The Failure of Messaging in Health Care Reform

“Hume was right. The mind is divided into parts, like a rider (controlled processes [consciousness]) on an elephant (automatic processes [unconsciousness]). The rider evolved to serve the elephant. .... intuitions come first, strategic reasoning second. Therefore, if you want to change someone’s mind about a moral or political issue, talk to the elephant first. .... Republicans understand moral psychology. Democrats don’t. Republicans have long understood that the elephant is in charge of political behavior, not the rider, and they know how elephants work. Their slogans, political commercials and speeches go straight for the gut .... Republicans don’t just aim to cause fear, as some Democrats charge. They trigger the full range of intuitions [emotions] described by Moral Foundations Theory.” -- psychologist Johnathan Haidt, The Righteous Mind: Why Good People are Divided by Politics and Religion, 2012

Way back in the 1990s, before the internet was much of anything, president Bill Clinton took two shots at health care reform. Both failed an those efforts arguably damaged Clinton for the remainder of his time in office. A key factor in the failure was poor messaging by Clinton and his administration, coupled with the scourge of dark free speech that scared many people witless.

An 1995 article by analyst Daniel Yankelovich points to multiple causes for the failure, with poor messaging to the public being a key part of the failure:

Explanations range from blaming the plan itself, with its endless complexity and poorly understood provisions, to blaming the Clinton administration for its inability to articulate its vision to a confused, often frightened public. Not to be discounted is the role of special-interest groups and the millions of dollars spent on mass-media campaigns to discredit the plan. .... The problem, as he states in this paper, is a “disconnect” between the American public and its leaders. That is, although elites have no problem conversing with one another, they carry out “a bizarre dialogue of the deaf with the people. As far as the American people are concerned, Yankelovich says, “the great health care debate of 1994 never took place.” Successful reforms in the future hinge on the nations ability to mend this “disconnect” and begin genuine public deliberation on a topic that is so crucial to the future health and economic well-being of the nation and its citizens. 

Because all complex phenomena have multiple causes, the choice of which cause to highlight depends on one's purpose. My purpose here is twofold: to understand how to avoid this kind of failure in the future, and to learn how to get health care reform back on track—that is, to learn how to shape health care reforms that reflect the values and priorities of the American people. With these purposes in mind, I suggest that the defeat of the two health care initiatives—catastrophic coverage for the elderly in 1989 and the Clinton reform plan in 1994—both reflect a massive failure of public deliberation [i.e., crappy messaging]. (emphasis added)

The electorate and the nation's leadership class (which includes leaders of medicine, industry, education, the legal profession, science, religion, and journalism, as well as national and community political leaders) do not seem to be able to converse with one another productively. Instead, they talk at each other across a void of misunderstanding and misinterpretation. The failure of health reform is a direct consequence of this “disconnect.” 

The nation's leadership and the public are carrying out a bizarre dialogue of the deaf. The nation's elites have little trouble conversing with one another, but when it comes to engaging the public, there is an astonishing lack of dialogue. Public relations, punditry, advertising, speechifying, spin-doctoring, and so-called public education—these mechanisms of top-down communication abound. The absence of plain give-and-take between leaders and the public is striking.  

The downfall of the Clinton health care plan unfolded with the inexorability of Greek tragedy. First, we watched the administration respond to opinion polls and other political signals that persuaded it that health care reform was the public's top priority and seduced it into believing (falsely) that the public supported its reform proposals. Then, as the administration climbed further and further out on a limb of commitment to its reform plan, we saw public support mysteriously fade away. We watched, with fascination, as this weakening of support made it sickeningly easy for the opposition to cut off the limb. The administration fell bitterly into the dust of defeat, without ever really understanding what happened. The spectacle makes compelling drama and good partisan politics. But defeats of this sort deepen public cynicism and weaken the fabric of American life.  

The blame for this failure of public deliberation lies squarely at the feet of the American leadership class. Public deliberation requires that leaders engage the public in debate on choices that the public can understand and is prepared to confront. This requires skillful leadership that the leadership class, with all of its communication skills and resources, failed to provide. Its failure was spectacular in scope, which makes this post-mortem of the Clinton plan so important. If our society is to continue to function, this kind of failure cannot be repeated too many times. 

If one accepts that analysis as mostly true, not necessarily completely true, one has to ask if it is still relevant in 2020? It seems so to me. It seems that scaring people in 2020 with ads containing frightening lies and hyperbole, combined with complexity of most issues and crappy messaging is what killed health care reform in the 1990s. It is what blocks various needed reforms now. Just about anything the democrats want to try to do can be blocked by lies and fear mongering, while the same factors do not seem to apply with nearly as much effect to what the president and the GOP are doing to this country right now.

There is messaging asymmetry and it is deadly serious

There is an asymmetry in this endless messaging war that I do not completely understand. The GOP reforms are tearing America to pieces, and that does not seem to faze most people on the political right. But whatever the left wants to do is met with solid walls of impenetrable opposition. That is true even when most conservatives agree with the proposed reform, e.g., universal background checks for gun purchases. The playing field is not level.