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Framing The Health Care Debate


Democratic strategist Paul Begala has written a brilliant point-by-point rebuttal of GOP consultant Frank Luntz's widely circulated strategy memo on health care.  

Begala urges Democrats to push back hard against "Republican Orwellian rhetoric."  He has written a blueprint for us all to help win one of the most important debates of our lifetime.

Begala's argument is that Luntz's memo "attempts to teach Republicans how to kill health care reform by misleading people." (emphasis all mine)
Because they know they cannot win the argument honestly, Republicans are resorting to mendacity. Democrats must not let them get away with it."
Begala's key point:
...the overwhelming majority of American support health care reform. In fact, Dr. Luntz himself notes that voters trust Democrats over Republicans by a whopping 20 percent on health care . If health care reform were unpopular, Republicans would not resort to misleading rhetoric to mask their opposition.
Begala sums it up thusly:
The Republicans have three goals:
1. Co-opt our messaging
2. Confuse voters
3. Kill health care reform
Begala walks the reader through Luntz's ten suggestions, then proposes mock scripts that offer ways to shed light on the Republican's misleading arguments.

1. Humanize your approach:

When Republicans repeat the Luntz talking point about humanizing the argument, we should say: When I think of health care reform, I think of ____________________. She works hard and plays by the rules. But she could no longer afford health insurance after her hours were cut back and her pay was cut. Now her daughter has asthma and she can't afford an office visit for an inhaler - and the bills from the emergency room visits are piling up.

I also think of __________________. He has health insurance, thank goodness, but he's worried. Worried about rising premiums pricing him out of the market. Worried about rising co-pays and deductibles hollowing out his insurance. Worried that if, God forbid, a real medical emergency strikes, some corporate bureaucrat will say the fine print of his policy doesn't cover him or his family.
2. Acknowledge the "crisis" or suffer the consequences:
When Republicans repeat the Luntz talking point about pretending to acknowledge the health care crisis, we should say: Obviously, if you don't have health insurance or can't afford health care, it's a crisis. But most Americans also lack the peace of mind that comes from knowing they're not one illness or one accident away from bankruptcy. They need the peace of mind that comes from knowing costs won't be jacked up beyond their ability to pay, that even if times are tough, they will still have a guarantee of quality, affordable health care.
3. "Time" is the government health care killer:
When Republicans repeat the Luntz talking point about delayed care, we should say: Everyone has a health insurance nightmare story. It's either happened to you or someone you know. The insurance company won't pay for something you need or makes you jump through hoops to get it. We fix the health care system, and not only will you be able to keep the insurance you have now if you like it, but it will be better. We'll have rules to stop them denying you care. And they'll have to charge you less because they'll be competing with a new public health insurance option. So if you get fed up, you've got somewhere to go.
4. The argument against the Democrats' health care plan must center around "politicians," "bureaucrats," and "Washington"...not the free market, tax incentives or competition:
When Republicans repeat the Luntz talking point about Washington bureaucrats and politicians controlling care, we should say: The Republicans want to put corporations in control; we want to put you in control. Right now, insurance companies boost their profits by saying no to what you need. When we fix the system, they'll be regulated so they have to charge reasonable prices and deliver quality service. You and your doctor will be more in control because you won't be arguing with insurance company bureaucrats all the time.
5 The health care denial horror stories from Canada & Co. do resonate, but you have to humanize them:
When Republicans repeat the Luntz talking point about Canada-care, we should say: We're America. We cured polio and invented the pacemaker. We're not Canada or Britain or anywhere else. Pres. Obama is committed to a uniquely American health care solution that builds on the best of what works now, but reduces cost and increases access. Our plan will also protect that classic American right: the right to choose. You will be able to choose your doctor and choose your plan.
6. Health care "quality" = getting the treatment you need, when you need it:
When Republicans repeat the Luntz talking point that our plan will deny treatment and increase waiting, we should say: Every day, insurance companies deny people care. As health care costs keep rising, it will only get worse. And yet the Republicans are committed to a system that puts profits ahead of people. That's why they oppose Pres. Obama's reforms and why they have no reform plan of their own. Our plan reduces costs, increases access, and protects choice.
7. "One size does not fit all.":
When Republicans repeat the Luntz talking point that our plan is "one size fits all" we should say: President Obama's health care plan gives you MORE choice than you have now. Right now, all most people have is the one or two plans offered through work -- and if you're out on your own in the private market, chances are you've got even less choice because health insurance is so expensive. When we create a new public health insurance option, you'll have one more choice. And you'll know that choice will be guaranteed to have the benefits you need, and you'll be able to afford it. So if you like what you have - great - you can choose to stay with it. But you'll also have an affordable alternative. And that's something most people don't have now.
As for the doctor-patient relationship: The doctor-patient relationship is under assault under the current system. Every time someone loses his/her health insurance, the doctor-patient relationship is interrupted. Every time someone can't afford to keep up with rising costs, rising premiums, rising co-pays, rising deductibles, the doctor-patient relationship is severed. By reducing costs, expanding access and ensuring quality we put the doctor-patient relationship at the heart of our health care reform.
8. Waste, fraud and abuse are your best targets for how to bring down costs:
When the Republicans repeat the Luntz talking point about waste, fraud and abuse, we should say: Obviously there is waste, fraud and abuse. But where's your plan to tackle them? Who do you think is going to crack down on waste, fraud and abuse: The entrenched interests making millions off of waste, fraud and abuse? Premiums have skyrocketed, CEO pay is through the roof, and insurance company profits are up, and we get less and less actual health care, while spending more and more money. It's time we had real reform and insurance companies had real rules to protect consumers.
9. Americans will expect the government to look out of those who truly can't afford health care:
When Republicans repeat the Luntz talking point about how government really should help those who can't afford health care, we should say: Pres. Obama is committed to health care reform. So am I. But the Republicans oppose reform. They have opposed every effort to reduce costs, every effort to make health care more affordable, every effort to expand coverage and to protect patients and their right to choose their doctor and their plan. They are the last defenders of the old, failed status quo. We are the reformers.
The Republican "plan" is really just the status quo on steroids. They want to keep pumping more money - your money - into the same broken system. If we fix the system, preserve the free market while we sensibly regulate insurance companies, and create a new public health insurance option, people will be able to afford good health care.
10. It's not enough to just say what you're against. You have to tell them what you're for:
When Republicans repeat the Luntz talking point that they're really for reform, we should say: Their plan is the status quo. Their plan is rising costs. Their plan is corporate bureaucrats and HMOs getting between you and your doctor. Their plan is cherry-picking the healthy and the wealthy and dumping you if you commit the sin of getting sick or injured. Their plan is Washington entrenched interests and lobbyists getting rich while working Americans get soaked. That's why they oppose our plan for real reform.
If you have a chance to read Begala's full memo which he titles; COUNTERING REPUBLICAN ORWELLIAN RHETORIC ON HEALTH CARE it is really quite amazing.  It's filled with some terrific Begalaism's like, "Amen, Brother Luntz," and, "As we say in Texas, what chutzpah," and it it is very well written, logical, and understandable.  A definite A+.

