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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Needed: Simplified Framing for Health Care Reform

While the basic principles of health care reform should be simple enough for progressive political leaders to frame as opposing forces gird for the battle over health care reform, American voters are being presented an ever-expanding range of complex issues and policies . As WaPo‘s Dana Milbank put it in his July 2nd column,

…Americans are passionate and confused about it — and their opinions are all over the lot.
A CNN-Opinion Research poll found that 51 percent of Americans favor Obama’s health-care plan, but a Wall Street Journal-NBC poll found that only 33 percent think it is a “good idea.” A New York Times-CBS News poll found that nearly six in 10 would be willing to pay higher taxes so that all could be insured, but a Kaiser poll found that 54 percent would not be willing to pay more to increase the number.
A Quinnipiac University poll found that a majority — 54 percent — believe that reducing health-care costs is more important than covering those who lack coverage, while the Times-CBS poll found that 65 percent thought that insuring the uninsured was a more serious issue. A Washington Post poll found that 57 percent of Americans are dissatisfied with the health-care system — but 83 percent are satisfied with the quality of their own care.
In short, when it comes to health care, the state of the union is confused. The confusion won’t be cleared up by the complexity of the debate, with all the jargon about community ratings and insurance exchanges and risk adjustments and guaranteed issues…

A point made also in Mark Blumenthal’s July 1 post at Pollster.com:

Let’s start with what is hopefully obvious: Democrats in Congress are drafting multiple proposals, and the Obama administration has not specifically endorsed any of these. So a well informed respondent ought to have trouble evaluating “Obama’s plan,” since Obama has not yet committed to a specific plan. Even more important, very few Americans are following that debate with rapt attention. Last month’s CBS/New York Times poll, for example, found only 22% of Americans saying they have heard or read “a lot” about the health care reform proposals (50% said they heard or read “some,” 23% not much, 5% nothing).

“Softness” of responses is also a concern with analyzing polling data, particularly regarding health care reforms. As Blumenthal notes of the difficulty of overgeneralizing about polling responses:

When pollsters push as hard as CNN/ORC for an answer, a lot of the responses are going to be very soft, often formed on the spot and based on very superficial impressions. Nonetheless, if I were charged with conducting a benchmark survey for a candidate over the next few months, and I had room for only one question about health care reform, I would be tempted to ask a very general question about “President Obama’s plan to reform health care” (though I’d strongly lean to the NBC/WSJ version that explicitly prompts for “no opinion”).
Yes, public opinion on health care reform is multi-faceted. Americans come to the debate with a rich set of values and attitudes about what they like and dislike about the health care system, what they would change and what they worry about changing. Most have not yet focused on the details of the legislative debate. Many never will. So questions about specific policy proposals can produce results all over the map. As Slate’s Chris Beam puts in an excellent summary this week, “health care polling is especially variable, depending on the wording, the context, and the momentary angle of the sun.”

The Kaiser Family Foundation adds in its wrap-up of some recent public opinion polling on‘Footing the Bill’.

What the public thinks about health care reform from this point will depend on what they learn about any proposals over the course of the summer – whether it be the actual details of any plan that might emerge or the spin on such a plan that will inevitably come from ideologues on both sides, the health care industry itself, and interested advocacy groups. Our surveys have repeatedly found that opinion on most specific proposals is quite malleable and can be moved in both directions. Expect this to happen.

It’s not hard to see why framing is critical to the success of any health care reform package. President Obama has settled on a current strategy of framing the debate in terms of cost. In his article in The Atlantic on “Obama’s Inversion Of Harry And Louise,” Mark Ambinder notes of the President’s framing of the health care reform debate:

His basic message: your health coverage will be taken away if we don’t reform health care this year.
His arguments for reform have focused heavily on rising costs and the unsustainability of the current system. His public remarks on the matter are rife with figures about how much costs have risen and will rise in the future, and how soon the nation won’t be able to pay them.
“In the last nine years, premiums have risen three times faster than wages. If we don nothing, they will rise even higher. In recent years, over one third of small businesses have reduced benefits and many have dropped coverage altogether since the early ’90s,” Obama told the audience at his town hall meeting on health care in Annandale, Virginia Wednesday.
“If we do not act, more will lose coverage and more will lose their jobs. Unless we act, within a decade, one out of every five dollars we earn will be spent on health care,” Obama said.
Obama’s economic rhetoric is all about how things can’t remain the same. It’s the same point the Harry and Louise ad made, but backward, and in Obama’s version, the “naysayers” who oppose health reform are the ones who play fast and loose with the coverage Americans currently enjoy. And as polling indicates that Americans are concerned heavily with costs, the president has, in turn, stuck to telling people about the costs of not passing his plan…And so part of his rhetoric is about shaking people with fear into supporting his reforms. If Harry and Louise made people afraid of passing Clinton’s reform plan, Obama is making people afraid of not passing his.

President Obama is undoubtedly right that cost-containment is a critical element of any successful health care reform pitch. But any successful pitch is also going to have to explain in simple terms how the reforms will improve health security for millions of Americans. Ruy Teixeira argues in a TNRtv clip that the public option of health care reform proposals has surprising bipartisan appeal in recent polling, which suggests it could have merit as a key messaging/framing point.
George Lakoff, along with co-authors Glen W. Smith and Eric Haas offer ten excellent messaging/framing suggestions in their HuffPo article “Health Care Reform: Some Basic Principles,” including

Principle 3. Health care is central to the moral mission of the American government.
The American government has twin moral missions: protection and empowerment of the individual – equally for everyone.
Protection includes not just the military and police, but also consumer protection, worker protection, environmental protection, safety nets, investor protection, and health care.
Empowerment is what enables Americans to make a living and have a good life if they work at it. It includes systems of public road and buildings, education, communication, energy, banking — and health.
No one can make a dime in America or achieve their goals in life without protection and empowerment by America’s government.


Principle 7. The American Plan provides care instead of denying it.
Why do HMO’s have a high administrative cost – 15 to 20 percent or more? They spend money to justify denying you the care you need and all too often delaying care so much that you are harmed by the delay.
The American Plan is there to provide you care, not deny or delay it. Its administrative costs would be low, about 3 percent.

And, also at HuffPo, In his post “Hoping for Audacity,” Drew Westen emphasizes the need to tell the “how we got here” story as a prerequisite for good framing of reforms:

The American people would understand why we need to offer at least one health insurance plan not controlled by the insurance companies if someone would just tell them the story of how it came to be that our premiums have doubled as millions more Americans have lost their coverage.
…The President is offering the public a series of stories that are all missing half the plot and half the characters–namely, the part of the plot that says how we got where we are (e.g., 50 million without health insurance…He is trying to sell health care reform without calling out the drug and insurance industries, whose profits have soared at our expense.

We should have no doubts whatsoever, that the opponents of health care reform are now focusing with utmost intensity on which frames will be most effective in obstructing meaningful reform, as my May 6 post noted. Let’s not be caught unprepared.

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