MEMORANDUM

TO: INTERESTED PARTIES

FROM: PAUL BEGALA
RE: COUNTERING REPUBLICAN ORWELLIAN RHETORIC ON
HEALTH CARE
DATE: MAY 21, 2009
________________________________________________________________________

“The only people who give any credence to Republican Senators’ rhetoric is Democratic
Senators.”
George Mitchell

The President and Congressional Democrats support reform that reduces costs,
preserves choice and assures quality, affordable health care for all Americans. Our plan
represents real reform; reform that protects what works and fixes what's broken.

This is an historic moment. Unlike the last major effort to pass health care
reform, industry groups including America’s Health Insurance Plans, the Pharmaceutical
Manufacturers of America, the American Medical Association, the American Hospital
Association and the Advanced Medical Technology Association have pledged to reduce
costs and play a constructive role in Pres. Obama’s health care reform effort. At the same
time, progressive organizations are more organized and energized, organized labor has
made health care a top priority and voters have given Democrats the House, Senate and
White House in part because they agree with the Democrats’ approach to health care.

And yet the road ahead will not be easy, and health care reform has powerful
opponents.

Veteran Republican pollster Frank Luntz has circulated a memo which attempts to
teach Republicans how to kill health care reform by misleading people. Because they
know they cannot win the argument honestly, Republicans are resorting to mendacity.
Democrats must not let them get away with it.

There is one fact that animates the Republicans’ strategy. It should animate yours
as well. That fact is this: the overwhelming majority of American support health care
reform. In fact, Dr. Luntz himself notes that voters trust Democrats over Republicans by
a whopping 20 percent on health care . If health care reform were unpopular,
Republicans would not resort to misleading rhetoric to mask their opposition. The
striking thing about Luntz’s memo is how the rhetoric he advocates apes our message.
The Republicans have three goals:

1. Co-opt our messaging;

2. Confuse voters; and
3. Kill health care reform.

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 Democrats should take their cue from Sen. Mitchell. Voters are not going to fall
for Republican rhetoric – as long as we don’t. We need to answer their falsehoods with
our facts.

Let’s walk through Luntz’s ten suggestions, along with ways to counter them.
Luntz’s ten-point plan is in bold. My commentary follows each point:

1. Humanize your approach. Luntz is right about this. His counsel to abandon all
references to the health care system is spot-on. The more the debate is personalized,
humanized and localized the better it is for advocates of reform. Reformers should tell
stories, not cite statistics. You should banish from your lexicon the oft-cited statistic that
48 million Americans lack health insurance. While it is true, it has two flaws: first, it
lacks emotion; second, it lacks resonance. Every single working American is suffering
with the high cost of health care today. Most have coverage, an increasing number don't.
But those who do are paying more for less, and the trend lines threaten their health care
and their finances.

• Remember: Stories, not statistics. Facts tell, but stories sell. Back in 1992 in
New Hampshire I met a man named Ron Machos, Jr. Ron lost his job in the first
Bush recession, and could no longer afford health insurance. Then he learned that
his infant son needed open-heart surgery. Bill Clinton told Ron’s story
everywhere he went – and it resonated with millions of Americans.

• Keep in mind that most Americans have health insurance, but they’re worried
about losing it. They’re worried about being priced out of the market or losing
their job or being turned down because of a pre-existing condition. They’re
worried about prices going up, bills piling up and having nowhere to turn.

• When you humanize your approach, tell stories of people you’ve met – people
you represent – who, like Ron, play by the rules but are worried they will not be
able to hang onto the health insurance they need.

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 When Republicans repeat the Luntz talking point about humanizing the
argument, we should say: When I think of health care reform, I think of
____________________. She works hard and plays by the rules. But she could no
longer afford health insurance after her hours were cut back and her pay was cut.
Now her daughter has asthma and she can’t afford an office visit for an inhaler –
and the bills from the emergency room visits are piling up.

I also think of __________________. He has health insurance, thank goodness, but

he’s worried. Worried about rising premiums pricing him out of the market.
Worried about rising co-pays and deductibles hollowing out his insurance. Worried
that if, God forbid, a real medical emergency strikes, some corporate bureaucrat will
say the fine print of his policy doesn’t cover him or his family.

