Two nights ago (September 14), Rachel Maddow, on MSNBC, during coverage of the DC tea baggers demonstration against health insurance reform, played a satirical clip called “Billionaires for Wealthcare,” in an attempt to give the alternative point of view to the demonstration. Just after the clip she made the point that Billionaires for Wealthcare had found the “antidote to the fact-free scream-and-holler syndrome that has disabled the debate about what to do to fix health care.” And that when people talk about a plan for putting Republicans in concentration camps, creating death panels for old people, and using mysterious interpretations of the Tenth Amendment to declare health care unconstitutional, “maybe singing satirical songs to the tune of the Battle Hymn of the Republic is the most appropriate way to counter that.”
Well, I, and I’m sure many others found the clip and Rachel’s point very amusing. But I also found myself thinking that such satire wasn’t going to persuade tea baggers or discredit their fables among those who find them plausible. They’ll just look at “Billionaires for Wealthcare” as another attempt by smart-ass, over-educated “liberals” to discredit their legitimate concerns by marginalizing them, and by insulting the tea baggers themselves. So, I guess I don’t think satire is the best way to answer the tea baggers’ increasingly ridiculous claims about pending health insurance reform legislation. I think a much better way to counter that is for the Administration and its supporters to stop promoting legislation that is so complex and difficult to read and understand that any silly story can be circulated about it, and also for them to explain the reasons why the health care legislation they are backing will solve the problems it is supposed to solve. Yes, I am saying that a more “rational,” though not unemotional, and also simpler approach to communication of health care reform, is the way to counter the tea baggers’ “screaming and hollering.”
Now, I can just hear the objections now. “Look the Right has been killing us progressives with irrational and non-rational messaging, and you want to counter them with rationality. Are you crazy? Isn’t that what we’ve been doing, and why we’re losing the messaging war?”
No. I don’t really think that the reason why we’re losing the messaging war is because, the opposition is using irrational appeals, the Democrats and progressives are using rational appeals, and since people are fundamentally irrational, they’re winning. Instead, I think the reason is that messaging from the progressive side is not very rational, and people remain somewhat puzzled by it, because it doesn’t clearly connect the legislative solution being advocated to the problems being addressed. As a result of this, and also serious and past failures of Government to deliver good results, they’re suspicious and mistrustful, and so are open to irrational appeals that feed upon that mistrust. To get the better of these kinds of appeals, those trying to pass health insurance reform need to present legislative proposals that very clearly are likely to solve the insurance problems we have now, so that there is really a very tight and obvious connection between problems and proposed solutions. The clearer and simpler the connection, the more trust and the less irrationality there will be, and I dare say the fewer problems we will have with tea baggers.
In order to “message” such proposals the first thing that has to be done is give a clear and truthful statement of the gaps we’re trying to close between where we are with our insurance outcomes and where we’d like to be. One way or another, that’s probably been done and most people probably know what the primary gaps are that health insurance reform is trying to close. Next, we need an account of why we have those gaps, i.e. of what the underlying problem is that leads to the gaps.
Here the Administration has been less than clear in emphasizing and re-emphasizing that the operation of the private, for profit insurance system is causing the health insurance gaps, and that if we are to close those gaps, we need to decide on how to change the health insurance system in such a way that the gaps can be closed. In saying this, I’m quite aware of the fact that the Administration talks about the need for changes in the system, and has talked about greater competition and public options. But what it does not do is to systematically describe the gap between the way the system operates and the way we need it to operate in order to close the outcome gaps (deaths, bankruptcies, needless economic hardships, needless family breakups, insecurity about insurance coverage, denials of coverage, etc.)
In this area, the Administration has talked all around the problem, but it really hasn’t talked much about the role of profit-seeking, the stock market, incentives in the health insurance organizations, executive compensation in that industry, and general operations in causing the unhappy outcomes of the insurance system that people experience every day. Why not? Probably because the Administration hasn’t wanted to demonize the insurance companies and blame them for the crisis in health insurance. This desire is admirable from the standpoint of keeping open the path of negotiation with the insurance companies. However, it is counter-productive in helping people to understand what the real problem is with the insurance system. Going further, however, if people are to understand and trust progressives who are offering solutions to the problem of how the insurance companies operate, those people need to have an unvarnished account of how the insurance companies cause the insurance outcome problems that people have. The goal of keeping open relations with the insurance companies has to be less important than explaining the problem to people. Simply because, if this is not the case, then they will never accept solutions targeted at the problem that they do not understand.
