Message trumps policy?
How to Talk About Health Care Reform: Summary of Research on Health Care Messaging
Celinda Lake and Drew Westen
Families USA, Herndon Alliance, Westen Strategies, Lake Research Partners
May 22, 2008
If you want to see universal health care enacted, stop using that phrase.
Message development: Using focus groups of swing voters and online dial-groups
Conservative message:
Families should be in charge of their health care dollars. Rising health care costs are a problem, and the best way to bring them down is to increase competition among health care providers and put an end to these million dollar lawsuits that drive up insurance costs and put doctors out of business. The best solution to our health care problems is to let the free market work, foster more competition, and help people deal with the rising costs of coverage with health savings accounts that allow people to manage their own health care decisions. The last thing we need is the government taking over health care and creating a massive bureaucracy that will cost us billions of dollars a year. Sure, we have problems, but what the naysayers always seem to forget is that Americans still have the best health care in the world. Europe and Canada have government run health care, and their patients come here for treatment due to long waits and poor quality care. The answer to our health care problems is a freer market, not socialized medicine.
MEAN DIAL RATING (0-100) = 55
Progressive message I:
I believe that people who work for a living ought to be able to take their kids to a doctor, and people who are retired, ill, or temporarily out of work shouldn’t risk losing their life savings because of one illness. We’re not just talking about poor people. We’re talking about middle class Americans who are getting squeezed. Too many people have to think twice before switching jobs or starting a business because they’re worried they won’t be able to get insurance. We need comprehensive reform, not a band-aid. That means putting government to work for taxpayers again, not for special interests, by requiring insurance companies to put more money into patient care and less into efforts to deny it. It means preventing insurance companies from excluding patients because of “pre-existing conditions” and overriding doctors’ decisions about what their patients need. It means giving us choices among plans so we can decide what’s best for our own families, including the choice to keep our current doctor. It means limiting the amount anyone has to spend out of pocket, so no one loses their life’s savings because of a sick child or a hospital bill. And it means giving small businesses tax breaks to offset the costs of covering their employees, and requiring big businesses to offer coverage to their employees instead of sticking middle class taxpayers with the tab.
MEAN DIAL RATING (0-100) = 71
Progressive message II:
I believe in a family doctor for every family. It’s not right that hard-working Americans are struggling to afford health care and prescription drugs, while we’re strangling small businesses with the cost of their employees’ health care. The market hasn’t solved this problem, and it’s not going to as long as big insurance and drug companies are profiting at our expense. But we don’t need to replace managed care bureaucracy with government bureaucracy. We need common sense reform that gives people more choices, not less, including the choice to stay with the doctor they have now. We need to make insurance companies compete with each other to keep costs down and quality up, and give people the option to buy into the same plan members of Congress get, because if it’s good enough for Congress, it’s good enough for the people they represent. And we need government to set high standards to keep deductibles low, stop insurance companies from cherry-picking patients by excluding people with “pre-existing conditions,” and guarantee preventive care like cancer screening that cuts long-term costs and saves lives.
MEAN DIAL RATING (0-100) = 69
This link will download the Lake/Westen PowerPoint presentation, but you will be able to open it only if you have an appropriate program on your computer:
www.familiesusa.org%2Flink-redirect.jsp%3FitemID%3D39611471%26domain%3Dfamiliesusa&hostgroupID=27078647">https://wadmin5.getactive.com/system/ga/redirect.jsp?redirectURL=http%3A%2F%2Fwww.familiesusa.org%2Flink-redirect.jsp%3FitemID%3D39611471%26domain%3Dfamiliesusa&hostgroupID=27078647
And…
Key Highlights from Herndon Alliance research
Celinda Lake, David Mermin, Dan Spicer
Lake Research Partners
November 15, 2007
A strong majority of voters favor Guaranteed Affordable Choice (GAC), and voters prefer it to other health care reform alternatives tested like HSAs, tax credits, or a single payer plan.
(Note: In the survey, the rhetoric of “Guaranteed Affordable Choice” was paired with the rhetoric of each of the other three options: “Health Savings Account,” “Tax Credits,” and “Single Payer.” In each pairing, Guaranteed Affordable Choice was preferred by about two-thirds of the participants, whereas each of the other options was preferred by about one-fifth. Only their rhetoric of “Guaranteed Affordable Choice” and “Single Payer” are included here since they relate to today’s message.)
Guaranteed Affordable Choice (GAC): An approach that would guarantee affordable health insurance coverage for every American with a choice of private or public plans that cover all necessary medical services, paid for by employers and individuals on a sliding scale. (64% preferred)
Single Payer (SP): A single government-financed health insurance plan for all Americans financed by tax dollars that would pay private health care providers for a comprehensive set of medical services. (22% preferred)
Comment:
By Don McCanne, MD
There is currently an intensive effort within the progressive community to establish unity in support of a message on health care reform that will resonate with swing voters as well as progressives. Those driving that effort contend that the policy debate is over, and it is now time to move forward unified behind one message.
What is that message? CHOICE! “It means giving us choices among plans so we can decide what’s best for our own families,” according to the progressive message above. You’ve heard the Democratic candidates say repeatedly that “you can keep the insurance you have if that’s your choice.”
People like choice. The conservatives understand that. They contend that government programs take away your choice. Of course a single payer system allows you to choose your health care professionals, whereas the private plans supported by the conservatives take away your freedom to choose your physicians and hospitals. But what about the progressives? They are now using the framing of the conservatives! You can have your choice of health plans! But then why deal with the real issues when the rhetoric works so well?
Now let’s look at the survey data on Guaranteed Affordable Choice (GAC). When GAC was paired with Single Payer (SP), 64% preferred the rhetoric of GAC and 22% preferred the rhetoric of SP. Let’s look specifically at the rhetoric, from a policy perspective.
Both of the GAC and SP sentences flow very well, and even members of the policy community might not detect any bias at first glance. But when you study the statements, you can see several problems with the rhetoric. As mentioned, people like the word “choice.” It’s in the GAC description but not SP, even though the SP choice of physicians and hospitals is much more important than choice of health plans. GAC has a “guarantee,” but SP does not, even though SP is automatic for everyone - the ultimate guarantee. GAC is “affordable,” but SP is silent on this even though it is the model that actually is designed to be affordable. GAC has an option of a “public” plan, but SP is a “government” plan - meant as a rhetorical pejorative. GAC is paid on a “sliding scale,” but the even more equitable progressive nature of SP tax financing is not mentioned. Someone else (“employers”) are paying a large part of the GAC premium, whereas you pay your own (“taxes”) in the SP model. Even “paid for” (GAC) is a more comfortable phrase than the sterile term “financing” (SP). SP uses “providers” whereas GAC is silent and presumably uses physicians and other health care professionals. GAC has “all necessary” medical services, whereas SP has only “a comprehensive set.”
What happened here? The policy was set in advance, frozen in the model supported by the Democratic candidates. Then a message was developed to precisely coincide with that model. This was not a survey of which policies swing voters would prefer. This was a survey of what message produces a more supportive response of a model already fixed in concrete, at least fixed from the perspective of many of those supporting unity. The problem is that the policy debate is not over.
That said, the progressive community is right in one very important regard. It is time for unity. It is time for us to unite together in support of health policies that would ensure that every individual would have access to reasonably comprehensive health care services in an equitably funded system that is affordable for each and every individual and affordable for society. Unity is fragile. Trading away these principles would divide us, but by uniting behind them, we can finally get the job done.