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Why the President Needs to Re-frame Health-care Reform:
What’s in it for us?

Elvin Lim is Assistant Professor of Government at Wesleyan University and author of The Anti-intellectual Presidency, which draws on interviews with more than 40 presidential speechwriters to investigate this relentless qualitative decline, over the course of 200 years, in our presidents’ ability to communicate with the public. He also blogs at www.elvinlim.com. In the article below he looks at how the President has communicated his health-care plans. See his previous OUPblogs here.

The only times when words don’t matter is when events speak for themselves, especially in rare crisis moments. In such moments we are not. As a result, many Americans, who already have health insurance, feel no especial need to take a shot in the dark with President Obama on health-care reform. That is why the correct framing of the health-care reform issue is critical. By “framing,” I mean the rhetorical strategy of setting an argument out in a specific way that predisposes a listener to a preferred conclusion.

But on this crucial pre-battle of words, the Obama administration has failed. The president has told 80 percent of Americans that “if you are happy with your present insurance, nothing will change.” This is a fatal error. Not only is his message lacking even the slightest hint of a call to collective social responsibility that may help influence Democrats and foot-dragging Blue Dogs, there isn’t even a concomitant sell to unconvinced Republicans about what could be in it for them. The latter error is more egregious than the former, because most citizens are not crusading social workers but consumers of public policy.

The president made a mistake by starting the debate on the defensive. Instead of making a positive case for health-care, he has focused too much on the need to keep the costs of health-care reform down. Accepting and perpetuating the metaphor of the imperative to “bend the cost curve” of federal outlays was foolish, because it accepts the metaphorical entailment that if the trajectory is untouched, the costs of a public option will only go up in the future, while leaving unsaid that the costs for health-care sans reform is also on an exponentially upward trend. Where is the talk of “bending the cost curve” on the consumer’s end? People don’t want to know what steps are being taken to prevent a reform from exploding the deficit; they want to know what is in it for them. For the grand majority of Americans who are privileged to be in possession of health-insurance, they need to know why the president wants to rock the boat. And we are only willing to share our privileges (to the involuntarily uninsured) only if those of us who are already privileged get yet some more (in terms of more affordable, quality health care.) The only way to get over an atavistic distrust of the state is to speak in the currency of consumerism – what’s in it for us?

Without a positive case for health-care reform, there has only confusion out there about what the final health-care bill will look like. Compounded by the fact that there is still no White House plan – Obama is still waiting for Congress to hammer details out – uncertainty and poor framing have engendered the fertile soil on which doubt can and has been planted. In an informational vacuum, stories about death panels and health-care for illegal immigrants have taken hold.

No one but Obama can frame the issue right for him. Not even the “liberal” media can help him this time. Consider the fact that even outlets like MSNBC have been constantly featuring incensed questioners in Town Hall meetings around the nation, albeit with disapproving commentary. The coverage is only reinforcing the growing belief that public indignation around the nation is not contrived or orchestrated but real and widespread. There is no liberal media working in Obama’s favor this time, because the media has a different story-telling agenda than the policy-selling one that the president has. Barack Obama can take that bull-horn and reframe the health-care reform debate, or he can keep playing catch-up to a debate that has already spiraled out of control.

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