Sending the right message on health care Drew Westen, Ph.D.

1. Sending the right message on health care Drew Westen, Ph.D.

2. An experiment What networks are active at Fox?

3. Why networks matter Volvo-driving Tax and Spend Elite Godless atheists LIBERAL Sushi-eating Cut and run Big government Special interests Latte-drinking

4. Associations to immigrants among U.S. swing voters (based on focus groups, Westen Strategies and Greenberg, Quinlan, Rosner Research, Winter, 2008) Hard working Better life Don’t speak English Nation of immigrants Immigrants American Dream Breaking the law Opportunity Government benefits Don’t pay taxes

5. No network is an island unto itself… Health care Welfare Education Terrorism Immigrants Crime

6. Three principles of effective messaging • Tell a compelling, memorable story • If you don’t feel it, don’t use it • Know what networks you’re activating

7. Principle 1: Tell a coherent, memorable story • We are a story-telling species • Shopping lists of facts, policies, and 12-point plans lack • Emotional resonance • Memorability • The moral of the story: values and principles • Values are at the core of winning narratives • Universally, those on the left tend to hide their values in the fine print of their policies • Branding: define and differentiate • What happens when you don’t tell a coherent story? • You lose • Jim Martin’s introduction to the people of Georgia • Hillary’s Christmas

8. The GOP story on health care reform The Democrats want a government takeover of our health care system, because they believe government bureaucrats know better than you do what kind of health care and health insurance you need. They want to put a government bureaucrat between you and your doctor. They will ultimately set up rules for when you live and when you die, because government spending always mushrooms, and some board of bureaucrats is ultimately going to have to decide when to pull the plug on grandma. And the same that’s true of end of life decisions will be true of beginning-of-life decisions: They will publicly fund abortion, and they will decide which babies born premature or with birth defects are worth saving. And because there’s only so much money to go around, they’ll raise taxes on the middle class and cut Medicare benefits to seniors. And all of this talk of a “public option” just gets at their real motives: to drive out the private sector entirely, so we all have the public option, which means taking away our freedom to choose, because ultimately they don’t believe in the free market, and they don’t believe in the American ingenuity that has created the greatest medical care on earth. We all agree that we need reform and we’ll have reform, so that people with pre-existing conditions don’t have to worry about getting health care. But we don’t need socialized medicine to accomplish that. We need to use the principles of free market capitalism, because if we just followed those, we’d have government off our backs, efficiency, and freedom to choose.

9. The administration’s story on health care reform, summer 2009 46 million people don’t have health care in this country. Hmmm….that’s no good—we need a story that appeals to the middle class. Okay, scratch that. Costs for the average person are rising out of control. So we need to cover 46 million more people while cutting costs at the same time. Oh, that’s a little hard to believe…Electronic records? That’s chump change. OK, doctors should stop giving unnecessary tests, because we’ve all had the experience of having our doctor foist on us unnecessary tests—haven’t we? Hmm….that didn’t resonate. Okay, try this: We should tax the really good plans that some middle class people get from their employers because…we don’t like middle class people to have really good plans? Wait—I promised I wouldn’t tax the middle class—and taxing good employer-based health insurance was John McCain’s plan that I attacked because it will just give employers an incentive to stop offering decent insurance. But we need a public option, because it’s essential to creating competition in the health insurance market. Okay, maybe not essential. Maybe a co-op. Or a trigger, so when this all starts in 2013, if it doesn’t work out, maybe someone will pull the trigger, say, in 2020. And Olympia Snow likes triggers. We shouldn’t really have a public option anyway because Congressional Republicans don’t like it, and we have to have a bipartisan solution, even though voters thoroughly repudiated the Republicans in the last two elections, because true virtue lies in mixing failed ideologies with new ideas. And health care for all is a moral imperative, because I’m talking to an evangelical audience today, and our internal polling says they like that kind of thing.

10. What’s wrong with this story? • No narrative coherence • No antagonists • No moral • What are the underlying causes? • What are the solutions, and how do they follow from the causes?

