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By Drew Westen -- What We Talk About When We Talk About Health Care


(By Jacquelyn Martin -- Associated Press)

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By Drew Westen
Sunday, June 28, 2009

"Universal health care." "The uninsured." "Public option." These are the buzzwords you often hear from Democrats and proponents of President Obama's plan for health-care reform. But if they want to see that plan enacted, they'd do well to excise those phrases from their vocabulary.

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Words send messages, but they're not always the messages we intend. Recent polls show overwhelming support for health-care reform, including the "public option" in Obama's plan. But the reality is that which side prevails in this battle will depend as much on which one has its messaging right as on which has its policies right.

Republicans and other opponents of Obama's plan are already operating on this assumption, guided by a memo on "the language of health care" that conservative wordsmith Frank Luntz circulated to GOP members of Congress last month. In it, he conceded that the public wants real reform and argued that the only way Republicans can defeat Obama's plan is by co-opting the language of reform, describing the president's plan as a "government takeover" and painting it as a bureaucrat's dream and a patient's nightmare.

In fact, as easy a sell as health-care reform ought to be, ideas do not sell themselves -- particularly when someone is trying to sell them short. Reform advocates need to remember the four things that persuasive leaders do well: tell compelling stories, focus on principles, move people emotionally and send clear messages.

Humans are a storytelling species. People have trouble remembering lists of facts, figures and 12-point plans, which is why candidates who run on them get taken to the cleaners. In politics, if you want people to get the gist of what you're saying, give it to them: What's the problem? How did it come about? Who are the protagonists and antagonists? How are we going to get out of this mess? That's a story.

Remember Harry and Louise? They were the average middle-aged couple who took on another couple named Bill and Hillary in insurance-industry-sponsored television ads during the last health-care debate 15 years ago. Their first ad, set "sometime in the future," showed the couple at their kitchen table, going through bills, musing about the good old days when their health insurance plan covered their costs and government bureaucrats didn't control their health care.

The Harry and Louise campaign capped a well-funded effort to defeat the Clintons' effort at health-care reform in 1994. It was effective because it told a story that resonated with Americans' values and concerns (particularly regarding freedom and control): Let the government get a foothold in your health care, and soon you'll be on the receiving end of socialized medicine and big government bureaucracy.

This year's implicit story line from the Republicans, as they follow Luntz's guidelines, is similar: "Watch out for these guys. They'll tell you they just want to include a government plan as one option among many. But their real agenda is a single-payer system, where you won't have any choices because they believe the government knows what's good for you."

Luntz recognizes that opponents of reform face an uphill battle: Americans want comprehensive reform. But they're ambivalent. Though 85 percent have insurance, they are worried about what it no longer covers and what it will look like next year. The trick for conservatives is to make middle-class Americans fear the devil they don't know. So Luntz also advises the GOP to talk about long lines and delayed care.

Luckily for Democrats, they have a storyteller in chief whose talents rival those of Bill Clinton and Ronald Reagan. Obama's recent address to the American Medical Association included an evocative story about a young mother with breast cancer, as well as the personal story he tells of watching his mother struggle with her health insurance company as she battled cancer in her final months. He made clear why their stories are our stories.

Obama is also focusing on principles -- on the moral of the story. Campaigns that focus on principles tend to be far more effective than those that barrage voters with facts and policy details. And those principles, like the personal stories that exemplify them, should be emotionally compelling. They should speak to our values and interests. They should indicate that our leaders understand what matters most to us -- in this case, choice, security, cost and the quality of the doctor-patient relationship.

In a May 11 speech, Obama spelled out the principles that have become his mantra. "Whatever plan we design upholds three basic principles," he said. "First, the rising cost of health care must be brought down; second, Americans must have the freedom to keep whatever doctor and health care plan they have, or to choose a new doctor or health care plan if they want it; and third, all Americans must have quality, affordable health care." Lower cost, freedom to choose and coverage for all Americans -- that's memorable, principled and emotionally compelling.


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