Posted on May 7, 2009

Frank Luntz's "The Language of Healthcare 2009"



By Dr. Frank I. Luntz

This document is based on polling results and Instant Response dial sessions conducted in April 2009. It captures not just what Americans want to see but exactly what they want to hear. The Words That Work boxes that follow are already being used by a few Congressional and Senatorial Republicans. From today forward, they should be used by everyone.

You simply MUST be vocally and passionately on the side of reform. The status quo is no longer acceptable. If the dynamic becomes “President Obama is on the side of reform and Republicans are against it,” then the battle is lost and every word in this document is useless. Republicans must be for the right kind of reform that protects the quality of healthcare for all Americans. And you must establish your support of reform early in your presentation.


(1) Humanize your approach.

(2) Acknowledge the “crisis” or suffer the consequences.

(3) “Time” is the government healthcare killer.

(4) The arguments against the Democrats’ healthcare plan must center around “politicians,” “bureaucrats,” and “Washington” … not the free market, tax incentives, or competition.

(5) The healthcare denial horror stories from Canada & Co. do resonate, but you have to humanize them.

(6) Healthcare quality = “getting the treatment you need, when you need it.”

7) “One-size-does-NOT-fit-all.”

(8) WASTE, FRAUD, and ABUSE are your best targets for how to bring down costs.

(9) Americans will expect the government to look out for those who truly can’t afford healthcare.

(10) It’s not enough to just say what you’re against. You have to tell them what you’re for.


By Don McCanne, MD

This is an important document. It is Frank Luntz’s recommendation to the Republican politicians on how to frame the debate over health care reform. If you have been listening to the Republicans speak on reform, you have already heard some of the rhetoric, and you will recognize it as you read this report.

This is not a report on health policy. If you read it as if it were a policy paper, you will likely become angered over the liberties that Luntz takes with policy concepts. You will recognize a great many distortions and, worse, many instances in which his statements are not supported by the facts (i.e., “lies” in common parlance).

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.

A note of caution: As you read the report, you will tend to fall into the trap of responding based on their framing of the issues. Do not do that. Always address the issues within our own framing structure. When you identify rhetoric that is blatantly untrue, you will tend to say, “That’s a lie.” Such ‘tis so/’tis not debates are never productive and tend to favor the smooth talkers (predominantly Republicans). Instead, respond with highly credible facts that use the framing from our own arena.

Another word about lies. You will see that Frank Luntz does not have an issue with this. What counts is a strong message that appears to be credible, regardless of whether or not it is. On our side, we must never lie, nor even distort our message. We have established unblemished credibility with our message, and we must never do anything that might impair that credibility. That makes our task more difficult because we must be very careful that anything we say is supported by sound health policy science. But it also makes the Republicans vulnerable since they tend to concentrate on sound bites that are not based on sound policies. That risks exposing them as charlatans; we can do that with our carefully framed messages.

Some parts of the report actually provide good advice not only for the Republicans, but for the Democrats as well. In fact, you will identify some recommendations that have been lifted from our camp. We can continue to use these, and we should not attack them when they use the same rhetoric. Only when they twist it unfairly should we counter with our rhetoric describing the beneficial impacts of our policies.

Look at this example from the report: “What Americans are looking for in healthcare that your ‘solution’ will provide is, in a word, more: ‘more access to more treatments and more doctors…with less interference from insurance companies and Washington politicians and special interests.’”

What Luntz left unsaid is that these are features that more closely describe the progressive position. Most of the Republican policies would make these worse. Again, you wouldn’t respond by saying, “That’s not true.” You would respond by providing accurate sound bites on how the single payer proposal provides improved access by eliminating financial barriers to care, and single payer would eliminate the private insurance industry so it could no longer interfere with your care.

Wait. Progressive? Single payer? Isn’t my comment supposed to be talking about the framing to be used the Democrats? Well, we have a problem here.

Look at another example from Luntz’s report: “We suggest ratcheting up the rhetoric against insurance companies to almost the same degree as you do against Washington bureaucracy. Call the Democratic plan a ‘bailout for the insurance industry’ — both because it is, and because it will build lasting credibility by going after the two things the American people hate most: Washington bureaucracy and insurer greed.”

Wow! Luntz is right! The Democratic plan IS a “bailout for the insurance industry.” In fact, the Democrats have lost all credibility on this one when they have AHIP’s Karen Ignagni front and center at every hearing, every forum, every summit, and her operatives providing input to the closed-door sessions, while they have excluded from the process those who most vigorously attack the insurance companies - the single payer advocates.

Read Luntz’s report. Be prepared to respond using our framing. Attack their credibility when they provide us with obvious openings.

What is sobering is that we have to use the truth to attack both the Republican and the Democratic politicians. And this was to have been our great opening to provide high quality care for everyone.

But don’t give up. The Democrats’ plan won’t work. They’ll still need us to fix our system when their failure becomes painfully obvious.