Loaded Health Care Words and Terms

“Redistribution is a loaded word that conjures up all sorts of unfairness in people’s minds.  It’s a word, in the political world, you just don’t use.”

William M. Daley, President Obama’s former chief of staff, as quoted by John Harwood, “Don’t Dare Call the Health Law ‘Redistribution’” New York Times, and November 24, 2013

Throughout the process of creating the health care law, the Obama administration knew the law would create winners – the uninsured, the underinsured, and those with lower incomes requiring subsidies – and losers - the wealthy, the middle class, employers, and the young.   

And they knew certain words were emotionally explosive, like “redistribution”. It conjured up the image or association with “class warfare” or other terms that rendered rational or unprejudiced thought difficult. 

In other words, the idea of “bringing the poor and dispossessed “into the economic mainstream of health care had to be gingerly approached.

When it comes to health care reform and the health law, “redistribution” is not the only loaded word or expessions as well.  Politicians  and critics know them well.

They include.

·         “Fair share,”  “Fair shake.”  “Together.” As President Obama said  in his re-election campaign, “ Understand this is not a redistribution argument. This is not about taking from the rich to give to poor people.  This is about us together making investment in our country so everybody’s got a fair shot.”   That was the last time the President used the word “redistribution.”   For good reason.  His ideological opponents picked up the word and used it as a hammer against Democrats. Stephen Moore, senior economics writer for the Wall Street Journal,  devoted an entire book to the counter argument – that redistribution diminishes opportunity for the ambitious and talented,  raises taxes, burdens entrepreneurialism,  and redistributes wealth ( Stephen Moore,  Who’s the Fairest of Them All? The Truth about Opportunity, Taxes, and Wealth in America, Encounter Books, 2012).

·         “Affordability.”  “Accountability.”  “Transparency.”  These are the key words the Obama administration deployed to justify the Health Care Law and to make it palatable.  These words would make the law more”affordable” to all without being unfair to anyone. Everyone would be held “accountable” especially those who were unfairly “profiting” from providing health care, among them health plans, hospitals, physicians in the medical industrial complex.  The law would be “transparent.”  Everybody would know why, when, what, and how the left hand of government and right hand of business were doing  through the use of electronic medical records and digital monitoring  at the point of care. Costs would be lowered, quality would be raised, and economic playing field would be levelled.

·         “Single-Payer”    “Universal Health Care.”  “Socialized Medicine.”  These loaded terms were verboten. The existing system of employer-provided insurance would be preserved,  the individual insurance market would be phased out, Medicare Advantage would be gradually ended, Medicaid would be expanded, and the fears of the Middle Class would be addressed by promising you could keep their health plans,  doctors, and hospitals.  Through a hybrid plan, disruptions would be minimized and equality would be maximized. – all without a whimper of dissent. The political dice would be loaded to fall in a particular way, and no one would notice otherwise.

·         “Obamacare.”  “Accountable Care Act.”  “ACA.”  The “Accountable Care Act,” rather than the full name, “Patient Protection and Affordable Care Act,” was at first in favor.  It was neutral.   Its positive features - covering children, those with pre-existing illnesses and young adults under their parent’s plans could be emphasized.   The “ACA” shorthand never caught on, perhaps because it smacked of a bureaucratic acronym   in the beginning, policy makers and shakers did not like “ObamaCare,” too political, too pejorative, too partisan, and too narcissistic.    But the name stuck, and President Obama finally embraced it when he saw it wasn’t going away and, besides, it showed how much he “cared.”

·         “Tea Party.” “Extremists.”  “Republican  Obstruction or Opposition.”  These terms are frequently employed to explain why the health law is not selling well among the public at large and  its key subgroups – employers and business, those who have lost their plans, those reeling from “sticker shock,” independent physicians, the unemployed, residents of Red States and Governors who resist Medicaid expansion.   It does not seem to matter that these dissidents did not write the law, did not create the exchanges, did not design or have a hand in creating healthcare.gov.   Somehow “they” are responsible for the health law’s unpopularity, rocky implementation, and ensuing chaos.  Somehow “they” created the instability and uncertainties surrounding the law.  Somehow “they’ managed to hide the fact, or the “facticity,” a new word for me, that the law punishes those in good health, the young, the self-insured,  the middle class who  do not qualify for subsidies, and those who want to buy plans based on their needs, not government who needs their money to finance an unpopular law.

Tweet:  Certain words or terms are politically correct or incorrect and effective  in selling or opposing  implementation of the health care law.