War of the Words

Public opinion on health care reform is shifting rapidly.  Public disapproval of Obama’s “handling of health care” rose from 42 percent in June to 52 percent in July according to a Quinnipiac University poll.  As the New York Times reports, “President Obama’s ability to shape the debate on health care appears to be eroding as opponents aggressively portray his overhaul plan as a government takeover that could limit Americans’ ability to choose their doctors and course of treatment.”


This ten percent change in opinion in less than a month is dramatic considering that public opinion scholars rarely find such large shifts in such a short period.  What is it that accounts for this dramatic change?  The primary factor is probably not the substance of health care reform itself, since no bill has yet emerged from Congress.  Five proposals are still floating around in committees, and information on which will win the day is scant.  This suggests that some other factor is at work in changing public attitudes.  A more likely cause is the effort on the part of Republicans in Congress and town hall crashers to muddy the reform debate.


According to an August USA Today poll 69 percent of Americans report following the town hall skirmishes either “very closely” or “somewhat closely” in the news.  Most of those questioned feel that “angry attacks” on members of Congress are a sign of “democracy in action,” although most reject the “shouting down” of representatives as excessive.  About a third of Americans say the demonstrations “have made them more sympathetic to protestors’ views.”  While the attacks of town hall protestors may not be convincing everyone, they are clearly making an impact on a large number of people.


There’s much disagreement about whether the town hall skirmishes are degrading the quality of debate on health care.  It is undeniable that those who are protesting Obama and the Democrats are guaranteed the first amendment right to speak up against government and that they are entitled to be as rude as they like in public forums.  Whether this kind of discourse is harmful to a vibrant democracy, however, is another question.  Modern political philosophers often stress the need for open dialogue in the effort to promote democracy.  An individual’s belief system, they contend, is enriched when that person seriously wrestles with the competing claims of others.  Hans-Georg Gadamer argues that we need to “put ourselves in someone else’s shoes” if we want to create a “genuine human bond” with others.  Jürgen Habermas laments those who pursue a “one sided dominance” of discussions, since this approach instrumentally uses others simply to win a debate.  Those who are interested in “rational expressions,” he argues, express “a willingness to expose themselves to criticism.”


There is little indication that the screaming and shouting in town hall meetings constitutes an open dialogue on health care.  Sarah Palin’s fabricated claims – disseminated faithfully by conservative media – that an emerging health care bill will establish “death panels” that allow the state to kill elderly people – do little to encourage democratic debate.  Town hall crashers often attack health care reform by relying on emotion over substance.  Demonization of the Obama administration for promoting “big government,” “socialism,” health care “rationing” and “death panels” does much to incite public outrage, while distancing town hall crashers from a productive discussion of reform.


Aside from hateful rhetoric, we should consider some of the forms of coercion that are emerging from the town hall meetings:


          A health care protestor in New Mexico has encouraged those who read his Twitter comments to take their guns to town hall meetings and to shoot ACORN and union members if they are provoked.


          A St. Louis man who attended a local meeting to protest health care reform initiated an unprovoked attack on a black minister who attended the meeting.  The minister criticized the man for selling buttons depicting Obama in blackface, and was pushed to the ground and repeatedly punched in the face.  The beating continued, despite the assailant being informed that the man was a minister and that he wasn’t going to fight back (see Don Fitz’s “Health Care Foes Start Violent Fray in St. Louis”).


          An anti-Obama protestor at a health care town hall meeting in Portsmouth, New Hampshire stood outside the meeting with an anti-Obama placard and a 9mm openly strapped to his leg.  When asked if the gun was loaded, the protestor responded: “Well, who would be silly enough to carry an unloaded firearm?”


          Protestors across the country – echoed by Rush Limbaugh – now compare Obama to Hitler in town hall meetings.  Demonstrators carry signs reading “Hitler Gave Great Speeches Too,” and “No to Fascism.” Limbaugh claims that Obama’s health care logo “looks damn like the Nazi logo” and that there is a “similarity between the Democratic Party of today and the Nazi Party in Germany.”



Most of the town hall protestors may be peaceful, but the combination of irresponsible rhetoric (claims that Obama is a Nazi, for example), when mixed with violent actions, are a recipe for fascism.  These developments are a danger to democratic discourse.


While the liberal commentators at MSNBC stand behind the president and the “public option,” Fox News pundits lambaste not only Obama’s plan, but single-payer health care.  Very little effort is made to explore the differences between the public option and single-payer, as they are lumped together as a singular “socialist” threat.  My review of all Fox News programming from July 29th to August 11th finds that 18 programs referenced single-payer health care, most of them failing to distinguish between Obama’s proposed reforms and single-payer proposals (single-payer proposals, to date, do not seriously enter into Democrats’ plans).  Some examples below are instructive: On his July 30th program, Sean Hannity linked “the single-payer system” with “rationed care.”  On the July 29th Your World with Neil Cavuto, Republican Congressman Bobby Jindal warned: “if what they [Democrats] really want is another step towards a single-payer system, I don’t think you can get bipartisan agreement on that.  So long as they continue to insist on a government-run health care plan, I think that is going to continue to cause problems for conservatives, for Republicans.”  On the August 5th On the Record, Greta Van Susteren prodded Obama’s former physician – who supports single-payer health care – about “whether [Medicare] might interfere” with patients getting medical service (Medicare is a single-payer based program).  Regarding the public option, Fox is similarly vigilant in its rhetoric.  Reporter Trace Gallagher expressed this approach best when he admitted – after cutting away from Obama’s town hall meeting – that Fox would continue its reporting of Obama’s speech if there was evidence of “any contentious questions [and] anybody yelling [against the proposal].”  Of course, demonization and incitement are not the only ways to kill discussion on single-payer care.  The most popular way to do this is simply by refusing to mention it as an option – a tactic preferred by mainstream media (for more see the FAIR study: “Media Blackout on Single-Payer Healthcare”).


