Field Notes Inside an Integrated Communications Agency

If there is any agreement among political pundits these days, it is a sense that the GOP has the grabbed the political "mo." That's not unreasonable, what with President Obama's poll numbers dropping like a rapper's pants, a dismal economy, and the stunning loss of Teddy Kennedy's seat to a GOP neophyte in blue-blue Massachusetts. But the latest polling data from Rasmussen highlights some significant problems for both parties.

The rightward swing has been undeniably unkind to the President.  Only 21 percent of Americans believe one of the central claims of President Obama's State of the Union address: that he's cut taxes for 95 percent of Americans. A majority (53 percent) say that has not happened and nearly half expect their own taxes to rise under Obama.

But Rasmussen data also suggest some challenges for their party's traditional candidates as well.  In a number of races, GOP front-runners are losing ground to more conservative candidates. After an early lead in the Florida Senate race, Governor Charlie Crist is now trailing conservative Marco Rubio by 12 points. In the Texas gubernatorial race, support for Tea Party activist Debra Medina has quadrupled since November and she was recently asked to participate in a televised debate with incumbent Rick Perry and leading GOP challenger Kay Hutchinson.

And while the number of registered Democrats has fallen, the GOP lost ground as well.  According to Rasmussen, the percentage of voters not affiliated with either party is at its highest point since 2007. Is it possible that Americans have simply had enough of DC gridlock and the ugly sausage-making evident in House and Senate passage of health care legislation?

Perhaps the most alarming finding from Rasmussen is that people don't seem to grasp that fully half of the federal budget goes to national defense, Medicare and Social Security. Although budget documents released by the Obama administration clearly document this, only 35 percent of Americans believe it.

That neither party has been able to communicate where all the money is going bodes ill for the formation of sound fiscal policy.  With the public lost in the weeds, it's no surprise that Tea Party conservatives calling for draconian government layoffs are gaining steam.

The prestigious British medical journal Lancet made big news this week by retracting a 1998 article citing a link between autism and the measles, mumps and rubella vaccine(MMR). The study had claimed that eight out of 12 children attending a routine hospital clinic had reported problems with GI disturbances that led to autism-like symptoms within days of MMR injections.

A vaccine required for school enrollment might trigger autism? Profoundly troubling. Parents abandoned vaccines in vast numbers, leading to a resurgence of measles. Multiple, rigorous studies have since been unable to substantiate an autism link. The methodology of the original study was questionable at best, and was further compromised by an unreported conflict of interest – parents already convinced of the MMR-autism tie helped fund it. Even after the Lancet retraction, some parents may remain wary of vaccines, preferring to risk virulent diseases rather than vaccines that repeated studies say are safe and effective.

MLOS - Mothers and Apple pie

Sadly, emotion's predominance over reason in health matters is hardly unusual. In the mid-1990s North Carolina passed a "maternity length of stay" (MLOS) law guaranteeing insurance coverage for a minimum 24-hour hospital stay after childbirth. The MLOS law came into being through a floor amendment proffered on the final day of the Legislative Session, after a new mother was sent home too quickly from the hospital in the opinion of her mother-in-law, a state legislator.

Sure, there had been no committee debate and the database was a single case, but talk about motherhood and apple pie! The vote was not close. Only several years later did data emerge showing that the average stay for a normal, vaginal birth at the time the bill passed was already about 24 hours. (After the law passed, of course, the average stay crept up considerably, because discharges don't happen in the middle of the night. A 2006 study published in Pediatrics showed the longer stays produced no change in the one-year mortality for infants.)

Breast Cancer and Bone Marrow

In the late 1990s, a raging controversy emerged over coverage for high-dose chemotherapy plus autologous bone marrow transplant or “HDC-ABMT” in the parlance of dedicated supporters. Insurers were denying coverage for the procedure based on its high ($80,000) cost, combined with a dearth of evidence of advantages over cheaper and less risky treatment options.

Despite extremely limited evidence of HDC-AMBT’s effectiveness for breast-cancer patients, hysterical media coverage featured tales bean-counting insurers withholding payment for life-saving care. Intensive lobbying and a rash of legal challenges built into a backlash that lead many states to mandate coverage for the treatment. Numerous, rigorous studies have since raised serious questions about the efficacy of the approach relative to other options. An article published in Health Affairs suggests that "health insurers spent more than $3.4 billion during [a] ten-year period on a treatment that turned out to offer no appreciable medical advantage over standard-dose chemotherapy, which can be had for less than half the price."

