal at his health-care news conference on July 22 was to answer an important question being asked by real people:

With all the charges and criticisms that are being thrown around in Washington, a lot of Americans must be wondering: What's in this for me? How does my family stand to benefit from health-insurance reform?

In his opening remarks, he ticked off, with quite general sentences, benefits for individuals: "If you have health insurance, the reform we are proposing will provide you with more security and stability....It will keep government out of health care decisions [????]....No insurance company will be allowed to deny you coverage because of a preexisting medical condition."

He had two sentences on real individuals--a woman whose insurance company wouldn't pay for her cancer surgery despite her payment of hefty monthly premiums, and a professional who changed jobs, lost insurance and woke up from emergency surgery with $10,000 in debt.

That was largely it for "humanizing" the health policy debate. The following Q&A dealt with the stuff of Washington: eadlines (August?), politics (can the R and D's cooperate in any way?) and various policy ideas (taxing expensive health insurance plans; a special Medicare Board with authority to cut costs...etc).

And, then, of course, the whole effort imploded when, in the last five minutes, the president, without knowing the facts, rendered judgment on a local police story and, without preparing the ground, raised another vital, controversial national issue in a cursory way: racial profiling.

As we all know (!!), at every dinner table and around every coffee pot in the days that followed almost every American argued who was right: the Harvard professor or the Cambridge cop? Without the benefit of a scientific poll, I would venture that following the press conference virtually no Americans debated the hard questions about health care or were any less confused about what it meant for them (if they were confused in the first place).

People could lock onto the Gates-Crowley saga because it was vivid and human and ambiguous---and raised, though hardly answered, emotional and important issues about racial prejudice, the privacy of the home, and proper methods of law enforcement.

Yes, the president deserves some credit for the "beer summit' as successful damage control. But, overall, his personal intrusion into the Cambridge arrest was very damaging: he diverted attention from health care; he failed to teach the nation a lesson on the critical importance of getting the facts right before rendering judgments; and, by subsequently saying that both Professor Gates and Sergeant Crowley were good men but each had overreacted, he put the salient issue of racial profiling to the side and, to some extent, just rekindled the debate about the particular facts of a particular arrest. The general public will have largely forgotten the whole matter by September as the news cycle relentlessly moves on.

But then the question of humanizing the health care debate--the subject of the ill-fated news conference and a great leadership challenge--will return. As the sausage making proceeds apace, can the president mobilize concerned citizens with the many, tragic stories about health care but without doing violence to the complexity of the subject?

He may need to rally the nation around some core principle if the legislative process is not to result in a weakened, self-contradictory bill (such as future cost restraint along with future increased coverage) that leaves many hard questions to the regulatory process. He may need to find the positive public energy for health care that can match in intensity the negative energy of Gates-Crowley.

To be sure, over the past 15 years especially, politicians have orchestrated fanfares to the common man. Firefighters, wives of war heroes, social workers, up-by-their-bootstraps entrepreneurs--all have been acknowledged in the gallery during the State of the Union address. A common trope of the modern political rally is to tell a story or two about a worthy local person who exemplifies a problem or a solution.

This technique is now so common that the American people may cynically view these stories--however admirable the individuals--as yet another prop in the inauthentic governing or campaign costume drama.

So the administration will have to overcome many barriers in humanizing health care and mobilizing people across the nation as the Congress hurtles towards crunch time. An ad campaign, a national town hall meeting where people can speak, another try at a press conference with more vivid stories.....?

We do know that two "people," Harry and Louise, played an important part in defeating the Clinton health plan in an ad sponsored by the then-Health Insurance Association of America.

Can the administration find some key personal health-reform stories that can be discussed at dinner tables and around coffee pots in an affirmative (not the much easier negative) way? To me, that is the most important immediate question to emerge from the illustrative but damaging Gates-Crowley incident.

By Benjamin W. Heineman, Jr.

 |  August 4, 2009; 10:59 AM ET
Category:  Making mistakes Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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All people are "needy". Rich girl, poor girl it's all the same. The fuse is burning, let me do you right. Shut out the lights. Doctor earn more because they aren't politicians. To get rich in politics you have to be a crook. Slip off your blouse.

