Saturday, January 3, 2009

Framing The Health Care Crisis: How do we do it? Talk is not cheap....

George Lakoff did me - and I think, the world - a favor, when he brought attention to the idea of "framing" in his book "Don’t think of an Elephant." Due in no small part to reading that book, I began to think differently about my work, about the world, and even began to believe that I may have the capacity to make a difference in the world and in the political process. If you haven’t read it I encourage you to do so, even though some of the "frames" put forth are certainly open to debate.

One of the very most pressing issues of our time is the DESPERATE need for universal health care in these United States. NYCEve on dKos and others point out tirelessly the reality that people are dying due to the mess on our hands. That’s reality, and it bears repeating.

The spark for this posting was people asking me the question "How can anyone be against universal health care?" I realized I really wanted to know the answer to that question, and that in terms of advancing the cause,that I feel it is imperative for us to understand the "frames" of the opposition. I don’t claim to have all the answers, but follow me on as I explore....

Part of the critical piece that Lakoff puts forward is that when the facts are in conflict with the frames that we have around an issue, that people tend to throw away the facts and keep the frame. This is witnessed, for example, by the fact that in 2003, even with lots of coverage to the contrary, four out of ten people believed that we HAD found weapons of mass destruction in Iraq...

So it’s reasonable to assume the same sort of cognitive dissonance also occurs in relation to health care. I’ve assembled some of the frames of the opposition....Hopefully as a community we can come together and work on how to re-frame these issues. I believe that is part of how we change society, and that is part of how we end up with universal health care.

Frame #1. "The Nanny State." (I had never heard this expression, apparently, it's common...)

Some conservatives believe that what we are trying to create is a "nanny state" that takes care of everything, absolves us of personal responsibility, and is bloated and huge.

Hold your nose. This is a post from Freeperland (AKA "The Free Republic.")

Before you can have "universal healthcare," you will have to surrender all of your freedoms. The nanny state will tell you what you can and cannot drink and eat. The government will also dictate to you what you can and cannot do. "Universal healthcare" will finally give the Communist "DemocRATS" what they've always dreamed of having. TOTAL CONTROL OVER THE POPULATION.

Ok, well, this certainly implies that a freedom frame is necessary. That health=freedom. That there will be limits on governmental control, in re: health care.

Total control over the population? Yeah, right. I won’t dignify that with a response....

It’s important to note, however, that there is a tone on some Freep threads that implies that some of them "get it," at least that there is a crisis, that something needs to be done. However, there is also lots of talk about "slackers" and people who won’t pay $100 a month for health insurance.

You don’t have to look far to see what it is that people are fearing about universal health care...addressing these fears will be an important part of the efforts: (This is more from the "freeps." Funny, that rhymes with "creeps!")

It's only a vote away. Start thinking what doctor and hospital you will be assigned to, not that you will have much choice. And you doctors out there, start thinking about how you can speed up the entire process so you can accomodate lots more patients. Soon your office waiting rooms will look like the waiting rooms at the hospital and you'll have your hands more than full - for less money.

There is at least one doctor posting there in full glory that is outraged about the "universal health care" discussion—he sees it as "slavery and servitude," and says he’ll retire before working in such a system. Granted, maybe his patients would be better off if he got out of the business, but that’s beside the point. I think this needs to be addressed. In the UK, doctors are allowed to take private insurance, can see private patients, and can charge whatever the market will bear, I think, if they wish to do so. I think this needs to be built into the system~ Good ole American greed is not going to go away—and allowing for this is part of how this change can happen, IMHO.

From (an interesting site that lets you vote on "where you stand" on issues...)

"The government has no duty, and no right, to be the guardian of public health. Medical costs are outrageous, and regulations should be made to prevent the industry from gouging people in need, and everyone should give liberally to help those in need, but the costs of a person's medical treatments are their own; taxpayers have no obligation to pay for them; the government should not force charity."

Forcing charity... now there’s a frame. "Obligation." You’re on your own. Ducky.

I never thought the day would come that I’d read something Newt Gingrich had to say on purpose, but check out this:

"First, the act should establish a Capabilities Program to help both Americans with disabilities and those with work-related or other injuries lead the fullest possible lives. The program should provide incentives to people with disabilities to be productive, rather than threatening them with a loss in benefits if they get a job. The program should also allow participants to capitalize on technologies and therapies that maximize their abilities, and that emphasize integration into social, family and work life."
...sounds relatively sane, right? Read on...

"This philosophy closely resembles the government's successful approach to rehabilitating and reintegrating amputees and other wounded veterans from the Iraq campaign."

Oh yeah, while members of the public have to send our wounded soldiers PHONE CARDS and while a lot of them qualify for food stamps?? Ok, sure, I’m over here believing that....

