Frank Luntz, the guru of Republican phraseology and the ventriloquist behind the Republican lock step warnings against a "government takeover of health care," has given the Republicans a powerful sound bite. The Republicans are marching to the drum of a 28 page memo Luntz wrote for the Republican leadership. It's a brilliant text book of clever wordsmithing.
I've taken three of Luntz's list of "10 rules for stopping the 'Washington takeover' of health care" and tried to imagine how the president could parry the attacks that are now underway. First I quote from Luntz's memo. Then I've put the words I imagine the president using into bold italics:
Luntz: "Humanize your approach. Abandon and exile ALL references to the “healthcare system.” From now on, healthcare is about people. Before you speak, think of the three components of tone that matter most: Individualize. Personalize. Humanize."I'm a doctor who's interested in ethics, not a sound bite machine. I'm no Luntz. But I think the president can perform jiu jitsu on Luntz's tactics and turn the force of Luntz's practical advice in the direction the health care system really needs!
The president has made a good start humanizing and personalizing the issue of health care costs. We (the American public) need to understand that less spending (done right) means better health, not worse. Here's how the president could follow Luntz's advice: "Out of control health care costs are a cancer. They've pushed our economy to the brink of collapse and they're ruining the health of the country. Losing a job hurts our health. Losing a home hurts our health. Getting a grip on runaway spending will be good for our health and our economy!"
Luntz: "Healthcare quality = 'getting the treatment you need, when you need it." That is how Americans define quality, and so should you. Once again, focus on the importance of timeliness, but then add to it the specter of 'denial.' Nothing will anger Americans more than the chance that they will be denied the healthcare they need for whatever reason. This is also important because it is an attribute of a government healthcare system that the Democrats CANNOT offer. So say it. 'The plan put forward by the Democrats will deny people treatments they need and make them wait to get the treatments they are allowed to receive.'"
The president has a tough challenge here. The public believes that more care is better care and less care means worse health. Wise physicians know that "getting the treatment you need, when you need it" means care that would be significantly different in nature (more primary care, less specialty care) and quantity (more time with the doctor, fewer procedures) than what we have now. Here's how the president could follow this piece of Luntz's advice: "Wise doctors - the kind of doctor we all want to have for ourselves and our families - know that the best medicine involves more listening and more healing attention then they can give now. We must stop forcing them to do tests and procedures that aren't needed. Tests and procedures that are done because doctors are afraid of being sued or because they can't take the time that's needed don't just drive up costs - they cause harm by all the complications that can occur.
Luntz: " 'One-size-does-NOT-fit-all.' The idea that a “committee of Washington bureaucrats” will establish the standard of care for all Americans and decide who gets what treatment based on how much it costs is anathema to Americans. Your approach? Call for the “protection of the personalized doctor-patient relationship.” It allows you to fight to protect and improve something good rather than only fighting to prevent something bad."
The president has to undermine the argument that whatever the individual physician wants to do is the right thing. We know that close to half of the care delivered deviates from what the best physicians would do. And we know that when Michigan routinized what was done in its intensive care units potentially fatal infections were almost completely eliminated. Here's how the president could use the tactic Luntz proposed to the Republicans: "We want our doctors to have the best information about what works. That's what let's them cure our cancers and relieve our pain. Our plan invests in research to tell them which treatments work, which don't, and which actually cause harm. Our doctors want this kind of knowledge so they can do what they went into medicine to do!"