Contrast is the driving principle behind all decisions. You have to know how your options differ, and by how much, or else you have no basis for a decision. President Obama solved for the contrast problem by designing Obamacare to cover more people than before. The rest of the details - especially the costs - were hard to predict, so our brains flushed that noise and focused on the greater number of people covered.
Everyone knew Obamacare would need future tuning to get it right. That gave us mental permission to focus on the good parts we understood - the greater coverage - and hope the other details would get worked out later. President Obama nailed the Contrast Problem like the Master Persuader he is.
That was then.
Now, President Trump and the Republicans have the "going second" problem. The public will compare their proposed bill with Obamacare and conclude that the one metric they understand - the number of people covered - does not compare favorably with Obamacare. The contrast is fatal.
We know Paul Ryan will do his wonkish best to tell us about all the amazing advantages of this new bill. And we know the public won't understand any of it. But they sure will know it doesn't cover as many people. Done. Bury it.
During the campaign, candidate Trump made some references to taking care of everyone. It sounded like universal coverage, but no one thought he meant it.
He did mean it.
He meant it because he understands the contrast problem. Any Obamacare replacement needs to cover more people than Obamacare, or else it is dead on arrival. Any skilled persuader would see that.
Paul Ryan doesn't see the Contrast Problem as important, evidently.
I think most trained persuaders would agree that the one-and-only path to a successful replacement of Obamacare should include AT A MINIMUM a plan to reach greater coverage. And the only way to get there is by goosing innovation in the healthcare field. We can't tax our way to full healthcare coverage. We need to lower the costs. And President Trump also needs to solve the Contrast Problem.
To that end, I suggest creating a special low-cost (or free) plan for low income people who are willing to accept a bit more risk. If the plan is robust enough, it could provide a path to greater patient coverage compared to Obamacare and solve the contrast problem. As a mental exercise only, the plan might have the following elements:
1. Online doctors for 90% of routine cases.
2. Require big pharma to provide free meds for people in this plan as a condition of selling in the United States. The low-income people covered would be the ones who would not otherwise buy these drugs, so the companies would only lose the cost of the materials themselves, which is trivial.
3. Recruit and approve special doctors for this plan who are by law exempt from any malpractice suits so long as they provide reasons for their decisions. This would allow them to avoid some red tape and also use new and inexpensive medical technology before full FDA approval - but only for the new stuff that common sense tells the doctors would not be especially dangerous. I'm not talking about pills and internal medicine. I'm talking about medical devices, mostly. It would be up to the doctor to decide when it was safe to risk using the new methods.
4. Patients agree to wear health monitors - the newest prototypes - and to share their medical information (anonymously) for the greater benefit of society. This would allow early detection and treatment. Perhaps the low-cost insurance could be free to those who walk 10,000 steps a day, or something of that nature.
5. Shine a government light on any medical technology or systems improvements that would lower cost, to guarantee that the good ones are known to doctors and investors. (Then stay out of the way.)
This is just a starter concept for what a special low-cost plan (with slightly higher risks) might look like. The main point is that you could cobble together a low-cost plan if you had some government muscle behind it to clear out the useless regulations and to focus energy in the right places.
If President Trump presents us with a healthcare plan that doesn't cover as many people as Obamacare, but will cover more people eventually, that's a winning contrast.
Otherwise, the bill will die on the Contrast hill. And that's the direction we're heading.
As I've said before, America can't make a strong claim to greatness if we can't do healthcare right. So let's do it right. Or at least have a plan to get there.
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