Gingrich continues:

"The second area would address the needs of the relatively healthy poor, who have much different needs than people with disabilities or the elderly. Poor individuals should be offered vouchers for health savings accounts that sensitize them to the benefits of prevention, wellness and early detection."

That smacks of a frame that "poor people are sick because they don’t take care of themselves..."

But wait... health SAVINGS accounts?? I don’t think so. This reinforces the frame that it’s NOT a "right" to have health care... that it’s your responsibility to "get your own." I am capable of spending a lot of time and energy doing effective comparison shopping when I am really sick, how about you?

More Newt:

This would also encourage a more rational use of health care; prenatal care, for example, is far cheaper than neonatal intensive care.

Ok, sure. That last bit after the semi-colon is true. Part of what has made this exploration interesting is how they’ll start with one piece that has a grain of truth in it—and then go to left field. For example, the sentence above is followed by:

Government leaders need to rethink the part of Medicaid serving the healthy poor in the same way we rethought welfare in the 1990s.

Didn’t we "rethink" welfare by kicking people off of it? Hmmmmm......

A red-stater speaks: (Sorry, I don't link to hate-sites like Red State or Freep. Google it yourself, if you must...)

"Canadians DIE while on waiting lists for government-funded treatment. It isn’t unusual to see Canadians crossing our northern border to get treatment for various ailments before they become life-threatening. Waiting lines for needed services like MRI’s and non-elective surgeries are growing in Canada. If you were faced with a choice between risking your life by waiting for so-called "free" health care, or visiting a private practice and paying your own way, what would you do? A "long wait" at an American clinic generally means a couple of hours. In Canada, it can stretch into weeks.

Ok, so I went to check that out, even though the facts get discarded, it’s important to know them, right? The truth of the matter (as our Canadian friends can attest...) is encapsulated in a study I found:

Opponents of the Canadian health care system commonly conjure up the image of hordes of Canadians crossing the border to receive health care in the U.S. due to long waiting lists. Yet, the studies that have been done on this issue do not support the legitimacy of this idea. Katz et al [14] developed a multi-faceted strategy to study this issue, drawing upon 1) Surveys of ambulatory clinics in three large U.S. cities near the Canada border (Detroit, Buffalo, Seattle); 2) State hospital discharge data from Michigan, New York, and Washington State; and 3) Surveys of the U.S. News and World Report "America's Best Hospitals", where Canadians might be thought to go to for care.

* 136 ambulatory healthcare facilities in Detroit, Buffalo, and Seattle responded to the survey. In 1997-1998, 52 of these facilities reported seeing no Canadians, 56 reported seeing fewer than 10, 21 reported seeing 21-25, and 7 reported seeing more than 25.

* Federal and provincial government surveys of the citizenry. Only 90 of 18,000 respondents to the 1996 Canadian National Population Health Survey indicated they had received health care in America in the past year, and only 20 of these had gone to the U.S. specifically for that purpose.

So that’s another frame and another fear. We have the "best system in the world" and "people want to come here for our medical treatment" and if we "change it, you will have to wait forever and pay more," (like the poor Canadians do...) (/snark)

...all unfounded fears, of course. Ask any European or Canadian and nine out of ten would rather have their system than our so-called system, nine out of ten will say they'd keep their own, thanks...

Other anti-health-care writers posit that "they don’t see how they will benefit" if they have to "pay for a fat man’s bypass." It seems to me that this is a frame that we need to construct—as to how, exactly, you benefit, say, if the company you work for no longer has to pay for your health care and so, your wages go up. Or, say, if your accountant is not worrying about how his mom is going to pay for a broken hip or their child who is in an oncology ward.

Unfortunately, I don’t have all the answers, ( I do have enough material saved to write about this for days, but I’ll stop here for now.) I do know this topic needs close consideration and discussion, over and over again. That’s how we get the frames and memes and concepts into the general converstation.

Digby sums up some of this quite nicely in a post here:

The Republicans have an economic framing model that's very successful and we can learn from it. They sell an optimistic, simple philosophy of "If only the government would get out of the way you can be successful." This means that if you aren't successful it's the government's fault. (And Democrats believe in government so they are actively working to keep you down.) Their frame is always, entirely, the frame of self reliance and self interest. They preach it as a moral good no matter what the situation. This is a notion that has a very long history in American culture and it's one that appeals to a very basic aspect of human nature. It has become the dominant strain in political discourse over the last thirty years.

NOTE: We see how well the "Government getting out of the way worked out vis-a-vis the current economic meltdown, no?"

Anyway, I think Digby's post is very telling. It says that while the Republicans have been able to move self interest to the front and center of political discourse, displacing the values of community and altruism as things people feel they ought to say when quizzed about such things.

He’s right. The question are we going to change that?

Do I have takers for a discussion? Thanks for reading...

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