2. Acknowledge the “crisis” or suffer the consequences. Here Luntz suggests twisting
the word “crisis.” Ron Machos, Jr. has a crisis. The crisis is he does not have quality,
affordable health care for his son. Rather than address that real-world crisis, Luntz
counsels Republicans to redefine the crisis as mythological lines at the doctor’s office of
the future, writing, “If you have to wait for weeks for tests and months for treatment,
that’s a health care crisis.”

• You must not let Republicans succeed in defining the crisis downward. Having to
sit in the waiting room is a nuisance. Not being able to afford to go to the
doctor’s office at all is a crisis. That is the actual crisis we’re addressing with the
President’s proposal for quality, affordable health care for all.

Luntz also suggests that “If some bureaucrat puts himself between you and your
doctor, denying you exactly what you need, that’s a crisis.”

• Amen, Brother Luntz. That is precisely the crisis so many Americans face today
at the hands of insurance company bureaucrats. It’s not that the insurance
company bureaucrats are evil; it’s just that, in many cases, their jobs depend on
getting between you and your doctor and denying you the care you need. It is
precisely this kind of crisis that the President’s plan for quality, affordable health
care is intended to address. Make the Republicans own the status quo, and
remind people just how scary the status quo is – even for people who have health
insurance.

Luntz’s own data shows how powerfully the public is aligned with us. 69.5% of
Americans in Luntz’s survey say the health care system is “in crisis and needs a total
overhaul” or “is seriously troubled and needs significant revisions.” Only 2.1% say “It is
one of the best systems in the world and doesn’t need to be changed.” That, of course, is
the true position of most Republicans. They’re just being told not to tell the truth about
their position, because only 2 percent of Americans share their view.

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 • Your job is to smoke them out. Point out that the Republicans had the House, the
Senate and the White House, but never even proposed quality, affordable health
care – because they do not support reform. You do.

When Republicans repeat the Luntz talking point about pretending to

acknowledge the health care crisis, we should say: Obviously, if you don’t have
health insurance or can’t afford health care, it’s a crisis. But most Americans also
lack the peace of mind that comes from knowing they’re not one illness or one
accident away from bankruptcy. They need the peace of mind that comes from
knowing costs won’t be jacked up beyond their ability to pay, that even if times are
tough, they will still have a guarantee of quality, affordable health care.

3. “Time” is the government health care killer. Luntz advises Republicans that
“Nothing else turns people against the government takeover of health care than the
realistic expectation that it will result in delayed and potentially even denied treatment,
procedures and/or medications.” Increased delays are not a realistic expectation, and you
cannot allow the Republicans to pretend otherwise.

• This is where the word “choice” is critical. Under Pres. Obama’s plan you will
have the choice to keep what you have. You can choose your doctor and choose
your plan. The power to choose harnesses the power of competition. Under the
status quo, corporate bureaucrats, HMO bureaucrats and insurance company
bureaucrats have the power. They choose whether or not to cover a treatment.
They choose whether or not to cover you at all. Care is delayed and denied right
now. That will change under our plan.

Strikingly, Luntz actually counsels Republicans to attack insurance companies. From his
memo: “We suggest ratcheting up the rhetoric against insurance companies to almost the
same level as you do against Washington bureaucracy. Call the Democratic plan a
‘bailout for the insurance industry.’”

• As we say in Texas, what chutzpah. Do not let them get away with this. Our plan
will stop insurance companies from denying you coverage or dumping you for
having a pre-existing condition. The Republican status quo – which is the GOP
plan – is a blank check for insurance companies.

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 When Republicans repeat the Luntz talking point about delayed care, we should
say: Everyone has a health insurance nightmare story. It's either happened to you
or someone you know. The insurance company won't pay for something you need
or makes you jump through hoops to get it. We fix the health care system, and not
only will you be able to keep the insurance you have now if you like it, but it will be
better. We'll have rules to stop them denying you care. And they'll have to charge
you less because they'll be competing with a new public health insurance option. So
if you get fed up, you've got somewhere to go.

4. The argument against the Democrats’ health care plan must center around
“politicians,” “bureaucrats,” and “Washington”…not the free market, tax
incentives or competition. Here again, Luntz is advising Republicans to put our plan on
trial and to ignore the status quo. After all, you can’t defend the indefensible. He warns
Republicans against systemic arguments – and candidly admits “any help from the
government to lower costs will be embraced.”

