The Social Medicine Portal

Frank Luntz advocates stoking fears with "The Language of Health Care 2009"

In a memo titled, “The Language of Health Care 2009,” pollster Frank Luntz has made recommendations to conservative politicians how to talk about health care reform. And from the quotations from John Kyl, Tom Coburn, and Eric Cantor that he highlights in the brief, it is clear that these “words that work” are already being incorporated into conservative talking points. However, this approach to discussing health care – focusing on words that can manipulate voters instead of novel ideas and policies that will actually address the problems at hand – is simply unacceptable at this point in time. There are too many Americans without insurance or adequate access to high quality affordable care. We need to fix the health care system now.

Luntz’s recommended language, summarized in a Politico article yesterday, ranges from the obvious (“humanize your approach”) to the intellectually dishonest (“YOUR quality of care will go down if THEY in Washington make YOUR health care decisions for you”), and serves to create a fantasy scenario where President Obama and Democratic reformers desire a system of government bureaucrats and special interest groups running health care, where patients suffer with long waiting lines and rationing of care. However, this is not reality. No one has proposed “Washington controlled” health care and these fear tactics do nothing to guarantee high quality, affordable health care for all Americans.

Most incredibly, Luntz’s recommendations fail to address the most pressing health care concerns emphasized by his own polling data. Respondents report most commonly that “the American healthcare system’s single biggest problem” is that it is too profit driven (59.9%). They believe that “the greatest short-coming of America’s healthcare system” is not having insurance (49.8%) or dealing with the insurance companies (43.0%). If these are the things that Americans are concerned about, it would be irresponsible for our elected representatives to ignore proposals guaranteeing health insurance or regulating for-profit insurance companies. There are many different ways to guarantee access to high quality care, but the for-profit, market driven health insurance system has failed to achieve this and therefore needs to be the target for reform.

In picking out “words that work,” Luntz and his conservative allies are more focused on attacking Democratic proposals than working to improve the health care system. He notes, “the word ‘rationing’ does induce the negative response you want, but what you really want audiences to focus on is the ‘consequences of rationing’”. He emphasizes that “the arguments against the Democrats’ healthcare plan must center around politicians, bureaucrats, and Washington.” This fear that bureaucrats will stand in between patients and their doctors denying needed care certainly polls well, however, the reality is that this interference with the patient-doctor relationship already exists – except that the bureaucrats are low level administrators or non-practicing physician medical directors at private insurance companies denying care.

As a physician, there are many words that I know – and I imagine that many patients know these words as well – that are frightening realities, not just fear tactics:

• Uninsured: Mr. A is a very young man whom I diagnosed with colon cancer last month in the hospital. His job does not provide him with health insurance. Since he came to the hospital through the emergency department, he was guaranteed care, but it is not clear how he will get ongoing chemotherapy and surgery.
• Prior Authorization: Mr. W, a patient of mine with HIV whose medications had stopped working, has had essential blood tests delayed as we wait for prior authorization from his private insurance company. If he were enrolled in the government health insurance that many of my HIV positive patients have, which does not have this restriction, we would have already had the results and adjusted his HIV medications. Instead, he waits, off of treatment and at risk for illness.
• Prior Condition: Private health insurance companies may deny claims or drop members from their coverage because of prior health conditions. Individuals with medical problems such as cancer or diabetes, are unlikely to find affordable coverage on the individual market if they lose their job and with it their health insurance. This is the case with Ms. K, a cancer survivor who lost her job and whose COBRA coverage is coming to an end.
• Out of Network: Ms. V, a young woman with diabetes, had been going to the same pharmacy for years. Last week she told me that her insurance no longer covered her insulin, and the pharmacy was charging her $50 for the prescription. She could not afford this. It took several phone calls to her insurance company during a busy clinic session, but it turned out that the insulin was covered, however the pharmacy was no longer in the network covered by her insurance.

In my clinical practice, it is the private insurance companies that most commonly impede my medical decision making. Medicare, the government health insurance program for people over 65, is not an obstacle to care, and by propagating a myth of government involvement inherently leading to poor quality and denials of care, Luntz and conservatives are simply being dishonest. In fact, 80 percent of people with Medicare are either “extremely” or “very satisfied” with their health care and access to physicians, which is a higher rate than for 50 to 64 year olds with private insurance.

Whether it is through a single payer system, where patients chose a private physician or clinic and the government reimburses claims, or through a regulated system where everyone is guaranteed health insurance and can choose between private health insurance plans and a public health insurance option similar to Medicare, our goal needs to be universal coverage and high quality affordable care. Americans, including patients and physicians, realize that the profit driven health care system is the problem and cannot be relied upon to provide a solution. Creating fear around government involvement in health care, despite the success and efficiency of Medicare, does nothing to improve access or quality of care. While Dr. Luntz was off base in most of his conclusions, he certainly got one thing right. There is a health care crisis and people want change.

Aaron Fox, MD