Checking Language & Facts
in the Healthcare Debate

By Alan Shapiro

To the Teacher:

Healthcare reform was a major issue in the presidential campaign and has become even more important to many Americans since the severe recession hit. Millions have lost their jobs-and often their healthcare insurance along with it. Some 48 million Americans are now without it (www.americanprogress.org, 5/4/09)

You probably don't know how many of your students are among the uninsured, but it is increasingly likely that a fair number are. With work on a federal healthcare reform bill well underway, action on it promised by mid-summer, and media attention growing, this is a teachable moment, not only about healthcare but also about the accuracy of arguments, pro and con.

The first student reading below is an excerpt from a Republican strategist's memo to Republican leaders about how to attack the Democrats on healthcare issues. The second includes a transcript of a TV ad attacking the Obama administration on healthcare. The third outlines President Obama's approach to healthcare reform and reports on differences of opinion about what healthcare executives agreed to do at a 5/11/09 meeting with the president. Discussion questions following each reading call for critical thinking about language, factual, and substantive issues.

See the high school section of www.teachablemoment.org for the following additional materials on healthcare: "Presidential Election 2008: Five Issues the Candidates Won't Touch"; Presidential Election 2008: Fixing the U.S. Healthcare System"; and "A Single-Payer Health Insurance System for the US" (with a DBQ).

Student Reading 1:
Excerpts from a Republican strategist's memorandum

President Obama has made congressional action on "quality, affordable healthcare" for all Americans a priority for his first year in office. Lawmakers are at work on a bill that Speaker of the House Nancy Pelosi has said she expects will be passed by July 31. Republicans also are at work. Their chief public opinion analyst and language expert, Frank Luntz, sent leading Republicans a memorandum early in May detailed his strategic advice.

"The arguments against the Democrats' healthcare plan must center around 'politicians,' 'bureaucrats,' and 'Washington,'" Frank Luntz wrote. "Stop talking economic theory, and start personalizing the impact of a government takeover of healthcare." To do that, Luntz proposed, Republicans need to understand that the American people "don't want to hear that you're opposed to government healthcare because it's too expensive (any help from the government to lower costs will be embraced) or because it's anti-competitive (they don't know about current limits to competition). But they are deathly afraid that a government takeover will lower their quality of care-so they are extremely receptive to the anti-Washington approach. It's not an economic issue. It's a bureaucratic issue."

"The best anti-Democratic message," he wrote, is that "No Washington bureaucrat or healthcare lobbyist should stand between your family and your doctor. The Democrats wants to put Washington politicians in charge of your healthcare."

"'Healthcare quality=getting the treatment you need, when you need it.' That is how Americans define quality, and so should you….Nothing will anger Americans more than the chance that they will be denied the healthcare they need for whatever reason. This is also important because it is an attribute of a government healthcare system that the Democrats CANNOT offer. So say it. 'The plan put forward by the Democrats will deny people treatments they need and make them wait to get the treatments they are allowed to receive."

"It's not enough to just say what you're against. You have to tell them what you're for. It's okay (and even necessary) for your campaign to center around why this healthcare plan is bad for America. But if you offer no vision for what's better for America, you'll be relegated to insignificance at best and labeled obstructionist at worst….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."

(For the entire memo, see http://wonkroom.thinkprogress.org/2009/05/06/luntz-memo/)

For discussion

1. What questions do students have about the memo? How might they be answered?

2. What are the main points in Luntz's recommendations to Republican leaders?

3. Why does Luntz tell Republicans that Americans don't want to hear that "you're opposed to government healthcare because it's too expensive…or because it's anti-competitive"?

4. Words have denotations, or dictionary meanings. They also have connotations, or suggestive power. What three words does he urge Republicans to use in their criticisms of Democratic health plans? What does each word denote? What connotations of each word do you think Luntz has in mind. Why?

