Neither President Obama, Congress nor the advocates of health care reform have made a compelling, practical and easily-digested case for how anyone can find enough savings in the system to extend coverage and reduce inflation, without sacrificing the level of care that many people are satisfied with.
They claim they can do it, but the argument against it -- rationing, delays, inadequate care, the worst of Canada and the U.K. -- is more poetic, fear-inducing and tangible than the argument for reform. Nobody thinks that our system is flawless, but there's a long cultural history, in movies and TV, that mocks stereotypical, clipboard-wielding efficiency experts.
We also get nervous when we hear talk about "efficiency" because the truth is that we are quite fond of many of the inefficiencies in our health care system. They make us feel confident. Protected. Important. And comparing protocols based on some grading system activates everything we've learned to loathe about monsters of standardization, from the SATs to the IRS.
So if it's inefficient on a macro-economic level to give a 35 year old asymptomatic male with a family history of heart disease a nuclear stress test -- but his conservative doctor feels the need to do that -- most Americans would probably think that's just fine. Behavioral economists constantly tell us that our brains aren't built to understand mathematical concepts like percentages and fractions. But fear requires no processing; it sets off the amygdala , the most primitive part of the brain.
The president is fighting an amygdalic war with PowerPoint logic. That's a losing battle. He and the Democratic Congress are basing their central economic argument on abstract modeling and forecasting projections. The data may say that we can save billions by eliminating waste, inefficiency and redundancy, but we don't buy this theoretical exercise. (After all, wasn't it models and forecasting that got us into the subprime crisis?)
We have no cultural framework or anecdotal memes to support the argument that health care efficiency is anything but a brutal surgery without civic anesthetic. On the other hand, we have been programmed to believe that in the world of health care, cutting costs ends up hurting people when clinical standards are applied to human realities.
Right now, our health system is very much like our judicial system. The latter is based on the belief that it's okay for ten guilty men to go free so one innocent man doesn't go to jail. And our health system says that it's okay to spend money on screening healthy people to identify the small percentage that's sick.
So health care reform advocates need to drop the inefficiency language and re-frame the argument as "We're going to bring common sense to cost-savings." Offer examples everyone can relate to. Talk about how we wake up every patient in the hospital to take their temperature, even though less than ten percent of people need their temperatures to be monitored. Remind people about how they have to fill out the same form over and over again. Use language like "take money from the bureaucracy and reinvest it in tests and preventative medicine that actually help people -- rather than following outdated protocols and rules."
Health care advocates have made it easy for Sarah Palin and others on the right to convince too many people about death tribunals and other imaginary state interventions. But unless they understand why their plan is so vulnerable to distortion, they won't be able to fix the way they're trying to sell it.