First there was Frank Luntz. Now, Celinda Lake is trying to do for the Dems what Luntz did for the GOP. Lake, a longtime Democratic strategist, has been hard at work crafting the right words and phrases to persuade the public that Dems really do have their best health care interests in mind. For months, politicians, advocates, and especially the president have talked about “affordable, quality” health care—a Lake-fashioned phrase that has caught on big time. Reporters have repeated these words without providing any context about what they mean—that is, if they mean anything. Insurance premiums lower than $12,000? A guarantee that your doc will never make a mistake? Take your pick. Those words are as hollow as a straw. They’re supposed to be.
In early June, a memo circulated from the Herndon Alliance and Lake Research Partners telling advocacy groups and other interested parties precisely what words they should use to counter Republican messages as health reform’s verbal war begins. The Herndon Alliance, which calls itself a non-partisan coalition, has partnered with some 200 organizations, including former single-payer advocates, think tanks, foundations, advocacy groups, businesses, and health care providers. The Alliance claims to “provide value-added services to partner organizations”—i.e., helping them develop communications strategies. Lake has worked closely with the Alliance in crafting messages its partners can use. She has counseled the Alliance’s partners against using the term “universal coverage.” Maybe that’s why it’s not talked about much anymore. Similarly, she tells activists never to say “Medicare for all.” Instead, they should say “choice of public and private plans.”
You might say that the memo was the Lake version of a Frank Luntz message that was leaked to Politico in mid-May. Luntz’s memo quickly raced through the blogosphere, with liberal bloggers hotly debating what it meant for reform prospects. In the memo, Luntz counseled Republicans to humanize, personalize, and individualize their approaches by using personal stories, and to talk about eliminating waste, fraud, and abuse as the ways to reduce health care costs. Luntz also told GOP politicians to acknowledge there is a health crisis but to blame it on the government; to demonize “politicians,” bureaucrats,” and “Washington;” and to use the term “government takeover” whenever they can.
Lake advised her followers to parry that message by saying:
It’s time to stop playing politics and solve the health care crisis. Health care reform will give you the freedom of choice to keep your current plan including keeping your current doctor, or choose another private plan, or the choice of a quality affordable public health insurance plan…. Health care will be affordable—it will cost less and cover more. It will be a uniquely American solution that gives you peace of mind of knowing you will always have quality, affordable health care.
Lake says that frame is “so effective” because it taps into the public’s key expectations for health reform, such as the choice of keeping your current plan and doctor—the president uses that one; affordability (paying less and getting more)—lots of groups are using that one; and finding a uniquely American solution—insurance companies and Sen. Max Baucus have used that one. But wait a minute. Didn’t the phrase “uniquely American solution” surface with Bill Clinton? In the early 1990s, as Clinton began to craft his plan based on managed competition, he framed it as his “uniquely American plan.” How many uniquely American plans can there be?
Whether Luntz is a bad guy or Lake a good gal is beside the point. The real takeaway is what journalists can learn when they write about health reform from this moment on.
Lesson One: Democrats play the same game as Republicans. What we’re seeing is a game of spin vs. spin, and a reporter’s job is to sort it all out for the public.
Lesson Two: Recognize Lake’s focus-group tested words when an interview subject stays on message and keeps talking about affordable, quality health care. It’s best to avoid quoting someone who uses those words unless they have something more significant to say. Reporters shouldn’t be used as propaganda ministers.
Lesson Three: Be on the lookout for other empty, Orwellian terms. If you find them, same advice applies.
Lesson Four: If you must use these terms, please add context. Lake advises: “Don’t just say ‘bring costs down,’ and that ‘“It is better to say ‘health care reform will make health care AFFORDABLE—it will cost less and you will get more.’” Hey guys, that’s not likely to happen if the current nostrums for reducing medical costs remain the only ones on the table. As for getting more? The current trend in health insurance—shifting costs from insurers and employers to policyholders—means thousands are getting fewer benefits, not more.
Lake’s memo advises that advocates should not compare the U.S. to other countries, or assert that America does not provide quality health care; neither should they mention that the U.S. is thirty-seventh in the world in health outcomes. Does Lake want to hide the fact that the U.S. performs poorly? My goodness, she almost sounds like a Republican!Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.