Too little, too late on “You can keep it”

By Trudy Lieberman
Columbia Journalism Review, October 31, 2013

I have a question for all the reporters busy asking whether Obama misled Americans with his oft-repeated line that “if you like your health plan, you can keep it”: Where have you been? You should have challenged this claim well before now. You should have been reporting that some people in the individual insurance market might receive cancellation letters … well before it started happening to them….…

The origins of, “If you like your health insurance you can keep it”

By Richard Kirsch
Huffington Post, November 1, 2013

There are good reasons why President Obama’s leading message on health care during the 2008 campaign … was “if you like your health insurance, you can keep it.” That message was created to overcome the fear-mongering that had blocked legislative efforts to make health care a government-guaranteed right in the United States for a century….

As one of the people who engaged early on in building the effort that led to the passage of the Affordable Care Act, I am keenly aware of this history. …

As we predicted, the opponents of reform used fear-mongering … to try to kill the Affordable Care Act….

The opponents of reform have used reckless, baseless charges to try to kill reform. I’m glad that President Obama used a slight exaggeration to finally provide secure health coverage for all Americans.…

As Trudy Lieberman noted in her article for Columbia Journalism Review, and as some noted as early as 2008 (1), it has been known for a long time that millions of Americans would not be able to keep their health insurance under the Affordable Care Act. Yet President Obama and many other proponents of the ACA claimed this would not happen. They said people who liked their health insurance could keep it.

If Obama et al. had made this claim once or twice in the heat of a debate, few would be questioning their integrity now. But they made this claim repeatedly, both before and after the ACA was enacted. The chickens are coming home to roost. Obama and other Democrats are taking a terrible beating for having made a promise they knew or should have known they couldn’t keep.

What explains such irrational behavior?

In his essay for the Huffington Post, Richard Kirsch takes a stab at an answer. Kirsch is in an ideal position to give us one. He was present at the creation of the marketing strategy that was supposed to neutralize the inevitable attacks on the ACA from the right. Kirsch was the chairman of the “health policy refinement committee” of the Herndon Alliance, a coalition formed in 2005 to promote whatever it was the Democrats decided to put forward in the name of “health care reform,” and he later became the campaign director for Health Care for America Now, the leading organization in the fight to enact whatever it was the Democrats decided they could get through Congress.

Kirsch tells us the mantra was invented to “overcome … fear-mongering” that he and the entire rest of the world predicted conservatives would use to stop the ACA. But this argument merely begs another question: Why would the public be reassured by an argument that was so easily rebutted, at first by commonsense and eventually by reality as well? Why wasn’t it obvious to Kirsch et al. that inaccurate statements would come back to haunt the makers of those statements?

The answer can be found in the “framing” and “messaging” craze that erupted late in 2004 after John Kerry lost to George Bush.(2) George Lakoff and other “framing” gurus claimed that conservatives were winning elections liberals should have won because conservatives were “messaging” better than liberals. More specifically, the argument was that voters respond to emotions, not “facts,” and if voters and conservatives don’t care about facts, liberals shouldn’t either. Instead, liberals should convene focus groups and conduct polls to determine what buzzwords and claims “resonate” with voters’ emotions – their “frames” – and use those buzzwords and make those claims.

In this comment I don’t propose to take sides on whether Lakoff and other “framing” proponents were promoting science or pseudoscience. I do argue that “framing” theology was easily interpreted as an excuse to say anything regardless of the evidence, regardless of whether a proposal or legislation actually existed, and, after legislation had been introduced, regardless of the actual language in that legislation. I argue that that’s what happened to Kirsch, the Herndon Alliance, and other advocates of the ACA.

Consider this memo published by the Herndon Alliance and others in June 2008.(3) The memo urged advocates of “health care reform” to claim that “reform” (“reform” was not explained) would:

•  guarantee “choice among plans,”
•  guarantee that Americans could “keep our current doctor,”
•  “make insurance companies compete to keep costs down and quality up,”
•  stop insurance companies from “overriding doctors’ decisions about what their patients need,”
•  keep “deductibles low,” and
•  save “billions by cutting administrative waste and moving to electronic medical records.”

The memo made no attempt to document the truthfulness of these claims. That is not surprising, because not one of these claims was accurate then, and not one is accurate now.

So how did the Herndon Alliance et al. justify urging advocates to make these claims? They cited “framing” theology. They said these claims had been “market-tested” on focus groups and “online dial groups” of “swing voters” to determine what “frames” lurked in the minds of the participants and what “messages” were consistent with those “frames.” In short, the Herndon Alliance et al. convinced themselves that misrepresentation is moral and effective if the misrepresentation has been shown to elicit positive responses in focus groups and surveys.

Several factors contributed to the widespread acceptance of this flimsy rationale for inaccuracy among the leaders of the pro-ACA movement. One was the failure of the media to question the buzzwords and claims concocted by the Herndon Alliance and promoted by HCAN and eventually Obama and members of Congress. Trudy Lieberman criticized the media for this failure even before the ACA was enacted. In a 2009 article she called the Herndon Alliance’s buzzwords “hollow as straw” and “Orwellian” and recommended that reporters “avoid quoting someone who uses those words unless they have something more significant to say.”(4)

But the media did not do that, and the Herndon Alliance’s claims quickly mutated into conventional groupthink among leaders of the pro-ACA movement. To those leaders and members of Congress who could have warned Democrats not to repeat “if you like your health insurance etc.” and now lament the fallout from the constant repetition of that canard, I repeat Ms. Lieberman’s question: Where have you been?