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Democrats, Reframe Health Care Debate So Americans Know You’re On Their Side

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Democrats, Reframe Health Care Debate So Americans Know You’re On Their Side

health care

Reprinted with permission from AlterNet.

For those of us who support the Affordable Care Act and health care as a right, we need to bolster messaging for politicians and mainstream media in the face of unprecedented lies and misinformation.

I get why you may think Congressional Budget Office scores are enough. As the defense lawyer for the ACA, you’d look the jury in the eye and say, “Swampcare is of the Swamp, for the Swamp and decidedly written by the Swamp. Swampcare will cause 22 million people to lose coverage, the death of tens of thousands and a doubling of personal bankruptcies across the nation. The defense rests.”

But we live in a world where these plain truths may not be enough.


Good old-fashioned greed propped up by the old standbys—lower taxes and free markets that will reduce premiums, increase choice and spur growth—may still win the day.

Solid reporting on these fallacies is abundant, from the Kaiser Foundation to the Washington Post to AlterNet. But on mainstream and cable news, it’s a different story, where protocols permit unchallenged lies and favor the repetition of simple talking points, true or not.

While admittedly not a marketing maven, I’m going to take a shot at framing some of the critical elements in the ACA that are not receiving the attention they deserve. OK, repeat after me:

Freedom is coverage.

Say it louder!

Freedom is coverage.

You too, Perez, Ellison, Schumer, Sanders and Warren.

Freedom is coverage.

Yes, repetition matters. A lot. Ask Larry Bird.

Freedom is coverage.

Because you don’t choose to get sick, you just do.

Why is it important? Because we can’t cede a concept as basic as freedom to the opposition—and we have.

Because the 10 Essential Benefits truly are essential.


Freedom and choice, freedom and choice, freedom and choice, is their mantra.

Tom Price, as Secretary of Health and Human Service is the message lead and champion of health care “freedom,” helping citizens “to select the kind of coverage that’s right for them and their families, not that Washington forces them to buy.” Tom Price wants to turn back the “tide of all the rules and regulations that decrease choices that increase costs.”

Libertarian wingman Senator Rand Paul says, “perhaps we should try freedom.”

From their perspective, the mandate reduces freedom, the 10 Essential Health Benefits limit freedom, the caps restrict freedom and yes, even the pre-existing conditions requirements interferes with free markets, choice and personal freedom.

They want citizens to have freedom of choice and to save money. And for the states to decide on their plans. Who doesn’t like choice? And freedom?

What’s not to like?


In real life, people really hate paying a premium every freaking month for 10 years and then when they need the insurance, discovering there was a loophole, disclaimer or exclusion for an “act of god.”

You have a car accident, and want the policy to cover the cost of repair with a modest deductible. A tree falls on your house, and you expect the homeowner’s policy to cover the cost of repair with a modest deductible. If your business has errors and omissions, you expect it to cover the legal costs when you or your company make an error or omission.

When it comes to insurance, what people hate is no coverage.

In real life, 69 percent of U.S. adults have less than $1,000 in savings.

Most Americans are living close to the edge, paying bills month to month and watching every penny. They would easily fall prey to cheaper plans that did not cover essential benefits. It’s human nature. They need to feed their kids, pay the rent or fix the car to get to work.

They will roll the dice, and pray.

When it comes to insurance, what people really want is coverage.

In real life, no one knows when they are going to get sick, or have a Steve Scalise moment.

According to the CDC in 2014, the “number of medically attended injury and poisoning episodes in the population: 39.5 million. Episodes per 1,000 population: 126.3. Number of emergency department visits for unintentional injuries: 28.1 million.”

Translation—your chances of a medically attended injury each year is over one in 10.

And sadly, Steve Scalise is not alone; in 2016, according to the Gun Violence Archive, there were 30,616 gun-related injuries. I doubt any of them were planned for.

You won’t need more than a million dollars in coverage this year and would rather save $200? Bam. Bankruptcy.

When it comes to insurance, what people really need is coverage.

In real life, most businesses and families want to lock into monthly fixed costs.

A CFO will tell you it is better for planning to have monthly costs to avoid fluctuations in expenses whenever possible. If you are a family with the income and luxury to budget, you pay for the security of insurance. And if you are at the lower rung, even a modest expense can throw your life into a panic.

