Healthcare Pitches vs. Health Law Product

For a year, back in 1981-‘82, I sold (or attempted to sell) automobiles for Bolton Ford, then a dealership on the lakeshore in Lake Charles, Louisiana. That experience gave me insights into the process of sales that should be common knowledge, but aren’t.

The first of these insights is people do not buy a product in most instances. They really buy a concept, a mental image based on the sales pitch. My sales manager, Chris Cross (If I'm lying I'm dying! That really was his name.) told me to give the customer a good story. A good salesman can sell purfumed dog poo, he said (in not quite those words) if he has a good enough story to sell the customer. If the salesman is good enough, that is he captures the trust of the customer, the customer will come back to the salesman for reassurance when the product seems not to live up to promises. That leads to a second insight.

Most people don't trust their own judgement. When a customer has really invested trust in the salesperson the shortcomings of the product will be seen as an unaccountable anomaly. If the salesperson has firmly established the desired image in the mind of the customer the customer will strongly resist changing that image, even in the face of strong contradictory evidence. The reasons for this are complex, but they boil down to fear of humiliation. We don't want to find out we've been duped, and will internally deny the validity of the evidence that we have been.

Now, a lot of well educated people feel secure that they can resist this sort of appeal. In the car business thirty years ago these folks were called "pipe smokers". I couldn't sell Louisiana Cajuns boudin and dirty rice, but I could sell snowshoes to pipe smokers. The trick with self-absorbed intellectuals was to reassure them of their intelligence while using product knowledge as a screen behind which one hid the shortcomings of the product. If the details of the particular product one had, say, a Ford EXP, fell well short of the norms of the category then one emphasized the INTENT of design details while tossing up a fog of non-comparitive information. Every vehicle, however humble, gives opportunities to reveal design details with favorable comparisons. I was a product trivia genius, so I could sell a pipe smoker on Ford's ill-fated horn-on-the-stalk (the horn button in the turn indicator stalk) based on comparisons of response times (while musing internally that all Ford test drivers must have been left-handed). As long as these customers came away reassured they had made an intelligent choice and had been given the tools to explain their choice to their peers they could be comfortable even buying an inferior product.

That experience from decades ago richly colors my perception of the healthcare debate. The people who are selling this program actually do not know the product they have to sell. Even Democrats involved in the process have been willing to admit this in the light of the difficulties they have faced. We call it "Obamacare" because the president's is the face Democrats chose to poster the debate with, but the construction of this edifice is really in the hands of lobbyists and the Congress. That means there is a minimum of four bills to scrounge through, and that ignores Senate versions that have no ghost of a chance of passage.

When one tries to debate the merits of a particular point that is actually in a bill, such as a provision that a database of previously confidential medical record coverted into electronic records may be used to determine the merit of a particular therapy (and the potential threat that poses to confidentiality itself [see ''(a) (3)Powers]) those selling the program will say they are not "aware of that particular provision". Then, when people object to these possibilities, based on having read the bills, they are derided as "uninformed' because they have not taken the word of the trusted saleman about the INTENT of the design detail. That's just silly.

I'm sorry to have to inform people of this but when objections to this program start wending their way through the courts what we were told about intent won't mean diddly squat, but the actual words in the bill that say, among many other things, that the decisions of the Secretary of Health and Human Services are not subject to Judicial Review will. Are you troubled by the decisions of greedy, power-hungry people who are subject to the power of the courts? You'll love the decisions of greedy, power-hungry people who aren't. One only needs a smattering of knowledge about the results of court cases in the aftermath of the passage of Title IX legislation decades ago to comprehend the freedom that can be lost by crawling into the government's pocket for anything, let alone one's physical well-being.

My experience selling cars was bracing. When I buy a car I try hard to concentrate on the car, not the pitch. That goes double in purchacing a law. I want to see the product. I want to know about all the bells and whistles. Finally, when the salesman can't give a straight answer based on actual wording of actual legislation I will say "NO".

In the healthcare debate the promises and the pitch, Chris Cross's "good story", all mean nothing. The perfume on the poo means nothing. All the ingratiating intent mans nothing. Only the product, the actual words of which healthcare law is really eventually made will mean anything.

If you'll buy that without reading it you're being, at best, very foolish.

