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.

Regarding Democratic Political Messaging

I have criticized democratic political messaging here before. Informed experts have been criticizing it for years.[1] I criticize it again. This is from a letter to the editor at the San Diego Union Tribune on September 4, 2020:

“Donald Trump may well win in November. 

Why? In a nutshell, the strategists who designed the Democrats’ convention message seem to have learned little from their defeat four years ago.

They appear to live in a dream world, in which good triumphs over bad, people always recognize truth from falsehoods, and voters will “do the right thing.” Unfortunately, none of these assumptions are true. If they were, Hillary Clinton would be president.

The strategy .... is simple and twofold: first, maximize use of the “Big Lie” technique and, second, let the media (that you supposedly hate) give you all the free publicity you could want.

Let’s look at the Big Lie tactic first. It didn’t originate in Germany in the 1930s; it’s been around a lot longer than that. Autocrats love it.

Consider the word “crooked,” used to label a recent presidential candidate. In this (and all other Big Lie endeavors), there are four phases. First: “Gee, that’s kind of mean-spirited.” Second: “Well, I’ve heard that she did do … something.” Third: “It must be true — everyone’s talking about it.” Fourth: You’ve won — enough of the voters believe it.

Sadly, it works, at least through phase three, almost every time.

The second strategy — let the media do your promotion for you — helped promote Trump from a noncontender to leading candidate in 2016. Current example: use (even promote) every violent demonstration, knowing the media will always give free top-story publicity to fires and Trump’s assurance that only his hardcore “law and order” enforcement can save America’s cities. Strategy two ensures the success of strategy one. Any defensive Democratic reply may get buried on page nine.

And what was the Democrats’ convention message? “We’re nice guys; they’re not.” But no plan to counter Trump’s allegations. The Democratic National Committee needs to go on the offense before the polls show Trump closing in on Joe Biden just as he did with Clinton in 2016. Then, the vacillating voter will opt in November for the allegedly strong, decisive, neighborhood-saving Trump, while MSNBC assures us niceness will prevail. The latter didn’t work in 2016, and it won’t in 2020.

The Big Lie offensive must be vigorously countered; Hillary Clinton learned the cost of not doing so. The Democrats need a much more aggressive counterattack, including rightful outrage at closing in on 200,000 coronavirus deaths, Russian election interference, numerous emoluments clause and Hatch Act violations, IRS document withholding, White supremacy approval, billionaire-enriching blatant cronyism, impaired postal delivery, Putin pandering and the loss of our allies’ respect.

At their convention, the Democrats unveiled no effective winning strategy, and they have only a few weeks left to find one.

The alternative, with disastrous results for our country: Donald Trump wins in November.”

No, that's not my letter. I didn't write it. 

But it basically does represent my opinion about democratic messaging, how awful it is, and how badly the professional media deals with the situation. In my opinion, if the democrats lose in November, their crappy messaging will have been a major factor in their loss. Only widespread revulsion of the president seems able to defeat him. That alone may not be enough to get him out of office.

After decades of their messaging weakness, the democrats still have not figured this out. Unfortunately, the MSM isn’t much better.

Footnote: 

1. This gets right to the point: “Republicans understand moral psychology. Democrats don’t. Republicans have long understood that the elephant [the unconscious mind] is in charge of political behavior, not the rider [the conscious mind], 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.” (emphasis in original)

Coronavirus Update 14

A shows droplet counts per time slice (1/60 second)

B shows speech-emitted droplets scattering green laser light

A couple of things merit mention. One old thing is that it is unusual to get a COVID-19 infection from surfaces that contain the virus. A new thing is that data suggests that talking increases droplets a person emits.

Old data

The Washington Post writes:

“No one is touching anything, and everyone is cleaning everything. Despite initial reports warning people that the novel coronavirus can be transmitted from contaminated surfaces, the Centers for Disease Control and Prevention has told Americans in no uncertain terms that the virus is primarily transmitted person-to-person, through breathing, speaking, shouting and singing. While it may be possible to catch covid from a doorknob or a package, it’s a long shot, and “not thought to be the main way the virus spreads,” says the agency. (It still recommends disinfecting high-touch surfaces.) .... the most important things that will help them avoid catching covid-19? Wearing masks, staying more than six feet apart, avoiding enclosed spaces.”

The communications problem: An unintended consequence of extended concern for exercises in mostly ineffective surface disinfecting is that it creates a false sense of security in some people, leading them to be less concerned with the risk of airborne infection. One expert commented on the delicate communications problem. Early experiments with contaminated surfaces used unrealistic virus concentrations of virus that “have little resemblance to real-life scenarios. I do not disagree with erring on the side of caution, but this can go to extremes not justified by the data.”