• You must not let the opposition get away with defining our reforms as
bureaucratic. Our reforms are quality, affordable health care. The
government’s role in this will be to help control costs and ensure quality.

When Republicans repeat the Luntz talking point about Washington bureaucrats
and politicians controlling care, we should say: The Republicans want to put
corporations in control; we want to put you in control. Right now, insurance
companies boost their profits by saying no to what you need. When we fix the
system, they’ll be regulated so they have to charge reasonable prices and deliver
quality service. You and your doctor will be more in control because you won’t be
arguing with insurance company bureaucrats all the time.

5 The health care denial horror stories from Canada & Co. do resonate, but you
have to humanize them. Luntz wants the GOP to call our reforms a “government
takeover.” He advises them to say “politicians will make your health care decisions.
They decide if you’ll get the procedure you need, or if you are disqualified because the
treatment is too expensive or because you are too old.”

• Bullfeathers.

• This is where Luntz advocates outright dishonesty. Under our system you and
your doctor will control your care. And if you don’t like your insurance
company, you will have the power to choose another option. Under the current
system – which the Republicans want to protect and preserve – insurance
companies hold the decision-making power and control your coverage.
Republicans want to keep it this way, with corporations in control.

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 • President Obama has been explicit about the fact that he rejects a British or
Canadian-style single-payer reform. The phrase he uses is a “uniquely American
solution” that preserves the employer-based system and gives Americans the
option of a public health insurance plan. The President has said he wants to
“leave the provision of health care and health insurance in private hands” but
create a marketplace within which insurers can compete on price, and not avoid
insuring the sickest patients.

• The important word here again is choice. Under our reform, your choice of
doctor and your choice or plan are guaranteed. That’s not the case under the
Republican status quo – if your premiums go through the roof and you can’t
afford to hang on, you’ve lost all choice, you’ve lost all control. We are not going
to let that happen. We’re going to pass quality, affordable health care for all
Americans.

When Republicans repeat the Luntz talking point about Canada-care, we should
say: We’re America. We cured polio and invented the pacemaker. We’re not
Canada or Britain or anywhere else. Pres. Obama is committed to a uniquely
American health care solution that builds on the best of what works now, but
reduces cost and increases access. Our plan will also protect that classic American
right: the right to choose. You will be able to choose your doctor and choose your
plan.

6. Health care “quality” = getting the treatment you need, when you need it. Luntz
instructs the Republicans to “focus on the importance of timeliness, but then add to it the
specter of denial.” He claims, bizarrely, that Democrats cannot offer a health care reform
that does not deny treatment. Oh yes we can.

• That’s the whole reason we want to reform the system: too many Americans are
at risk of being denied the care they need because they can’t afford it, or because
corporate bureaucratic rules are keeping them from getting coverage and care.

Luntz advises opponents to say, “The plan put forward by the Democrats will
deny people treatments they need and make them wait to get the treatments they are
allowed to receive.”

• That’s a better description of the status quo, which the Republicans are defending,
than Pres. Obama’s reforms. The Republicans are committed to a system that
puts profits ahead of people.

In Luntz’s research, 59.9% of American say the single biggest problem with
health care in America is it’s too profit-driven. That’s 21 points ahead of the number two
problem – too bureaucratic. Notice how so much of Luntz’s language focuses on

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bureaucracy. We need to be on guard to defend the false charge of bureaucratic takeover,
but at the same time we should always, always repeat the central problem of cost.

When Republicans repeat the Luntz talking point that our plan will deny
treatment and increase waiting, we should say: Every day, insurance companies
deny people care. As health care costs keep rising, it will only get worse. And yet the
Republicans are committed to a system that puts profits ahead of people. That’s
why they oppose Pres. Obama’s reforms and why they have no reform plan of their
own. Our plan reduces costs, increases access, and protects choice.

7. “One size does not fit all.” Here again, Luntz wants his minions to rail against
“Washington bureaucrats”.

• You already know the response: The Republican status quo keeps Washington
insiders, entrenched interests and lobbyists in control.

Luntz then calls for protecting “the personalized doctor-patient relationship.”