Posted by Lee Emmerich Jamison at September 2, 2009 6:03 PM
Comments
Comment #287372

Those “pipe-smokers” weren’t intelligent, they were arrogant. Unfortunately, too many people confuse their own arrogance and broad knowledge for true intelligence. But I agree that it is important for people to think about this proposition very carefully. That is why I’m all for healthy, intelligent, critical debate. Why is it then that Republicans are trying to sell perfumed dog-poop to people to try and get them against reform? Why aren’t they trying to inform the consumer of the merits, or lack there of, of the bill rather than selling them an “image” or “concept” that is wholly nonfactual? The Republicans are just as much the slimy car dealer—no offense meant—as are the Democrats!

Posted by: Mike Falino at September 2, 2009 7:18 PM
Comment #287375

Lee, thanks for the story and parallel with the health care debate. I was the finance manager for a medium sized car and truck dealership and can attest to what you say.

Frankly, I believe we should simply scrap all the congressional proposals and publicly argue the merits of any changes in anticipation of the 2010 congressional election. Let the voter elect those who they believe will construct changes that will work and can be understood. This issue is too important to be decided without direct public influence by virtue of the ballot box.

Posted by: Royal Flush at September 2, 2009 7:40 PM
Comment #287378

Perhaps I am missing something, but I find no language in the cited provision providing that a “database of previously confidential medical record coverted into electronic records may be used to determine the merit of a particular therapy.”

The cited section simply provides that the new center for comparative health research shall have access to relevant data available from other government entities, e.g., NIH. It does not amend current law providing for confidentiality of patient records (HIPPA, Federal Drug and Alcohol Confidentiality Regulations, etc.). Those records remain protected under current law. Individual patient authorization is and will be required for any use of personal clinical data for research purposes.

This article is one more example of the far right’s effort to mischaracterize a laudable provision of the proposed legislation as some Orwellian nightmare.

Comparative research on treatment and drug efficacy is clearly desirable. Indeed, it is necessary if we are to get a handle on health care cost inflation and advance medical knowledge.

It seems so rudimentary. What is the comparative effectiveness of alternative drugs or treatments? Who in there right mind would object to such an effort? Yet, here you have it.

Posted by: Rich at September 2, 2009 8:11 PM
Comment #287417

The only way to buy a car is to know the market prices.

BS is just BS. Whether it comes from a pipe smoker, a self agrandizing salesman who thinks HE’s actually superior, or a politician.

While law isn’t a car, it is always a perception, and ever changing. Arguing that one cannot know the future isn’t a reasonable argument. We know that unless we approach this problem, disaster awaits.

Posted by: gergle at September 3, 2009 9:53 AM
Comment #287434

Rich,
As with other so-called “protections” (such as lack of any method of enforcement for prohibitions of payment for service to illegal aliens and dependence on the annually sunsetted Hays Amendment to prevent payment for abortions) the bill here permits loopholes, so the intent of the design detail given here-“(C) continuously develop rigorous scientific methodologies for conducting comparative effectiveness studies, and use such methodologies appropriately; …is used as an excuse for this in the next paragraph- (Under “powers”)- “(C) Access of GAO to information.—The Comptroller General shall have unrestricted access to all deliberations, records, (my emphasis) and nonproprietary data of the Center and Commission under subsection (b), immediately upon request. Provisions like this actually occur in other places as well. You are, indeed, protected under federal law against searches of your records for cause. But all some government official need do to have an investigation is get your records for an “off-book” purpose. Nothing whatsoever stands in their way.

Then you have to get the government to stand up for you against the government.

Posted by: Lee Jamison at September 3, 2009 12:54 PM
Comment #287437

gergle,

A law is like anything else people sell you. It is what it is, not what someone told you it is. We are being sold something that is intentionally too complex to understand by people who want to use our ignorance to control us.

The statesmen who fashioned the Constitution, by contrast, argued phrase by phrase and even comma by comma. That document, in all its wisdom, could fit in this one (H.R. 3200) four words to a page.

