The Anatomy of Health Care Messaging Part 1

The Northern Ireland of American Politics

by Robert Kraig, executive director

In this edition of the Progress Points Message Blog we begin a five part series on one of the most consequential divisions between conservatives and progressives in America today: health care reform.

Since we launched the Progress Points Message blog this spring we have explored core concepts such as the progressive over-reliance on fact-based persuasion and the importance of conceptual metaphors.  We have also explored issue topics, such as the right’s exploitation of code racism, privatization, budget and revenue fights, and the building blocks for a more compelling progressive economic message.

To dig deeper into how we can develop transformational message strategies, it is instructive to break down one major issue area. Health care is our first guinea pig both because we at Citizen Action of Wisconsin have already developed a ten year communication strategy in that area, and because it is one of the handful of highly contested first tier issues that will determine the future role of American government in promoting economic and social justice. In fact, the hotly contested health care debate is a surrogate for the broader debate about the future role of government in American society.

To develop a serious long term message strategy you need a clear headed analysis of the broader context in which your persuasion will take place. One core element of this context is the fundamental motives and purpose of the opposition. Not understanding the opposition would be like an NFL coach devising a game plan without accounting for the specific team they are playing on Sunday: you need a different game plan for the Bears than for the Vikings.

Although it is been frequently misunderstood by many mainline Democratic politicians, it is for very good reason that conservative elites have thrown everything they have into vanquishing the Affordable Care Act (ACA). The heart of the modern conservative project in America is to disable the power of democratic government to intervene in the corporate economy. Health care reform threatens the core of this project because it is a keystone progressive issue that is capable of shifting public attitudes towards the role of government and markets. Just as the tax issue has been used by conservatives over the last four decades to constrain proactive efforts to guarantee social and economic opportunity (by defunding them), the expanded government role in the health care system supports core public values which have the potential to warrant bold action on a whole range of other progressive social and economic justice issues. The success of comprehensive health care reform will open new space for other fundamental progressive reforms, while its failure could foreclose these possibilities.

At the inception of the current division over health care, Conservatives understood this much more quickly than most Democrats, and moved very quickly early in the 2009 legislative process to consolidate complete partisan ideological unity. It is often forgotten that the Tea Party rebellion, systematically fomented by the vast conservative communication apparatus, targeted not only Democratic officeholders but also the handful of GOP leaders who were constructively working with the Democrats in Congress on ACA, quickly scaring them into renouncing long held policy positions and falling into lockstep opposition.

This is why the debate over “ObamaCare” seems like the Northern Ireland of American politics (it never seems to end). Despite President Obama’s attempt to attract crossover support by adopting a number of policies developed originally by right-wing think tanks, conservative elected leaders who had long supported these provisions quickly turned against them. Ever since conservatives have been on a seemingly permanent war footing trying to undermine the ACA anyway they can, including the courts, elections, and the use of GOP control of Congress, Governorships, and State Houses. This emotional intensity has produced a conservative movement imperative to constantly offer fresh acts of opposition, leading to a ridiculous 56 repeal votes so far, putting every Republican member of Congress on record for unconditional repeal.

Both GOP party leaders and conservative independent expenditure groups have a strategy of consistently elevating ObamaCare as an electoral issue, and have poured millions of dollars into paid media, both for immediate purposes (winning elections) and long term purpose of motivating the base, keeping the law unpopular, and achieving eventual repeal. One of the great successes of this conservative infrastructure-led backlash has been making health care a defining partisan issue. You can’t be a good conservative unless you vehemently oppose ObamaCare. In the 2016 election campaign, every single GOP candidate for president is campaigning on repeal of ObamaCare. Despite some lip service to “repeal and replace,” conservatives like Scott Walker are not offering serious alternatives because their real goal is to deny the expansion of the government’s role in guaranteeing affordable health care for all Americans.

In fairness, it has likewise become an article of party loyalty for Democrats to support ACA, and oppose repeal, but emotional intensity is much lower than among conservatives. Many Democratic politicians, conflict-averse by nature, are confounded by the intensity of movement conservatives on the issue in their own districts. Many Democratic officeholders add nothing to the defense, try to avoid the issue, and seem themselves confused by the law. The complexity of the law, the slowness of the White House to develop effective message framing, and the lingering aftertaste of the disastrous rollout of, have contributed to the problem.

Contrary to the economic determinism that still pervades many sectors of progressive thought, a purely economic analysis can’t account for the intensity of conservative opposition to ACA. While it is true that major vested interests such as the health insurance industry and conservative business associations such as the U.S. Chamber of Commerce and NFIB oppose ACA, it was supported by powerful economic interests such as the hospitals, the AMA and other medical providers, and even Pharma. In addition, hospitals and doctors have strongly supported Medicaid expansion across the country, often clashing with conservative governors and legislators. Vehement conservative opposition to health care reform has an ideological (i.e. worldview) component that goes well beyond the influence of economic interests.

This conservative worldview is expressed powerfully in their dominant health care message frames and narratives, especially in their insistence that the ObamaCare is a violation of the freedom of Americans to control their own health care decisions.

In Part 2 of this special health care messaging series, we will dig into the clash of contesting versions of American freedom exemplified in the battle over health reform. As we will see, when it comes to winning or losing the hearts and minds of the American people, this is the main battlefield progressives must contest to firmly establish the ACA and to move beyond it to building a health care system that works for every American.

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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