Wednesday, February 01, 2017

The problem with a Mad Libs approach to advocacy

 People commonly receive notifications from membership associations or advocacy groups asking for support of a cause. Typically, all that the recipient of such a request needs to do is fill in their name and address. A letter will be auto-generated to some political representative and it is generally the hope of the advocacy group that enough people will behave like lemmings and will answer the call to send in the letters.

I call this ‘Mad Libs’ advocacy because people are expected to look at the blank line in the ‘From:’ category and willingly offer their name and information, much like you had to provide nouns, verbs, adjectives, and adverbs for the popular template-based word game.

Just like Mad Libs, people often don’t deeply study the content that they are signing their names to, or they simply trust the advocacy group to be asking for something that they supposedly would support. Unfortunately, people might often be surprised at what they are signing their names to when they fill in the Mad Libs advocacy forms.  Technically the forms are editable, but how many people really edit these forms?  Most just type in their names and click 'SEND.'

When they do so, the results might not be so humorous.

One example for occupational therapists to be concerned with is the current American Occupational Therapy Association call for advocacy about the Affordable Care Act repeal. Here are some basic concerns with the phrasing of their Mad Libs Advocacy Action:

1. They ask that any repeal and replace approach should not disrupt stability of costs and coverage in the current market. That is impossible, because any change will obviously lead to some degree of disruption – even if it is carefully constructed. What they fail to acknowledge is that the IMPLEMENTATION of the ACA itself caused severe disruption and was clearly based on misinformation – e.g. ‘If you like your doctor you can keep your doctor’ or ‘If you like your plan you can keep your plan’ or ‘Most people will see their insurance premiums decrease by $2500 annually.’ To believe that some basic requirement of repeal and replace plans should be that it will somehow be less painful than the disaster that the law caused upon its construction is ridiculous. Change will be disruptive – and requiring no disruption is naïve and disingenuous.

2. They ask that repeal and replace should assure access to affordable health insurance. That is another impossible requirement. The ACA itself did not assure access to affordable health insurance for many people. In fact, premiums, deductibles, and co-pays went up for many people. There is no way to assure that health insurance will remain affordable for everyone, even in a reasonably constructed plan. It is another impossible requirement that even the original law did not achieve.

3. They ask for meaningful coverage and benefits so that people can receive services and live healthy, independent, fulfilling lives. This is another impossible requirement that the original ACA did not achieve. ACA recipients have a hard time finding MDs and other providers because the reimbursements are so low and the networks are so constricted. It makes no sense to demand that a replacement to the law be able to achieve what the original law could not.

4. They ask for certain protections to be continued, like mental health parity, bans on limits, and other elements. Again, these are all things that were not achieved by the ACA. To ask that they be somehow created in a repeal and replace context is not realistic.

In sum, asking for elements to be assured or required or mandated that were not achieved in the original law is simply a call for obstructionism toward a repeal and replace effort. There are probably elements that are relatively non-controversial that many people would be willing to discuss for inclusion in a letter, for example efforts to promote affordable options for some level of continuing coverage in the event of job loss, options to allow parents to keep children on their plans for specified periods of time, or encouragement for coverage of non-controversial elements like options for children or adults who have disabling conditions. These would all constitute ‘safety net’ elements. Although some people would do away with all governmental assistance it is probably true that most people have some level of tolerance for basic levels of support in some of these instances.

That is very different than asking your members to sign a letter requiring improvements that are impossible.  The AOTA and other advocacy groups would be better off encouraging dialogue about basic elements of our health care system that a plurality of its members could actually support instead of creating a soapbox of obstructionism and saying that any repeal and replace has to do things that the original law couldn’t even accomplish.  This current effort does nothing to educate members on initial problems that the law attempted to solve, the ways in which it succeeded and failed on different levels, and how to responsibly advocate for changes that are aligned with the free thinking of individual members.

I encourage people to study the impacts of the ACA carefully and consider its impact on themselves, their communities, and their patients. Study the possibilities for replacement elements that might help to improve the health care system. Most importantly, people should be FREE THINKERS and consider their own personal belief systems and what role they believe our government should have in health care. Undoubtedly, some will feel differently than others. Individual opinions based on individual study should be the goal, no matter what those opinions are.

Even more importantly, there should be a halt to Mad Libs Advocacy where all you have to do to ‘participate’ is to type in your name and push a button. These issues are more complex than all of that. When advocacy is reduced to the mass mailing of obstructionist pablum that is fed to us from a membership group we don’t demonstrate any respect for our colleagues and we don’t demonstrate any respect for our civics and we most certainly are not trying our best for our patients.

1 comment:

Mike said...

People always advocate for the politically "impossible." They do so in order to shift the needle and change the terms of the debate, as well as to communicate their fundamental goals and desires. People know that at the end of the day, politicians are thinking things like, "Well, I got 50,000 letters from people who think the new ACA should be as much like the old one as possible." That informs the representative of what people want. If he says, "Well, 5,000 of those letters were dittos from Professional Association X, so I better listen to their lobbyist," then mission accomplished, too, from the point of view of the association. Does it matter if the specifics in the email were untenable? No, that gets worked out in committee. Probably what would matter more than the content of your message would be that you printed it out, put it in an envelope, and paid for a stamp to mail it. Even better, hand write out your letter neatly and pay for an overnight FedEx envelope to show you've got "skin in the game," as they say.