5. What does he mean by "personalizing the impact of a government takeover of healthcare"? According to Luntz, what are Americans' main fears? Do you agree? Why or why not?

6. How might Luntz criticize a rewrite of his "best antidemocratic message" to say: "No government official or healthcare advocate should stand between your family and your doctor"?

7. Specifically, what does he urge Republicans to say in "the best antidemocratic message"? What makes it so good from his point of view?

8. Does he offer any evidence for Republicans to use in their "antidemocratic" messages? If so, what? If not, why not?

9. Luntz concludes by emphasizing the crucial importance of Republicans saying what they are for and offering a vision for America on healthcare. "The status quo," he says, "is no longer acceptable." Do you agree? Why or why not? Is there a Republican plan for improving the "status quo"? How would you find out?

Student Reading 2:
Examining a TV Ad

Here is a transcript of the audio portion of a minute-long TV ad sponsored by Conservatives for Patients Rights (CPR), which began running in April. Rick Scott is CPR's chairman. (www.conservativesforpatientsrights.org.)

"Not So Innocent"

Scott: Deep inside the [economic] stimulus bill Congress buried an innocent-sounding board, the Federal Coordinating Council for Comparative Effectiveness Research.

It's not so innocent. It's the first step in government control over your healthcare choices. The federal council is modeled after the national board that controls Britain's health system. Listen to Britain's Dr. Karol Sikora about what happens to patients once the government takes over.

Skora: They'll lose their own choice completely. Lose control of their own destiny within the medical system.

Scott: Not only could a government board deny your choice in doctors but it can control life and death for some patients. Ask Canada's Dr. Brian Day about bureaucrats rationing care.

Day: Patients are languishing and suffering on wait lists. Our own Supreme Court of Canada has stated that patients are actually dying as they wait for care.

Scott: Tell Congress you won't trade your doctor for a national board of bureaucrats. Let's put patients first.

Conservatives for Patients Rights states that it "is a non-profit organization dedicated to educating and informing the public about the principle of patients rights and, in doing so, advancing the debate over healthcare reform. Those principles include choice, competition, accountability and responsibility. We believe the path to effective healthcare reform must be based on the patient-doctor relation and not from a top-down, big government perspective. Anything that interferes with an individual's freedom to consult their doctor of choice to make healthcare decisions defeats the purpose of meaningful healthcare reform."

Thinking critically about the ad

CPR warns that Congress recently took "the first step in government control over your healthcare." An "innocent-sounding" council is "modeled after the national board that controls Britain's health system." And that means you could lose "your choice in doctors" and end up "dying" as you "wait for care." This is enough to worry anyone who ever expects to need a doctor for a health problem, and that includes just about everyone.

Check these claims by going to FactCheck's website, www.factcheck.org. FactCheck's mission statement declares: "We are a nonpartisan, nonprofit 'consumer advocate' for voters that aims to reduce the level of deception and confusion in US politics. We monitor the factual accuracy of what is said by major US political players in the form of TV ads, debates, speeches, interviews and news releases."

As you examine the site, you will find it covers many political issues. On its home page are its most recent reports, including "Government-Run Healthcare?" (posted April 30, 2009), which offers a detailed critique of the CPR ad.

Study the FactCheck critique of the ad and, through a link to CPR, the organization's response to it.

The Fact Check website reports, "Obama hasn't called for…a government-run plan….In fact, he has flatly rejected it. The administration has said on the White House's 'Healthcare' web page that 'President Obama and Vice President Biden believe' that government-run healthcare is 'wrong'….Obama has long said he would allow individuals or small businesses to buy insurance through a public plan-like the one now available to members of Congress. But nobody would be forced to drop his or her current insurance, and private plans would exist as they do now. This was the healthcare plan he promoted as a presidential candidate." (www.factcheck.org)

The ad presents a highly critical view of "government-run" healthcare systems in Britain and Canada. The two countries in fact have very different healthcare systems: Canada has government-provided health insurance but healthcare itself is provided by a range of private and public providers, as in the US In Britain, the government employs most healthcare providers.