Posted by: Dermitt | August 5, 2009 12:21 PM
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Excuse me but the author, a professor of law at Harvard, has missed perhaps the most critical point of all: is healthcare a right or a privilege in this country? Yes or no, sir, is it a right or a privilege?

Long ago, the people of this country decided that a public education was the right of every American schoolchild, funded by society, and regardless of the parents' ability to pay a tuition. So whether or not a person has any children, he still has to pay taxes to fund the education of other peoples' stupid little rugrats, Octomom and her ilk included. Fine. Good. An educated populus helps our country.

Likewise our nation decided in 1964 that the elderly, including the demented and the incurable, should likewise get government-administered and funded medical care to ease their final years and help keep them out of poverty.

And now, as the ONLY nation in the civilized world that relies on a patchwork, broken system of private, for-profit insurance corporations to insure the rest of its population not covered under government plans (i.e., the shrinking Middle Class), have we yet evolved to the point where we consider that an American citizen has a basic right to healthcare, no less than he has a right to a basic education or a publicly funded library or access to public parks or beaches?

I posit to the learned author that yes, ALL Americans should have the right to basic healthcare funded by the government, not beholden to for-profit companies responsible to shareholders, just as much as they have the right to a basic education. Rights, sir, are not contingent on costs!

If Americans' rights were to be made solely contingent on costs, then every bloody stupid entrance door wheelchair ramp, braille stickers on drive-up ATM machines (for blind drivers...), handicapped elevator retrofits, and accessible bathroom retrofits, etc. would have all been deemed too costly. The Americans With Disabilities Act (passed by Republican GHB, btw) would never have passed a committee.

So no, I don't think an issue of hashing out basic American rights is comperable with (partially) working out an uncomfortable PR gaffe between a black guy and a cop over a few pints.

Posted by: hyperlexis | August 5, 2009 11:35 AM
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We have hospitals shutting the doors around here. The county just greatly expanded the morgue though. We had a blood bath at the gym last night and everybody is being taken care of or. In other words, the health care system is functioning just as it should. Society is another story. You can't save everybody and you can't insure them either. Try to have a nice day.

Posted by: Dermitt | August 5, 2009 8:26 AM
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This administration, condescendingly is attempting to change the calculus from genuine outrage against an over-reaching administration to one of the insurance industry versus the American people. It's sad to hear the "propagandists" dismiss legitimate protest as planned K Street financed operation. It sickens me and it shows the contempt this administration has for the American people. Call you Congressman tell them not only are you acting out of disgust and on your own but how dare they attempt to marginalize your first amendment speech rights to one of petty commercial advertising. Quit treating the American people like sheep, and respond to their concerns. Quit the Axelrod poll tested phases and govern.

Posted by: pauldia | August 4, 2009 9:45 PM
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I work for a hedge fund. I voted democrat or for nader in each of the last 3 presidential elections. I have devoted hundred of hours to analyzing health reform speaking with politicians, analysts, executives, lobbyists etc. The public debate is very misleading. Here are several facts not often discussed.

First, insurance companies serve the overwhelming majority of their members on an administrative services only basis. That means that they are not financially responsible for the medical bills of their members - it is the employer who pays. The insurance company negotiates rates with hospitals, physicians, pharmacies, etc. on behalf of the corporations whose employees are members of their insurance plans. So when a co-pay is required it is because an employer required it, not the insurance company.

Second, there are 1300 insurance plans in the country, many of which are operated on a not-for-profit basis. The medical benefit ratio (the term used to quantify the amount of $ insurance companies direct to cover healthcare costs vs claims administration, underwriting, regulatory compliance, sales and marketing, general overhead and profits) is almost identical between not-for-profits and for profit insurance providers (about 85%),

Third, the profit margins for health insurance companies are much lower than people generally believe. Even the largest, most efficient health insurance companies make 4% - 5% margins on traditional health insurance coverage.

Lastly, the health insurance industry is highly regulated. Some of the awful stories we hear such as those about individuals losing insurance coverage because they improperly disclosed prior conditions unrelated to their current healthcare needs only occur because state and federal regulations permit them to. Making the changes to regulatory regimes to address these issues would be easy to accomplish and go a long way to improving access to healthcare in the United States.

