Even the best of families have skeletons: the uncle who had some shady business dealings, the cousin in drug rehab, brother with the messy divorce and custody fight, or the adult kids who are maxed out on their credit and behind in their mortgage payments but have to “keep up appearances” with their expensive suburban lifestyle. When these things happen, there is a tendency to “keep it all in the family” – that is, don’t talk about things that might be embarrassing, because above all else, you have to keep up the image that all is fine and well.
This especially is true if the family already feels it is under attack by others in the community that have made it clear that they don’t like them and don’t want them to succeed — so the last thing the family wants to do is add fuel to the fire. It is true of historically persecuted ethnic groups: my Irish grandmother didn’t want anything bad said about the Irish (and her own immigrant family and believe me, there were plenty of skeletons in my ancestors’ closets!), because there were enough people already who wanted to keep the Irish down.
And of course, there are things one shouldn’t talk about, because they are private and not anyone else’s business.
All of this makes sense, except when it comes to things that are going to come out anyway, or are already well known — in those cases, denying reality isn’t going to help your case.
I may be stretching the analogy, but I think that is what is going on with many liberal (or progressive or just pragmatic) supporters of the Affordable Care Act. They know that not everything is going well. They know that not everyone is going to come out ahead. They know not everyone can keep their own health plan. They know that no one (not even the president of the United States) can guarantee that your own physician will be included in your new health plan. They know some people will pay more for coverage. They know that there still are problems with the federal enrollment website.
But they don’t want to acknowledge these or other potential ACA shortcomings, because they don’t want to give away anything that opponents will use to help make the case that it isn’t working. So they will talk among themselves about things that aren’t going so well with Obamacare — but not in public, everything must be kept inside the family of ACA supporters.
I understand the sentiment, because ACP supports that ACA, and we want to help ensure that it succeeds, not undermine it by saying critical things about it.
But when ACA’s progressive supporters aren’t willing to acknowledge problems and unintended shortcomings, they can come across as having a blind-eye to the legitimate problems some people are having. It doesn’t help the ACA to cast a blind eye to the problems that people have had signing up. It doesn’t help the ACA to cast a blind eye at the people who lost their current coverage and now have to pay more for it. It doesn’t help the ACA to cast a blind eye at people who couldn’t keep their doctor because the only affordable plan they could find had a “narrow network.” It doesn’t help the ACA to dismissively say “well, most people are better off” because of the ACA (even though, factually, most are) without acknowledging and empathizing with those who feel that they aren’t.
Casting a blind eye to the disruption caused by the ACA only appears to make you seem indifferent to the people who feel ill-served by it. That isn’t any way to make any new friends for Obamacare.
Recently, the American College of Physicians released a progress report on the ACA’s implementation. We talked about the millions it is helping. We expressed our opinion that it is the right thing for the country.
But we also talked about things that have come up in its implementation that are causing problems — especially the narrow health plan networks and restrictive formularies that are making it harder for people to continue to see the doctors they trust and the medications they need. We offered specific ideas to make improvements in how the ACA is being implemented, so that there doesn’t necessarily have to be a trade-off between getting health insurance and keeping your doctor.
Do we run the risk of adding fodder to the anti-Obamacare crowd? Sure. But I also think that there is no one in a better position to help improve the ACA than its supporters. When the ACA’s opponents find fault with it, their motives are suspect because their single-minded objective is to discredit it and get it repealed. When ACA supporters point out things that aren’t quite right, it is to get them corrected so that the law works better for everyone, including those who now feel ill-served by it.
If we really care about the ACA’s reputation, we can’t keep it all in the family when we know there are things about it that can be made better.
Bob Doherty is senior vice-president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog.