For several years now, George Lakoff has been pointing out that how you "frame" a political discussion can be very important in the public's reaction to your policies and ideas. Democrats, Lakoff advises, must choose their words in such a way as to gain maximum support from the public. This framing is something that Republicans, with only a few evil geniuses like Karl Rove and Frank Luntz, have been doing (and continue to do) very successfully for years. It is astonishing that with all their brilliant politicians and advisors – Barack Obama, both Clintons, David Axelrod, Rahm Emanuel, Paul Krugman, and more – Democrats still seem to be slow in thinking in these terms.
The latest failure to communicate on the part of Democrats is in using the term "health care reform." What does that term mean to the public? Why it means that the government will diddle with our great medical care! Obama will put a government bureaucrat between you and your doctor! As with every government program, your costs are going to go up! You'll be denied necessary care! And worst of all, to save money old people will be required to undergo counseling as to how to end their lives! That last is no exaggeration. Republicans are actually making this charge.
The very disheartening thing is that this Obama program need not have been carefully framed in such a way as to make it politically palatable. The problem is that it has been misframed. Obama is proposing relatively little in the way of changing the health care delivery system -- only such improvements as digital record keeping, better communication among a patient's health care providers, and elimination of duplicate and unnecessary tests and procedures. Obama and his staff should simply have called their proposals what they really are: "health insurance reform," rather than health care reform. Evidently, in his July 22nd meeting on the subject, Obama has begun (at last) to make this change. He referred to health insurance reform five times. In an e-mail of August 8th from Mitch Stewart of Obama’s Organizing for America, Stewart asked Obama supporters to contact their Congressional representative in support of “health insurance reform.” Stewart used that term four times in his short message; “health care reform” appeared not once.
Why is the phrase “health insurance reform” important to use? It is because nearly everyone has had a problem with private health insurance ranging from minor annoyances like refusal to cover the cost of a specialist to denial of coverage for a major operation. Thus nearly everyone can relate to improving the health insurance system.
Democrats could then emphasize a number of easily understandable and popular points that would turn the Republican response on its head:
- An insurance company bureaucrat will never stand between you and your doctor!
- Lower insurance company executive bonuses and salaries as well as company profits will mean your costs will go down!
- Insurance companies will no longer be able to restrict your choice of doctor!
- Only you and your doctor will decide what care is best for you!
- You'll be able to see any licensed medical practitioner including optometrists, chiropractors, psychiatrists, psychologists, and acupuncturalists!
The problem of cost is a good illustration of why it is health insurance that should be reformed. The infoplease.com web site gives the annual per capita expenditures on health care for the United States and 61 other countries for the year 2006. That of the U.S. was $5,711. (It has since risen substantially.) The next most expensive nation in the world was Norway with a per capita expenditure of $3,809. The average cost for the 14 next most high cost countries after the U.S. (all but Iceland, Australia, and Canada were in Europe) was only $3,022, slightly more than half of what we pay in the U.S. Yet mortality and morbidity statistics indicate that by most measures the U.S. lags behind all these nations.
The other industrialized nations have a variety of approaches to health care. Great Britain has socialized medical care in which all medical personnel are employees of the government (and spent only $2,389 per person). Canada has a single-payer system in which the government pays all medical expenses but health care providers are mostly private. Other nations like Switzerland and the Netherlands rely on private health insurance as well as private practitioners.
What, then, accounts for our extremely inefficient health care in comparison with these nations? The one distinguishing feature of the U.S. system is that it relies on for-profit health insurance. Even in those countries like Switzerland and the Netherlands that have private health insurance, the insurance companies are very tightly regulated and by law must be non-profit.
In the U.S., at least 20% -- some estimates are as high as 30% -- of health care expenditures go into executive bonuses, shareholder dividends, employee salaries, and other administrative expenses. Given that the U.S. now spends approximately $2.4 trillion per year on health care, the elimination of expenditures for non-medical reasons would yield $500 to $800 billion in savings, certainly enough to provide health coverage for the 47 million Americans that now lack it.
Clearly we Democrats should be stressing health insurance reform rather than health care reform.
by Herb Engstrom
Herb Engstrom is a retired physicist who worked on materials problems related to energy production and storage at both Brookhaven and Oak Ridge National Labs.