Death Panels

Which brings us to… Death Panels. As I've blogged before, the idea that President Obama planned to cut Medicare costs by whacking your grandma was based on a pretty selective reading of legislative language guaranteeing coverage for counseling on end-of-life issues. Yet the concept caught fire along ideological lines, overwhelming a reasonable attempt to encourage people to consider the issue and execute living wills.

Then there's the recent flap over cancer screening. A government panel weighed evidence that suggested the benefits of early screening for younger women were outweighed by the risks inherent in additional exposure to radiation. Government rationing was the immediate and predictable response from conservatives and right-wing nut jobs, but disease advocates also fanned the flames and respected organizations like the respected American Cancer Society dug in hard in support of early screening. The Obama Administration, unwilling to give the GOP another shibboleth, missed the opportunity to champion evidence-based medicine by backing off the new standards almost immediately.

If all this makes you a bit worried about America's ability to translate scientific evidence into rational health policy, well, yeah -- me too. The health care debate is so polarized along partisan and ideological grounds that people seem unable to think clearly. Those of us who communicate on health issues must remember the ideological and emotion filters through which information on health care passes.

I'm open to ideas on how to get people to turn off Bill O’Reilly AND Keith Olbermann in pursuit of more even-handed analysis. In trying to give reason a better shot, promoting The Health Care Blog or Health Affairs Blog might be a good place to start.

There was a terrific article in the New Yorker last week that points out why the debate is Washington over how to "fix" health care is focused on the wrong things.

Fans of a single-payer system -- as legion and ardent as any crowd of Deadheads you'll ever meet -- subbornly equate "reform" with a government run system.  Period.  Anyone with doubts about putting 16 percent of our nation's GDP in the hands of the same folks who brought us FEMA trailers are painted as reactionaries, obstructive, self-interested or worse.

This confuses universal coverage with public sector control. Yes, Canada and England have a single system, but Germany and Australia get the job done with a public-private mix.  Or think about how Medicare and private supplemental coverage works.  While our current system doesn't pool risk as effectively as it could, the primary problem is not the funding mechanism.

Which brings me to a terrific article in the New Yorker by Atul Gawande.  Dr. Gawande examines two Texas towns of similar demographics and health status, but startlingly different health care costs.  Why, Gawanda asks, is McAllen, Texas, the "most expensive town in the most expensive country in the world?"  An interesting question, especially since Medicare costs in the demographically similar population in nearby El Paso county are HALF what they are in McAllen.

The good folks at the Darmouth Atlas program have been documenting such oddities in great detail for a quarter of a century.  Yet local health care providers, from specialists to hospital administrators, couldn't explain this cost differential, and some were surprised to find that their costs were high in comparison to other markets.

The evidence supports none of their guesses as to why this is.  We give better care.  (But outcomes aren't measurably better.)  We have so many sick and poor people here. (But McAllen's population is not very dissimilar from many other locations with much lower costs.)  Our town is more litigious. (But Texas tort reform has significantly curtailed malpractice costs.)

What seems to be the problem is that McAllen's health care providers simply provide more care, LOTS more care, of virtualy all kinds. And there are more of them in McAllen doing it.  Why not?  That's what our do-more, earn-more reimbursement system rewards.

We could, instead, pay for the most cost-effective care. Federal stimulus legislation funds studies on comparative quality in health care that would make this possible.  Creating a comprehensive database on what methods, devices and drugs work best should be a road map on how we should reimburse health providers and manufacturers. 

Resistance to this small section of the bill was fierce, and it only passed when it was specified that this research would not impact reimbursement practices.  See, you can't cut health care costs without someone making less money.  And what group or organization will volunteer to do that? 

Any system, public or private, that doesn't break this logjam won't give us the real reform we need.  

Everyone with sight knows Shepard Fairey's famous "Hope" image of Barack Obama. It was everywhere during the campaign. That image is now smack in the center of a three-way copyright spat between the artist, the photographer and The Associated Press.