In other words, keep focused on aerosols, and don't worry so much about possibly contaminated surfaces. Just keep your hands away from your face after touching possibly contaminated surfaces and wash hands later when you can.

New data

Some recent research has generated interesting data about talking. Not surprisingly, talking generates more airborne droplets than not talking. Talking loudly generates more droplets that talking quietly. A recent study found that loud speech can generate thousands of oral fluid droplets per second. That data was interpreted to mean that there is a ‘substantial probability’ that normal speaking causes airborne virus transmission in confined environments. More research is needed to confirm these initial observations.

An earlier short report (some data is shown in the image above) indicated that the number of droplets decreased a lot if a damp cloth covered the speaker's mouth while speaking. So again, both mask wearing and speaking quietly or not at all appears to be helpful, while not wearing a mask or speaking loudly increases the possibility than an infected person can pass the virus to an infected person and cause an infection. In all situations, one is better off outside and distanced from others who might be infected compared to being inside where the droplets can persist in significant numbers for a longer time.

A 2019 paper commented:

“Here we show that the rate of particle emission during normal human speech is positively correlated with the loudness (amplitude) of vocalization, ranging from approximately 1 to 50 particles per second (0.06 to 3 particles per cm3)[1] for low to high amplitudes, regardless of the language spoken (English, Spanish, Mandarin, or Arabic). Furthermore, a small fraction of individuals behaves as ‘speech superemitters,’ consistently releasing an order of magnitude more particles than their peers. .... other unknown physiological factors, varying dramatically among individuals, could affect the probability of respiratory infectious disease transmission, and also help explain the existence of superspreaders who are disproportionately responsible for outbreaks of airborne infectious disease.”

Safety tip, don't be a sloppy (juicy?) talker or a loud talker. And, wear your mask. And, stay outdoors but distanced everywhere.


Footnote:
1. That number shows a lot fewer emitted droplets than the data reported later. I presume the difference is due to a rather insensitive air flow measurement method in the 2019 paper compared to a more sensitive laser light scattering method in the 2020 publications.

I moved from the US to Canada — here's why I'll never go back

 Kimberly Banks

\https://www.insider.com/american-who-moved-to-canada-experience-2018-6

Now that I'm in Canada, I don't have any plans to go back to the United States. 

• I moved from the United States to Canada over a decade ago. 
• I like the quiet politics, cross-country train, and the poutine in Canada.
• Canada also has fun nicknames for its currency and legalized recreational marijuana. 

• To me, the United States is like a gregarious relative who slaps you on the back, laughs too loudly, and somehow takes up all the space in whatever room they happen to inhabit.

  Now I live in Canada, which is like a soft-spoken, more respectful, more tactful cousin who really brightens the space they're in. 

  Before anyone assumes that I fled the US due to the political strife that's made headlines in recent years, I've been gone for a decade.

  I left the US for love in 2008. Initially, my plan was to stay in Canada for a year or two, but the longer I stayed, the deeper my roots here grew, and the more the US felt like a place to which I can never return. 

• Here are some of the things that keep me tied to the Great White North.

  The politics are quieter in Canada

• For the most part, in Canada, I can engage in political discussion with people holding opposing viewpoints without it turning into a character assassination of ourselves or politicians.

  The pre-election campaign cycles are much shorter than they are in the US, and there are five active political parties. Politics are still politics, but most of the time, I don't think they're incredibly sensational here. 

  Canada's borders seem more open to me

  As the world is faced with a migrant crisis, it seems to me that Canada is committed to opening its doors. 

• Rather than just providing charity for refugees and immigrants, Canada's goal is to solve labor shortages and bolster the population to power the economy for years to come.

  As an immigrant, being given the chance to have a positive economic impact and contribute to a thriving society is much appreciated.

  They have a cross-country train

  Like in the United States, train travel is expensive here. But both the Trans-Canada Railway and VIA Rail offer options to take you from coast to coast, giving people a way to see a large swath of the country. This one's on my bucket list.

• Canada has universal healthcare

  Contrary to popular rhetoric, healthcare in Canada is not free — it's funded through a combination of personal and corporate taxation.

• But as long as you have your health card, you don't have to pay for the most basic services, including doctor visits, ultrasounds, and hospital stays. (Well, unless you want a private room. That will cost extra.)

