We lost this debate in the very first minute.
Not when the teabaggers started taking over the townhalls, or when Obama started "waffling" on the public option. We lost it the moment we started to talk about the issue, because we were talking about the wrong issue. We thought it was the right issue. It certainly looked like the right issue: people were getting sick and dying, and they weren’t getting helped by doctors when they could have been saved. They weren’t getting healthcare. So we thought we had, and continue to have, a healthcare crisis.
But that’s actually not what we have. We have something subtly but importantly different. It’s not too late to start talking about the real crisis, but we’ve lost a lot of time. Let’s start now.
What we actually have is...an insurance crisis.
The root problem here isn’t that there isn’t enough care to go around. It’s that too many people can’t, or don’t, carry the financial support necessary to pay for that care. We need to stop talking about our healthcare crisis and start talking about our health insurance crisis.
What difference does it make? In making policy, not much at all - it's basically semantics. In selling policy to the public, a LOT. Here’s a few that pop to mind:
- Healthcare is intimate and personal. Insurance is neither.
Usually focusing a crisis around something boring is politically disadvantageous. But in this case, it makes all the difference in the world. What is the fear that the Republicans and their airwave minions are playing on right now? Wait, don’t answer that – the list is too long. The one I’m getting at is the fear that big, bad government is going to get in between you and your doctor, and start telling your doctor what to do and when to kill you. That meme works because we talk about "government healthcare." Healthcare. The thing your doctor provides, that...what, the government wants to provide now?
Let’s talk about government-underwritten insurance for a while and see how much blood you can get boiling.
- Many Americans like their direct healthcare provider. Few care at all about the insurance behind it.
I’ve been amazed at polls that show even relatively even support/opposition numbers for the public option, because the fact is that most Americans – and certainly most voting Americans – already feel like they get decent care from and access to their doctor. They have to tolerate some headaches but generally feel like they’re taken care of. Hell, they can go down just about anytime and their doctor gives them a prescription for that pill they have on TV that give you boners. That’s a pretty appealing system.
But who really likes, or even feels kind of strongly about, their insurance? Who feels emotionally connected to their insurer in the same way as their OB/GYN? Who says, "Oh, you’ve got to go to United Health, they’re the absolute best, I’ve been using them for years?" only to be met with, "No way, I’m a CIGNA man, through and through." Who's going to go to the mat to defend the sanctity of the relationship between a person and their dedicated customer service representative at the other end of the line, who will be with you shortly, because your call is very important to us?
- Insurance just feels right for the government.
Again, I invite you to consider the phrase "government healthcare." If you’re not going out of your way to learn and stay informed about the debate, you might legitimately think that government is going to take an active role in caring for your health, and that might concern you. I don’t want to wait in a government hospital. I don’t want to be examined by a bureaucrat. I don’t want to wait 17 months to have my broken arm treated. The misconceptions pile up, resistance is growing (even subconsciously) and the first ad, the first stump speech, none of it has even hit the airwaves yet.
Now, consider the phrase "federal agency-provided health insurance." So you can buy health insurance from the government? Eh. I think I got my mortgage through some kind of federal doohickey. You know what, I think Uncle Jim is already on that federal insurance, right? The FD-VA something? From the war?
Making actuarial tables and underwriting insurance feels like exactly like the kind of thing most people thing government could do a decent job at, and they’re not at all threatened by the thought.
- It short-circuits the ‘friends and neighbors’ response.
Nothing is more infuriating than the Republican response that ‘good (white Christian) neighbors help out other good (white Christian) neighbors when there’s a time of need.’ As if change jars at the 7-11 are an appropriate vehicle for medical financing in the 21st century.
When you stop talking about how to get healthcare, though, and start talking about how to get health insurance, this response withers on the vine. Because sure, your friends and neighbors can pull together to get you that operation if you really need it – and we would all do that for a loved one too. But would we really underwrite an open-ended insurance policy for a neighbor? Would it ever cross our mind to expect our neighbors to do that for us?
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I don’t know if we can wind back the debate on health care and start having a debate on health insurance. We may not be able to un-ring that bell. I’d love to give it a shot though. Because, yes, at the end of the day, it’s semantics (at least 99% of it is). But semantics matter. It’s not enough to be right. Your audience has to believe that you’re right, and we’re coming up short on that score.