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MEMORANDUM
To: Interested Parties
From: Frank Luntz
Re: Health Reform Language Highlights
Date: Wednesday, October 28, 2009

OVERVIEW
“Those who cannot remember the past are doomed to repeat it.”
I was there in 1994. I saw what happened when a once-popular president tried to push
healthcare legislation that Americans didn’t want or appreciate. I witnessed the electoral
implications when his administration tried to expand the role of government against the wishes
of, well, almost everyone. And it’s happening once again.
Let me be clear: this memo isn’t meant to be partisan and it’s not just for Republicans. It
is my hope, in fact, that they will share the contents of this document with their moderate
Democrat counterparts – those who care more answering to the people they represent than
answering to their leaders who are, quite frankly, pushing them off a cliff.
Nancy Pelosi and Harry Reid’s recent insistence on including a massively expensive
“public” option (in reality, it is a “government” option) has been met with a resounding thud by
a majority of Americans. For some reason, advocates of government-run insurance are intent on
including it in health reform even if its inclusion brings down health reform altogether. Whether
this insistence on public/gov’t option is driven by ideology or by a misplaced belief in some of
the more recent superficial polling on this issue is hard to know – and it’s just plain wrong
One thing is for sure – anyone who would place their political future in the hands of a
single survey question purporting to show that Americans want Washington to jump into the
healthcare business probably deserves to lose.

Yet while the public/government option is getting all the attention it is becoming a side-show
to the real issues driving this debate for most Americans:
-- The fact that the current proposals will cost them more, personally – and they
know it;
-- Increase already ballooning deficits and looming national debt; and
-- Further insert government into Americans’ lives and harm the quality of their
care. (Don’t take my word for it – the NBC/WSJ poll last week says it all: 40%
believe their quality of care will worsen, while only 21% think it will improve.)

 
 
 
 
 
 
 
Our research this month shows that:

x Individuals believe this will add to – not reduce – their personal health care costs. We’re
not alone. That NBC/WSJ poll is only the most recent to uncover this painful perception.
The margin is HUGE: 47% think their costs will go up thanks to “Barack Obama’s
healthcare plan,” while only 13% think their costs will go down. This is NOT a good
sign for legislation that’s been sold as beneficial for the economy and promised to reduce
health spending. Various public and private cost reports have clearly seeped into the
national consciousness, despite Democrats' frantic efforts to discredit them. The longer
the debate goes, the more likely people are to see healthcare costs rising, not falling.

x Claims of deficit-neutrality are roundly rejected and even ridiculed. No one believes that
the government will enact a massive new entitlement without costing Americans more
money. In fact – and quote this – by an incredible 61% to 14% margin, more people
believe scientists will discover life in outer space than believe the current healthcare
plan won’t add a penny to the deficit. The President has clearly diminished his
credibility by claiming this won’t add “one dime” to the deficit.

x The intensity is with the opponents of the current legislation. Fully 25% of those
surveyed said they would “actively work to defeat” members of Congress who vote for a
government insurance plan, while only 8% said they would work to support them.

x Overall opposition to the Congressional healthcare plan generally – and specifically to


any kind of government-run insurance -- is, predictably, more intense in the states of
centrist Democrats.

x Seniors are soundly against the current plans. They aren’t buying that $400 billion in
cuts aren’t really cuts and they really don’t like the idea that Congress appears to be
paying for health reform on their backs.

x This legislation may have been more tolerable to Americans months ago, before the
various stimulus, bailouts, etc. – but now it is much too much. Americans are deeply
concerned that Congressional Democrats are over-reaching and heaping too much on the
table at the risk of bankrupting the country. The sense of fragility about the current
“jobless recovery” is palpable – and you see it in the just-released consumer confidence
numbers – but some people aren’t listening.

The bottom-line is that pushing through major economy-altering legislation in the


absence of any bi-partisan support is a recipe for disaster – either now or later. The fact that for
most Americans the result of the legislation is expected to be higher taxes, higher premiums,
and/or reduced services is not likely to engender great good-will after the fact.

