Communication Currents

Communicating About Health Care Reform

April 1, 2010

The health care debate has been discussed in many ways: public vs. private, big government vs. small government, freedom vs. tyranny, socialism vs. liberty, and change vs. choice. Effectively communicating about health care reform is essential as it is a predominant issue on both the presidential and congressional agendas. Unfortunately, 48% of the American public still reports being confused about health care reform. Too much time has been spent manipulating words to convince the public that specific policies are superior. Instead, policymakers should focus on clearly communicating main tenets of the plans and allowing citizens to decide for themselves.

Information about “rhetoric on health insurance reform” leads the White House webpage. President Barack Obama has acknowledged the importance of communicating about health care reform and has presented addresses on the issue to both Congress and the public. The Department of Health & Human Services has devoted a website to health care reform that provides links to specific pages oncommunicating about the issue. Additionally, 2009 saw both the White House andcongresspersons (e.g., Arlen Specter) hold open public debate forums across the country regarding national policy on health care. These political sources all attempt to influence policy and public opinion, but many are so burdened with partisan rhetoric that it is nearly impossible to extricate embellishment and rhetorical manipulation from fact. Never has communication been so central to a major political issue, and never has it been so complicated.

With Congressional votes being largely party motivated (Olympia Snowe stands as one notable exception), health care reform has been the most divisive political issue in Obama's tenure. Politicians have spent months hammering out the policy details in Congress while interest groups, media outlets, bureaucrats, and pundits struggle to frame the issue on both sides of the aisle. Framing, or making a specific dimension of an issue salient to a given population, has become a priority for politicians in recent years. George Lakoff has written extensively about how controlling the messaging surrounding an issue can change the policy landscape. In Don't Think of an Elephant, Lakoff explains how Republicans have successfully framed such issues as estate taxes (i.e., “the death tax”) and global warming (i.e., “climate change”) to push policy in their favor. This swirling rhetoric exists on both sides of the aisle; both liberals and conservatives are squarely focused on exploiting the power of words in their pursuit of health care reform.

Howard Dean's book (Howard Dean's Prescription for Real Health-Care Reform) gives special treatment to the way the health-care reform is communicated. Dean stresses the idea of choice in health care. That is, American citizens must feel like they have options regarding their care. Lakoff has also outlined communication strategies for progressives involved in health care reform. He argues that evoking concepts like empathy and democracy will help liberals advance their reform goals.

Frank Luntz similarly wrote a document targeted toward Republicans in Congress instructing them how to talk about health care reform. Based on a national survey, Luntz's data suggest specific tactics Republicans can use to defeat Democratic proposals and win the battle of public opinion. For example, Luntz recomends that Republicans talk about American citizens as human beings and avoid directly referring to President Obama. He also writes that shifting the blame away from individuals and onto Washington bureaucrats may be a fruitful avenue to gain public support.

Of course this all sounds well and good, as great minds from both parties are consulting communication research and framing theory to guide communication regarding one of the most important political issues of our time. But a problem remains. These groups are trying so hard to exploit the power of well articulated frames that it is impossible to tell what is truth and what is just spin. Spin has been and will likely remain a pervasive force in politics, but the health care debate has escalated it to a new level. It appears that what matters is not the policy content, as few citizens, or members of Congress are well acquainted with the legislation. What seems to matter most is what the public thinks the policy says. This lack of public understanding has sparked minor hysteria regarding a public option, so called death panels, and opt out policies. Spin from both sides does nothing but hide the facts and complicate the health care policy landscape.

Despite the lack of clarity provided by most politicians and interest groups, some organizations are attempting to communicate directly to the public about health care reform without attempting to extol the superiority of one plan over another. For example, the Kaiser Family Foundation has developed a tool that allows individuals to compare plans approved by the House and Senate as well as committee plans and individual plans advanced by President Obama and several other members of Congress. The website also provides a health reform subsidy calculator that allows individuals to enter personal information, such as age and annual income, to compute projected costs associated with different plans. These online tools can be complicated and highlight health literacy issues, as even informed citizens may have difficulty understanding the content. Still they are less convoluted than the policy text. They also provide an opportunity for citizens to gain unbiased, concise, and accurate information about the different plans.

With public support of the current health care reform plan hovering around 40%, it is evident that, despite explicit attempts by both sides to successfully frame the issue, neither side is really winning; meanwhile, the public is losing. EvenLakoff and Luntz, experts poised on opposite sides of the debate, insist that framing cannot be used to manipulate the facts and must only be used to communicate truth to the people. Message framing is not a weapon to be hastily wielded like hatchet; the only way framing can benefit policy makers and the public is when it is used precisely, properly and with good intentions. If politicians can focus on clearly outlining proposed plans to their constituents instead of hatching crafty catchphrases that sell words, not policy, then we may be much closer to narrowing the gap between health care reform plans than many think.

About the author (s)

Lindsay Neuberger

Michigan State University

Doctoral Candidate