How to Talk About Health Care Reform: Summary of Research on Health Care Messaging Celinda Lake and Drew Westen May 22, 2008

Lake Research Partners & Westen Strategies 2 Project Goals and Summary Translate the language of think tanks into the language of the living room and the kitchen table Provide progressive leaders, elected officials, and others with principled stands we know in advance work Identify the strongest attacks and counterattacks Weed out language that is counterproductive If you want to see universal health care enacted, stop using that phrase The product: narratives we can take to the bank to present our prescriptions, critique the alternatives, and respond to attacks

Lake Research Partners & Westen Strategies Methodology Message development: we identified underlying hopes, concerns, and sources of ambivalence (conflicting networks) Developed language aimed at activating, de-activating, and creating new associations Conducted focus groups with swing voters (Independent and/or weakly partisan likely voters) to refine draft messages February 25, 2008 – Denver, CO February 26, 2008 – Billings, MT March 17, 2008 – Las Vegas, NV March 20, 2008 – St. Louis, MO Online dial-groups of 1200 respondents April 25-30, 2008 – Nationwide 3

Progressive Health Care Messages That Work

Lake Research Partners & Westen Strategies 5 All four progressive narratives substantially outperformed the conservative message. THE CONSERVATIVE MESSAGE: Families should be in charge of their health care dollars. Rising health care costs are a problem, and the best way to bring them down is to increase competition among health care providers and put an end to these million dollar lawsuits that drive up insurance costs and put doctors out of business. The best solution to our health care problems is to let the free market work, foster more competition, and help people deal with the rising costs of coverage with health savings accounts that allow people to manage their own health care decisions. The last thing we need is the government taking over health care and creating a massive bureaucracy that will cost us billions of dollars a year. Sure, we have problems, but what the naysayers always seem to forget is that Americans still have the best health care in the world. Europe and Canada have government run health care, and their patients come here for treatment due to long waits and poor quality care. The answer to our health care problems is a freer market, not socialized medicine. MEAN DIAL RATING (0-100) = 55

Lake Research Partners & Westen Strategies 6 People who work for a living ought to be able to take their kids to a doctor… I believe that people who work for a living ought to be able to take their kids to a doctor, and people who are retired, ill, or temporarily out of work shouldnt risk losing their life savings because of one illness. Were not just talking about poor people. Were talking about middle class Americans who are getting squeezed. Too many people have to think twice before switching jobs or starting a business because theyre worried they wont be able to get insurance. We need comprehensive reform, not a band-aid. That means putting government to work for taxpayers again, not for special interests, by requiring insurance companies to put more money into patient care and less into efforts to deny it. It means preventing insurance companies from excluding patients because of pre-existing conditions and overriding doctors decisions about what their patients need. It means giving us choices among plans so we can decide whats best for our own families, including the choice to keep our current doctor. It means limiting the amount anyone has to spend out of pocket, so no one loses their lifes savings because of a sick child or a hospital bill. And it means giving small businesses tax breaks to offset the costs of covering their employees, and requiring big businesses to offer coverage to their employees instead of sticking middle class taxpayers with the tab. MEAN DIAL RATING (0-100) = 71

Lake Research Partners & Westen Strategies 7 A family doctor for every family. I believe in a family doctor for every family. Its not right that hard- working Americans are struggling to afford health care and prescription drugs, while were strangling small businesses with the cost of their employees health care. The market hasnt solved this problem, and its not going to as long as big insurance and drug companies are profiting at our expense. But we dont need to replace managed care bureaucracy with government bureaucracy. We need common sense reform that gives people more choices, not less, including the choice to stay with the doctor they have now. We need to make insurance companies compete with each other to keep costs down and quality up, and give people the option to buy into the same plan members of Congress get, because if its good enough for Congress, its good enough for the people they represent. And we need government to set high standards to keep deductibles low, stop insurance companies from cherry-picking patients by excluding people with pre-existing conditions, and guarantee preventive care like cancer screening that cuts long-term costs and saves lives. MEAN DIAL RATING (0-100) = 69