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SETTING THE CONTEXT

1. You STILL need to acknowledge the need for reform. We’ve seen a small erosion
in the public sentiment that there is a healthcare crisis. This is likely due to the
healthcare debate itself: the threat of a government takeover of healthcare has made
some Americans more appreciative of the healthcare they have right now.

Even so, a clear majority of Americans believe healthcare in America still at least is
“seriously troubled and needs significant revisions.”

2. While Americans still perceive a genuine healthcare problem, they do not view
the Democrats’ approach as the right solution. Our language survey is consistent
with most national polls: half of all Americans (49%) now oppose the plan, while
only 39% support it (and 12% remain undecided). This is almost a perfect reversal of
where support for the President’s reform plan stood in the spring. Clearly, the
language of the opposition is resonating. But to identify the words, themes, and
emotions that resonate most on the issue, our poll goes further.

-- First, notice that more than third of Americans strongly oppose the
legislation (34%). They are primarily, but not exclusively,
conservative voters.

-- Importantly, 48% of self-identified independents oppose the


legislation (30% strongly), compared to only 40% who support it.
The untold story of the past six months is the collapse in support
among independents and moderates. Republicans always hated the
Obama approach, while Democrats were always in his corner. But to
see Americans in the political center turn from cautiously supportive to
increasingly opposed is the most significant political consequence of
the debate.

-- Seniors, obviously a key constituency, are in firm opposition to the


reform plan (57% oppose, 36% support). Back in April, they were
evenly divided. More precisely, it is men aged 60+ who are the
angriest. Fully 47% of men 55 or older are strongly oppose the
plan (61% are at least somewhat opposed).

Suggestion: So far, most of the ads featuring concerned patients have been
women. It’s time to include men in these ads, too. Treatment of prostate
cancer can be delayed just as much as for breast cancer when the government
takes over care – and American men deserve to know about that.

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3. There is no change in support for the plan if it is called “Barack Obama’s” plan
instead of the plan of “Democrats in Congress.” In the spring, we counseled strongly
that you should avoid direct confrontation with President Obama. That has changed.
As Percy Sledge sang in the 1960s, “the thrill is gone.” So long as the attack is
grounded in policy and NOT personage, you can talk about opposing “President
Obama’s Plan.”

But don’t. While you no-longer shoot yourself in the foot by criticizing the President,
you would do much better to criticize Congress – which has disapproval ratings that
will clearly sink some re-election hopes. And with House Democrats supporting
healthcare reform components strong opposed by large majorities of Americans, you
will be accurate and effective at the same time.

Suggestion: Many Republicans remain fixated on calling it “Obamacare” or going


directly after the President. Stop. You get a much bigger payoff by attacking
“Washington.”

4. Public anger is REAL (note to certain media outlets & bloggers who will
eventually savage this memo: the town hall phenomenon is NOT manufactured).
A majority of Americans (55%) agree that “When it comes to the healthcare reform
debate in Washington, I’m mad as hell and not going to take it anymore.” Only 26%
disagree (leaving 19%). Nearly one in five Americans strongly agree. Some key
demographics:

-- 59% of those aged 55-64 agree (29% strongly)


-- 68% of those aged 65+ agree (28% strongly)
-- 59% of men agree (22% strongly)

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5. Members beware: vote for the bill and you risk not just being voted against…
but being worked against, too. For proof that the intensity in this debate is all on
the side of the opposition, look no further than this finding. We’re not even in an
election year yet and a quarter of Americans are gearing up to campaign against
any member who votes for this healthcare bill.

6. We said this in April and we’ll say it again: It’s not enough to just say what
you’re against. You have to tell them what you’re for. You can – and even
should – continue to focus on why this healthcare plan is bad for America. But if
you offer no vision for what’s better for America, you’ll be labeled as “negative”
and “obstructionist” when you should be getting credit for fighting for smart
healthcare reform.

Instead, offer “a better approach.” The good news is that the Republican
alternatives are looking more and more appealing to the public than the
Democratic approach of a complete takeover. So provide them (in list form so
that they are more memorable).

WORDS THAT WORK

We can do better with a targeted approach that tackles the biggest


problems. Here are four important areas where we can agree, right now.