  For the most part, guns are for hunting

  There are plenty of guns in Canada. Yes, some of them are used for violent crime, and there aren't numerous strict gun regulations in place, but the culture around guns doesn't seem as fanatic here.

  For reference, per crime data gathered by BBC,  73% of homicides were gun-related in the US in 2017 — and 38% of homicides were gun-related in Canada in 2018. In addition, per a Small Arms Survey conducted in 2018, US civilians own far more guns than Canadian ones. 

• Canada continues to update its gun regulations, too. Earlier this year, Prime Minister Justin Trudeau announced a ban on 1,500 kinds of assault-style weapons, making it illegal to sell, import, transport, or use them.  

• The currency in Canada is pretty cool 

• No more worrying about taping that bill back together as you may have to do with US money — the bills are made of a durable, synthetic polymer here. 

  Plus it's pretty cool that one of Canada's recent $10 bill designs features Black Nova Scotian civil-rights activist Viola Desmond.

  The currency has fun nicknames, too 

  The dollar bill and two-dollar bill are coins, nicknamed the loonie and the toonie.

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• Poutine is seriously amazing

• 

  
  The star of the dish the cheese curds — the fresh, squeaky bits of curdled milk. Although some Canadians think any variation of this classic is sacrilege, I think lobster poutine is pretty divine.

• Recreational marijuana is legal here

• Whatever your thoughts about using marijuana, it's a fact that criminalizing usage is expensive for courts and law enforcement.

  In Canada, marijuana was officially legalized for adults in October 2018.

• https://www.youtube.com/watch?v=pASE_TgeVg8
  

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Asymmetric Warfare: Propaganda Has a Huge Advantage

“.... what Gilbert demonstrated is that if the brain is overloaded, it will accept lies as truth. The reason is that when the brain becomes taxed, it essentially shuts down. .... As Gilbert explained explains it, “when resource-depleted persons are exposed to .… propositions they would normally disbelieve, their ability to reject those propositions is markedly reduced. .... We wear helmets to protect our brains from physical injury but no such device exists to prevent us from mental entanglements [lies and manipulation]. Until then, the best we can do is to avoid shallow forms of information or anything that is likely to contain a lie.”

This general concept of an imbalance of power has been on my mind for at least 3-4 years. It seems timely and urgent now. Liars, emotional manipulators and purveyors of flawed reasoning are out in force on both the hard core left and right. We are absolutely awash in lies, deceit, manipulation and logic fallacies. People who support trump claim this true for people who oppose the president and essentially all of the mainstream media. They believe that extreme crackpot liar sources such as Breitbart, Rush Limbaugh and Fox News are telling the truth. People on the hard core left rely on extreme crackpot liar sources such as Sputnik News and RT News because they are perceived as telling the truth.

Both sides absolutely rip mainstream sources such as the New York Times, Washington Post, CNN, MSNBC, CBS and NPR as extremist liars and deceivers.[1] In my lifetime, I've never seen anything close to this kind of extreme polarization and bitter disagreement. Facts are subjective and personal, not objective. At present, there is probably no way to bridge the different perceptions of reality, possibly absent a massive shock accompanied by mass destruction and/or death. But maybe even a disaster won't help much. The liars are probably never going to go away. There is little or no penalty for lying and destroying civil society.

What does it all mean?

Obviously opinions will differ. In my opinion, it means we are in very serious trouble. Authoritarianism on the left and right is pressing hard to fill the power vacuum left as democracy recedes. Power flows from the government tasked with protecting the people and their liberties to powerful authoritarian ideologues, special interests and the politicians they can buy or coerce. The relentless attacks from the left and right and their lies and false realities clearly is slowly pushing democracy, truth and the rule of law aside.

Authoritarians the world over, including Putin, Trump and Xi, are rejoicing over the fall of truth for so many people. Their tyrant power increases in step with our ebbing democratic power.

What does it mean for political and broader discourse? It means that people who still believe in values like truth, democracy and the rule of law need to up their messaging game.[2] They need to do that because they are at a major disadvantage in messaging wars. Why? Because the messaging that people who rely on facts, truths and sound reasoning is far more constrained and significantly less persuasive than lies, emotional manipulation and bogus reasoning.

The human mind evolved to respond strongly to irrational emotional manipulation, especially fear, but also to other negative emotions such as anger, disgust, distrust, intolerance and bigotry. The best way to foment those things is to lie. Truth tends to have less emotional impact because reality is usually less awful and threatening than lies and irrational manipulation can easily make it seem. If truth and sound reason have X persuasive power, my estimate is that lies, deceit, manipulation and irrationality have about 3-5X persuasive power.

