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Herndon Alliance’s misleading messaging leads to failure of real health care reform

October 12, 2009

This was first posted last month on Social Medicine Portal.

Over the past several years, in almost every meeting I’ve attended about health care reform, someone has suggested using “messaging” strategies to communicate more effectively. They often mention the Herndon Alliance as a resource. Herndon has been described as “the most influential group in the health arena that the public has never heard of … the messaging arm of a vast center-left infrastructure pushing health care reform.” But I’ve concluded that over reliance upon messaging strategies in general, and on message recommendations from the Herndon Alliance in particular, is a main reason real health care reform will fail this year.

“Messaging” uses techniques from public relations and cognitive science that tap into people’s values and beliefs in order to create an emotional reaction that leads to opinion or behavior change. Sophisticated messaging relies upon in-depth research through surveys, focus groups and other methods to discover clusters of values and beliefs that groups of people share. Any individual tends to fall into one of these clusters. Communications can then be tailored to reach particular groups. There is no doubt that these techniques can be effective in changing minds because they are the same techniques that sell us new cars and shoes every year. They can be used to promote anything without regard for the truth or evidence. For people working for true social justice this kind of strategy can never be effective.

One of the tenets of the messaging strategy is that most people don’t reach opinions based on evidence or facts. Herndon’s specific messaging strategies discourage any mention of facts. Since it is always easier to sow doubt than confidence about any change, messages with no connection to fact or reality give an advantage to the status quo. People’s beliefs are often not based upon learning but on misperceptions acquired through individual experience, the grapevine and the media. Catering to these beliefs and values means reinforcing them, even if they are untrue or against the general welfare.

Progressives are angry about the tales of “death panels” spread by the right wing. However, the messages Herndon promotes are also misleading. Not in the outrageous way that right wing messaging is, but untrue just the same. A current statement recommended by Herndon is, “Reform will give us the freedom of secure choices—to keep our plan and doctors, to choose another private plan, or the choice of a robust public health insurance option.” As it looks now, this statement is false. It is likely that only people without insurance from their employer will have the option of choosing the public plan – if there even is a public plan. If you get insurance through your employer, your employer chooses your plan options, and can switch them at any time.

Trudy Lieberman, in Columbia Journalism Review, noted another misleading Herndon frame.

(Herndon) advises: “Don’t just say ‘bring costs down,’ … It is better to say ‘health care reform will make health care AFFORDABLE—it will cost less and you will get more.” Hey guys, that’s not likely to happen if the current nostrums for reducing medical costs remain the only ones on the table. As for getting more? The current trend in health insurance—shifting costs from insurers and employers to policyholders—means thousands are getting fewer benefits, not more.

The Herndon messaging suggestions are worded this way because their goal is to get people to accept whatever ends up emerging from the legislative meat grinder as “health care reform”. Rather than messaging about specific demands, they use words with highly positive associations to state what health care WILL do: “You will have the choice of a QUALITY affordable public health insurance plan.” This phrase doesn’t explain what characteristics a QUALITY public plan should have so that people can demand those characteristics from the congress.

There is no guarantee that the health care system we get after the legislation passes will be anything like the Herndon Alliance says. Even if people agree with the messages, they also hear the claims made by Republicans. They (rightfully) don’t trust the congress to deliver what is best for ordinary people. The health care reform debate becomes a competition between which set of misrepresentations you want to believe in. And with a third of Americans illiterate or barely literate, and most getting their news from television, they don’t have any rational basis on which to decide.

Messaging works most effectively on an uninformed disempowered population and serves only to further disempower them. The Herndon Alliance disconnects people from real potential solutions to the US health crisis with messages like, ‘Health care reform will be a uniquely American solution.” This reinforces the already deeply ingrained and harmful belief in American exceptionalism, preventing people from learning from the experiences of other countries where there are better health systems.

Even health care reform activists seem to get confused by these messages. They begin to think of messaging recommendations as true statements about the actual legislation or as policy recommendations. Because of the language about “keeping your plan if you like it” some activists, are losing sight of the fact that what people really want is to be able to keep or choose their medical providers. Beyond that, “progressive” activists shouldn’t be promoting the idea of keeping your private insurance as characteristic of good reform when the private insurance system is the problem in the first place.

