Anatomy of Health Care Messaging Part 2

Negativland: Health Care & Conservative Freedom
by Robert Kraig, executive director

In the last edition of the Progressive Points Message Blog, we began our five part series on the epic battle for the future of health care in the United States with an analysis of the motives of conservatives, explaining why they are trying to make ObamaCare the Northern Ireland of American politics. Their frenetic attempts to undermine health care reform stems from their deeply felt belief that the precedent of guaranteed health care and strict regulation of health industry abuses is a serious threat to the conservative project to handcuff the capacity of democratic government to intervene in the economy to pursue social equity. (Rigging the economy to benefit large economic actors is a legitimate use of government for 21st Century American conservatives, with the possible exception of a handful of libertarians).

In the conclusion of part 1 of this series I suggested that the battle for the hearts and minds on health care reform comes down to clashing conceptions of freedom. Part 2 of our series begins to dig into the battle to define freedom, starting with the negative vision of freedom propagated by conservatives (which we will explain in detail later in this blog).

Even the most casual observer of conservative health care messaging will notice that it focuses obsessively on alleged threats to the freedom of average Americans. The conservative tactic in 2010 was to use a constant stream of fear mongering claims (many made up out of whole cloth) to whip their base into a frenzy, a strategy that was so successful that it sparked the Tea Party outburst in the Summer of 2010 which has had on-going ramifications for American politics. Mostly but not always coded racial appeals focusing on President Obama were combined with a series of triggers which evoked a deep seated fear that traditional American freedoms were being taken away by an intrusive federal government.

“ObamaCare puts Washington in charge of your health care,” is consistently the best conservative poll tested message. This fits in perfectly with their long term attack on government, and as a frame leaves out of the picture all those who have no reliable access to affordable health coverage. The only people in the frame are Americans who don’t think they need any assistance from government to get good health care. (Never mind the fact that the U.S. spends more on making employer-based health care tax free, regressively benefitting those with jobs good enough to provide health coverage, than it does on the ACA). This frame is powerful enough that even Medicare recipients believe they fit within it. (Remember the Tea Party rally signs: “Keep Government Out of My Medicare”).

There are a number of variations on this theme that are deployed based on news cycles. In 2013, conservatives trumpeted the fear that millions of people were having the health policies they liked cancelled by ObamaCare regulation. The most infamous threat-mongering was Sarah Palin’s deliberate lie that ObamaCare established “death panels.” But even this extreme fabrication, believed for the time being only by the most ardent Tea Party adherents, is fully aligned with the broader conservative freedom frame.

This idea that any government expansion of guaranteed health coverage interferes with private medical decisions is by no means new. This conception of health care freedom was at the heart of the AMA’s vehement opposition to national health care from the 1920s through the 1990s, and was articulated cynically and powerfully by Ronald Reagan when he infamously asserted that Medicare was a slippery slope towards extinguishing all American freedom.

There are two reasons this vision of freedom works for conservatives.

First, there is the distinctly personal way American think about health care. It is with good reason that America was the last major industrial country to adopt a national health care system. Americans do not think about health care in terms of systems or social goals. This is why telling Americans in focus groups about the number of uninsured or the advantages of a “single payer system” fall flat. (Citizen Action was involved in focus groups in August which reaffirmed this finding). The deep opinion research in 2006-2009 by the Herndon Alliance that was done to prepare for the campaign for the ACA (in which Citizen Action of Wisconsin was a partner) identified a very individualistic version of freedom as the dominant way Americans view their relationship to health care. Mostly they think of it in terms of their own personal control, and much more as consumers than as citizens. Health care is a very private and personal matter, and there is a visceral belief that decisions ought to be between patients, families, and doctors without coercion from external actors.

Combined with traditional American attitudes towards government, stirred to a fever pitch by the conservative communication infrastructure, this fear of interference in personal health care decisions is a powerful weapon conservatives have very effectively wielded against the ACA.

Second, conservatives have at their disposal the emotional power of a negative conception of liberty where freedom is understood as an absence of external constraints. (Liberty is the more archaic term, and has been largely superseded by freedom in the 20th Century).

All invocations of freedom, when effective, have emotional power. In his book Whose Freedom?, cognitive linguist George Lakoff offers a trenchant explanation. Lakoff argues that all versions of freedom rely on a metaphor for bodily experience. When one is moved by effective language to believe their freedom is being violated, what is evoked is the kind of emotion one feels when being physically restrained, chained, held back, imprisoned, or otherwise blocked from going somewhere they want to go (Lakoff, Whose Freedom?, pp. 26-28). This metaphor for physical restraint is what gives freedom its emotional power.

There is good reason to believe that conservatives have an advantage in triggering this moral emotion because their appeals tend to be grounded in an older and more visceral version of freedom.

Drawing on a philosophical concept going back at least 250 years, the British Philosopher Isaiah Berlin distinguished in the 1950s and 1960s between positive and negative liberty. More recently, the psychologist Jonathan Haidt has done interesting work on the implications of these two competing versions of freedom for American politics.

Negative liberty is the absence of constraints, and tends to focus on external intrusions into individual autonomy. Positive liberty, the newer conception which underlies political progressivism in the United States, focuses on the creating the conditions needed to live a fulfilling life, usually public structures like a first-class education system, affordable housing, access to family supporting jobs, programs to make up for historic discrimination, etc. Louis Hartz in his classic work Liberalism in America, brilliantly accounts for how a very negative and emotionally visceral version of liberty has dominated most of American history, and made it impossible for socialism to ever gain a major foothold.

Progressive “positive liberty” can evoke powerful emotions, but it is more challenging because it is focused on more abstract concepts like high quality public education system. One of the chief messaging challenges for progressive health care advocates is to find a way to match the moral intensity of the right’s negative freedom in appeals that build public support for a health care system that guarantees affordable care.

As we will see in part 3 of this special health care series, part of the answer is an Orwellian term devised by insurance industry bureaucrats to suppress emotion: “pre-existing conditions.”

The Anatomy of Health Care Messaging Series

Part 1: The Northern Ireland of American Politics

Part 2: Negativland: Health Care & Conservative Freedom

Robert Kraig is executive director of Citizen Action of Wisconsin. He holds a PhD in Rhetoric (University of Wisconsin-Madison, 1999) and has published a number of articles and a book on American public discourse. He is one of the leaders of a major new project to transform Wisconsin progressive communication which is a partnership between Citizen Action of Wisconsin, High Ground Institute, and Wisconsin Voices. Robert can be reached at

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