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Michael J. O'Neil Headshot

Health Care Reform: Losing the Message War

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Martha Coakley may have run a poor campaign, but she was also saddled with having to defend a healthcare plan that is poorly understood by the public and whose adherents have failed to effectively articulate its core aspects and benefits.

This weekend, I was asked to participate in a television show to discuss the current healthcare bill before congress. The segment was to air immediately following an interview with Sen. Jon Kyl (R-Ariz.).

To prepare, I reviewed available data on public attitudes towards healthcare and towards this bill.

A review of this data showed that there are four areas where Republican opposition to the currently proposed legislation plays to existing public concerns. The majority of the public is afraid that the proposed legislation will
  • Increase costs
  • Decrease the quality of care
  • Weaken Medicare, and
  • Increase the deficit

While the accuracy of these beliefs may be debatable, each currently reflects a majority sentiment. One cannot ignore or dismiss these beliefs without consequence.

Of course, the public holds a multiplicity of beliefs about these and most public issues. Indeed, this same review demonstrated that the public is in favor of most of the individual elements of the proposed healthcare reform legislation. The same public that has these concerns about the legislation also:
  • Favors extending Medicare to those 55-64
  • Favors the public option (by about 2-to-1)
  • Favors a surtax on incomes over1M
  • Favors a tax on cosmetic surgery
  • Favors requiring insurance portability (by about 6-to1)
  • Favors employer mandates (by 3-to-1)
  • Favors a prohibition on dropping the policies of ill policyholders
  • Favors subsidizing premiums for those with incomes under88k
  • Favors prohibiting the exclusion of those with pre-existing conditions, and
  • Favors expanding Medicaid!

If you watch Kyl's initial response to the very first question posed to him, you will see that the entirety of his response was to reference these four areas of public misgiving about the proposed reforms, while avoiding mention of any of the publicly supported features. He and the Republican opposition to this bill have been well- briefed on the sensibilities of the public. More importantly, they have been highly disciplined in staying completely "on message" in reminding the public of concerns they already have about this legislation.

And, while surveys have consistently shown that a majority of the public opposes the current bill, those few that have probed for the reason for this opposition have found that about a third of the public opposes the current bill because they feel it does not go far enough. Combine this with those who favor the current legislation, and you get a clear majority who want to see significant reform of the current health care system. But we have seldom seen any advocate of reform point this out.

Advocates of healthcare reform have not been nearly as disciplined in articulating the many aspects of reform that are widely supported. And so reform's opponents have been able to win the day by citing the four concerns which I had identified in my brief research and which Kyl articulated. They have also been aided by the ability to reference other unsavory aspects of the process (such as the infamous and indefensible Louisiana and Nebraska purchases).

Because advocates have failed to focus the public's attention on the many elements of the proposed reforms that have broad public support, they have lost the argument. While they may be able to get some legislation passed in spite of the loss of a Senate seat in Massachusetts, this will create political vulnerabilities which are likely to persist at least through the next election cycle.