I am not arguing that opinion and values research isn’t useful to help activists understand what the general population or subgroups are thinking. But activists shouldn’t be so naïve as to accept the analysis and recommendations of one group without considering that group’s political goals. All opinion research is biased by the questions that are asked and the way they are asked. (I won’t critique Herndon’s research because it has been done elsewhere: HERE and HERE). Although it claims to be non-partisan, Herndon has very close ties to the Democratic Party. Democrats are the recipients of huge amount of money from the insurance, health care and pharmaceutical industries. Most analysts agree that failing to pass some kind of health care reform legislation will be a huge blow to the party. They have to pass something and Herndon has its own ideas about what it wants. What they specifically don’t want is national health insurance (single payer) and all of their messages are designed to keep people from considering that idea on its merits and convince activists that Americans don’t support it.

Like the founding and board organizations of Herndon Alliance, Families USA, Health Care for America Now (HCAN), AARP, and SEIU, most of the approximately 200 Herndon Alliance partners are groups that either have never supported a social insurance or single payer model, or are so convinced it is not politically feasible (some sincerely and some not) they will support almost any other reform when faced with a choice. Many have actively undermined campaigns for single payer that would have had a chance for success – if all “progressives” stuck together. The same scenario we are going through nationally has happened repeatedly on the state level with the same groups. Although their goal is “high-quality, affordable health care for all Americans,” the specific policies they push are those that increase access by increasing the flow of money from individuals and the government to the private insurance and pharmaceutical companies. Families USA, SEIU, and AARP are part of the PR front groups Healthy Economy Now and Americans for Stable Quality Care that also include Pharmaceutical Research and Manufacturers of America (PhRMA), the American Medical Association, the Business Roundtable, and the Federation of American Hospitals. These coalitions have presented millions of dollars of TV commercials promoting health care reform using the same warm and fuzzy misleading language as Herndon.

The climate for health reform this year is different for one reason: the rate of profit that insurance and pharmaceutical companies are making has reached its limit in the US. They need more customers to keep growing. The current health care reform increases profits by 1) requiring people to buy insurance products 2) providing government subsidies so they can actually afford the products. Even the so-called public option, since it is completely undefined (and has functioned as a marketing slogan, a bargaining chip, and a red herring for opposition), can easily be structured to channel public funds into private profits. For example, it could be modeled after some state employees’ health plans, where the government pays private health plans to provide health coverage, while assuming the financial risks involved

The question remains why so many self-identified progressives are buying the Herndon Alliance strategy and message. Some just haven’t taken off the glasses and are themselves manipulated by Herndon rhetoric. Some are looking for a way to change opinion without doing the hard work of political education and consciousness raising. For the rest, Helen Redmond had a good explanation in Counterpunch.

For the Democrats, with the exception of John Conyers and a few others, they simply don’t want to abolish the private insurance industry. They are capitalists and believe in the capitalist system that makes health care a commodity to be bought and sold. For them, health care is not a human right. And importantly, they don’t want to take on President Obama who is opposed to single-payer. Like the  true cowards they are, they will not oppose Obama on health care reform even though they disagree with him.

HCAN thinks it’s impossible to get rid of the insurance companies, they’re too powerful, and they have too much money and influence. They don’t believe a large social movement can be built to take on and win against the insurers and the government. The leadership of HCAN are the ones who would have said under slavery, “We can’t win abolition, so let’s settle for a few reforms that make the lives of slaves more bearable.”

Public relations strategies are the antithesis of a human rights based or social justice approach. Social justice requires meaningful participation by people affected by a problem. Meaningful participation means that people must have the capacity to engage in advocacy for themselves. They need to participate in identifying the problem and its causes, and be supported with the tools and resources to understand it. Then they must be engaged in making demands on their representatives, government or other duty bearers. These citizens will be resistant to PR manipulation by any party. With our government seemingly incapable of making policy based upon evidence and the general, rather than corporate, welfare, there are no shortcuts to social justice.

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