Posted by: hnah | August 4, 2009 9:30 PM
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Health care now costs about 17 percent of GDP and is moving toward 20 percent. We pay twice as much as other countries and like GM, we will become non-competitive. The reform, if it costs 1 trillion over 10 years would be 0.7 percent of GDP but would save money elsewhere by less use of emergency rooms by citizens and legal residents. The uninsured need to be covered and pre existing conditions need to be covered, but if we don't get reduction in the 17 percent of GDP annual cost of health care (lower costs by malpractice suit reform and by increasing the supply of RN's and GP's (probably letting health care practices bring in j visa immigrants - coming just for the job - leaving if the job ends), we will lose competitivity. There won't be jobs, except in hairdressing, government and health care. Something must be done or our country is in big trouble.

Posted by: pomeroyt | August 4, 2009 9:01 PM
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"We have the best medical care in the world."

By what metric? Studies I have seen show that we have solidly average to below average medical care in regards to patient satisfaction with the highest cost. You should really rephrase your statement to say:

"We have the most expensive medical care in the world."

Posted by: hdimig | August 4, 2009 4:55 PM
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Obama's town hall meetings and press conferences have been filled with "soap-operatic" stories compliments of his constituents and his speech writers. In fact, they should be billed as "Live from The National Enquirer."

Americans want facts about the health-care plan. What Obama needs to do is dispense with the drama, read the provisions of the proposed legislation, grasp the effects of the provisions on American citizens, and honestly and realistically explain those effects.

He also needs to ask for a true accounting of how many Americans are without health insurance not by choice (47 million is simply tossed around), and he needs to justify why the government claims it can run a cost-effective health care program for the masses when its two primary existing ones--Medicare and Medicaid--are billions in the red.

Finally, Obama needs to explain how any new plan will be funded, particularly when tax revenue is already down 18% and while the recession continues to rear its ugly head in terms of unemployment numbers and mortgage defaults.

Posted by: judithod | August 4, 2009 4:54 PM
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I doubt that many people minds were actually changed one way or another by any of the President's statements about Dr. Gates. At best, he managed to sooth emotions a little in an instance that was only about emotions.
Even among those with some potential to vote for health care reform, there is a wide range of ideological positions that the President has little or no potential to influence.
What is going to happen is that the members of Congress are going to spend several weeks in their home districts and get a chance to take a reading of their constitutents thinking and degree of flexibility on health care reform. When they come back to Washington in September, we will see how the votes fall. The main potential contribution of the President is help in finding whatever level of consensus exists and actually getting a realistic bill passed.
The ideologs of leadership who imagine that people are just waiting for the right minister, demagogue, or professor to tell them what to do need to develop a little more respect for democracy and for people's stubborn insistence to rely on their own judgement.

Posted by: dnjake | August 4, 2009 4:54 PM
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The government is attacking the wrong issues and trying to socialize medicine. We have the best medical care in the world. What we need to bring healthcare within reach of the greater majority is to: 1. Reform tort laws regarding medical malpractice. Of course we won't because the Trial Lawyers Association is the biggest contributor to re-election funds; 2. Increase the number of doctors by offering college tuition to qualifying students with the stipulation that they will practice in areas where doctors (GPs) are needed; 3. Government investment in the high-risk medical technology and pharmacutical research and development efforts which will decrease the cost of MRIs, CAT SCANs, etc. Giving control of oure healthcare to a government that can not run the two it has is stupid plain and simple.

Posted by: staterighter | August 4, 2009 4:31 PM
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"However, if you weigh their probable loss against 47 million people not covered and all our manufacturing base being non-competitive then some kind of reform seems inevitable."

That is exactly right. I cringe when I hear stuff on NPR about how terrible US auto manufacturers are. Those companies provided thousands of blue collar jobs. Although they have each had their own marketing and quality issues, we as a country also let them down big time by forcing them to absorb exorbitant health care costs. Look at all of our competitors: Japan, Germany, even South Korea, all have nationalized health care. We are backwards on health care, not cutting edge and it is time to admit it and fix the problem.

Posted by: hdimig | August 4, 2009 3:34 PM
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Actually health care reform is a de-investment in the insurance companies.

As Wendell Potter, a former VP at Cigna, remarked on PBS 2 weeks ago - in 1996 - the Health Insurance Industry got 5% of the dollars marked for health care now they get 20%.

