For many left-leaning Americans, little is more important aside from the state of the economy right now than healthcare reform – and they’re inextricably linked. Coverage of healthcare reform is pretty high this week, with the expectation that the Supreme Court will hand down their decision regarding the constitutionality of the Affordable Care Act this Thursday. This hasn’t always been the case.
Interestingly, while this is being considered a flagship of the Obama Administration, in his first year as President, healthcare reform ranked third in terms of media coverage mentioning Obama:
One would think that covering healthcare reform – and specifically, the details of the Affordable Care Act, and what the law really means – would be imperative after the passing of the ACA. Ensuring that the law was really understood by citizens would seem to be fairly essential, but what happened instead was a decline in media coverage of HCR after Obama’s first year as President – as shown by the Pew Research Center:
So what does that mean? If coverage goes down, and little has been done to ensure that people truly understand the law (for example, understand what the mandate really means, and what the implications are if it is struck down, which was recently elegantly laid out by the NY Times), the short messaging around the issue becomes even more important.
Cable news can be inflammatory, reactionary, harsh, exaggerated, and at times, unsurprisingly infuriating. They often preach to their respective choirs on the political spectrum, and because of this, I worry that they’ve become so comfortable with their audience that the arguments aren’t as sharp, or clear, as they could be. The brief messaging lacks context and nuance, and headlines or key phrases can substitute for deep understanding of one’s understanding of an issue (and taking today’s ruling on the Arizona immigration law, one can see how brief messaging can create some confusion – one headline read that SCOTUS struck down three components of the immigration law, and the next one I saw trumpeted that SCOTUS had upheld a key component of the immigration law – both were true, neither were particularly informative)
In the context of the fight for comprehensive health care, conservatives seem to have won this messaging game. The new study from the Pew Research Center shows that while liberal talk shows spent more time talking about healthcare reform –
– certain select terms used by healthcare reform opponents that really emphasized negativity were used at rates nearly twice that of terms used by supporters that underscored positive elements of healthcare reform:
Take a look at these terms – which would you say were more compelling? Phrases that would incite more visceral, gut reactions from listeners? I can see how “insuring pre-existing conditions” would actually appeal to both sides, but this barely stood a chance against “more taxes with health care reform” which was mentioned nearly twice as many times and can certainly appeal to the financial fears of viewers. “More competition” would seem to appeal to many free-market espousing conservatives, but is trumped by “more government involvement,” which is the base fear of many Republicans. “Rationing health care” just isn’t true, but instead of rebutting that with facts about the law, HCR supporters shot back with “greedy insurance industry,” which likely wouldn’t win over any opponents to the law, who can claim that insurance agencies are just businesses, trying to capitalize on profits. And that’s where I think the HCR supporters had an in that they didn’t take – commenting on the prioritization of profits for a specific industry over the health of our communities and country as a whole.
Is the assumption that compassion is not an effective communication tool? If so, why is that? I find myself deeply moved by stories of people who are in desperate need of health care but lack the resources – insurance, financial, proximity to quality affordable care – to get it. And I’m certain that I’m not the only one. New York Magazine today touched on the alarming fact that the moral argument – the empathetic position, the community cares idea, the position that healthcare is a fundamental human right – has been remarkably absent from the healthcare debate. I fear that it mostly plays into the uniquely American mentality that regardless of circumstance, each individual has to be able to fend for themselves. While this concept underscores certain types of resiliency and determination that are I think are overly-admired, the fact of the matter is that disregarding the circumstances is not possible. Disregarding the impact of staggering inequality of access to care and financial resources is short-sighted and, more importantly, I would say rather cruel.
If the discussions had focused more on why everyone deserves healthcare – why everyone deserves to be treated with dignity, receive comprehensive care, understand how to care for themselves – since healthcare is an essential component of our right to life (not to mention the pursuit of happiness), would the results have been different? If we appealed to our humanity and illustrated the absurdity of someone dying from a treatable illness, when people who could have helped them essentially stood by just because…they didn’t have any money? Because that’s essentially what this is – the inability to personally protect oneself and one’s family because of dearth of resources. If we had made it more personal, and less political? If we focused less on the greedy agencies, the so-called rationing of care, the increased business competition, if we had actually responded to the claim of too much government intrusion with the response that the government should in fact be intervening when doing so can save the lives of its citizens? Does the punishment of death really fit the ‘crime’ of not getting oneself health insurance, if one was not able to do so because they couldn’t afford it?
Is that the legacy we want to leave?
Larkin Callaghan 
Larkin – Great post, great issue. It strikes at something I really want to understand. It’s the same question as “why is it so difficult for government policy to address the social determinants of health,” which I’ve been reading and thinking about lately.
A book that I find profoundly convincing on the subject of “I pulled myself up by my bootstraps, why can’t you” is Annette Lareau’s ‘Unequal Childhoods: Class, Race, and Family Life.’ It’s so obvious to me that if you are raised in poverty, as opposed to being raised by elite helicopter parents, your understanding of what is possible in your life – and thus your behavior – will be completely different. Your social capital is different, as Bourdieu would say.
But I don’t think there is any evidence or argument that would logically convince someone to change their mind. It’s an emotional position, not a logical one. I suspect people are less inclined to be compassionate when economic conditions are declining and insecure. Paul Starr wrote a book last year (Remedy and Reaction: The Peculiar American Struggle over Health Care Reform) in which he concluded: Those who have Medicare and those who have health insurance through their employer are happy with the way things are and are unwilling to risk any changes.
I think it’s possible to understand why some people are in favor of government policies that address issues only government’s can address and some people are opposed to the government doing anything. This is part of the American tradition you refer to. (I’m currently reading Michael Lind’s ‘Land of Promise’ to try to understand this better.) I’m wondering if the basic question is not “why are some people compassionate and others not” but something else. When I think about that, I’m led to “why doesn’t everyone else feel the same way I do,” which I know is not the right question to ask. Why did people feel it was OK to own slaves? Does the answer about compassion lie in anthropology – seeing some people as “other” and less than human? I would really, really like to understand this better and would enjoy exchanging ideas with you some time.
Jan, thank you for such a thoughtful reply! I agree that the basic question is not “why are some people not compassionate,” but far more complex than that, and involves an individual’s complicated personal history, social and economic circumstances, and in cases like the healthcare law, how messages are being directed at them and how they interpret them. The anthropological perspective is essential. I’d love to delve more into this!