Health Care

What Now?

It is not too late. The statistic I've heard is that over 80 percent of citizens want a public plan, but the right-wing's framing has been overwhelming public debate, taking advantage of the right's communication system and framing prowess.

The administration has dug itself (and the country) into a hole. At the very least, the old mistakes can be avoided, a clear and powerful narrative is still available and true, and some powerful, memorable and accurate language should be substituted for Policy Speak, or at least added and repeated by spokespeople nationwide.

The narrative is simple:

The narrative is simple: Insurance company plans have failed to care for our people. They profit from denying care. Americans care about one another. An American plan is both the moral and practical alternative to provide care for our people.

The insurance companies are doing their worst, spreading lies in an attempt to maintain their profits and keep Americans from getting the care they so desperately need. You, our citizens, must be the heroes. Stand up, and speak up, for an American plan.

Language

As for language, the term "public option" is boring. Yes, it is public, and yes, it is an option, but it does not get to the moral and inspiring idea. Call it the American Plan, because that's what it really is.

The American Plan. Health care is a patriotic issue. It is what your countrymen are engaged in because Americans care about each other. The right wing understands this well. It's got conservative veterans at town hall meeting shouting things like, "I fought for this country in Vietnam and I'll fight for it here." Progressives should be stressing the patriotic nature of having our nation guaranteeing care for our people.

A Health Care Emergency. Americans are suffering and dying because of the failure of insurance company health care. Fifty million have no insurance at all, and millions of those who do are denied necessary care or lose their insurance. We can't wait any longer. It's an emergency. We have to act now to end the suffering and death.

Doctor-Patient Care. This is what the public plan is really about. Call it that. You have said it, buried in Policy Speak. Use the slogan. Repeat it. Have every spokesperson repeat it.

Coverage Is Not Care. You think you're insured. You very well may not be, because insurance companies make money by denying you care.

Deny You Care ... Use the words. That's what all the paperwork and administrative costs of insurance companies are about - denying you care if they can.

Insurance Company Profit-Based Plans. The bottom line is the bottom line for insurance companies. Say it.

Private Taxation. Insurance companies have the power to tax and they tax the public mightily. When 20 percent to 30 percent of payments do not go to health care, but to denying care and profiting from it, that constitutes a tax on the 96 percent of voters that have health care. But the tax does not go to benefit those who are taxed; it benefits managers and investors. And the people taxed have no representation. Insurance company health care is a huge example of taxation without representation. And you can't vote out the people who have taxed you. The American Plan offers an alternative to private taxation.

Is it time for progressive tea parties at insurance company offices?

Doctors Care; Insurance Companies Don't. A public plan aims to put care back into the hands of doctors.

Insurance Company Bureaucrats. Obama mentions them, but there is no consistent uproar about them. The term needs to come into common parlance.

Insurance Companies Ration Care. Say it and ask the right questions: Have you ever had to wait more than a week for an authorization? Have you ever had an authorization turned down? Have you had to wait months to see a specialist? Does your primary care physician have to rush you through? Have your out-of-pocket costs gone up? Ask these questions. You know the answers. It's because insurance companies have been rationing care. Say it.

Insurance Companies Are Inefficient and Wasteful. A large chunk of your health care dollar is not going for health care when you buy from insurance companies.

Insurance Companies Govern Your Lives. They have more power over you than even governments have. They make life and death decisions. And they are accountable only to profit, not to citizens.

The Health Care Failure Is an Insurance Company Failure. Why keep a failing system? Augment it. Give an alternative.

The Needed Communication System

A progressive communication system should be started. It should go into every Congressional district. It should concentrate on general progressive ideas. President Obama has articulated what these are.

The basic values are empathy (we care about people), responsibility for ourselves and others, and the ethic of excellence (making ourselves better and the world better).

These values form the basis of democracy: It's because we care about our fellow citizens that we have values like freedom and fairness, for everyone, not just the powerful.

From that, it follows that government has two moral missions: protection (of consumers, workers, the environment, the old, the sick, the powerless; and empowerment through public works; communication, energy and water systems; education; banks that work; a court system, and so on. Without them, no one makes it in America. Taxes are what you pay for protection and empowerment by the government, and the more you make the greater your responsibility to maintain the system.

Appropriate language can be found to express these values. They lie at the heart of all progressive policies. If they are out there every day, it becomes easier to discuss any issue. This is what it means to prepare the ground for specific framings.

