Marketing Bad Health Care Decisions as a New Form of Stealth Health Policy Advocacy

A remarkable set of video advertisements appeared a few weeks ago that seem designed to frighten people into making bad health care decisions.

The "Bad Uncle Sam" Advertisements

As described by Businessweek,

In the first ad, dubbed 'The Exam,' a young woman who has signed up for Obamacare arrives at a medical facility and changes out of her clothes and into a flimsy hospital gown. Following the instructions of a doctor, she reclines on a hospital bed and spreads her legs into a pair of stirrups. The doctor leaves the room. Then, suddenly a mascot wearing a plastic Uncle Sam mask and sporting an unwavering grin—Creepy Uncle Sam!—pops up between her legs. As she screams, the ad pans out. 'Don’t let government play doctor,' reads the kicker.

The final message, for some reason not described by Businessweek, was

Opt out of ObamaCare


A second spot, entitled 'The Glove,' follows a similar narrative arc. A young man sits in an examination room and tells a doctor that he’s signed up for Obamacare. 'I saw the ads and figured, why not?' he says. 'Okay,' says the doctor. 'Take your pants off.' The man drops his trousers, reclines on the hospital bed, and brings his knees to his chest. The doctor leaves the room. Behind the young man, Creepy Uncle Sam pops up, raises his hand into the air, snaps on a latex medical glove, and wiggles his fingers menacingly.

Once again, the final message is

Opt out of ObamaCare

The Ostensible Message of the Advertisements

Again per Businessweek, the ads were sponsored by " Generation Opportunity, a Virginia-based conservative organization funded in part by Charles and David Koch,..."  According to an article on the Atlantic website, Generation Opportunity means to be

urging Millennials not to sign up for insurance on the health care exchanges created by the Affordable Care Act. It claims that paying the individual mandate's tax penalty and buying insurance that doesn't meet government coverage rules is a 'better deal' for young people.

As many have noticed, that is not the implication of the visuals.  As an opinion piece in the National Journal put it,

 the message is that the government is trying to forcibly rape women with a blunt metal instrument.

Furthermore, the final written message of both advertisements is not a nuanced one about where one should seek to go to buy health insurance.  It is simply "opt out of ObamaCare."

A Nonsensical Premise

Also, the premise of the advertisements is nonsense, to put it politely.

ObamaCare does require health insurance to pay for various kinds of preventive care without requiring patients to pay deductibles.  It does not make physicians and nurses provide these services.  Whether a patient gets, for example, a pelvic exam, is up to that patient and her doctor or nurse practitioner, not the government.  Of course, the legislation does not remotely suggest creepy government agents should perform pelvic or rectal exams. 

Thus, the entire point of these advertisements seems to be to generate irrational fears that will drive young people away from health insurance now available through ObamaCare.

Stealth Health Policy Advocacy by Means of Marketing Bad Personal Health Care Decisions

In the US, the Affordable Care Act, aka ObamaCare, still arouses a lot of controversy.  There are many people who have been critical of various aspects of the law.  (In fact, we criticized it for not addressing most of the issues about which we write on this blog.)  Furthermore, there is at least a large minority who want to repeal the law.  So there has been an ongoing barrage of persuasive messages meant to support or criticize various aspects of the law, and to support or discredit the entire law.

However, the "Bad Uncle Sam" advertisements are different.  They do not urge people to vote for any particular person or initiative.  They do not urge people to express their own policy views.  They do not ask for contributions to political or advocacy organizations.

Instead, they urge people to make particular health care decisions.  Despite the more nuanced messages espoused by Generation Opportunity when interviewed, their advertisements try to irrationally scare people away from purchasing health insurance made available by ObamaCare.

They are aimed at young adults, who are less likely to have spare funds to pay for expensive health insurance, less likely to get sick or injured, and more likely to feel relatively invincible.  However, were an uninsured person, even a young one, to suffer a significant illness or injury, the resulting costs in our dysfunctional and extremely expensive health care system could drive them bankrupt.  This is all the more likely since the uninsured are likely to be charged "rack rates" for health care, while insurance companies negotiate discounts for their subscribers.  Furthermore, uninsured people may put off needed tests and treatments due to financial concerns, yet doing so may lead to worse health care results, or even death.

An article in the St Louis Post succinctly listed the costs associated with some unlucky outcomes for uninsured young people, for example, 

Suppose you twist your knee playing soccer. Without coverage, fixing it will be at least $20,000 to repair the ACL ligament, according to an estimate from

Can’t pay it? Buy some crutches. They run about $30. You’ll also take on the risk of tissue damage and early arthritis.

Personal finance columnist Jim Gallagher concluded,

 although the vast majority of young adults stay healthy, serious trouble is not rare. Those without insurance are playing the odds. If they win, they’ve saved the insurance premiums. If they lose, they’re ruined.

Generation Opportunity may claim to be

 a free-thinking, liberty-loving, national organization of young people promoting the best of Being American: opportunity, creativity and freedom. 

However, what it appears to be doing is urging bad health care choices  based on a false premise to serve an ideological agenda.

Thus, its advertisements are a unique and uniquely bad mixture of marketing (of bad decisions) and stealth health policy advocacy.  If they want to publicly oppose ObamaCare, that is their right.  Fooling people into making bad decisions in the hopes that this will financially burden ObamaCare is completely unethical and amounts to disinformation, in my humble opinion.  The leadership and funders of Generation Opportunity ought to be ashamed of themselves.

The US has many major health care problems.  They deserve discussion and debate.  Disinformation that tries to confuse people into making bad personal health care decisions is likely to make our health care dysfunction even worse.  

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