Did you read Drew Westen's WaPo op-ed today on health care reform messaging? If so, you may understand why I'm so gloomy

After reading Westen, I worry that the case for health care reform has been sent over the heads of the American people.

"House liberals are warning the Senate, Democratic leaders and President Barack Obama that a government-run insurance option must be included in any health reform bill, or else the powerful bloc will vote it down.

"'Usually, we work behind the scenes to strengthen legislation,' said Rep. Lynn Woolsey (D-Calif.), co-chairwoman of the 80-member Congressional Progressive Caucus. 'We’re careful not to take on our party’s leadership, or President Obama.'

"'This time, however, is different.'"

-- from Steven T. Davis's Roll Call report today,
"Liberals Draw Hard Line on Health Reform"

"'Universal health care.' 'The uninsured.' 'Public option.' These are the buzzwords you often hear from Democrats and proponents of President Obama's plan for health-care reform. But if they want to see that plan enacted, they'd do well to excise those phrases from their vocabulary.

"Words send messages, but they're not always the messages we intend. Recent polls show overwhelming support for health-care reform, including the 'public option' in Obama's plan. But the reality is that which side prevails in this battle will probably depend as much on which one has its messaging right as on which has its policies right."

-- Drew Westen, in a Washington Post op-ed today,
"What We Talk About When We Talk About Health Care"

by Ken

Okay, the liberals are hanging tough for the necessary public option. That's good, I guess.

I say, "I guess," because . . . well, listen to what Drew Westen has to say in his WaPo op-ed:

[P]erhaps the most important element of effective communication is knowing what messages you're actually sending. Every word we utter activates what neuroscientists call networks of association -- interconnected sets of thoughts, memories and emotions. Consider the term "universal health care." Every time Democrats use it, they reduce the likelihood of health care reform. Why? Because it evokes precisely the associations that Luntz and other conservatives want to evoke: socialized medicine, government bureaucracy, impersonal clinics and lack of choice.

Over the past couple of weeks, the health care debate has centered on the "public option" in Obama's plan. Unfortunately, "public option" shares nearly all the negative connotations of "universal health care" -- with additional associations to low quality and welfare. It's no accident that Republicans have seized on this, because the longer people hear about the "public option," the more they are likely to associate the entire plan with government control. Advocates could turn the tables by asking Americans whether they prefer choices dictated by the insurance industry or the range of choices that their elected representatives get, including a high-quality plan that doesn't rely on the goodwill of industry executives.

I wrote last night about my own war-weariness with the whole health care reform thing. After reading the Westen piece, I'm thinking maybe it's not all my fault, that the entire effort has been mismessaged from the start.

Here's more of what Westen had to say:

Reform advocates also set back their agenda every time they talk about "the uninsured" or "the underinsured." Those phrases turn an "us" into a "them," which decreases empathy and activates what social psychologists call the "just world hypothesis," the idea that somehow people get what they deserve. It also activates the "welfare" network, tainting by association people who work full-time or want to work but still can't afford insurance. (Most people on welfare have access to Medicaid. It is the "working poor" -- another term that distances and depersonalizes -- who constitute most of "the uninsured.")

Can these simple phrases really make that much difference? Yes, they can.

Last year a coalition of nonprofits dedicated to health-care reform commissioned Democratic pollster Celinda Lake and me to figure out how to translate a set of policies into everyday language that would speak to Americans' concerns about health care. Messages that laid out the principles behind reform -- such as giving people control over their own health care decisions, protecting the doctor-patient relationship and making sure that no one could be denied health insurance because of "pre-existing conditions" -- solidly beat the best conservative messages, whereas messages that turned people into statistics or focused on nitty-gritty policy details fared poorly. The same people who expressed strong negative feelings toward a candidate who proclaimed his belief in "universal health care" strongly supported a candidate who began a message with the statement, "I believe in a family doctor for every family." To the average American, a family doctor for every family connotes something warm, comforting, human and nostalgic, whereas universal health care connotes something cold, sterile, distant and creepy-futuresque. The two phrases evoke different networks of association.

The American people want health-care reform, and the battle of words, images and narratives has begun. If the president and his party want to win it, they'll stand up and say what they believe -- and say it clearly and with conviction. Ultimately, there's no more important principle of political communication than that.