I fell in love with Fairey's work through his Obey campaign. The boldness of his work rises out of skate and hardcore culture developed from extensive use of stenciled appropriated images and collaged intricate flourishes. The images are conceptual, compelling, entertaining and super tasty.

The Associated Press is suing Fairey for copyright infringement of their Obama photo taken by Mannie Garcia. Fairey actually sued them first. That's another story. Fairey has said he used the shot as reference for his image. He claims fair use for artistic expression. This is not new. Andy Warhol made a fortune this way. "Webelieve fair use protects Shepard's right to do what he did here," says Fairey's attorney.

Mannie Garcia, the original photographer, was on assignment at the press club to cover George Clooney who was sitting beside then unannounced candidate Obama. Garcia says he shot hundreds of photos that day and didn't even know "Hope" was based on his photo.

"I've been on the campaign for twenty-something months says Garcia, "I would see the artwork, I would photograph it, and think what is with this image? But it didn't snap. It never occurred to me it was my picture…It's a really cool piece of work."

Okay here's the deal. Fairey used a commonplace image to draw from. Certainly if you put them side by side you'll see the reference. You'll also see the difference. With respect to Mr. Garcia, he shot hundreds of photos that day and thousands over the course of the campaign. This image could belong to anyone that happened to sit in front and slightly below Mr. Obama.

While there remains uncertainty on how this case will affect future intellectual property issues, one thing is certain. Shepard Fairey's work is about the art of appropriation. The medium is the message. This street artist, known for being arrested 14 times, now has historical work in the National Portrait Gallery. He'll inspire a group of disenfranchised apathetic design students to pursue the career. His credibility will grow with his audience. This whole brewhaha just makes his work more noteworthy and him more cool.

President Obama is Web 2.0's dream communicator. His oratory skills are now legendary, but his use of social media to reach an audience is the 'new norm' in how politicos are communicating with the masses.

With today's first presidential online town hall meeting, set for 11:30 a.m. ET, regular folks (with access to the Internet), can ask their president any question --and yes, if you're lucky, he'll respond to your question (if it's voted as a popular one).

I recall my first town hall meeting. It was in the old courthouse downtown on a hot July day. The homemade flyers had dual purposes – part agenda, but mostly used as paper fan to cool down. Not from any hot debate, just plain old heat.

President Obama's skill at communicating with the masses trumps any Sunday morning talking heads TV show. Instead of a bunch of politicos telling the viewer what they think regular folks are thinking, now, through Facebook or Twitter, regular folks tell you exactly what they're feeling – in real time.

As social media evolves, politicos (and their communications teams) must step up their game. President Obama's team has. Any governor, senator, county commissioner, mayor or school board member must follow suit. Politicos' staffers will learn that they are just a Tweet away from handling a massive communications headache – one that could last for many hours.

So, I'm off to http://www.whitehouse.gov/openforquestions/ to put in my two cents. And if you have any comments, DM me on Twitter at @Lilyn.

CNN is running an article describing how a number of US Congress members used Twitter to deliver a kind of running commentary on President Obama's first State of the Union address.

It might be tempting to read this article and proclaim that if the US Congress - the single un-hippest joint in the whole of our great republic - has jumped on the Twitter bandwagon, then surely, this whole social media thing has truly arrived. But if you season this with just a tiny bit of healthy cynicism, I don't think it's too hard to see the thinking here. We just learned how young voters can turn an election your way, and that the Internet can play a big role. I don't think we should really be all that surprised that we now have Congresspeople twittering during the SOTU.

If you think about it, it's not hard to imagine that a lot of the of tweets coming out of the chamber last night were pre-scripted (scripted to sound spontaneous), and mostly written by staffers. For each Congressperson-twitterer, there was almost surely a debate-like preparation - a strategy on how to react to things they were certain the President would talk about.

The story here is not that this body of predominantly old white dudes has found their inner nerd and embraced the technology of this decade ("Tubes!" indeed). Rather, this is one of those sublime instances where the story is the story. The interesting thing isn't  that folks who are usually well-known as techno-luddites used Twitter en masse, it's that their twitterings made the front page of CNN. If there actually were any Congresspeople who were using their mobiles to twitter a genuinely spontaneous dialog during the speech last night, you can rest assured that this was the last time that will ever happen.

