The Selling of Health Care Reform

Last week, several new polls appeared that underscored the rhetorical challenges facing supporters of the Affordable Care Act (ACA). In the most recent USA Today/Pew poll, for example, a majority (53%) of Americans now disapprove of the health care law; remarkably, a similar percentage disapproved of President Obama’s handling of health care policy. The most recent NBC News/Wall Street Journal Poll revealed that even Americans who are currently uninsured remain unpersuaded that they’ll be better off after the implementation of the ACA; 34% of uninsured Americans believed they’d be worse off under reform, while a majority (52%) felt the law would have no difference for them. 

Administration officials continue to blame the “misinformation” campaigns led by Republicans in Congress and conservative critics for the public’s lukewarm response to the ACA. From a rhetorical perspective, however, there’s more to the story. In debates over reform, the burden of proof rests with supporters of the law, beginning with the President. Blaming opponents for criticizing the ACA misses the point. Administration officials need a better story that connects with the public. To date, critics of the law have successfully planted doubts about its impact on Americans’ choice of providers, the quality of care available to patients, and the cost of reform. Many of these critiques focus on the expanded role of government, and the importance of personal liberty as a value in health care reform debates. While Administration officials continue to dismiss such attacks, neither President Obama nor other supporters of the ACA have been able to defuse them. Writing more than 25 years ago in Human Communication as Narration, Walter Fisher argued that “the experts’ stories are not at all beyond analysis by the layperson. The lay audience can test the stories for coherence and fidelity.” The most recent polls that the the real work for supporters of the ACA remains persuading a skeptical public that health care reform can work, and that the result will be consistent with American values. After three and a half years, a new rhetorical strategy is clearly needed; merely repeating the same arguments is unlikely to “bend the curve” of public opinion.