In a 2007 study by the Commonwealth Fund comparing the US healthcare system with that of four other countries, including Britain and Canada, the US ranked lowest-even though the US spends two or three times as much for healthcare as Canada, and nearly three times more than the UK. (http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/May/Mirror--Mirror-on-the-Wall--An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx)

A 2002 study reported in the journal Health Affairs found that the United States "generally ranks at the bottom among the five countries [Australia, Canada, New Zealand, the United Kingdom and the United States] on most indicators of patient views and experiences." (http://globalhealth.kff.org/Daily-Reports/2002/May/20/dr00011269.aspx)

For discussion

1. What questions do you have about the TV ad? How might they be answered?

2. What would Frank Luntz think about this ad? What makes you think so?

3. What questions do you have about the Fact Check analysis? How might they be answered?

4. Does the president support "government control over your healthcare? Why or why not?

5. If you are uncertain, how would you find out? The most obvious thing to do is to go to the White House website at www.whitehouse.gov to find what the president has said about healthcare reform. You can find out by clicking on "Issues" and then "healthcare."

6. What do you find? Does the president say that he supports a government-run
healthcare program? Taking away your choice of doctor?

7. What questions do you have about how people in healthcare systems in Canada, Britain, and elsewhere? How might they be answered?

8. One other aspect of the ad worth considering is its language.
a. In the second paragraph, the ad states of the board that "It's the first step in government control over your healthcare choices." Does the ad support this assertion factually? If so, how?
b. Note in the next sentence the words "modeled after" and then "what happens to patients when the government takes over." Does "modeled after" mean "the same as"? Does the ad demonstrate that the council it approved will mean a government takeover of healthcare? If so, how?
c. The ad twice uses the term "bureaucrats"-"bureaucrats rationing care" and trading "your doctor for a national board of bureaucrats." Why do you suppose it uses that term, rather than "government officials"?

Student Reading 3:
Obama's healthcare reform principles & the coming debate

Most Americans agree that the healthcare system in the United States is badly in need of repair. Among the problems: soaring health costs, the 48 million Americans without health insurance, and lack of access to care even among insured.

President Obama supported healthcare reform during his presidential campaign and as president has proposed a budget of "$635 billion over ten years to help finance reform of our healthcare system to achieve coverage for all Americans." (www.healthreform.gov)

He stated recently, "Whatever plans emerge, both from the House and the Senate, I do believe that they've got to uphold three basic principles: first, that the rising cost of healthcare has to be brought down; second, that Americans have to be able to choose their own doctor and their own plan; and third, all Americans have to have quality, affordable healthcare." (www.whitehouse.gov, 5/13/09)

Additional information about what the president thinks "comprehensive health reform should include:

• Reduce long-term growth of healthcare costs for businesses and government
  
• Protect families from bankruptcy or debt because of healthcare costs
  
• Guarantee choice of doctors and health plans
  
• Invest in prevention and wellness
  
• Improve patient safety and quality of care
  
• Assure affordable, quality health coverage for all Americans
  
• Maintain coverage when you change or lose your job
  
• End barriers to coverage for people with pre-existing medical conditions

The president has also supported a mix of private and public health insurance programs. He maintains that the reforms do not mean that anyone satisfied with his or her current private health insurance will be required to change it. Obama has left the details of a health reform bill up to Congress.

