Frank Luntz reappeared last week when a tipster slipped Politico a twenty-eight-page document called “The Language of Healthcare 2009” that Luntz had given to Congressional Republicans. It quickly traveled through the blogosphere, and health reform proponents thought they had caught Luntz red-handed in oiling up the Republican message machine.
Over at The New Republic’s health blog, Jonathan Cohn wrote that the appearance of the latest Luntz communiqué made him “slightly” more optimistic about chances for reform. Cohn argued that Luntz had toned down the Republican message; his memo was more benign than a similar one written by William Kristol in 1994, advising Republicans to tell people “there is no health crisis.” This time Luntz advises them to acknowledge the crisis but define it in terms of the audience—“if you’re one of the millions who can’t afford health care, it’s a crisis,” or if a bureaucrat gets between you and your doctor, it’s a crisis.
Before going further, it’s good to remember who Frank Luntz is: a GOP pollster and consultant par excellence, known for testing language on focus group participants to find which words resonate best with ordinary folks. Republican pols can then use those words to sway public opinion in their favor. In the mid-1990s, Luntz helped shape the messages that led to the FDA Modernization Act of 1997, a conservative triumph that, among other things, let drug companies expand their markets for “off-label” uses (uses other than those for which the FDA had approved the drug). Stressing a “corporate partnership for safety” and talking about “better science—bureaucracies are stuck in the past,” the new law reduced the number of clinical investigations needed to establish drug safety and effectiveness and eliminated certain consumer protections. During the first Congressional attempt to privatize Medicare in the mid-1990s, Luntz told Republicans to use the words “saving,” “preserving,” and “strengthening”—but not the word “improving”—to describe Medicare, because it will make seniors think they will lose benefits they value.
“Words are especially important,” Luntz instructed at the time. “Setting the right tone at the outset is critical.” This go-around, Luntz and his Republican clients are hoping that the words they suggest will indeed set the right tone. Cohn has done a good job of showing where the pollster’s message is substantively incorrect. But rhetoric can be substantial, too. With all stakeholders trying to push public opinion (and the outcome) in their direction, key words and phrases matter. Here’s where journalists come in.
Luntz counsels Republicans to “humanize” their approach and stop talking about the “health care system.” “Individualize,” “personalize,” “humanize,” Luntz advises. Journalists, take note! Campaign Desk has been urging the press to humanize and personalize its stories for over a year. During the campaign, very few stories told how the candidates’ proposals affected real people. Once legislation emerges, stories that analyze and probe how people will be affected should become a staple.
“Waste, fraud, and abuse are your best targets for how to bring down costs,” Luntz tells Republicans. Democrats and their allies, too, have been using terms like “waste” and “inefficiency” for some time. By now, the public “knows” waste, fraud, and abuse are bad. When pols use those terms, it’s best to add a graph or two explaining that it is doctors, hospitals, and other providers who often engage in wasteful, fraudulent practices, and that much health care inflation stems from the overuse of new medical technology that has not yet been proven effective. Letting the phrase “waste, fraud, and abuse” stand without context is almost akin to misquoting someone.
Make the government the bogeyman, Luntz advises, suggesting that Republican arguments against the Democrats’ health care plan (whatever that is) must focus on “politicians,” “bureaucrats,” and “Washington.” Republicans should also use the term “government takeover” rather than “government run” or “government controlled;” they should also define the consequences of such a government intervention:
In countries with government run healthcare, politicians make YOUR healthcare decisions. THEY decide if you’ll get the procedure you need, or if you are disqualified because the treatment is too expensive or because you are too old. We can’t have that in America.
In the last few weeks, the press has started to use the term “government run” to describe a public insurance option that would compete with coverage sold by private insurance companies. “Schumer Points to a Middle Ground on Government-Run Health Insurance,” read a recent New York Times headline. The phrase has become pejorative short hand for describing what a public plan is, even if Luntz thinks “government takeover” works better. In reality, no one—least of all the public—knows exactly what a public plan will look like. Journalists should describe what a plan will and won’t do, and curb the tendency to use shorthand that unwittingly passes along the Luntz-tested terminology.
Use horror stories from Canada, Luntz says. They “do resonate,” he explains. I say think twice about running them. Whenever some anecdote is trotted out about poor care in Canada, it’s wise to remember that the media ran with the horror stories during the last round of health reform, and misled the public. When The New York Times reported that women were waiting in line for pap smears, the Canadian ambassador sent a letter to the editor refuting the claim; but by then it was conventional wisdom that women could not get pap smears in Canada. The takeaway: When some pol makes a claim about rationing in Canada and waiting in line for health care, investigate it. Make a call or two to Canada and find out what’s really going on.
When, in the early 1990s, the claim was made that people in British Columbia were denied heart surgery, I went to Canada to find out. A judge who headed a royal commission investigating the claims told me everyone one of the stories fell apart when Canadians scrutinized them. However, that didn’t stop the American press from repeating them.
Frank Luntz’s message teaches and reinforces what good journalism is all about. Language matters. So use it well.