It also doesn’t help public debate that many conservatives are taken in by racist and xenophobic characterizations of the president.  Distortions disseminated by conservative media take a dramatic toll on Obama’s reputation.  As of April 2008, an estimated 10 percent of Americans, (and an alarming 23 percent of Texans) believed Obama was a Muslim.  A poll from July of this year finds that Republicans widely embrace the “birther” conspiracy theory – which claims that Obama is not a U.S. citizen.  Amazingly, 58 percent of Republicans said that Obama was either not a citizen or that they were unsure of his citizenship.


A responsible reframing of the public debate on health care requires tackling a number of issues:


Death Panels


Reporting needs to consistently emphasize the fact that there are no “death panels” in the reform proposals.  Sarah Palin popularized this claim when she implied on Facebook that Obama and the Democrats are out to kill her baby and parents: “The America I know and love is not one in which my parents or my baby with down syndrome will have to stand in front of Obama’s death panel so his bureaucrats can decide, based on subjective judgment of their level of productivity in society, whether they are worth of health care.  Such a system is downright evil.”  The claim caused quite a stir in the media.  In reviewing Fox News shows in the week following Palin’s statement, I found that Glenn Beck, Bill O’Reilly, Neil Cavuto, Sean Hannity, Bret Baier, and Laura Ingrahim were all sympathetic to the claim that Democratic health care reform would either impose death panels or something similar to it.  Death panel claims are not substantiated in reports on health care reform.  The New York Times reports that “there is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure.”  The end of life provision in question – which was eventually jettisoned from Congressional debate because of the death panel fiasco – merely required that patients speak with their doctors about how best to obtain service if they or a family member are terminally ill.  As the Wall Street Journal reports, “tucked inside a sweeping House bill to overhaul the health system is a provision that would require Medicare to pay physicians to counsel patients once every five years.  During those sessions, doctors could discuss how patients can plan for such end-of-life decisions as setting up a living will, obtaining hospice care or establishing a proxy to make their health decisions when they are unable to do so.”



Socialism, Big Government, and Rationing 


It is worth looking at the perspectives of doctors for an answer to these charges.  One such doctor, Obama’s former physician David Scheiner, is speaking out publicly against the public option and in favor of single payer health care (a.k.a. Medicare-for-all).  On the charge of socialism, Scheiner says that a single-payer health care system – which is far more progressive than what Democrats are proposing – still relies on “private doctors, private hospitals, private clinics, private companies making the [medical machines], the only thing that’s national is the insurance.”  At best, then, to claim that the system is socialized is an exaggeration, if not an outright distortion.


On the issue of “rationing” health care, Scheiner explains that under private health care, “every patient I see, the insurance people are in the room watching me telling me what I can do and what I can’t.  Medicare [as a single-payer system] has never interfered with me…Medicare doesn’t tell us which hospital to go to, doesn’t tell us which specialist we can use.  It’s extraordinarily rare that it ever denies a procedure.  Private insurance is doing this all the time.”  Addressing anxiety over “big government,” Scheiner fires back that “we [already] spend $400 billion a year in handling administrative costs of health care that would cover the 50 million who are uncovered” under Medicare-for-all.  In short, Medicare-for-all would probably cost less than private health care.


While rational citizens are free to disagree about the merits and drawbacks of a Medicare-for-all, Scheiner’s comments at least demonstrate what one would expect from those contributing to a productive health care debate.  The use of concrete evidence, statistics, and relevant personal experiences are a way for doctors to add nuance to the debate over health care, whereas the abstract attacks on Obama as “Hitler” and the Democrats as “socialists” do nothing to encourage respectful debate.


While the mass media and town hall crashers play an integral role in demonizing Medicare-for-all, polling firms also play a vital role in limiting debate.  I’ve seen little evidence in the polls I read of any questions probing the public on whether they support Medicare-for-all, in contrast to the more limited public option supported by Democrats.  What very little survey data I can find on Medicare-for-all polling suggests that people do support it, despite the media blackout. Polling from as far back as 2007 shows that 64 percent of Americans support “a national health insurance program for all Americans, even if this requires higher taxes.”  A July 2009 poll from the Kaiser group finds that, as of July 2009, 59 percent of Americans support "having a national health plan in which all Americans would get their insurance through an expanded, universal form of Medicare-for-all." What’s truly fascinating is that the Kaiser poll finds that, when the words "single-payer" are added to the same question, support drops by nearly 10 percent.  This is a strong indication that political officials and media are able to manipulate public opinion and demonize a program, not in substance, but through buzz-word phrases.


Mass media, pollsters, Republicans in Congress, and town hall crashers are creating a perfect storm in order to demolish health care reform.  Unfortunately, the use of name calling and slogans is replacing reasoned, open debate on how to move forward.  Of course, it’s not too late to promote a respectful dialogue.  The sooner we realize the toxicity of today’s mudslinging, the quicker we can promote a real discussion of the problems that burden the American people.



Anthony DiMaggio teaches U.S. and Global Politics at Illinois State University.  He is the author of Mass Media, Mass Propaganda (2008) and When Media Goes to War (forthcoming February 2010).  He can be reached at: adimagg@ilstu.edu

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