Posted by: Lee Jamison at September 3, 2009 1:01 PM
Comment #287442

Mike Falino said

“Why is it then that Republicans are trying to sell perfumed dog-poop to people to try and get them against reform? Why aren’t they trying to inform the consumer of the merits, or lack there of, of the bill rather than selling them an “image” or “concept” that is wholly nonfactual?“

I honestly think the republicans have a low opinion or almost a detest for their own base. Rush Limbaugh isn’t going to try to explain complicated policy to his audience. They’d never understand. So instead of talking about all the things in the bills to not like; they talk about death panels. illegal immigrants and government paid abortions. Things that are not in the bill.

Lee, thanks for the sales information. A lot of what you say is very true.

Posted by: Mike the Cynic at September 3, 2009 1:54 PM
Comment #287445

maybe not such a low opinion, but a realization that their base will not understand complex matters. Not all of course, but a large segment of the republican base things we should consider the merrits creationism and a 6,000 year old Earth model. A large portion of Rwingers are less educated as a group. Likewise, a large percentage of Lwingers are in fact “pipe-smokers” in regards to their uncritical application of their education in practice.

But, it is true that Limbaugh would never consider explaining anything rather than insighting deep-seeded fears and hatreds simply because the people who generally listen to him either don’t want/can’t understand complex explanations, or simply wouldn’t accept facts in any case.

Posted by: Mike Falino at September 3, 2009 2:38 PM
Comment #287448

Limbaugh would never consider explaining anything for fear he’d bore his audience. Keep them stirred up and they’ll keep listening.

Posted by: Mike the Cynic at September 3, 2009 3:15 PM
Comment #287450

Lee, of course, your insights are based on a sub-sample of the population that actually buys anything from a salesman. Which means, if they are willing to listen to a salesman, they may already be predisposed to gullibility. Which in turn, means, extrapolating to the population, can have some severe probability and statistical sample and design errors.

As I have said many times, there is no policy that could be presented to Congress that would not have its critics and would not meet some portion of the population’s expectations. In other words, there is not such thing as a perfect policy or bill in Congress.

Example, Medicare. When established in the 1960’s it could not anticipate the projections of deficits the system would engender in just a few years, and some 4 decades plus later. That said, most everyone receiving Medicare assistance highly approves of the system. And the majority of Amercians polled say universal health care insurance is a good idea.

So, Okay, the Health care reform bill can’t solve all the nation’s problems, not even all of the health care system problems. But to expect it to is pure ignorant uneducated foolishness. The fact that it solves many problems for 50 million or more Americans without substantial adverse effects up the rest, makes it a reasonable bill to present to the people and the Congress.

I understand the politics of Republicans feeling that a Democratic victory in passing health care reform which may end up being approved of by the majority of Americans in time, constitutes a grave political threat to the GOP, but, it doesn’t change the realities of the day. The nation MUST have health care reform or bankrupt in the absence of it.

Posted by: David R. Remer at September 3, 2009 4:24 PM
Comment #287453

To the Mikes,

Facinating that when I threaten to get people reading the bill that when “Rwingers” (or any wingers at all for that matter) really do read in depth they virtually ALL hate you immediately resort to impugning the “base”.

Why would you do that? Perhaps to prejudice people against really looking into the bill. Why would people from the left look into the bill except to question their own leadership (read ‘the salesmen’)? But to do so they would have to fly in the face of others on the left who characterize the right as racist Neanderthal Rush zombies. In other words they must walk past a psychological fence thrown up by people on the left similar to the epithets of race baiters from the past.

That takes some courage.

We on the right may also have our qualms about Rush. I certainly do, but his website, unlike those of almost any of the other talking heads, is a wealth of well-researched information often, if not USUALLY, drawn from mainstream news sources.

David,

As I’ve said often before I am not against central payer systems, and de-facto government health care already exists. That’s not what this bill is. It is a means of getting control of people through the leverage of their health care. The person who can force me to accept his help is not my servant. He is my master.

There is no circumstance whatsoever in which I will accept a master.

Posted by: Lee Jamison at September 3, 2009 4:51 PM
Comment #287454

Lee, also, since the 1980’s and your experience, the internet has been invented and propagated around the world, and far more consumers are far more saavy, with the internet at their disposal, on big ticket items, than in your day as a salesman. I for example, would never buy a big ticket item, nor small, for that matter, without researching consumer feedback on the product first. I bought MagicJack in this manner and have not been disappointed. Helped my daughter buy her 2 year old Honda Civic with 40,000 miles for 14,000 from Enterprise without ever discussing the pros and cons of that particular vehicle with a salesman. We got the Carfax report, and did the research on the car on the internet before ever contacting the dealer. I visually inspected the entire vehicle, told them to fix the front hood latch, replace the left rear tire, and provide an owner’s manual, and we had a deal. They did what was asked, and my daughter walked away with a good deal and no sales pitch was ever desired or accepted.

