Wednesday, August 19, 2009

Health Care Reform, "Call it the American Plan, because that’s what it really is"

Barack Obama ran the best-organized and best-framed presidential campaign in history. How is it possible that the same people who did so well in the campaign have done so badly on health care?

The following is a must-read for anyone frustrated by the messaging around health care reform and looking for an effective alternative. Internationally known linguist and author, George Lakoff, breaks down how the healthcare debate has spiraled out of the Obama administration's control, and what we do now to reset the conversation. 

The answer is simple and unfortunate: The president put both the conceptual framing and the messaging for his health care plan in the hands of policy wonks. This led to twin disasters.

Howard Dean was right when he said that you can’t get health care reform without a public alternative to the insurance companies. Institutions matter. The list of what needs reform makes sense under one conceptual umbrella. It is a public alternative that unifies the long list of needed reforms: coverage for the uninsured, cost control, no preconditions, no denial of care, keeping care when you change jobs or get sick, equal treatment for women, exorbitant deductibles, no lifetime caps, and on and on. It’s a long list. But one idea, properly articulated, takes care of the list: An American Plan guarantees affordable care for all Americans. Simple. But not for policy wonks.

The policymakers focus on the list, not the unifying idea. So Obama’s and Axelrod’s statements last Sunday were just the lists without the unifying institution. And without a powerful institution, the insurance companies will just whittle away at enforcement of any such list, and a future Republican administration will just get rid of the regulators, reassigning them or eliminating their jobs.

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’m 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. 50 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 PolicySpeak. 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% - 30% of payments do not go to health care, but to denying care and profiting from it, that constitutes a tax on the 96% 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 you 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.
There's more. It's a long read, but really worth it.

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