A major issue is and will continue to be how to cut healthcare costs to help with comprehensive healthcare reform. Six major healthcare organizations met with President Obama on May 11. This was, the president said, "a historic day, a watershed event" because, "doctors, hospitals, drug makers and insurance companies voluntarily offered $2 trillion in cost reductions over 10 years," the New York Times reported. "Robert Gibbs, the White House press secretary, said Mr. Obama had told the healthcare executives, 'You've made a commitment; we expect you to keep it.'" (5/12/09) The president also said, "Over the next 10 years from 2010 to 2019, they [healthcare organizations] are pledging to cut the rate of growth of national healthcare spending by 1.5 percentage points each year--an amount that's equal to over $2 trillion." (New York Times, 5/15/09)

A few days after the meeting, Richard Pollack, the executive vice president of the American Hospital Association, wrote to affiliated organizations, "The groups did not support reducing the rate of health spending by 1.5 percentage points annually." David Nexon, senior executive vice president of the Advanced Medical Technology Association, said, "There was no specific understanding of when the lower growth rate would be achieved." But Nancy-Ann DeParle, director of the White House Office of Health Reform, told the Times, "I don't think the president misspoke. His remarks correctly and accurately described the industry's commitment." (5/15/09)

Meanwhile, a range of groups representing doctors, nurses, consumers and others, argue that the only way to effectively control healthcare costs is to provide universal national health insurance, as do most other industrialized countries that spend far less on healthcare than the US Such a "single-payer" system is sometimes called "Medicare for all" because it would expand a beefed-up version of that federal insurance program for seniors to every American.

A single-payer system would eliminate the role of private insurance companies. Instead, health insurance would be provided to every American through the government. Proponents argue that eliminating insurance company bureaucracy and profit-taking would dramatically cut healthcare costs. It would also mean that people would not lose their insurance when they change or lose their job. A 2008 poll of doctors published in the journal Annals of Internal Medicine found that 59% of doctors support a single-payer plan.

President Obama has said that if the US was "starting from scratch" in creating a healthcare system, single-payer would "make sense." But he says such a system is not now obtainable, and he has assured private health insurance companies that they will continue to play a leading role in our healthcare system. Insurance companies have supported reforms that would provide subsidies to Americans to buy health insurance, which would likely increase their customer base and revenues.

In the coming months Americans can expect more misunderstandings and a heated political debate featuring information and infomercials, charges and counter-charges, competing TV ad campaigns, misrepresentations of others' views, and artful uses of language by Democrats and Republicans to convince the public of the virtues of their positions, the wrong-headedness of their opponents'.

For discussion

1. What questions do students have about the reading? How might they be answered?

2. Where will the $635 billion to pay for Obama's healthcare reform plan come from? What does Obama say? If you don't know, how might you find out? If you do find out, what questions might you ask of the president?

3. Note that in Obama's three principles there are differences in the nature of the language used. Which principle or principles can be factually verified? Which depend upon a person's opinion? What difference does it make?

4. Are the president's healthcare principles and ideas vulnerable to the attack Luntz discusses in his memo? To the CPR ad? In each case, if they are, how? If not, why not? And if not, why do you suppose that Luntz and the CPR ad attack the Obama administration as they do?

5. Why do you suppose Obama has left details of a health reform bill to Congress? What advantages and disadvantages might there be in this strategy?

6. How would you explain the different understandings the president and healthcare executives came away with after their May 11 meeting?

7. Why do you think \ President Obama does not support a single-payer healthcare plan?

For writing

You Are:

1. A Democratic political strategist. Write a memorandum to your party's leaders about the best ways to respond to Republican attacks on healthcare.

2. A Republican political strategist. Write a memorandum to your party's leaders about what you think a Republican healthcare proposal should include and why.

3. An Independent political strategist. Write a letter to your local newspaper expressing your criticisms of Democratic and Republican healthcare ideas.

Media reports on provisions of a healthcare bill will be frequent during the weeks ahead. So will reports of arguments, pro and con. Factual and language issues will be worth examining.

Assign a few students each week to find out what is happening and being said during the healthcare debate and to report on their findings for class discussion

This lesson was written for TeachableMoment.Org, a project of Morningside Center for Teaching Social Responsibility. We welcome your comments. Please email them to: lmcclure@morningsidecenter.org.

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