She learned a lot in this purchase as a consumer and won’t be one of those who can be sold a bill of goods by some salesman whose earnings depend on making sale, whether the customer wants to buy or not.

I worked for Kirby Vaccum cleaners as a salesman for about a week. I discovered they were selling these way overpriced machines to people who could barely afford their rent, collecting a couple payments, repossessing the vacuum, and selling it again to another family who could barely afford their rent. And their sales tactics were very Republican, based on scaring the customer into believing their very health was at risk without this Particular Machine. I walked away from that job understanding how immoral and unethical their company and sales management were. I learned from it be a saavy consumer and skeptical of ANY salesman of any kind.

Posted by: David R. Remer at September 3, 2009 4:55 PM
Comment #287466

Lee,

The use of medical data bases, private or public, for research purposes is not unusual, unique or new. Qualified researchers routinely use such data bases for medical research purposes. Federal privacy rules under HIPPA protect the identities of the individuals in the data bases by requiring either personal authorization or requirements of stripping the records of personal identifying information (name, ss#, etc.) and provide penalties for disclosure of any such information.

Now, you suggest that such regulations could be abused in violation of law. Well, maybe. But is that a reason to shut down important comparative research using some of the richest data bases available? I think not. Should we decline to collect taxes because the data base could be abused by Federal officials? Should we decline to conduct a census because the data base could be abused? Jeez, under your paranoid perspective, the Federal goverment should not maintain or utilize any data bases.

Of all the proposed legislation, this should be on of the least controversial. Providing empirical evidence as to the efficacy of alternative procedures and medications has promise for saving enormous amounts of money as well as advancing medical knowledge.

Posted by: Rich at September 3, 2009 8:07 PM
Comment #287473

lee

good to see you.

if look likes dog poo, and smells like dog poo, there’s really no reason to taste it.

Posted by: dbs at September 3, 2009 9:46 PM
Comment #287479

dbs-
The healthcare system smells like poo. Do we need another fifteen years of the status quo with that stink?

See? I can use poo, too.

Posted by: Stephen Daugherty at September 4, 2009 12:18 AM
Comment #287493

“you have to get the government to stand up for you against the government”

Reference the judicial branch of government here.

“racist Neanderthal Rush zombies.”

I don’t think even the neanderthals were throwing poo at eachother. The zombie part is a little relevant, though. Where do people come back from the dead? On soap operas!

Posted by: ohrealy at September 4, 2009 10:14 AM
Comment #287511

The Problem here is that we’re not having a real policy debate, about what is right or not right to do. What we are having is an irrelevant character debate where “facts” like the above (what is really a misinterpretation of a fact) are sought for the sake of making an emotional appeal centered on alleging bad things about the character of the Liberals, thus justifying unthinking, unswerving opposition.

The argument isn’t that the law is truly bad. As others have said, the personally identifiable information is removed, satisfying the demands of confidentiality. No, the argument, falsely founded on an omission of that fact, is that the Liberals are bad, and they’re trying to foist bad law on people without giving them the chance to protest.

This plays into the larger emotional appeal to fear which has the Liberals as dangerous tyrants. It is the nature of the appeal’s logic that makes it untrustworthy.

Posted by: Stephen Daugherty at September 4, 2009 12:43 PM
Comment #287539

stephen

“This plays into the larger emotional appeal to fear which has the Liberals as dangerous tyrants. It is the nature of the appeal’s logic that makes it untrustworthy.”

boy this sounds very similar to the way the republicans were demonized by liberals when they were in power. where was your righteous indignation then? turnaround is fair play. time to get over it.