It is the conservative, prudent and more business-like approach. Which one would expect Republicans to embrace. Instead, we have conservatives, Republicans and libertarians ignoring common sense and suggesting the American public play Russian roulette with their health to save a short-term buck.

When it comes to insurance, what people really expect is coverage.

What Should Dems Say?

Drop the qualifier. Democrats—please stop leading with “we know it could be better” and “we are ready to work with Republicans.” You think it makes us sound less partisan, but it makes us sound weak, like we don’t even believe in the bill we fought for.

Try this…

The ACA is the greatest piece of legislation in this generation.

Nine out of 10 Americans live with the freedom afforded by full coverage, the freedom to change jobs, the freedom to live without bankruptcy, the freedom to choose plans in an open market.


Isn’t it telling that male Republicans use maternity leave as an example of a benefit that is not “essential?” They don’t want to pay for it, ladies.

So what else is new?


Dems, Berniacs, Indivisible groups, everyone on point for 10 days, asking the same question: Why shouldn’t every plan provide coverage for_______?

Day One is ambulatory, Day Two is emergency services. Etc. By the time we get to hospitalization, Republicans will look ridiculous. Let’s ask them to list the coverage they will skip in their family plans.

As a reminder, the 10 Essential Benefits are:

  • Ambulatory patient services (Outpatient care)
  • Emergency Services (Trips to the emergency room)
  • Hospitalization (Treatment in the hospital for inpatient care)
  • Maternity and newborn care
  • Mental health services and addiction treatment
  • Prescription drugs
  • Rehabilitative services
  • Laboratory services
  • Preventive and wellness services, including chronic disease management
  • Pediatric services


When Republicans talk about freedom and choice, they repeat two points about Obamacare—the insurers are leaving rural counties (46 without plans) and Obama didn’t let you keep your doctor, reducing choice.

The Senate and House bills only offer the “free market” as a solution.

Both problems are driven by insurance profits. Insurers leave rural counties because they can’t make as much money—so “skinny” plans will be the cure. As anyone who has ever wrestled with the “in-network” search tools on a health care site knows, it is the insurers who pick your doctors—even in employer plans.

When Republicans talk about “freedom,” it’s freedom for insurers and doctors they are mostly talking about. So here are some amendments to solve the rural and doctor problem that insurers and doctors will hate, but will stir the freedom and choice discussion.


Insurance companies offering insurance in a state must offer insurance in all counties in the state. Doctors who accept insurance in a state must accept insurance from all providers in the state.

Want to talk about real patient freedom? Rural problem is solved. Throw away those thick “in-network” books forever—if you have insurance, just go to the doctor.


Government employees, including congresspersons and the executive branch, will purchase the least costly health plan offered in the state in which they permanently reside.

Republicans would never offer their constituents a plan that was unsafe that they would not take themselves—would they? Do unto others…what is good for the goose is good for gander. And so on.

I am certain good Republicans throughout the government, devoted to saving their fellow taxpayers money wherever they can, will embrace the cheapest plan being offered in their home states, along with fellow constituents.


Freedom is coverage. And lots of protections in the Affordable Care Act are worth fighting for.



  1. dtgraham July 17, 2017

    This is all true, granted. Can’t argue. The problem is that Trump and the GOP have turned America into Bullsh!t Nation.

    Donald Trump has stayed ahead of his critics because they missed his immediate threat — turning the United States into Kelly-Anne Conway’s alternative fact universe, or to put it another way…Bullsh!t Nation.


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  2. old_blu July 17, 2017

    It’s never been about healthcare for the Republicans, it’s all about erasing the Black Man from history.

    They’ve had 7 years and what they’ve come up with is nothing more than another tax windfall for the wealthy. Only this time people will die. Poor people, disabled people, children and older people. How pathetic really. . . . .

  3. JF July 17, 2017

    Somewhere in this, the author mentions not being in marketing. That said, the point here is well made. One simple message, repeated. But given my own decades of experience in marketing, I’d like to throw in a couple more suggestions.

    First, Dems, is targeting. We’re not going to sway the Trump-faithful. Or the GOP rich with nothing at stake and a low store of compassion.