Westen takes extensive note of the famous Frank Luntz memo:

Republicans and other opponents of Obama's plan are already operating on this assumption, guided by a memo on "the language of health care" that conservative wordsmith Frank Luntz circulated to GOP members on Capitol Hill last month. In it, he conceded that the American public wants real reform and argued that the only way Republicans can defeat Obama's plan is by co-opting the language of reform, describing the president's plan as a "government takeover" and painting it as a bureaucrat's dream and a patient's nightmare.

In fact, as easy a sell as health-care reform ought to be, ideas do not sell themselves -- particularly when someone is trying to sell them short. What reform advocates need to keep in mind are four things that persuasive leaders do well: tell compelling stories, focus on principles, move people emotionally and send clear messages.

Humans are a storytelling species. People have trouble remembering laundry lists of facts, figures and 12-point plans, which is why candidates who run on them tend to get taken to the cleaners. In politics, if you want people to get the gist of what you're saying, you have to give it to them: What's the problem? How did it come about? Who are the protagonists and antagonists? And how are we going to get out of this mess? That's a story.

Remember Harry and Louise? They were the average middle-aged couple who took on another couple named Bill and Hillary in insurance-industry-sponsored television ads during the last health-care debate 15 years ago. Their first ad, set "sometime in the future," showed the couple at their kitchen table, going through bills, musing about the good old days when their health insurance plan covered their costs and government bureaucrats didn't control their health care.

The Harry and Louise ad campaign capped a well-funded effort to defeat the Clintons' effort at health-care reform in 1994. It was so effective because it told an evocative story that resonated with Americans' values and concerns (particularly regarding freedom and control): Let the government get a foothold in your health care, and before you know it, you'll be on the receiving end of socialized medicine and big government bureaucracy.

And from where I sit, even though the Democrats have known all about the Luntz memo for, well, forever, and therefore have known exactly how the Republicans and their insurance-company and pharmaceutical allies were going to message their opposition, the opposition has succeeded at almost every point. Yes, polls still show that people want health care reform, but there's no evidence that they want it enough to face down the lies and evasions of the Luntz-based pushback, which seems to me to have accomplished virtually all of its objectives.

As I wrote last night, I have the dreadful feeling that if we get a bill at all, it's going to be one pounded into submission by the big money interests at stake -- primarily the insurance companies.

The other day former Labor Secretary Bob Reich wrote a mostly terrific post for TPM in which he laid out what the president has to do to achieve meaningful health care reform. The one controversial point he offered was the last: "Put everything else on hold." One of the wisest of my colleagues countered:

It makes me groan to say it, but they need to work smarter, not harder. To listen to the politicians talk, the insurance industry are pillars of the community. Obama could drop all the other political issues and skip the gym hour to try and work for a public option, but there's no coherent rationale for changing a system run by such fine, upstanding companies.

Policies don't just fall to 'recission', they are fraudulently terminated by companies who refuse to provide services paid for. People don't just 'lack coverage', they lack care, and they die because of it. People don't just get 'dropped from their policies' or 'tied up in claims denial' when they have expensive cancers or need transplants, they get sentenced to death. People don't just 'stop taking medication because they can't afford it', they lose years of health and life to pain and early death.

Americans are deliberately put out to die for money, for profit, in our current system. There could not be a deeper breach of public trust and good faith.

If politicians started bluntly saying so, I think they could get a lot more done in a lot less time.

UPDATE: "MYSTERY QUOTE" AUTHOR REVEALED . . .
ER, EVENTUALLY

Okay, this was kind of naughty of me. Before leaving my office I went ahead and scheduled the above post for publication, and at the same time I shot off an e-mail asking for permission to use the above spectacular riff on the insurance companies. And then I got distracted. Okay, if you want the truth, on the way home I actually missed my subway stop (I do that occasionally, especially if I get caught up in something I'm reading), and then took the long way home, even presuming to stop for a slice of pizza. By the time I got home it was after 9pm ET, the post had gone up, and I didn't want to think about it.

If I'd been more on the ball, I would have discovered that before our post time the writer had not only graciously okayed publication but was quite willing to be quoted by name. I thought it might be fun to leave that identification to the morning's first post, at which time I'm going to present a full post she wrote on this subject.

Oh, come on, quit whining! You already know that she's a "she." I happen to think she's as dazzling a writer as there is currently practicing in the English language. You can wait a few more hours, can't you?

(While we're at it, in fairness to Bob Reich, it might be nice to take a look at the "terrific" part of his TPM post of advice for the president, rather than citing just the one final point with which some of us are taking issue.)

#