Why people are screaming about health care (it’s all about the middle)


Marketers could learn a thing or two from the ongoing debate on U.S. health care. Namely, in public communications battles, you don’t have to convince everyone — just a few percent in the middle.

First, the news: The United States is embroiled in arguments over whether and how to reform its health system. About 18% of Americans under 65 lack health insurance, and the United States is the only Western industrialized nation that does not provide universal health care. Universal coverage does not necessarily mean socialism or extreme taxes — there are actually four very different economic models which can be mixed to pay for it, including single-payor, private insurance, public insurance, and compulsory insurance. In a way, the U.S. already has universal coverage: emergency rooms provide last-resort care to the ill without insurance, and hospitals must offset those unprofitable cash drains by earning more in specialties such as cardiology and orthopedics. Critics of reform respond that healthcare will account for 21 percent of the U.S. GDP by 2020, that the free market is the most efficient check and balance on those costs, and that government bungling would lead to rationing and diminished services.

No matter. The issue is complex, so both the left and right have created glowing/demonizing language around the issue. Liberals have coined the positive-feeling “Public Option” title, minimizing future rationing or tax costs. Conservatives have suggested a federal plan (which includes end of life counseling) might kill old people and is downright evil. And so this week townhall meetings erupted into fights, putting people in hospitals. Everyone pointed fingers, with liberals blaming conservatives for inciting riots and conservatives suggesting liberal union thugs were threatening Middle America.

Tipping the scale requires pushing the middle

Why such extremes? It’s good communication science. Hyperbole works because in politics or crowds where the average opinion must be swayed, public relations doesn’t have to change everyone — just the central balance of the scale.

For example, the U.S. population remains relatively split between the two major political parties. While the 72 million registered Democrats now outweigh the 55 million Republicans, the recent presidential election was neck and neck until the economy collapsed in September 2008. If the Dow had gone up instead of down, McCain would now be president. The even split, plus general apathy on most issues, means any political consensus could swing either way with enough push.

Communicators influencing the masses know that in the middle of any spectrum, there are a few who can be swayed. Liberals and conservatives are already dug in. But if 1 in 20 people in the central base believe (pick your reality) that healthcare reform could protect the lives of 46 million Americans who don’t have coverage / will risk the lives of millions by rationing their current insurance, the issue will tip toward victory or defeat.

Which explains extreme messaging. Everyone on the edge of an issue already hears you. So you have to shout to get to the center.

Image: Room 116

One thought on “Why people are screaming about health care (it’s all about the middle)

  1. First of all, thanks for crediting my debate with you on Twitter as the inspiration for this post. I feel I can’t take even that much credit, but it’s appreciated.

    I agree with all your points here, but feel that you might be missing the most important one.

    As you already know, I agree with you that universal health care is a right, not a privilege. I also like your assessment that the middle is the true battleground for this, because the polar opposites aren’t listening anyway. But having said this, I don’t believe we can throw out the opinions of the polar extremes as nothing more than rhetoric.

    We can say, “killing old people” is an extreme statement (and it is) but there is no doubt that every universal system rations health care to where it can best meet the needs of the many. In smaller systems it works beautifully. (Norway, for instance.) In bigger systems, not so much. (China and Russia as examples.) This is because these programs at scale become spread too thin. So the statement about “killing old people,” has at it’s core a very real fear that, “When I’m old, the doctor may be forced by law to rank my care needs below those of a more vital, younger person.”

    God knows if this scenario would actually play out. But the fear is real and legitimate. It needs to be addressed.

    So getting back to your marketing theme, the Democratic majority is forgetting the very social marketing principles that got them elected. They are trying a “push” strategy, rather than embracing a “listening” strategy. Or more accurately, they are only listening to their base and thus playing into the characterizations of “big, unresponsive government” coming from the right.

    There’s no hope of winning over the extreme right’s support. But this is too important an issue for me to accept that I just have to trust Papa Congress to formulate a solution, especially given their recent track-record. So as frustrating and seemingly ineffectual as it may seem on the surface, they need to actively address the heart of EVERY right-wing concern to win over the middle. They need to show a plan that is fiscally responsible, does not diminish care and is administered much better than the recent cash for clunkers program was. And when I say address concerns, I don’t mean argue and prove wrong. I mean change the plan. Not to satisfy (again, that can’t be done) but enough to prove you heard to the middle.

    It’s like we’ve said many times on The BeanCast, Ben, “Public acts of customer service may not even resolve the dispute with the individual, but they are seen and appreciated by the silent masses looking on.”

    To say it in a nutshell, The Obama administration needs to stop selling this plan and start listening and responding to the road blocks.

    Bob Knorpp
    Host of The BeanCast
    Posts Every Monday @ http://beancast.us

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