The One Risk to Democrats’ Prescription Drug Costs Messaging

And an important reminder for health care communicators

My last job was all about something called “value-based care”. That’s the label for the idea that our health care system should invest in keeping people healthy, instead of just waiting until they get sick.

It sounds pretty commonsense. But there’s one small problem with communicating that idea, and I have United States of Care to thank for getting it stuck in my head.

The experts at US of Care spent 10 months conducting focus groups and polling patients about value-based care. They found that nearly everyone loved the idea. They just couldn’t stand the title.

“Value-based care” is subjective and encourages misinterpretations and misunderstandings of what is trying to be achieved. It is thought to be cheap, inferior, and low-quality. Rather than using the term “value-based care” shift the conversation to how the approach improves quality and puts patients first.

One presenter of the results noted in a webinar that “value” reminded people of the clearance rack at a department store — or the cheap food in a grocery store that sits next to the universally-known brand name.

In other words, value meant low-cost and low-quality, too.

In communications, it’s easy to fall into this trap: You find your audience’s top concern and end up crafting messages that make it sound like you think it’s their only concern.

“Value-based care” hit on people’s top concern for health care (costs), but it ignored the real complexity of how people think about their health care. And I worry that the Democratic Party’s messaging around prescription drug prices could fall into a similar trap.

Health care isn’t just one thing. It’s three.

People in America universally agree that we pay too much for health care.

But that’s not all! They also generally agree that it can be hard to access the care we need, largely due to our patchwork of health insurance, and that care can vary widely based on where you live.

Back when I worked at HHS in the Obama Administration, we had a rule of thumb — if you were talking about any reform to make the health care system better, you’d better have three bullets in your talking points or three sections in your speech:

Access, Affordability, Quality

This was a real pain in those moments when all you wanted to do was hammer home how the Affordable Care Act had expanded health coverage to historic levels. But it was a smart communications strategy. If we were expanding coverage, people might naturally worry that their own premiums were going to rise. They might fear that the quality of their own insurance or the time they could spend with their doctor would drop.

People enjoy having their problems fixed. But in our base, lizard brain we are all hardwired to be loss averse. We hate losing more than we love winning. And so much of messaging about proactive policy reforms is assuaging people’s fears that if we try to fix today’s problems, we’ll end up making the future worse.

Here come the ads

Speaking of today’s problems — social media!

I saw something great on Instagram the other day:

Democrats are officially kicking off the 2024 general election, and they’re doing it by starting with their best issue, at least from a communications perspective.

Lowering drug prices for Medicare beneficiaries is a straightforward policy win that is universally popular and widely unknown. In comms speak, high popularity and low salience. According to a KFF poll — more than 80 percent of all voters support it and nearly 70 percent aren’t aware it’s happened yet!

If you’re a communications professional on the Biden-Harris 2024 campaign and you’ve seen these numbers, you have instantly and like an unconscious reflex, bought a ton of ads telling more Americans that this President successfully opened the door for Medicare to negotiate lower drug prices and cap the price of insulin.

But how you message those ads can make a world of difference.

Back in 2021, KFF conducted some polling on how support for drug price reform shifts when voters hear counterarguments . They found some concerning weaknesses:

All voters, including independents and Democrats, flipped their support for Medicare drug pricing reforms when they heard the (false) arguments that these lower drug prices would lead to less research and development of new drugs or limit people’s ability to get newer prescription drugs (cough cough QUALITY and ACCESS cough cough).

In a totally normal communications environment, this kind of soft support would be a concern. In the crazy, algorithmically-charged, hyperpartisan echo chamber that is an American presidential election in 2024, that kind of soft underbelly to an argument is a real risk.

Democrats, in other words, need to get ahead of the counter-messaging.

How to do that?

I assure you, there are much smarter comms professionals than me thinking through this on a regular basis — and tons of advocacy organizations and political groups are funding research and focus groups to help them do it. But you don’t start blogging to defer to the experts actually doing the work, do you? So here’s my armchair quarterbacking:

Straight-up “Choice” framing — The White House has already leaned into this approach , highlighting congressional Republicans’ commitment to repealing drug price reforms.

Investing in Better Quality through Research — The Biden Administration can tout some bold commitments to medical research and science. The 2024 budget called for $48.6 billion in new funds for the National Institutes of Health, including $7.8 billion in the National Cancer Institute in support of the President’s Cancer Moonshot. Now a President’s budget isn’t law, but if voters send President Biden and more Democrats back to Washington, it comes a step closer to reality.

Improving Access by Cutting Red Tape — The Administration has proposed fixing “prior authorization ” that all too often comes between a patient and the medication their doctor recommends. This has the added benefit of putting the Administration on the side of the doctor-patient relationship and against the unpopular bureaucracy of insurance companies.

This is an Administration that has a ton of policy accomplishments to tout. Democrats shouldn’t fall into the trap of selling any one of them as one-dimensional. They shouldn’t make good policy wins sound cheap.