Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor
Dept. of Podiatric Medicine
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences
St. Pomona, CA

Patient Views on Obamacare and the Power of Psychology: Part 1

As anyone not living in a box knows, the big news over the past couple of weeks has been the troubled rollout of the Affordable Care Act (ACA), also known as Obamacare. Now, I don't plan on discussing the merits and disadvantages of the plan – honestly I'm kind of bored listening to the extreme opinionaters blather their views for and against the plan on national television, radio, and the Internet. I will say, for disclosure's sake, that I am a supporter of the program, and I don't personally feel it's going to destroy the country. Just my own opinion.

With that aside, what I do find interesting is the individual reaction to the ACA and what this news that affects so many of us (either as providers or patients) brings out. As a matter of divine coincidence, I just happened to experience two specific patient encounters this past week where the ACA came up as a topic of discussion. I found the patients' reactions to Obamacare amusing and informative about the human condition.

The first patient was a cash pay diabetic who was following up after I saw him in the hospital for an infection. The patient spent quite some time in the hospital, racking up a bill that I can only imagine was very large. Unfortunately, one of the problems was this patient did not have a primary care doctor. One can imagine this was part of the reason the patient ended up in the hospital in the first place. During our conversation, I mentioned Covered California, which is California's health care marketplace, its part of the ACA. Additionally, as California was one of the states that elected to expand its Medicaid program, Covered California is also taking care of this part.

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During our discussion, I brought up the need for the patient to find a primary care provider for all of the obvious reasons, and I recommended Covered California as one possible way to get set up with healthcare. The patient was very excited about the potential benefits of this program...

...Until I offhandedly mentioned this was Obamacare. The patient immediately turned off. I could see the disapproval etched on his face. He said he would rather go without insurance than apply for Covered California. I tried to push the point, but after a couple of minutes I gave up.

The second patient was similar in many ways. This patient encounter was actually in the hospital a couple of days after limb sparing surgery. This patient was also uninsured. As before, we started talking about Covered California, but this time without my using the names Affordable Care Act or Obamacare. And, just as before, when I finally mentioned the "dread" terminology, the patient reacted negatively to finding out that the same benefits that minutes previously he was excited to have were now a problem. Interestingly, this patient had just one day prior asked if I could assist him with being listed as permanently disabled. I guess he was agreeable to milking the system one way but not the other.

Whether you agree or disagree with the law itself, I think we can all agree to the oddity of changing one's reaction when the thing you thought to be true turns out to be false. These two patients' reactions speak to the very intriguing human phenomenon of being unable to change one's beliefs in the face of a changing environment.

I wonder: if we were able to understand this aspect of human nature, would we as providers be more effective at changing our patients' behaviors? As it just so happens, psychological research has looked into this very issue. I'll leave you here to wait with baited breath to find out what social psychology has to tell us and how we can use that information to help our patients.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
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