The biggest question looming in the wake of Barack Obama's historic victory is this:

What the heck is he going to do with all those email addresses?

No one knows exactly how many millions of email addresses the Obama campaign captured during his run for the presidency. But his emotional appeal to the electorate, coupled with a low-cost, instantaneous connection to millions of supporters, has the potential to fundamentally change the way public affairs is practiced in the United States.

Think about it. The U.S. House of Representatives is debating, for example, President Obama's immigration reform proposal. Congresswoman Virginia Foxx, one of Capitol Hill's most strident anti-immigrant voices, gets a half-million emails in support of Obama's plan from her own congressional district.

No industry group, trade association, non-profit entity or even political party has ever assembled such a massive public affairs asset as Obama's list. Millions on the list made the deepest investment one can make in a political campaign – they gave money. They are much more likely to heed an appeal from the new president to contact their member of Congress to urge the Change We Need.

Even an army of lobbyists can't compete with a message from a voter back in the district. The Obama administration's ability to demonstrate that the sender of the email does, indeed, live in Congresswoman Foxx's district and will, in fact, vote against her at the next election, portends a new era of grassroots public affairs.

I've been involved in political campaigns for years. In the days and weeks after Election Day, the mismatched campaign headquarters furniture is shipped off to someone's basement – or carted to the landfill. Files are dumped. And the hard-earned lessons are washed away in a sea of champagne or a trail of tears.

My prediction is the Obama campaign will be different. The campaign has been disciplined in every respect. It will find new ways to use its millions of email addresses. Count on seeing unprecedented grassroots support for the new administration's programs and in ways that no one has yet conceived. Change is on the way.

I am a North Carolina son, born and bred. And today, I am proud to add to my geographic bio.

I live in a blue state.

This Presidential primary season is wearing me out. I'm tired. Both Democratic candidates are offering attractive platforms of change, but on the surface there have been very few stark differences between them...UNTIL NOW.

Insert the smoke and mirror parlor trick that is the Gas Tax Holiday.

On April 6th I bought a tank of gas for my 1998 Honda Civic HX** at $3.29 per gallon. Yesterday I purchased a tank of gas for $3.54 per gallon, almost exactly one month after the previous. I feel it. It hurts. Something must be done. Is it elitist and out of touch for me to feel that this 'holiday' being proposed by Clinton and McCain is so much hot wind blowing down Pandering Alley?

I took economics in college. Even if I had not, I would still smell a rat. Who's going to pay for this? According to Clinton, Big Oil is going to cough up the $8 billion in the form of a windfall profit tax. Never mind that there is no precedent for this tax. Never mind that this tax has not yet even been proposed, but rather is part of the bundled proposition set forth by the Clinton campaign. What if it doesn't pass? Who will pay for it? Both of those questions were rhetorical. It will not pass - it's been tried and has died before. I will pay for it. And you. In the short run, we'll simply play middle man between China and Saudi Arabia.

Meanwhile, 18.4 cents worth of Federal highway dollars will be getting sucked down the ol' drain for every single gallon of gas purchased during this proposed holiday. This, during an election cycle focused in part on the dire straits of our national infrastructure.

Using today's pre-Memorial Day price as a benchmark, trimming that 18.4 cents off the top - and rounding up, of course - puts the price of gas at $3.36 per gallon. Sounds dreamy, I know. Now imagine the siphon on demand that will be created by the knowledge that, once the 'holiday' is over, the prices will catapult back to an adjusted level. People will line up at the pumps to top off their tanks. Demand goes through the roof. OPEC is not going to increase production just because we decided to take a break from reality. The reality is, profit margins for Big Oil will skyrocket.

I'm hearing the argument that the anticipated household savings of $28-$30 over the course of the 3 month tax holiday is tangible to working Americans, and that anyone opposed to the plan is out of touch with the middle class struggle. I disagree. Ten dollars is a non-issue in all but the most restrictive of monthly budgets. In the case of those most restricted household budgets, blowback will in some way or another generously offset that monthly ten spot. If this is allowed to play out, we will all be out far more than $30. I have not seen anything resembling a perfect way out of this mess we've gotten ourselves into. But come on - can't we at least try to keep our feet on the ground as we try to work through it?

