I was going to use "debate" instead of "issue", but that word is not right. Fact is, there is essentially no debate that universal single-payer is the best way to finance healthcare according to every positive metric: fiscal soundness, comprehensive coverage, portability, and freedom, opportunity, and security (more on these later). The only people who will take you to task with that statement are those with vested interests in the private health insurance plans, and a handful of people who have not been properly informed about single-payer healthcare financing. Even those who insist on fitting the square peg of private insurance plans into the round hole of healthcare financing will often openly admit that single-payer is the best way to go, except that <insert your favorite excuse here>...
But this discussion is deeper than that reality. I wish to focus on ways to avoid continuously losing this issue to the other side, the side that would have us stay the course - or worse - with our current antiquated way of financing healthcare. What are we missing? (this diary entry is guaranteed to be Link Free for life - how refreshing!)
Borrowing heavily (ok, completely) from Lakoff, we have, in broad brush-strokes:
- We must speak from our values. Anything less smells of inauthenticity.
- Our values (and principles) spring from empathy and responsibility for ourselves and others.
- Though the bulk of evidence always supports our arguments, winning hearts and minds through rational discourse is hopeless.
The other side has been mastering the art of framing issues for far longer than our side, largely because our only answer to their assault has been rational discourse heavily laden with facts and figures - actual evidence - and their only recourse has been to concoct and drill effective frames into our culture. You can see the rational discourse in all its glory here on dKos. I'm not being dismissive - it's great stuff and I love it! And really useful once you have the ear of the other side.
That's the key. We lose the issue at the outset by being so goddam right all the time! There are ways to be right, and ways to be effectively right.
Framing. I'm not going to explain or define it. I'm just going to use it. Let's approach the typical "Man on the street" (Mots), a bi-conceptual - another Lakoffianism, it just means someone, like most of us, who holds progressive views on certain issues and conservative views on others. The issue of single-payer healthcare financing has come up (important frames are in boldface):
Mots (dismissively): "I just can't support socialized medicine."
You: "It's not socialized medicine." Crap! - you just affirmed Mots' frame by repeating it.
...rewind...
You (puzzled): "What is that?" [feign ignorance] Ninety-nine percent of the time, Mots will have no idea. Good job, you just helped Mots destroy/loosen his own frame! Note that the word "socialized" never passes your lips.. This is a different tactic than framing, but very effective in countering frames from the other side that are completely off-base because they are simply parroting something they have heard.
In the event that Mots can actually define "socialized medicine" in a passable way,
You (firm but friendly): "With single-payer, everyone contributes and everyone benefits. In this way, the individual is responsible for contributing to the healthcare kitty, and the community is responsible for making sure everyone has comprehensive coverage. All of our healthcare is publicly funded and privately delivered. Isn't that brilliant?" [add the rhetorical only if you're feeling a bit British]
Mots (insisting): "I refuse to give up the choice that I have right now with my health insurance."
You: "Ya know what your choice really means? It means that the private insurance companies can make money off of healthy people at the expense of all of us. Without the government run safety net programs, the whole shebang would collapse overnight!" Sweet Nibblets! You really blew it this time! Not only did you imply that Mots was a jerk for exercising his god-given right of free choice, but you invoked the "government run" frame as well! Oy!
...rewind...
You (with conviction): "I value freedom of choice very much. With single-payer, I can choose any doctor or provider I like. I am never out of network. PPO and HMO provider restrictions are a thing of the past! Coverage is comprehensive, affordable, and guaranteed for life."
Mots (revealingly): "Right now I'm pretty comfortable with what my employer offers as a benefit. I certainly don't want to give that up!"
You (affirmingly): "I value job opportunity a lot. Single-payer maximizes opportunity. I can find the employer that suits me the best, be self-employed, or even be unemployed if that's necessary, and never have to consider what is being offered for healthcare coverage. The field is wide open!"
Mots (floundering): "Isn't rationing a huge problem in that kind of system?"
You (thoughtfully): "With single-payer, everyone is in - nobody is out. Perhaps you've heard that since the year 2000 over 150 thousand of us have died from lack of healthcare coverage. With single-payer no one is ever denied necessary medical treatment. It simply does not happen." OK we hedged a bit here by throwing in a factoid - but we led with the frame. This is probably one of the more difficult myths to bust using framing alone. We have at least countered the notion that people die from "rationing".
Mots (almost defenseless): "I'm feeling a bit insecure. I don't want to lose my healthcare, ever."
You (angelically): "I understand and agree. I value security most of all. I want the security of healthcare that is guaranteed for life - no exclusions for pre-existing conditions, no co-payments, and no deductibles."
Mots (sheepishly): "How can I find out a little more about this single-payer thing?"
Another win for the good guys, or at the very least a firmly planted seed for shifting the conversation in the right direction. Mots is now ready for your wonderfully informed rational discussion about single-payer healthcare financing. Heck, he might even come to your next organizing meeting.
Note that Mots is bi-conceptual, which means he is reachable. This will not be true of hard-core conservatives. Still, I wouldn't change the tactics with them, simply because you won't know until you start talking - they have no distinguishing features. Just disengage sooner, you're probably wasting your time, but you might still plant a seed of doubt. Stick to frames.
An Important Thing to Remember
The subject of private health insurers didn't come up in our conversation with Mots. Often it will, and often the tactic on our side is to vent heavily against these evil purveyors of junk insurance, these leaches, and so on. Everyone has a frustrating, terrifying, sad, or tragic story to tell about their dealings with the private health insurers. So it is easy and natural to attack them. However, this is not a great tactic.
It is not the private insurance companies that we wish to get rid of, it's the private insurance plans.
This turns the conversation around. Not only is it more accurate, it now largely places the onus back on the companies to do something about the change that is coming. It's not as if they were oblivious to the flaws in their products. The companies are welcome to go on selling insurance for things that are not on the single-payer menu, or other types of insurance. And they will.
For our unreconstructed leadership, these conversations might be a bit different, but I still advise throwing in a healthy dose of these frames, just to ensure that they will be more apt to use them once they get fully on board with the rest of us.
When it comes to framing, repetition is everything!
Publicly Financed - Privately Delivered
Everybody Contributes - Everybody Benefits
Guaranteed Comprehensive Affordable Healthcare for Life
You got a good one?