After a clear and true statement of the problem, the progressive narrative needs to consider solutions to the problem. It can’t just jump to a solution, because, if it does, people won’t trust it, since they won’t understand why it’s the best solution for America. The progressives’ problem from the beginning of this has been a lack of consideration of the primary alternatives, and this is traceable to the fact that the President and the leaders of Congress took Medicare for All off the table, while claiming to be open to every reasonable option. This was confusing. Why is it off the table? Why hasn’t the Administration and Congress deliberated about it in comparison with other alternatives. Many people are familiar with Medicare. They know it works. They have to be wondering why the progressives haven’t been talking about extending Medicare to everyone. The Administration and the progressives haven’t adequately explained why this is not the best alternative that they should try to pass, and I think that this, and the broad support that Medicare for All has in the United States according to surveys, is one reason why they are mistrusted.
In addition, in the process of considering solutions to the problem of poor operation of the insurance system, why haven’t progressives and the Administration been talking about the experience of other nations who have successfully dealt with the insurance problem? There are all manner of solutions already in play in other major industrial nations. Apart from any arguments about whose health care is better, all of the insurance systems in the other major nations are better than the American insurance system, since in every other nation costs are much below the US, there is universal coverage, there are no deaths due to absence of insurance and there is no financial hardship or bankruptcies due to the operation of the health insurance system. So what’s wrong with us? Why are we not talking about these systems? Why are we not developing variants of the solutions that have already worked in other nations?
What does this call for consideration of alternatives have to do with clear messaging, and maintaining the trust of people? Only that right now the progressive message comes off a less than entirely clear statement of the problem, and then jumps to a solution, namely reform bills with a public option as an important component, that is not selected based on a comparison among different reasonable alternatives. That is, it’s not clear in the messaging why a PO-based bill is the best solution to the problems of health insurance for America. So, if such a bill contains mandates, or is over 1,000 pages in length, or contains subsidies for people, or can’t be implemented until 2013, or is limited to individuals who can’t get insurance anywhere else, or contains a market exchange, it is not clear to people how these various characteristics contribute to the solution of our health insurance problems, and how they compare with the characteristics of other alternatives. It is not clear why such a solution is better than a Medicare for All bill such as HR 676, or a more competition oriented bill such as Wyden-Bennett, or the bill “the Baucus Caucus” is about to release, or a bill that would introduce a system like New Zealand’s, or Australia’s or Germany’s, or Japan’s, or Switzerland’s, all health insurance systems that work better than ours.
Without a comparative perspective, it looks to many like the Administration and its progressive allies are trying to put something over on people, because the PO choice doesn’t arise from any comparison of alternatives that people can understand. So, people wonder why it’s favored by those who favor it.
The problem with the messaging about health care solutions is that so much of it has been cast in terms of political feasibility, rather than in terms of presenting solutions that solve problems, that the connection between the problems and the solution is not clear and obvious to everyone. Instead, we have complexity inducing mistrust about what Congress and the Administration intend. People wonder about whether a particular solution being pushed will really solve the problems of health insurance, or is just a political compromise that can get through Congress and give the politicians an outcome they can claim credit for. That is, people wonder whether what politicians are advocating will work, or whether they’re just trying to pass it so they can say that they’ve done something about the problems they’re calling out. Some people conclude that it’s the latter and not the former, and then they don’t trust the proposed legislation and are much more inclined to be open to irrational appeals of various kinds. Irrational appeals arise in the soil of mistrust and cynicism about what politicians are trying to do. They do not arise in such abundance if people can really see the connection between the problems and the solutions being considered by Congress and the Administration.
In short, the most appropriate way to respond to the irrational appeals of those whipping up the tea baggers is not with satire, but with open communication to people; with communication that makes an honest and clear case for particular legislation, and that makes clear the connection between an underlying problem and a preferred solution. Such communication should not be diluted with reasoning about political feasibility, and what is likely to pass, since this only confuses people and makes them wonder whether public calculations about feasibility are just excuses by politicians for attempting to pass what important interests favor, rather than what is best for people, and this, in turn, gives rise to mistrust and cynicism. If in the course of the legislative process it becomes clear that a preferred solution can’t be passed despite our best efforts, then, and only then, is it time to consider alternatives that may be more feasible, but that are less effective solutions to a problem, and then, and only then, is it time to begin messaging about those and to explain to people why one of these less than preferred solutions is better than no legislation at all.
(Also posted at firedoglake.com where there may be more comments)