The Culture War Is On! You Can't Ignore it

President Obama wants to unify the country, and he should. It is a noble idea. It is the right idea. And he started out with the right way to do it. Campaign for what you believe - for empathy, social responsibility, making the nation better. Activate the progressive values in the many millions of Americans who have some conservative values and some progressive values.

But also inhibit the radical, harmful conservative ideology in the brains of our countrymen by directly saying what's wrong with it. Yes, there are villains. They have a very potent communications system and can organize their troops. Every victory makes them more powerful. They have put together powerful narratives. We need more powerful ones.

And avoid Policy Speak and Policy Lists.

What Should Have Been Done?

It is useful to review what should and should not have been done, because we need to understand the past to avoid future mistakes.

First, it was obvious to the framing community what the right wing would do. Almost every move could have been predicted and most of them were. There should have been a serious counter effort from right after the election.

Second, an effective communication system should have been built. Not for dictating what to say, but for creating a system of effectively trained spokespeople, who can get the basic progressive values out there every day to compete with the very effective conservative system. It should not work issue by issue, but in addition to the issues of the day; it should promote general values that apply to all issues.

The elements are all in existence. The money is there. Indeed it would be a lot cheaper to build than spending tens of millions of dollars on health care ads. What it would accomplish is laying the groundwork in advance of any particular issue. The work of such a communication system would be to activate ideas already there in the millions of citizens who have progressive as well as conservative worldviews in their brain circuitry. The idea would be to make progressive ideas stronger and conservative ideas weaker, balancing what the conservative communication system is doing now.

It is rather late in the game for the stimulus, cap and trade and health care, but better late than never. And it would be indispensable for future policy campaigns. Framing a powerful message is a lot easier when the groundwork for it has already been laid. Without the groundwork, it is much harder.

Third, a serious framing education effort with folks who do know the science should have been organized, not just for the communications system, but for the policymakers themselves.

Fourth, the villainizing of real insurance company villains should have begun from the beginning. As it is, the right wing turned the tables. They attributed to government all the disasters of insurance company health care: rationing, long lines, waits for authorizations and visits to specialists, denial of care. The administration is trying to turn that around, but it is harder now, and they are trying it using Policy Speak, which is the most ineffective of means.

Fifth, the positive policy should have been made in moral terms, with clear and vivid language. The term "public option" is a Policy-Speak loser. The public is the American public; it is all of us; it is America, and it should have been called the American Plan.

Sixth, the administration should have been on the offensive not the defensive all the way. The use of conservative language should never have been used in debunking.

Seventh, it was a mistake to shut out single-payer advocates. They should have been welcomed into the debate. Though the term "single payer" is hopeless Policy Speak and "doctor-patient care" would have been more accurate, nonetheless, the doctors, nurses and unions advocating for such a plan could have done a lot of the work of villainizing the health care industry and would have drawn fire from the right. An alternative on the left would have made the president's plan a compromise. Besides, there is so much to be said in favor of single payer, that there might have been fewer actual compromises with the right.

Eighth, it was a mistake to put cost ahead of morality. Health care is a moral issue, and the right wing understands that and is using it. That's why the "death panels" and "government takeover" language resonates with those who have a conservative moral perspective and have effectively used terms like "pro-life." Health care is a life and death issue, which is as moral as anything could be. The insurance companies have been on the side of death, and that needs to be said overtly.

Ninth, accepting the idea that health is a line item separate from agriculture policy, the food industry, regulation of food and drugs, education, the vitality of business, banking reform etc. is just bad economics. These are all tied up together. In this, health care might have been treated like the "recovery" package, but in reverse.

A causal approach to economics would be appropriate. Instead of putting funds in many places, it might have taken funds from sources of health problems. For example, big agriculture and the food industry produce and heavily market foods that have been central causes of the obesity epidemic and heart disease - corn syrup, too much meat, and so on. They might have been called upon to pay the costs of treating heart disease, strokes and diabetes. It would not be popular with those industries, but it would be causally fair, and might even save a lot of lives - and money.

Or, take another example of causal economics. Hugely high private taxation (that is, high costs and profit taking) by the health insurance industry helped drive American automakers into bankruptcy. The health insurance industry should have had to use a portion of their profits for bailouts of the auto industry, and the equivalent amount of bailout money could have been used for providing health care to those without it.

Given the systemic nature of our culture and our economy, a move in the direction of such causal economics should start to be seriously considered. At the very least, it would bring up the question, alert the public to systemic causation and start people thinking about the justice of causal economics.

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White House Appears Ready to Drop "Public Option"