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Saturday, November 18, 2017
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Healthcare as a Message Strategy

The New England Journal of Medicine is among the most widely read health professional publications in the U.S.

President Obama and Republican Presidential candidate Mitt Romney know how important the support of this core constituency is to their respective campaigns. NEJM invited the candidates to appeal directly to readers through personal essays, which appear in the September 26 online edition. You can read the President’s complete essay here, and Governor Romney’s here.

Each candidate offers praise for health care providers, and both agree that the current system needs to be fixed. They address insurance, Medicare payments, and overwhelming paperwork requirements that force physicians to spend less time with patients. How to get there, however, comes from two very different directions.

While Obama promises to follow through on the reforms initiated under the Affordable Care Act and to keep Medicare/Medicaid intact, Romney asserts that a free market approach with little government regulation is a better alternative.

The two candidates jab at each other’s ideas – Obama painting a bleak picture for the future of research, Medicare, and cost burdens should the Republicans enact their budget austerity plan and Romney discussing the problem of overreaching  federal regulation and less autonomy for providers and insurers.

Romney hopes to hit physicians where it matters – their wallets. He tosses around several budget figures without actually explaining how he got to those numbers. He also uses fear-mongering, citing a board of “15 unelected bureaucrats” to help make payment decisions. (He is referring to the Independent Payment Advisory Board, who have the authority to limit Medicare spending growth. Board members must be confirmed by Congress and cannot propose measures that limit or ration care, change eligibility requirements, or increase taxes).

President Obama makes his case by outlining step by step how Obamacare addresses issues of reimbursement, processes, quality of care, and insurance. He repeatedly points out how patients will benefit, and how physicians will be able to spend more time caring for them.

What is interesting here are not the candidate’s positions – we’ve heard them before. Rather, it is that they felt compelled to contribute lengthy Perspective articles and use a targeted medium to address key voters who could lean either way. Health providers practice medicine for many reasons – some altruistic and some financial. Obama plays up the “helping others” approach while Romney focuses on the “keep more money in your pocket, tell the government to back off” message.

Last week it was “60 Minutes.” This week, NEJM. Then there was the much-debated First Couple appearance on The View as world leaders congregated in New York City. And of course, the leaked “47 percent” video of Romney at a private fund-raiser.

As the candidates continue to define themselves and their platforms, the medium increasingly becomes the message. With varying spins on the health care discussion, examining these messages with a critical eye is imperative. In the words of Walter Cronkite, “in seeking truth you have to get both sides of the story.”

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  • NEJM did this during the last election, I believe, and was criticized for violating its own rules on authorship that require disclosure of all people who write a paper for the journal. This rule is to protect against ghostwriting. You know that the president and his opponent didn’t write these pieces themselves. I would have expected the journal to at least require an acknowledgement of the people who actually wrote the commentary. Or do the editors assume that people know the candidates only approved what someone else wrote?

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