Health and the Rule of Three

When policy debates heat up, it’s not enough for policy analysts to run the numbers and for political analysts to count votes and gauge the influence of affected interests. You also need communicators to craft a crisp, clean message. One that resonates with listeners consciously and, if possible, subconsciously.

Every word counts. As a result, one of the key communication battlegrounds is very basic: What do you call the policy?  If you can win the naming battle, you are a long way toward winning the policy war.

Having participated in a number of these debates, I would like to offer the following conjecture, which I will boldly characterize as a rule:

The Rule of Three:  If debate about an economic policy is sufficiently important, that policy will have three different names: one used by proponents, one used by opponents, and one used by non-partisan agencies that don’t want to take sides.

That rule is asserting itself today in the debate over reforming the health care system, much as it did in the debate over Social Security a few years ago.

In 2005, President Bush proposed that workers have the opportunity to direct some of their Social Security taxes into an account, owned by the worker, that could invest in certain stock and bond index funds (in return, participating workers would forego some of their traditional Social Security benefits).  The three sides of the debate rapidly diverged in their characterization of the accounts:

  • Proponents christened them as personal accounts, a phrase that relied on the positive associations of the word “personal” (e.g., personal attention and personal responsibility).
  • Opponents referred to them as private accounts, a phrase that formed the basis for their larger charge that the proposal would privatize Social Security.
  • To maintain their non-partisan positions, the Congressional Budget Office (CBO) and Social Security’s Office of the Actuary (OACT) couldn’t use either name for the accounts, lest they appear to be taking sides.  So CBO and OACT referred to them as individual accounts.

You could often tell where someone stood on the issue just by the name they gave to the policy.

Today Washington is in the midst of an even larger debate – how to fix our struggling health care system.  And the rule of three is again asserting itself.

This time the issue is how to refer to President Obama’s proposal that Americans have the opportunity to purchase health insurance from a Federal insurance provider.

  • Proponents refer to this as a public option, a framing that draws on positive associations in both words.  “Public” suggests the idea of open to all, for example, while “option” suggests that the policy would expand your choices, not mandate that you buy a particular health plan.
  • Opponents refers to this as a government plan (sometimes government-run plan), a framing that draws on the negative connotation of “government” (e.g.,”I’m from the government, and I am here to help you”).  The use of “plan” also leaves open the possibility — which some opponents believe is a probability — that Federal insurance might become less of an option and more of an inevitability.
  • The Congressional Budget Office, finally, has split the difference and referred to this approach as a public plan in their most recent analysis, thus using one word from each side.

I welcome other examples of the (conjectured) rule of three.

13 thoughts on “Health and the Rule of Three”

  1. Another example:

    Proponents of repeal call it the “death tax”.

    Some opponents of repeal call it the “inheritance tax”.

    Non-partisan / technical labeling is the “estate tax”.

    Of course, aside from the “Rule of Three”, there are other notable battles over whether or not a particular label is appropriate. I recall the 1990s debate over Medicare “cuts”. Republicans/conservatives were pushing for changes in policy that would reduce projected Medicare spending and they strongly objected to (and ridiculed as Washington-speak or liberal-speak) use of the word “cut”, since spending would be increasing, even in real terms. They were technically correct, but neglecting the broader meaning and real-world implication, which was, presumably, that the changes they were advocating would mean that at least some individual beneficiaries would receive less in terms of the value of his/her benefits. The higher spending despite these benefit cuts would result from the increased number of eligible folks due to demographics, and to the excess of the medical inflation rate over general inflation. To illustrate, if I’m an employer with 100 employees all earning $50,000, and I announce that I’m going to hire another 60 people and that all 160 employees will be earning $40,000, I could say that I’m not cutting salaries on the basis that I’m going to spend more in total on salaries (160 X $40,000 = $6.4 million vs. the previous $5 million), but I’m not so sure the employees would buy it!

  2. Rectify is the story of a man who was sentenced to death for a crime he didn’t commit, and spent 19 years on death row before getting out. Much like in my own real life case, the local politicians refuse to admit he’s innocent even after DNA testing points towards someone else. In fact, there was so much about this show that mirrored my own life I began to wonder how much of my story had crept into the script.

  3. The writer of the show, Ray McKinnon, was somewhat familiar with my case. His late wife, Lisa Blount was a friend of mine. She and I exchanged letters while I was on death row in Arkansas, and she even sang at a concert in Arkansas, along with Eddie Vedder, Patti Smith, and Johnny Depp, to help raise awareness about my plight.I heard that McKinnon also did research into the cases of other men who had been on death row and had been released or exonerated. It paid off. I can tell you from first hand experience that Rectify is a very realistic show.

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