What I am so very happy to see is that someone is taking on the Republican's at their own game and eating them for breakfast. I hope you will make sure your elected politicians have read it. If you stand up to the bullies they will cry.  I promise you.  It's time to take the Republican, head on.  The issues of the day are too important. 

In writing this I'm reminded of one of the most misunderstood philosophers of the last century, Twisted Sister, "We're Not Gonna Take It"

Oh, you're so condescending
Your gall is never ending
We don't want nothin', not a thing from you

Your life is trite and jaded
Boring and confiscated
If that's your best, your best won't do

Oh, we're not gonna take it
No, we ain't gonna take it
Oh, we're not gonna take it anymore


21 Comments

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Oh, you're so condescending

Condescension. Contempt. One of those straussian things they do to try to control those considered inferior. Part of their propaganda:

Inoculate yourself here:

http://tpmcafe.talkingpointsmemo.com/talk/blogs/therap/2009/05/who-is-leo-strauss-and-why-sho.php

Excellent blog!


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Thera, your excellent blog on Leo Strauss? is a must read to fully understand what we are up against. Thanks for referring us to it.

Murry says, "Begala is our "anti-propagandaite"..."

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Totally!

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"7. "One size does not fit all.":"

I thought that was number 1. First, they had to shut up every Democrat who was for single-payer.

But heck, I'll bite on #10.

I'm for single-payer universal health care now!! That's what I am for!

I'm not for reform. I am FOR universal health CARE.

Sorry, I totally reject this. I totally reject that they've tried so hard to shut us up. I totally reject that we've been framed but shut out.


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I'm for a "single pragmatic" system meaning something we can get, for now.

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One of the limits of pragmatism is when you win a little thing pragmatically, it's very easy for the other side to take it away pragmatically next time around. SCHIP has been a great example of that. Since we never win the argument that all children have a right to health care, we are continuallly fighting not to have more kids kicked off health care every time a federal or state budget gets tight. One way they do that is to redefine "affordable" and redefine income limits to increasingly restrict how many families can actualy be covered under SCHIP. Contrast that with Medicare where we went for the entitlement.

Begala wants to fight the argument on the THEIR terms. Well, they will win in the end if we do that.

They've scared Democrats away from arguing for entitlements, but its only the entitlements won in the past like Social Security and Medicare that we've been able to hold on to.

When this bill is finished it will require that you buy an "affordable" policy whether you can afford it or not. "Affordable" will be pragmatically adjusted over time. Likewise, the "choices" will be pragmatically adjusted over time so that the "choice" that is "affordable" is a "choice" that doesn't cover your actual health care needs. But you do have a theoretical "choice" not to be poor. It is a free market, oh, yes indeedy it is.

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"Our plan reduces costs, increases access, and protects choice."

Note the "increases access". See anything universal there? Notice how we START by taking universal off the table. We'll be compromising down from there. We have already conceded the very most important value.

