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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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If Obama's storytelling has a flaw, it's that he leaves out the antagonists. In his AMA speech, he never called the group on its opposition to Medicare in the 1960s. Nor did he mention that the insurance and pharmaceutical industries blocked reform for decades, even as their profits rose with skyrocketing premiums and out-of-pocket expenses. Whether Obama can win through inspiration and without benefit of populist anger or anxiety is unclear -- especially when the other side is selling fear.

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Finally, perhaps the most important element of effective communication is knowing what messages you're sending. Every word we utter activates what neuroscientists call networks of association -- interconnected sets of thoughts, memories and emotions. Consider the term "universal health care." Every time Democrats use it, they reduce the chance of reform. Why? Because it evokes precisely the associations that conservatives want to evoke: socialized medicine, government bureaucracy, impersonal clinics and lack of choice.

Over the past few weeks, the health care debate has centered on the "public option" in Obama's plan. Unfortunately, "public option" shares the negative connotations of "universal health care" -- with additional associations to low quality and welfare. It's no accident that Republicans have seized on this, because the longer people hear about the "public option," the more they are likely to associate the entire plan with government control. Advocates could counter by asking Americans whether they prefer choices dictated by the insurance industry or the range of choices that their elected representatives get, including a high-quality plan that doesn't rely on the goodwill of industry executives.

Reform advocates also set back their agenda every time they talk about "the uninsured" or "the underinsured." Those phrases turn an "us" into a "them," which decreases empathy and activates what social psychologists call the "just world hypothesis," the idea that somehow people get what they deserve. It also activates the "welfare" network, tainting by association people who work full-time or want to work but still can't afford insurance. (Most people on welfare have access to Medicaid. It is the "working poor" -- another term that distances and depersonalizes -- who constitute most of "the uninsured.")

Can these simple phrases really make that much difference? Yes, they can.

Last year a coalition of nonprofits dedicated to health-care reform commissioned Democratic pollster Celinda Lake and me to figure out how to translate a set of policies into everyday language that would speak to Americans' concerns. Messages that laid out the principles behind reform -- such as giving people control over their own health care decisions and making sure no one could be denied health insurance because of "pre-existing conditions" -- beat the best conservative messages, whereas messages that turned people into statistics or focused on policy details fared poorly. The same people who expressed strong negative feelings toward a candidate who proclaimed his belief in "universal health care" strongly supported a candidate who began a message with the statement, "I believe in a family doctor for every family." To the average American, a family doctor for every family connotes something warm, comforting, human and nostalgic, whereas universal health care connotes something cold, sterile, distant and creepy-futuresque.

The American people want health-care reform, and the battle of images and narratives has begun. If Obama and his party want to win, they'll stand up and say what they believe, clearly and with conviction. There's no more important principle of political communication than that.

Drew Westen teaches psychology at Emory University and is the author of "The Political Brain."


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