One, all individuals should have access to coverage regardless of pre-


existing conditions.

Two, individuals, small businesses and other groups should be able to join
together to get health insurance at lower prices, the same way large
businesses and labor unions do.

Three, we can provide assistance to those who still cannot access a doctor.

And four, insurers should be able to offer incentives for wellness care and
prevention.

Dr. Charles Boustany, delivering the GOP Response

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Barack Obama is right: what Americans want is a solution, not continued political
bickering. And what your “solution” must provide is, in a word, more: “more
access to more treatments and more doctors…with less interference from
insurance companies and Washington politicians and special interests.”

WORDS THAT WORK

We believe in the right of every American to choose the doctor, hospital,


and healthcare plan of their choice. No Washington politician or
Washington bureaucrat should interfere with that choice. Every
American should have access to the quality healthcare they deserve. No
politics. No excuses.

7. Set the context by defining the RIGHT way to reform healthcare… and the
WRONG way to reform healthcare. Context always matters. If you launch
right into a “what I’m against” tirade, you’re inviting voters to tune you out –
particularly those in who really do want reform. So as you open your message in
emails, town halls, or on TV, start with something like this to set the right tone:

WORDS THAT WORK

Americans are telling us that they want real solutions for the healthcare crisis
in America… but they are also telling us there is a difference between the
RIGHT and the WRONG way to refor m healthcare.
The RIGHT way is for our leader s to prioritize spending and be careful with
taxpayer dollar s. The WRONG way is for Washington to raise taxes still
higher and dig our debt still deeper just to pay for mor e wasteful progr ams
that don’t work today and won’t work tomor r ow.
The RIGHT way is for us to protect and expand the doctor-patient
relationship. We must embrace an approach to healthcare that puts patients
first, before profits and politics. The WRONG way is to allow a Washington
takeover of healthcar e. It’s no solution at all to simple replace the insurance
bureaucrats who stand between patients and doctors with government
bureaucrats. We must reject and overcome any attempts that just recr eate the
same problems alr eady in the system and then amplify those problems.

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8. “The American people have the right to expect GUARANTEES from
Washington about their health.” We want you to focus in on that word:
“guarantee.” As Washington’s credibility on healthcare continues to wane, and as
the President continues to make promises he has no idea whether he can keep,
words like those below will have an increasingly powerful, positive impact:

WORDS THAT WORK


The American people have the right to expect a few guarantees from
Washington as it works for healthcare reform.
Number one, Americans expect a guarantee that the decision making between
patients and their doctors won't be taken over by the government.
Second, the public wants to make sure that there won't be any kind of
government rationing that delays or denies treatment based on some
bureaucrat’s bottom line.
And finally, the public wants Congress and the President to guarantee –
credibly – that we will be responsible with taxpayer dollars. That we're
not going to break the bank. Unfortunately, when we hear that a
program costing more than a trillion dollars will be “deficit neutral,”
Americans have trouble believing that the supposed guarantees they’re
getting from Washington are truly credible.
-- House Republican Whip Eric Cantor

9. “Bipartisanship” is what Americans want from Washington when it comes to


healthcare. Here, the GOP needs to make a much greater effort. The words below are a
good start, but they need to be said more often.

WORDS THAT WORK

It's clear, the American people want health care reform. But they
want their elected leaders to get it right.

Most Americans wanted to hear the president tell Speaker Pelosi, Majority
Leader Reid and the rest of the Congress that it's time to start over on a
common-sense, bipartisan plan focused on lowering the cost of health care
while improving quality. That's what I've heard over the past several
months, in talking to thousands of my constituents.

-- Dr. Charles Boustany delivering the GOP Response

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Once you’ve articulated the goal of bipartisanship, it is fair game (and according to our
polling, supported by independents) to level a sharper attack on those who control
Congress:

WORDS THAT WORK

The Democratic Party controls a 77 seat majority in the House and almost
20 seats in the Senate, along with the White House. If they cannot get a
bill passed with such overwhelming control of Washington, it says there’s
something wrong with the legislation.

Rather than forcing a bill through with only limited support, they should
keep working until they can get a bill that represents the opinions of most
Americans.

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