Defining the (carefully crafted) terms of healthcare reform
There’s no reform bill to debate yet, but both sides know that shaping the debate early is crucial to victory.
The final details of healthcare reform have yet to emerge from the committee rooms and caucuses on Capitol Hill, but the battle to shape public opinion is already fully scripted and well under way.Skip to next paragraph
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The "messaging wars" are, in many respects, just as important as those taking place now in congressional committees. Democratic activists say that President Clinton's bid for healthcare reform in 1994 and - for those with longer memories – President Truman's failed 1946 plan toppled on fear, not policy.
Those administrations were outflanked rhetorically long before bills got near a vote. But this time both sides are keenly aware that the words they use now could play a decisive role in what happens to the policy to come.
So they are rolling out a new battery of poll-tested phrases to tilt the terms of the debate to their own advantage. Is it a "government takeover" or a "public option"? Is it "universal coverage" or "quality, affordable healthcare for all"?
"These are very carefully selected linguistic choices," says Kathleen Hall Jamieson, a professor of communication and director of the Annenberg Public Policy Center at the University of Pennsylvania. "There is a linguistic set of choices under every policy decision, and when you frame it poorly, you're going to lose the argument."
So far, the biggest flash point in the debate has been the prospect of a government-sponsored insurance plan to compete with those of private insurers. President Obama says it's needed to ensure affordable coverage for all Americans and to restore the nation's fiscal health. GOP critics say it's a slippery slope to an all-government, single-payer plan that will ration care.
But while the policy wonks work out the legislative language, messaging gurus and pollsters are working out what to name it.
The big messaging breakthrough for Democrats was to dump any reference to a "government-run healthcare plan" in favor of a "public option." Instead of "universal coverage," which signals a big government program, the new message is "quality, affordable healthcare for all."
For its part, the GOP is trying to humanize its messaging.
Don't talk about "healthcare systems," said pollster Frank Luntz in a leaked memo, confirmed by a spokesman, on the language of healthcare for GOP lawmakers. Personalize the impact of a government "takeover" on individual healthcare decisions.
"Nothing will anger Americans more than the chance they will be denied the healthcare they need for whatever reason," he wrote.
That phrasing is ubiquitous in GOP floor speeches, although some lawmakers or their aides deny that a pollster is behind it.
Previous attempts at healthcare reform – in 1994 and 1946 – underestimated the power of the opposition to define the message before the policy took shape. The American Medical Association sank the Truman plan by dubbing it "socialized medicine," and the insurance industry ran ads suggesting that the Clinton plan would limit choice.
There was no pushback. It's an error that Obama-era reformers say they will not repeat.
"At the national level, there was no messaging, no public discussion for months as we waited for a bill to come out, and it allowed the opposition to define the issue," says Robert Chittendon, executive director and cofounder of the Herdon Alliance, a coalition to promote healthcare reform.
"By the time we got around to getting a bill, we had an argument we couldn't refute," he says. It's a war of words - poll-tested, dial-tested, scrubbed, and polled again. The target is voter emotions.