When Republicans repeat the Luntz talking point that our plan is “one size fits
all” we should say:

President Obama's health care plan gives you MORE choice than you have now.
Right now, all most people have is the one or two plans offered through work -- and
if you're out on your own in the private market, chances are you've got even less
choice because health insurance is so expensive. When we create a new public
health insurance option, you'll have one more choice. And you'll know that choice
will be guaranteed to have the benefits you need, and you'll be able to afford it. So if
you like what you have – great – you can choose to stay with it. But you'll also have
an affordable alternative. And that's something most people don't have now.

As for the doctor-patient relationship: The doctor-patient relationship is under

assault under the current system. Every time someone loses his/her health
insurance, the doctor-patient relationship is interrupted. Every time someone can’t
afford to keep up with rising costs, rising premiums, rising co-pays, rising
deductibles, the doctor-patient relationship is severed. By reducing costs, expanding
access and ensuring quality we put the doctor-patient relationship at the heart of
our health care reform.

8. Waste, fraud and abuse are your best targets for how to bring down costs.
Puhhleeeze. Is that all you got, Frank?

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 Luntz’s fear of the power of our reform message is palpable. Look at what he
says: “Make no mistake: the high cost of health care is still public enemy number one on
this issue – and why so many American (including Republicans and conservatives) think
the Democrats can handle heath care better than the GOP. You can’t blame it on the lack
of a private market; in case you missed it, capitalism isn’t exactly in vogue these days.”

• Luntz is right. Cost is the problem. And our plan is the solution. Never let that
fact go unstated.

When the Republicans repeat the Luntz talking point about waste, fraud and
abuse, we should say: Obviously there is waste, fraud and abuse. But where’s your
plan to tackle them? Who do you think is going to crack down on waste, fraud and
abuse: The entrenched interests making millions off of waste, fraud and abuse?
Premiums have skyrocketed, CEO pay is through the roof, and insurance company
profits are up, and we get less and less actual health care, while spending more and
more money. It’s time we had real reform and insurance companies had real rules
to protect consumers.

9. Americans will expect the government to look out of those who truly can’t afford
health care. Amazing. Even the man behind the Contract With America is now
advocating a role for government in health care. He wants Republicans to support, “A
balanced, common sense approach that provides assistance to those who truly need it and
keeps health care patient-centered rather than government-centered for everyone.”
Sounds like our plan, doesn’t it?

When Republicans repeat the Luntz talking point about how government really
should help those who can’t afford health care, we should say: Pres. Obama is
committed to health care reform. So am I. But the Republicans oppose reform.
They have opposed every effort to reduce costs, every effort to make health care
more affordable, every effort to expand coverage and to protect patients and their
right to choose their doctor and their plan. They are the last defenders of the old,
failed status quo. We are the reformers.

The Republican “plan” is really just the status quo on steroids. They want to keep
pumping more money – your money – into the same broken system. If we fix the
system, preserve the free market while we sensibly regulate insurance companies,
and create a new public health insurance option, people will be able to afford good
health care.

10. It’s not enough to just say what you’re against. You have to tell them what
you’re for. I couldn’t agree more.

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 • Our corollary to that rule is that it’s not enough for us to simply say what we’re
for. We need to say what we’re against – and what the Republicans are for. Their
lack of a health care reform plan should be a disqualifier. Despite having the
House, the Senate and the White House they never made a serious effort to
provide quality, affordable health care for Americans.

Luntz concludes his memo with a powerful prediction: “If the dynamic becomes
‘President Obama is on the side of reform and Republicans are against it,’ then the
battle is lost and every word in this document is useless.” In fact that is the dynamic.
That is the truth. President Obama is for reform and Republicans are against it. You
should say so, and repeat it until the battle truly is won.

When Republicans repeat the Luntz talking point that they’re really for reform,
we should say: Their plan is the status quo. Their plan is rising costs. Their plan
is corporate bureaucrats and HMOs getting between you and your doctor. Their
plan is cherry-picking the healthy and the wealthy and dumping you if you commit
the sin of getting sick or injured. Their plan is Washington entrenched interests
and lobbyists getting rich while working Americans get soaked. That’s why they
oppose our plan for real reform.

Do not let the Republicans kill reform by co-opting our message. When they
repeat their talking points, you must punch holes in them. I hope this memo helps
empower you to do so.