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Liberate yourself from frames and see Bill Moyers :

http://www.pbs.org/moyers/journal/05222009/watch.html

"BILL MOYERS: Welcome to the JOURNAL. Health care reform. It's the talk of the town - if the town is Washington, D.C. But some possible reforms aren't being talked about at all. Not officially, that is.

The White House and Congress have kept the lid on one of the most controversial but popular options, known as single-payer. It's a story the mainstream press has largely ignored and that's why we are covering it in this broadcast.

You don't expect to see these people demonstrating in our nation's capitol. You'll most likely encounter them in the examining room, the operating theater, the clinic or the laboratory.

They're doctors, nurses, and other health care professionals, unaccustomed to making themselves heard in the streets....."


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Excellent, Steve. I'm going to paste this into "Word" and print it out. Then I'm going to add my own ideas. Thanks for posting this!

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Just carefully read Begala's talking points and note how many times he has the opportunity to speak of universal coverage but instead refers to expanded coverage or increased access. Again, remember this is where we start not where we end. We have already so limited our end goal it is very likely the Republicans will be quite happy with this bill. They'll negotiate away the public option. They'll negotiate down the cost. Since they've already conceded by the framing that they don't even intend to do more than "expand" or "reform" anything they pass can fit that meager little goal.

What we're really doing here is framing ourselves out of a commitment to provide health care for all Americans.

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The sense I get, Bluebell, is that no, the American people weren't invited to the debate, and that at some point who-knows-how-long ago (obviously at least weeks before last year's Democratic National Convention), Obama began committing himself to the "public option."

The Republicans aren't even willing to settle for that, but since that's what the Democratic leadership committed to nearly a year ago, it's the natural place to build rhetorical fortifications.

That's what Begala's doing. And given the context, I think it's a great idea.

Yes, single-payer makes more sense; it would work better and save more money, and the Democrats could have pushed it through if they had really wanted to. But it looks to me--and correct me, Bluebell, if I'm wrong--that there is no hope of achieving it this summer.

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The Blue Dogs have been all over the map on that with weasel words like public option "in some form". Keep your eyes on the fine print.

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"What we're really doing here is framing ourselves out of a commitment to provide health care for all Americans."

I don't agree with that premise as stated. Obama in his campaign and in recent speeches has clearly said that he wants coverage for everyone. I will look into it further.

Thanks for the comments. Healthy debate is the essence of our democracy.

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Sorry, this is the holy grail for me. Yeah, Obama is for insurance coverage. But that is not the same thing as health care. You really have to watch the words. I'm not trying to pick on Obama. The fix is really in from the Baucus types and all the other corporately owned Democrats and Republicans, of course.

They do not want to pay for this. They do not want to due harm to insurance companies. They've got theirs. One thing you learn about the truly vulnerable is that they and their caregivers are just so overwhelmed with getting through the day that they aren't out there lobbying. You've got nurses and other clinicians in the fight. And they only get heard on Bill Moyers Journal on the Friday night before a holiday weekend.

The American people have never been invited to this debate. We don't count. We are to be mollified and thrown a bone.

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We have to agree to disagree. The watchword of my life so far is, "You can't always get what you want, but you get what you need."

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Begalla is usually a milktoast--always smiling that politician's smile

Good for him. And good for you Steve. Great post!!!

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Another analysis of Luntz's brief; read the "comment" by Don McCanne, MD which replies to it.

http://www.pnhp.org/news/2009/may/frank_luntzs_the_l.php

short excerpt from the comment:

This is a report on political framing of the debate. It is designed to provide Republicans with political rhetoric that theoretically would shift support to the Republican positions for reform, and away from the Democratic positions. As you read it, you will see that there is a very strong emphasis on the latter, and very little on the former since the Republicans have almost nothing to offer in the way of substantial reform.
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This is great, Steve. Calm answers to stupid questions....seriously, I needed to read this, because when I'm in the same room with one of these blustering manure spreaders spouting off these antique opinions, I become so furious at their crap all I want to do is punch them in the nose....or at the very least, casually stick a foot out so they trip over it, fall down and go boom. Then, we'll see how good their health insurance is.

Now I can just refer to Begala's suggested responses. But, if they don't work, I'm going back to plan A.

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Bluebill, I do not think the Democrats are proposing a plan that would require people to buy health insurance.

Perhaps some of the blue dogs have said this and of course Republicans are against any public health insurance option.

Anyway the bill has yet to be written and there is quite a bit that people can do to get involved, namely checking Obama's website.

From most of what I have heard from people like Howard Dean is that a public health insurance option, run and funded by the government would compete with private insurance. Simple as that.

The specifics you're talking about were on Hilary's platform during the campaign but I haven't heard a requirement mentioned since.

Some nurses and doctors are for the public plan, but they don't really have a choice, neither do the drug companies.

I think the plan can pass whether or not Obama gets 60 votes in the Senate because the Democrats can pass it in the budget if they have to.

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They are not proposing a bill that would require people be provided healthcare either.

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I have government provided healthcare through Medicare. But even as they're talking about access for everyone, they're talking about taking mine away. It's hard to see how they can set up a program for everyone when they claim they can't support the one(s) we already have.

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steve katz

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