Health Care costs about 2.5 trillion a year - 15% of 2.5 trillion is 375 billion.

And that's why the Health Insurance Industry is throwing up a lot of smoke and screaming bloody murder.

They would lose 375 billion dollars - think of the devastation that would hit the CEO's at Cigna and the other companies.

They might have to sell off their 5th, 6th, and 7th homes.

And in this market it could be catastrophic.

And while its sounds funny its not.

Real people would lose real property.

However, if you weigh their probable loss against 47 million people not covered and all our manufacturing base being non-competitive then some kind of reform seems inevitable.

Posted by: agapn9 | August 4, 2009 3:23 PM
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"Encouraging the terminally ill to commit suicide is in the interest of most of those who are forced to live in shelters."

WTF?

Posted by: hdimig | August 4, 2009 3:16 PM
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Any health care reform must recognize that there are two parts to health care: insurance and non-insurance. Insurance polices indemnify events that are not likely to happen with a great deal of probability, for example cancer of the brain. less than 1% of the population gets brain cancer. If 100% of the population is certain to get brain cancer than brain cancer is not insurable.

on the other hand regular preventive doctors visits including the dreaded annual check up with the finger probe are not an insurable events. Preventive visits must be funded by some other mechanism and the answer to this may lie in the way we have done a great job in financing housing; through deductions and mortgages, that is we can deduct the mortgage interest and real estate taxes and mortgages cab be sold by the primary financier to the secondary financer such as Fannie Mae.

individuals should be able to finance the insurance part of health care( treatment for diseases, cancer, heart attacks) by buying insurance policies the premium for which should be deductible. The feds should provide this insurance along with private parties.

The non-insurance aspect, annual visits, are easy. We know how much these cost, about $1000 a year. The Fed should pay for such visits up to a 1000 dollar year.

If individual insurance policies are made deductible than individuals will make a choice: the big house or a good insurance policy including the one available through the feds.

At my age I need a moderate sized house and a decent insurance policy.

As I age I will choose a smaller house or apartment and spend less on housing and buy a great health insurance policy and pay a whole lot of more money for health insurance.

finally for those that cannot afford insurance: Medicaid and make it mandatory for medical providers to accept medicaid.

the governmnet can start by making Medicare available to all above the age 0f 55.

Posted by: jailkkhosla | August 4, 2009 3:00 PM
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This articles WaPo tease went flat went the beer.

Posted by: whocares666 | August 4, 2009 2:27 PM
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Obama has told personal stories about his grandmother and his mother. You can read about in Time Magazine.

Those who might defend the "status quo" must remember that powerful self-interests are at work in the debate over reforming health care. There are examples of other countries that have made reforms work for the public good.

Also, The LA Times ran a story told by a Canadian doctor and health care advocate. The Canadian health care, while not perfect, has universal care, and uses a single-payor system. While the quality of care may be similiar to the U.S. the overall cost is much lower. The LA Times article is a "must read."

Posted by: rmorris391 | August 4, 2009 1:59 PM
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Taxpayers should not bear the responsibility of keeping a cancer infested person alive. Fortunately terminally ill patients will be left to die under the new federal health plan. But those that have saved for a rainy day will be able to stay alive until they run out of cash. The new heath plan will clear the hospitals of penniless Cancer and Pneumonia patients and keep the beds open for the curable. Encouraging the terminally ill to commit suicide is in the interest of most of those who are forced to live in shelters. It would open up over a hundred thousand dwellings to healthy Americans. It would also give those ready to die a last chance to do a good deed before they depart. The burden of keeping alive the terminally ill is no longer being accepted by the public. Most taxpayers believe that terminal illness is a personal problem and should not be shared

Posted by: melvin_polatnick | August 4, 2009 12:59 PM
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Why humanize it? There are really three main reasons to pass health care:

1. Control out of control costs which will help American companies control expenses.

2. Improve quality which is no longer the best in the world by a long shot (unless you want lypo-suction or a boob job).

3. Cover the uninsured.

The humanizing element only comes in at #3 to me. I think the case needs to be made that reforming health care improves the economy and helps create jobs. It is an investment in public infrastructure and not a big new entitlement to help "needy" people.

Posted by: hdimig | August 4, 2009 12:58 PM
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