    And we don’t need to wake up those who are already in agreement that this is the way things are. The people you want to stir into action are those voters who know it matters but don’t bother to vote or speak up, mostly to grow the grass roots for 2020.

    And also those conservatives and fence-sitters who, despite that, might feel this goes too far. Either because they’ve got some heart left. Or because they’re afraid, in a self-interested way, what this will mean for future elections or them financially.

    After all, sickness knows no party line.

    Second, use small words. Please. Not because people are stupid, even if some are. But because there’s so much noise and only so much time in the world. We need instant absorption, not dense language that only makes the speaker feel smart.

    Third, stories. The statistics are shocking, that’s true. And you can share them. But you’re far better off sharing stories. For instance, we all know what happened when Obama turned out to be wrong about “keep your doctor.”

    It wasn’t a lie, but a simple truth about the quality of those doctors. And, more specifically, the plans that included them. They were, in a word, crap. So they had to go.

    You could list the facts of those horrible plans until you’re blue in the face. And it might persuade some. But far better would be to get the stories. Show us the people who thought they had insurance before Obama’s plan. Then tell their many sad tales of how it turned out they didn’t. See “Sicko” for inspiration.

    The world the GOP wants us to go back to was a terrible and dangerous place to get sick. People need to see that for themselves first hand, in the faces and stories of those who survived it. Or failed to.

    Show us the kid with cancer, as proof that getting sick isn’t a failure of morality, as the GOP has tried to argue. Show us the hard-working, white, middle-American family in the “heartland” that got slammed by a $500,000 medical bill, as proof this isn’t just a problem for the poor brown people that they don’t know or care about. Show them their grandmothers, give them a mirror vision of themselves in a year, five years, a decade, without sufficient medical coverage.

    Then flip the telescope and show them how it could be. Tell them an amazing treatment story about some lovable child, new parents, a miraculous recovery case… revealing at the end how it happened not here, where costs would have prevented it, but in Finland, France, Germany, or some shockingly small and supposedly lesser country that has way, way better health care. Show them interviews with people in those countries talking about how wonderful that care is.

    Americans, even the ones that voted Trump and will continue to defend that choice, just don’t realize how much better it really could and should be. Nor to they understand how bad this could get if the GOP gets its way. Because there’s just so much to think about. Too much.

    Simple, moving stories. Repeated over and over. That show how important this is at the most basic ground level. That’s the way to go.

    1. Jim Samaras July 17, 2017

      Right….let’s not forget Charlie Gard who in England must hope a court decides whether he lives or dies due to their wonderful health care system.

      1. 788eddie July 17, 2017

        What the heck does that have to do with the price of tea in China, Jim?!?

        1. Jim Samaras July 17, 2017

          Aren’t we talking about health care here eddie? England has free health care instituted by the government which is what the left wants here. I think the comparison is a good one

          1. 788eddie July 17, 2017

            Absolutely lame, Jim. But at least you’re consistent.

            We just got back from Scotland. One elderly person in our church group tripped and fell on the sidewalk, and had to be rushed to emergency care at a hospital in Edinburgh. She was held overnight and released in the morning.

            No Cost!

            The way it should be in this country, too!

          2. Jim Samaras July 17, 2017

            Why is it lame where I’m citing a current issue that, imo is plaguing any argument towards nationalized health care?

          3. 788eddie July 17, 2017

            I don’t know, Jim, maybe because it’ in another country where people of that other country will decide that issue.

            Just guessing.

          4. Jim Samaras July 17, 2017

            Well isn’t single payer nationalized health care for the US an issue in OUR house? Just citing an example of the ramifications of such for when we must decide

          5. 788eddie July 17, 2017

            You’re assuming that “single payer” means the same thing in every country, and that it has the same parameters. Not necessarily true, Jim.

            I do support nationalized healthcare. It is already in many countries and has been for years. We’re supposed to be “the greatest and most powerful country” on earth; we should be able to support that here.

          6. Jim Samaras July 17, 2017

            It has it’s benefits and drawbacks, I was pointing out something to be taken into consideration. I believe we are headed in that direction but don’t trust the federal government to do anything that resembles cost effective in anything they attempt.

          7. 788eddie July 17, 2017

            I do have faith in the American people.

            I do not have faith in the conservatives; they have majorities in both houses and the executive branch, and so far they have not shown hat they can govern at all.