11. Did the President solve the problem Wednesday night? • He clearly told a better story • Lapses in narrative coherence • No antagonists • Insurance companies kill people, but they aren’t bad people • Attacked unnamed politicians and then praised them by name • Mixed moral • Accepted GOP principles on abortion and immigration • What are the underlying causes, and why can’t he talk about them? • Is the problem political or psychiatric? • If you cut sweetheart deals, who is left to pick up the tab? • What are the solutions? • Take it from seniors • Take it from people with good plans

12. Principle 2: If you don’t feel it, don’t use it • Human behavior is motivated by emotion • If it’s emotionally inert, it’s politically inert • Greatest hits of Democratic communication I: Dukakis on Kitty • Greatest hits of Democratic communication II: Gore on Medicare • Jim Webb’s response to the State of the Union • The point is not to “dumb down” our messages • It is to increase their emotional intelligence

13. Why does speaking with emotion matter? • Feelings toward the parties and their principles • Feelings toward the candidates • Feelings toward the candidates’ personal attributes • Feelings toward the candidates’ policies • Facts about the candidate’s policies • Trickle Up Politics

14. Positive and negative emotions • Positive and negative emotions are not the opposites of each other • Do you love your spouse or partner? • Failure to inoculate and failure to respond to attacks: • Government takeover • Bureaucrats • “Illegals” • The deficit (cost) • You can’t win this debate after ceding populist anger to the other side • You can’t win with half a brain • On “hot” issues, people who are undecided are ambivalent

15. The four stories that matter the most in a campaign • What you say about yourself • What your opponent says about him/herself • What your opponent says about you • What you say about your opponent

16. Principle 3: Know what networks you’re activating • How have Democrats been so successful at losing on a winning issue? • S-CHIP • People who work for a living ought to be able to take their kids to the doctor • Universal health care • A family doctor for every family • The uninsured and the underinsured

17. The “public option” • You couldn’t design a worse phrase • Impersonal bureaucracy (DMV) • Low quality • You’re in an accident. Which would you choose? • Public hospital? • Private hospital? • Sounds like single payer • Alternatives • At least one insurance plan the insurance companies can’t control

18. A methodology for developing messages that work • Study the existing polls to understand the networks • Design messages and refine them in focus-groups • Poll and dial-test the messages online using large samples • Refine and test again • Identify a range of messages

19. Know your associations, Part I • Health care costs are skyrocketing • Pre-existing conditions • Many people are one catastrophic illness away from bankruptcy • Nearly 50 million uninsured • Both individuals and businesses are being strangled by the costs of health care • Changing jobs is now a health care choice

20. Know your associations, Part II • Socialized medicine • Government programs and bureaucracies • Personal control and choice • Many people are happy with their current doctor • If you can afford it, you can get the best medical care in the world • Illegal immigrants getting health care • How do you increase quality and cover nearly 50 million people without increases costs?

22. Project Goals and Summary • Translate the language of think tanks into the language of the living room and the kitchen table • Provide advocates of health care reform with principled stands we know in advance work • Identify the strongest attacks and counterattacks • Weed out language that is counterproductive

23. Methodology • Developed draft 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 • Ultimately used this work to develop and test ads

24. 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.

25. “A family doctor for every family” I believe in a family doctor for every family. It’s not right that hard-working Americans are struggling to afford health care and prescription drugs, while we’re strangling small businesses with the cost of their employees’ health care. The market hasn’t solved this problem, and it’s not going to as long as big insurance and drug companies are profiting at our expense. But we don’t 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 plans members of Congress get, because if it’s good enough for Congress, it’s 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 2/3 RATED HIGHER THAN CONSERVATIVE 25

26. “People who work for a living …” 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 shouldn’t risk losing their life savings because of one illness. We’re not just talking about poor people. We’re talking about middle class Americans who are getting squeezed. Too many people have to think twice before switching jobs or starting a business because they’re worried they won’t 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 what’s 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 life’s 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 2/3 RATED HIGHER THAN CONSERVATIVE 26

27. Conclusions • A campaign is not “a debate on the issues” • The economy was the deciding issue in the 2008 Presidential election • 6 in 10 voters reported having no idea how Obama intended to fix it • An effective campaign tells a coherent story that moves voters • In the words of that great unsung political strategist, Duke Ellington…