Howard Dean: How Republican Attack Dogs Plan to Thwart Health Reform

Editor’s note: In his new book, Howard Dean’s Prescription for Real Health Reform, the physician and former presidential candidate devotes a chapter to the forces arrayed against substantive health reform -- the insurance industry, big business, some pharmaceutical companies and political conservatives. The following is an excerpt in which he discusses the long fight against progress mounted by conservatives.

During the early 1990s, under the leadership of Representative Newt Gingrich (R-GA) and Senator Bob Dole (R-KS) and bolstered by the ideological support of the Heritage Foundation, Cato Institute, and Manhattan Institute, Republicans successfully defeated President Clinton’s health reform effort. Conservatives of all stripes argued that healthcare reform was “creeping socialism” or “big government,” denied the existence of a healthcare crisis, or co-opted the term reform to push their own agendas and dilute support for a comprehensive solution to the nation’s healthcare crisis. 

Unfortunately, today’s Republicans are no less inflammatory. Relying on a very similar playbook, conservatives are distorting progressive proposals in an effort to obstruct reform. In May 2009, GOP wordsmith Frank Luntz authored a new messaging memo defining the Republican rhetoric on healthcare reform. The memo, titled “The Language of Healthcare 2009,” “is based on polling results and . . . captures not just what Americans want to see but exactly what they want to hear.” The memo suggests “The Words That Work” and instructs that “from today forward, they should be used by everyone.” 

Luntz warns that “if the dynamic becomes ‘President Obama is on the side of reform and Republicans are against it,’ then the battle is lost and every word in this document is useless.” The trouble is, the document is already useless. Because rather than challenging the tenets of American reform proposals, Luntz establishes a straw man argument against a nonexistent health plan. Buried amid the usual rhetoric about government-run healthcare is Luntz’s predictable contradiction: He instructs Republicans to “be vocally and passionately on the side of REFORM” but then urges GOP lawmakers to misrepresent and obstruct any real chance of passing comprehensive legislation. 

“Humanize your approach,” but argue that healthcare reform “will result in delayed and potentially even denied treatment, procedures and/or medications.” “Acknowledge the crisis” but ask your constituents “would you rather . . . ‘pay the costs you pay today for the quality of care you currently receive,’ OR ‘Pay less for your care, but potentially have to wait weeks for tests and months for treatments you need.’” 

In other words, say there is a crisis but then argue that healthcare reform would lead to “the government setting standards of care” and government “rationing care” and would “put the Washington bureaucrats in charge of health care.” “This plays into more favorable Republican territory by protecting individual care while downplays the need for a comprehensive national plan,” the memo states. 

Readers are also instructed to conflate Obama’s fairly moderate hybrid approach to reform (building on the current private-public system of delivering healthcare) with “denial horror stories from Canada & Co.” 

Focus on timeliness—“the plan put forward by the Democrats will deny people treatments they need and make them wait to get the treatments they are allowed to receive”—and argue that Republicans will provide “in a word, more: ‘more access to more treatments and more doctors . . . with less interference from insurance companies and Washington politicians and special interests.’”