            I want better from my government.

          8. dpaano July 19, 2017

            Eddie….that’s the thing….it’s OUR government. We pay for it and we pay for ALL of their salaries, but they seem to forget that fact and think they can do willy nilly without letting the people know the truth! Someone needs to remind them who pays their salary and who elected them!

          9. 788eddie July 19, 2017

            You’re absolutely right, dpaano.

            Just a point: I can point with pride that I have never missed the opportunity to exercise my right to vote. Maybe we should be putting more effort to make sure that others have that same right.

          10. dpaano July 20, 2017

            As do I….I proudly march to my polling station and vote each and every time for both national AND state elections. It’s my right, and I’m going to take it!!! I just wish more people were like you and I, but they aren’t. If they were, we wouldn’t have this idiot sitting in the White House wrecking havoc!

          11. JF July 22, 2017

            You’re not completely wrong in that suspicion. I don’t trust them either, on many fronts. And believe it or not, I’m mostly a fan of free markets.

            But… consider… even before ACA, a family of four could easily pay — as we did — about $1,400 a month. Per year, that’s an extra $16,800. For private insurance. In a so-called free-market. I’m a high-income earner and that’s actually more than I pay annually in state taxes.

            And they were completely arbitrary and difficult any time we asked them to cover what they’d promised to cover (for instance, maternity and childbirth).

            So… what’s the difference if you have to pay $16,800 to cover a single payer system and that’s administered by, say, the folks who do Medicare (which is proven far MORE efficient than private insurance)… or hand it over to a private insurer with Monets hanging in the lobby of the headquarters (I’ve seen them).

            Meanwhile, we spend half the year in overseas in a single-payer country (France) and it’s been… incredible. The care is excellent. It’s efficient. And astonishingly cheap to free. Blows the US care that average citizens get out of the water.

          12. dpaano July 19, 2017

            Eddie: I certainly agree, but what the Republicans keep saying is that it’ll cost us more tax-wise. What they DON’T say is that the addition to our taxes would be minimal when you consider that you won’t be paying a big bunch of money for healthcare insurance….it would be covered in the taxes that you pay. People seem to not understand this concept, and the Republicans don’t seem to want to let people know this fact. If it adds a couple of hundred to taxes each pay period…..and you save that same amount by not having to buy health insurance yourself…..it’s worth it!

          13. 788eddie July 19, 2017

            Thanks, dpaano, for explaining that for those who need to still become aware. Keep up the good writing!

          14. JF July 22, 2017

            Jim, I appreciate the intent in citing the case. But some of the facts are being left out, which obscures its irrelevance. Charlie B isn’t in the predicament he’s in because of costs to the system. He’s in it because his doctors don’t feel further treatment or the intended course offered by the parents would be compassionate. A whole different question.

      2. Counterpoint: you’re a treason-supporting racist coward.

      3. JF July 18, 2017

        Let’s do even better than not forgetting him. Let’s remember that in the Charlie Gard case, the debate is over the ethics of prolonging suffering in a child who may or may not benefit from a treatment that his parents want but that medical experts say won’t help. Let’s also remember that a US doctor has flown there to help with that evaluation. And finally, let’s remember that, while Charlie’s case isn’t being decided solely by funding for care, literally millions of cases in the US health system… for people Charlie’s age and younger, included… are being decided based solely on dollars. Specifically, in the case of tax cuts rich Republicans would rather have, even if it costs many, many of those young lives. Charlie Gard’s case is tragic and controversial, to be sure. But it’s also a sick attempt to distract from the other fully different tragedy taking shape here in the US.

        1. Jim Samaras July 18, 2017

          Speaking of other tragedies how about the families of 4 who are paying $1600 a month (a house payment) for health insurance with a total out of pocket expense of $10,000? I’d call that catastrophic insurance to say the least but $1600 per month? Without all the mandated coverage that payment would be around $600.

          1. dtgraham July 19, 2017

            The ACA mandates that no more than 10% of your income can go to health insurance and health care. ACA subsidies will cover the rest. People with pre-existing conditions and those who are nearing Medicare age, but not yet eligible, will pay a hell of a lot more than that out of their income with this Republican health care bill IF they can afford it.