Why might that be? Because if the world of rhetoric truth and sound reason is Y big, the world of lies, deceit, manipulation and irrationality is at least about 30-50Y, and most useful stuff is at least 3-5Y. Just consider how freeing it is to just blow off facts, true truths and sound reasoning. Even I can make up some whoppers if I just blow off facts and reason.[3]

In other words, the good guys are fighting with one hand tied. The fight isn't fair. Maybe that just reflects the fact that politics isn't usually fair. Neither is life.


Footnotes:
1. The left and right attack and reject even the fact checkers as a pack of lying liars. No source is respectable any more except those that convey their own versions of reality, truth and reason. That's a huge win for things like actual and aspiring demagogues, tyrants, kleptocrats and liars. It is a huge loss for things like American democracy, the rule of law, truth, reason and civil society.

2. That assumes we are not going to engage in a full-blown civil war with tens of millions of deaths and mass destruction of infrastructure running in the tens of trillions.

3. For example, by blowing off facts I could argue this: The president demands that pro-military personnel interests buy at least $400 million per year from his commercial properties each year, even if the price is inflated two-fold for such special guests. In return for such "honest" business and the enhanced profits that would flow to the president, he has agreed to not cut military and veterans salaries and benefits by 50%.

Or, I could argue that the president secretly promised his supporters at least 25% lower taxes for voting for him, while taxes for Biden voters will be increased by 50%.

Well, at least I hope those are whoppers.

Where the Hell are the Russians?

It has now been about 24 hours since an article The Atlantic published, Trump: Americans Who Died in War Are ‘Losers’ and ‘Suckers’, appeared. But so far, we have not seen a dump of disinformation, information and whatever other major public distractions the Russians are planning to release to smear Biden and save the president. I was expecting it today, but where is it?

Where are they? Where is the Russian sleaze and lies?

Maybe the Atlantic article took those sneaky Russkies by surprise. Were they unprepared to respond as quickly as they did in 2016 after the release of the Hollywood Access tape?

Remember that? Trump boasted of grabbing them by the pussy because they liked it. Within a couple of hours, the Russians dumped a pile of stolen democratic emails to distract public attention from Trump's crude vulgarity and admission of sexual assaults.

Hand-to-hand combat today

Today, I spent about three hours engaging with Trump supporters. All of them believe the Atlantic article is just a pack of liberal lies and slanders. There were no exceptions among anyone I engaged with. One Trumpster referred to the author, Jeffery Goldberg, as a lying Jew. I gently but effectively defused that viciousness before it got out of hand. Well, defused it today. Tomorrow is a different day. Maybe it isn't as defused as I think at present.

Trump's supporters raised various reasons to reject the Atlantic article as a pack of lies, or something worse. One was based on John Bolton who was present. But he did not hear the president dump his sleazy contempt on US military personnel. Bolton said this: "I didn't hear that. I'm not saying he didn't say them later in the day or another time, but I was there for that discussion."

It took multiple attempts to explain why Bolton's comments meant that he could not debunk Goldberg's reporting. I think I finally got that across. Maybe. Then Sarah Sanders came out and said the reporting wasn't true because she was there. I pointed out that she, like her boss, is a chronic liar.

A few hours later came a blast from Trump's liar press secretary Kayleigh McEnany's assertion that she had 10 people who all claimed they never heard Trump say what he said. Then Fox News reported that and said those 10 people constituted proof that Goldberg's reporting was all lies. Then Fox News reported it had confirmed Goldberg's reporting. Then Rachael Maddow at MSNBC reported more confirmations of Goldberg's reporting, after NPR reported more confirmations of the original Goldberg reporting.

From what I can tell about how the media and former military personnel or their families have erupted, this bitterly disputed reporting just might cause a few folks to withdraw support for the president. That is not to say most or any will vote for Biden. They just will not vote out of disgust of the president.

It was a real poop storm of battling narratives out there today. The fragility of truth was so painfully obvious it sort of hurt.

The upshot

The Russians seem to have been caught flat-footed here. I did not expect that after how well they performed for the president in 2016. They saved his butt just a few hours after the Access Hollywood tape was released. Maybe this time, the Russians will not be able to put the president into the White House again. Maybe.

Where are those October surprises from the Russians? Or, has the US media actually learned a few lessons since their catastrophic failure in 2016 and decided to keep focus on what is important and real news? Maybe there is good reason for some hope after all.