My thoughts to this point have been overtly, unapologetically political, so let me end on a marketing communications note. No matter how bad an idea this is...no matter how much of a gimmick you may or may not believe it to be...I believe this proposed holiday is a marketing maneuver that will deliver for Hillary Clinton, in the form of primary votes in Indiana. People are frustrated over gas prices, and regardless of the facts of the case, this marketing tactic gives the good vibe of John Q. Public reaching out and touching his government.

 

** Stay tuned for my upcoming article on the choices we make as consumers of petroleum. My 1998 Honda Civic HX is 10 years old, with 158,000+ miles. I still get 37mpg city, 41mpg highway. I'm not trying to be smug or arrogant. But seriously, what the hell? 

I attended a fascinating lecture by CNN senior political analyst Bill Schneider last night at UNC’s school of Journalism and Mass Communications.  While the title of the lecture was “The Role of Media in Politics,” the discussion focused more on the role of public opinion and how the mood of the times shapes the political debate and ultimately decides who gets elected.

Schneider opened with a quote from former British Prime Minister Benjamin Disraeli. "There are only two things you must know to pursue a career in public life. You must know yourself, and you must know the times."  As someone who analyzes polls for a living, Schneider identifies “knowing the times,” as the key to political punditry.

Public opinion saved Bill Clinton’s political career. When the Monica Lewinski scandal hit, the media declared Clinton finished. A poll was taken, and Clinton’s already high approval ratings went up 10%. Two-thirds of Americans believed he should not be removed from office, even though the same two-thirds agreed he lied under oath. Overnight, conventional wisdom shifted, and the media was now talking about the “comeback kid.”

When it comes to public opinion and presidential elections, Schneider coined a concept he calls the “law of missing imperatives.” It asks the question: what do the voters want that they are not getting from the incumbent? In 1968, American politics, especially the Democratic Party was in turmoil. Violence and unrest were prevalent, and the country seemed to be coming apart. So voters elected Richard Nixon, because they viewed him as a strong man who could bring order. He was also a moderate republican in the middle of the political spectrum.

In 1976 after the Watergate scandal, Americans felt lied to and betrayed by their president.  Polls showed the American public wanted morality. Along came Jimmy Carter who famously stated, “I will never lie to you” and won the election. Four years later in 1980, Carter had earned a reputation for being wishy-washy and indecisive. In response, the country now yearned for a strong decisive leader, and Ronald Reagan fit the bill.

We can apply this logic to each presidential election cycle. In 1992 Americans saw George Bush Sr. as out of touch with regular everyday people. Bill Clinton, on the other hand, played saxophone on the Arsenio Hall show and specialized in empathy. His ability to connect won him the White House. Most recently, in 2004, John Kerry ran on the platform of a strong ex-military veteran, someone capable of taking on the role of commander-in-chief. According to Schneider, Kerry read the times wrong. People felt like they had a strong commander-in-chief already and weren’t looking for someone to fill that role. While this type of analysis does oversimplify things and paint very broad strokes, there is some truth to it and it illustrates the importance of public opinion.

Mr. Schneider went on to talk about this year’s crop of candidates. One of the most unique things about Barack Obama is that he is an African-American politician who does not come from the civil rights movement. His perspective isn’t one of racial grievance, as others have had, and he’s not making it a part of his campaign. Obama is also running as an outsider, someone not tied to special interests or “politics as usual” in Washington. Schneider believes that Obama is in tune with the times and is aware that people want to be united. They are tired of the rampant partisan politics perpetrated by the Bush administration and are looking specifically for someone to bring them together. (Ironically, before being elected president George W. Bush said, “I’m a uniter, not a divider,” and then spent the next eight years doing the exact opposite.) Hillary Clinton is running on her experience. She delivers, Obama inspires. That is why the race for the Democratic nomination is so close. Both options are attractive.   

Mr. Schneider pointed out that while this election should be a sure thing for the Democratic Party, it is not. John McCain also offers a uniting policy. He is viewed as outside the Bush administration and has acted bi-partisan in the past. In order for the Democrats to win, they must paint a McCain presidency as if it would be Bush’s third term.

A dynamic speaker, Mr. Schneider was insightful and confident about his topic. If there was one take-away from his lecture it is that politicians must know their times and ignoring public opinion will cost them.