          2. Jim Samaras July 19, 2017

            That bill is DOA and I for one am happy that it’s dead. Subsidies must go and free market must come back or just go to single payer and see how it goes

          3. JF July 22, 2017

            Single payer. Now that I can agree with.

          4. dpaano July 19, 2017

            Currently I’m on my company’s health plan, which is one reason at age 71 I’m still working full time. However, if I retired and had to depend on Medicare, AND if they charged me 5X what a young person would be charged…..that would eat up my Social Security in no time! I might as well just lie down and die quietly, which is exactly what the Republicans want apparently! As it was, I invested early in long-term care insurance which will help cover much of my care if I happen to get to that point. We also chose the in-home care in lieu of going to an “old age” home. It pays to think ahead, and I advise people in their 30’s to look at long-term care insurance….it’s a small price to pay for some peace of mind.

          5. Jim Samaras July 19, 2017


          6. JF July 22, 2017

            Well then, I’d tell them to seek a different insurance company.

            I head a family of four. I’m also self-employed. We used to pay $1,400 a month for a plan with a $5K deductible that would only pay 80% of the bill above that amount. And of course, none below it.

            With Obamacare, that plan switched to an $800 per month premium with a $6K deductible. Which, yes, is a little higher. But with no cap on max. coverage which is infinitely more important.

            No two ways about it, American healthcare was crap. And it’s still pretty crappy, but with ACA, it was definitively less so. For anybody with pre-existing condition. For anybody extremely poor and uncovered. For children and dependents. And so on.

            That line you throw in about “without mandated coverage” only works in one scenario, when that coverage they get for $600 is for an incredibly shitty plan that covers zilch, caps out low, has no viable doctor network and refuses to pay, even when it should.

            Five people in my extended family work in the insurance business. Three of them are medical professionals (two doctors, one nurse). Another works in a medical practice as an insurance company/Medicare liaison. So I know what I’m talking about here.

            P.S. Under the GOP plan, you’re kidding yourself if you think it would be in any way better… for the literally millions who would have zero coverage again… OR for that family of four you talk about. You forget, all too quickly I might add, why we needed ACA in the first place. Even going back to the pre-ACA status quo would be a disaster for the average American. But the GOP plan? The only demographic… only… that would benefit, are those wealthy few who will see their taxes go down as a result. But coal miners, factory workers, middle management, mall workers, and other middle to low income earners — including Trump voters — would all be screwed.to.the.floor.

        2. dpaano July 19, 2017

          Exactly….if Charlie lived in the U.S. and if the proposed plan went into affect…..Charlie would be left to die because it’s a “pre-existing” condition and would cost too much to be paid for by an insurance company. Fortunately, for the Gards, where they live, they don’t worry about that……and if the doctor from the U.S. can help him….more power to them….but if he were here, it would be a totally different story!

  4. FF July 17, 2017

    JF, very interesting comments.

    I’ve noticed Trump loves to find “victims” of Obamacare and parade them in front of the cameras. Can you imagine how many victims we’ll be able to find if the GOP healthcare bill ever makes it into law?

    Also interesting (or ironic) that the Senate is delaying bringing their bill to the floor to take coverage away from millions, while one of their own is off recovering from surgery no doubt paid for by taxpayers.

    1. dpaano July 19, 2017

      Congress people have a separate policy that is paid for by the government (meaning us, the taxpayers). They’ve excluded themselves from having to use the proposed healthcare plan, of course! They don’t want to give up their elite plan and have to use the one they expect most of us to use!

  5. dpaano July 19, 2017

    What’s truly scary is that many voters seem to think that even if Obamacare is repealed, they will still have insurance coverage through the ACA…..they don’t realize that both these plans are one and the same! Secondly, the Congress has excluded themselves from the proposed health plan and want to stay on the government-paid plan that they are currently on (and which we would ALL like to be on). The third problem is that many of the cable channels; i.e., FAUX News, etc., do not explain what’s going on and do NOT let their listeners know the pros and cons of the proposed plan…..they play DOWN the bad aspects and push the good parts (although there really aren’t many). The lack of understanding that Obamacare and the ACA are the SAME insurance plan is what helped our pseudo president get elected…..they though they would still have coverage if Obamacare was repealed…..and they were lied to!


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