Posted by: dbs at September 5, 2009 9:46 AM
Comment #287557

Stephen,

You say this is a discussion of irrelevant things. Nonsense. We are TOLD (sold) that the bill forbids paying for illegal aliens to receive free care. By the exact same standard so does current federal law. But it is FEDERAL COURTS that force Texas hospitals to provice indigent care to illegal aliens and forbids searches of their records to assure those payments are peoper.
So that plank in the sales platform is a flat out lie.
Likewise we are told (sold) that there will be no payments for abortions, though the only piece of law standing in the way of that today is the Hays Amendment. The Hays Amendment sunsets annually and everybody in current Democrat leadership actively campaigned against its renewal, including President Obama.

Furthermore you assume cynically that we will believe people working for the government feel bound by the law. They don’t. Had I argued that expansion of S-CHIPS should be opposed on the grounds that it would be used to intentionally discriminate agains low-income small businesses, and that onerous accounting demands would be placed on such businesses even when federal tax returns made it clear business owners children qualified for the program you would doubtless have called me a liar.
That is exactly what happened to me. My children had been covered for a year under the program, but when we attempted to renew we were punted from bureaucrat to bureaucrat, told we would be covered then denied, and finally were told by a particularly unpleasant person that I would have to bring him an accounting of my expenses PER PAINTING for the entire previous year. This sort of anal exam is not authorized under the law, and it is clearly impossible for an artist, working with materials, sketches, and photographs that may go back twenty years or more to make an accounting of such expenses that could not be labeled innacurate, or even, if the cloistered bureaucrat has a mind to do so fraudulent.

What is obvious is that these people had determined not to provide the service the law claims to offer me. It was easy to do to me because I am a greedy small business man who probably cheats on everything I do, not some upstanding government citizen who protects the public from scum like me.

When it comes to government like this sort it is better to die than to comply.

Posted by: Lee Jamison at September 5, 2009 2:50 PM
Comment #287558

Stephen,

One of your own congresswomen has recently bragged on how brilliant a political leader Fidel Castro is. What are we to think when people on your side are lauding a man who literally murdered and literally imprisoned his political opposition on the basis of the “good’ he has done?

Every tyrant THINKS he is doing what needs to be done for the good of his people no matter how many of his people die in the process. We are not cynically playing on the fears of unthinking masses. We are scared to death.

Posted by: Lee Jamison at September 5, 2009 3:04 PM
Comment #287562

Lee,

“When I buy a car I try hard to concentrate on the car, not the pitch.”

Perhaps I am alone in this philosophy, but when I go to buy anything I have already done my research on what I am buying. I don’t need, or want, the “pitch” as I am really only there to negotiate the price and make the purchase.

It seems to me that there is massive a “selling” going here from all sides, and very little research being done by those that the sale will affect the most.

Rocky

Posted by: Rocky Marks at September 5, 2009 5:57 PM
Comment #287577

rocky

on the contrary, plenty of research is being done, and no one is buying the current model. time to design a new one. i love analogies.

Posted by: dbs at September 6, 2009 12:00 AM
Comment #287580

dbs,

I disagree.
IMHO there is a lot of polarization, and political gamesmanship going on, but just like at a used car lot, there is very little truth telling happening.

I love analogies too.

Rocky

Posted by: Rocky Marks at September 6, 2009 12:51 AM
Comment #287653


Lee, what are we American workers to think when your political party, with full cooperation of the other political party, sold us out to the Communist Chinese, a group of thugs that makes Fidel Castro look like a choir boy.

According to Republicans, Social Security, the social safety net and of course government run health care are forms of tyranical rule that will destroy America.

How many times have these programs caused an ecomomic recession? How many times have they thrown millions of Americans out of work?

The only tyrany that this country has experienced is the tyrany by wealth and greed.

Posted by: jlw at September 7, 2009 2:33 PM
Comment #287997

Lee: interesting post. I too have worked extensively in sales, albeit B2B. But some of the principles remain consistent - if you can make the prospect nod, he or she will find it difficult to shake their head. It’s all about framing the question: “Would you say it would be a good thing if everyone had health insurance?” Nod frantically. “Would you pay extra taxes so that those who choose not to work could get the same benefits as a hard working American?” Frantic shakes of the head. Truly good (and I mean effective, not moral) politicians are essentially the same guys who sell you used Taurus’s at the local Ford dealership. We are right to be skeptical.

Posted by: Jon Rice at September 13, 2009 12:08 AM
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