Attacking the Conservative Message

Lake Research Partners & Westen Strategies 9 Just look at what the free market has brought us… Every time the market fails to solve a problem, we hear, "Just eliminate regulations and the market will correct itself." That's what we heard with the mortgage industry, the oil companies, and the big corporations that are outsourcing American jobs. Just look at what the "free market" has brought us on health care: Millions of people cant get insurance or are afraid to change jobs because they have some "pre-existing condition" which we all have if we just live long enoughand millions of parents who work full-time have no insurance for their kids. Insurance companies have complete control over the size of premiums, deductibles, co-pays, and how much theyll pay, and the rest of us have no choice but to take what they offer. They spend a fortune on administrative costs, wasting doctors' time filling out paperwork and denying people coverage for tests or procedures their doctors say they need. Drug companies charge whatever they want for new medications and lobby Congress so Medicare can't even negotiate lower prescription drug prices. We dont need more of the same, we need leadership. MEAN DIAL RATING (0-100) = 62

Lake Research Partners & Westen Strategies 10 It does nothing to… Im not sure exactly what problem this plan was supposed to fix. It does nothing about the 50 million working Americans and their families who have no health insurance, or for the other 50 million middle class Americans and seniors who spend more than 10% of their income on health care. It does nothing to control skyrocketing premiums and out-of-control insurance or drug company profits, or to prevent insurance companies from imposing huge co-pays and deductibles that force people to choose between their mortgage and their medication. It does nothing to stop insurance companies from denying people coverage because they have pre-existing conditions or making arbitrary decisions about what to pay or not to pay. And hidden in the fine print is a huge tax increase on the middle class, because it taxes working people on their employers contributions to their health insurance, encouraging companies to drop their health benefits. Its a great plan if youre the CEO of an insurance or drug company. MEAN DIAL RATING (0-100) = 62

Neutralizing Attacks on Progressive Health Care Reform

Lake Research Partners & Westen Strategies 12 Government/Bureaucracy Attack & Response ATTACK: This isnt health care reform, its socialized medicineanother big government bureaucracy like the IRS or the DMV, operating inefficiently and costing taxpayers hundreds of billions of dollars. Its just one more step toward government intrusion in yet another place where it doesnt belong. Well all end up paying higher taxes and getting substandard health care, with long waits to get treatment, and lots of red tape and paperwork. Keeping health insurance in the private sector is the only way to guarantee that we have the best health care in the world. (MEAN = 51) RESPONSE: If you want to see what bureaucracy and red tape look like, try reaching a person on the phone the next time you call your own insurance company, and try getting them to explain why they wont pay $800 of some medical treatment your doctor ordered. We need leaders willing to take on the insurance companies, by setting clear, high standards for whats covered, preventing them from requiring patients to jump through hoops just to get insured, and saving billions by cutting administrative costs and moving to electronic medical records. We need leaders who will hold insurance companies accountable, guaranteeing us all more choices, better care, and no more of those 45-minute phone-calls to the insurance company. And if we stopped wasting doctors time with paperwork so they had more time for patients, and stopped forcing people who used to have insurance into emergency rooms for basic care, we wouldnt have to worry about overloading our system. (MEAN = 68)

Lake Research Partners & Westen Strategies 13 Cost Attack & Response ATTACK: we need to make health care more affordable, but trying to add nearly 50 million uninsured people to the system all at once with a big new government program is a recipe for disaster. It will cost billions in taxes, and hospitals and doctors will be even more overloaded than they are now. It punishes families and businesses who are already working hard to pay for health care by adding billions in new taxes and raising their costs. (MEAN = 55) RESPONSE: Middle class Americans are having a harder time making ends meet, and we need to cut both their taxes and their health care costs. If that means cutting the profits of insurance companies and requiring big businesses to contribute to the health insurance of their employees, my sympathy is with people who work for a living. Health care premiums have nearly doubled for the average family in the last seven years at the same time as insurance company profits have more than doubled, and if we dont do something now, our costs will double again. And thats not even counting the billions we already pay in federal and state taxes for expensive emergency room visits for people with no insurance who end up driving up costs because they dont get preventive care. Its time to put some money back in the pockets of working Americans and give them peace of mind about the health of their families. Maybe we should build a few less hospitals in Iraq and start investing again in doctors, nurses, and hospitals right here in the United States. (MEAN =71)

Lake Research Partners & Westen Strategies Conclusions The messages we use affect whether we win or lose Theres no reason to go into this fight blind We need to talk with the American people honestly and evocatively about our values and positions We need to speak with one voice, and to know it works before we open our mouths 14