How to Talk About Health Care

John McCain will be spending the week promoting his health care scheme. The crux of the plan is to abolish employer-based health insurance and throw middle class working Americans to the wolves. It is market fundamentalism at its worst.

But I'm not here to talk about the policy details. I want to discuss message framing. During an election campaign, when our ultimate audience is persuadable voters, how do we talk about health care?

Let's first understand McCain's frame. His campaign understands one crucial fact (if nothing else): About 95 percent of the voters in the 2008 general election will be insured -- the uninsured don't tend to vote. Extensive polling and focus group research has shown, without a doubt, that people who are insured are more interested in preserving and improving their own coverage than in covering the uninsured. Americans want "quality, affordable health care." But of the two concepts, they are more focused on affordability than on quality.

McCain is trying to convince voters that Democrats are all about covering the uninsured while he, on the other hand, is all about lowering health care costs. Understand that this is a good strategy because it fits voters' stereotypes of Democrats (and is fairly true). To our credit, we focus on "universal" or "single-payer" coverage, "Medicare for all," "Canadian-style" health, and the like. But this is not good message framing for the 2008 election.

"Single-payer" makes persuadable voters -- the swing voters who will decide this election -- think of bureaucracy, inefficiency, and bad service (like the "typical" department of motor vehicles). You'd think that one way to sell health coverage would be to refer to one of our nation's great success stories -- Medicare. Unfortunately, Americans have become wary of Medicare, in large part because the Bush administration botched Medicare Part D, the prescription drug benefit.

And unfortunately, many Americans have a negative impression of the Canadian health care system. More important -- because it applies to more than just health care -- Americans are not persuaded by comparisons to other nations. If they were, we'd already have single-payer health care, strict gun control, and voting rights for ex-offenders, and we would have abolished the death penalty and signed the Kyoto treaty on global warming years ago. Americans want an American solution. (You're going to hurt your eyes if you roll them like that.) This is politics; just go with the flow. Evoking national pride helps us enact programs that benefit our fellow citizens -- so just do it.

But, you respond, these voters are wrong! We need to educate them about the merits of single-payer, Medicare, and the Canadian system, you say. I'm sorry, but politics doesn't work that way. You can't change people's minds in the course of a campaign -- that takes years and there's not enough time. No, our goal is not to change minds, it is to convince voters that they agree with us already.

We do that by starting from a point of agreement -- where polls show that persuadable voters are on our side -- and lead them to see that our solution fits their preconceptions.

In the case of McCain's proposal, the key fact is that the tax provisions will encourage companies to drop health insurance as an employer-provided benefit. Fortune Magazine points this out by quoting an expert in the field: "I predict that most companies would stop paying for health care in three to four years," says Robert Laszewski, a consultant who works with corporate benefits managers.

Put another way, the McCain plan will cause businesses to drop health care benefits like a rotten egg from a picnic basket. The argument for McCain depends on the idea that once they cut health care benefits, corporations will increase our salaries to offset our loss! And no persuadable voter in America will believe this. So if you're middle-class in America, this plan should scare the sox off of you. This is Bush economics on steroids!