Word Routes

Exploring the pathways of our lexicon

The Lexicon of the Health Care Debate

The fight over health care reform that has dominated American political discourse in recent months has often ended up as a fight about language. Let's take a look at some of the highly charged terms used by the supporters and opponents of President Obama's proposed health care initiatives.

astroturf: The crowds that have been showing up at congressional town hall meetings about health care have been predominantly conservative, expressing their anger at the proposals of Obama and his fellow Democrats. Those on the right say these crowds represent a spontaneous grassroots movement, while those on the left say they're being orchestrated from above. Astroturf has become a common term of disparagement for a "fake grassroots movement." Senator Lloyd Bentsen was an earlier popularizer of the expression, as in this quote from the Washington Post of August 7, 1985:

"A fellow from Texas can tell the difference between grass roots and Astro Turf," Sen. Lloyd Bentsen (D-Tex.) said of his mountain of cards and letters from opponents of the insurance provisions. "This is generated mail."

bending the curve: Those on Capitol Hill seeking to lower the cost of health care often speak of "bending the cost curve," or simply "bending the curve." The idea here is that when health care costs are plotted on a graph over time, the resulting curve needs to be bent or flattened so that the costs don't continue to rise uncontrollably. I've found examples of "bending the curve" going all the way back to World War I: in October 1915, a writer in The Scientific Monthly optimistically predicted that "the progress of science" would "bend the curve more rapidly toward the base line of permanent 'peace on earth and good will to men'" (where the curve plots the frequency of wars over time).

In the health care arena, "bending the (cost) curve" was popularized by congressional Republicans in 2003 to refer to their Medicare prescription-drug legislation. "We have to bend the cost curve as the baby boomers retire," Rep. Nancy Johnson said in March 2003. Democrats have taken up the term since the beginning of the Obama administration, drawing from a December 2007 report by The Commonwealth Fund entitled, "Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending."

co-op: The so-called "Gang of 6," consisting of three Republicans and three Democrats on the Senate Finance Committee, has formulated an alternative to the "public option" (see below). They have put forward a plan for the creation of non-profit health cooperatives, or co-ops. As I discovered when I went to the website of Sen. Kent Conrad, the main booster of the co-op proposal, co-op is actually being used as an acronym: "CO-OP" stands for "Consumer-Owned and -Oriented Plan." Congress loves creating these prefabricated acronyms: just look at the "USA PATRIOT Act," which, naturally enough, stands for "Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism."

death panel: In July, when Sarah Palin announced her resignation from the Alaska governorship, she memorably said, "Only dead fish go with the flow." Since then, her most significant contribution to the political lexicon has also been on the morbid side. In a Facebook note, Palin decried the concept of a "death panel," a system where "bureaucrats can decide" whether patients are "worthy of health care." She expanded on this in a followup discussing a provision in the House health care reform bill that would authorize Medicare reimbursement for physicians who provide voluntary "end-of-life counseling." Critics like Palin have claimed that this would ultimately encourage euthanasia for elderly patients ("pulling the plug on grandma," in the words of Sen. Charles Grassley). The bluntness of Palin's "death panel" catchphrase ended up resonating (despite fact-checks from the Associated Press, the New York Times, and others), and the Senate Finance Committee announced it would remove the House provision from its proposed bill.

Left-leaning bloggers have come to refer to believers in the "death panel" claim as deathers. This neologism is modeled on birthers, a term used to refer to those who doubt that President Obama was actually born in the United States. Birthers, in turn, are modeled on truthers, those who question the official explanation for the 9/11 attacks. (Note that I'm merely talking about word formation here; the similarity in labels does not necessarily imply a similarity in the activists so labeled!)

Obamacare: Opponents of Obama's health care proposals very often use the word Obamacare in their criticisms. Here the obvious model is Hillarycare, the epithet used against the unsuccessful health care plan of 1993 which then-First Lady Hillary Clinton spearheaded. In conservative literature, Hillarycare and Obamacare are frequently linked, with the implicit hope that the current health care proposal will go the way of the failed Clinton plan.

public option: The "public option" has been a cornerstone of Democratic health care proposals, advancing the creation of a government program that would compete with private health insurers. UC Berkeley political science professor Jacob Hacker is credited with popularizing the proposed system, though Hacker himself has written about it as "public plan choice." Recently, Democrats have fretted over Obama's apparent suggestion that the public option is, um, optional to the ultimate passage of health care legislation.

takeover: Republican political consultant Frank Luntz has proved his mastery in the framing of issues through words and phrases. For instance, he has promoted such terms as "death tax" (rather than "estate tax") and "energy exploration" (rather than "oil drilling"). In May, Luntz circulated a memo with advice for how Republicans should talk about health care. The word takeover featured prominently in the memo, with suggestions that lawmakers raise the spectre of a "government takeover" or "Washington takeover" of health care. As Luntz explained to the New York Times, takeover is "a word that grabs attention." Luntz's advice appears to have been heeded, as takeover has become a key buzzword on the right.

universal: Speaking of Luntz, the spinmeister recently pointed out on the NPR show "On the Media" that Democrats no longer talk about "universal care" because they discovered that the term was unpopular. "On the Media" guest host Mike Pesca suggested that universal sounds "too otherworldly." Carrying this idea to its absurd conclusion, Comedy Central's Stephen Colbert recently registered mock outrage about "universal" health care: "Now we're gonna insure the whole universe?" Any plan that does make it through Congress will no doubt be on the modest side, so rest assured, we won't have to worry about intergalactic coverage.

(Comments are welcome as always, but I trust that subscribers to the Visual Thesaurus are capable of greater civility than what we've seen lately in the national health care debate!)


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Ben Zimmer is executive producer of the Visual Thesaurus and Vocabulary.com. He is language columnist for The Wall Street Journal and former language columnist for The Boston Globe and The New York Times Magazine. He has worked as editor for American dictionaries at Oxford University Press and as a consultant to the Oxford English Dictionary. In addition to his regular "Word Routes" column here, he contributes to the group weblog Language Log. He is also the chair of the New Words Committee of the American Dialect Society. Click here to read more articles by Ben Zimmer.

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Comments from our users:

Friday August 21st 2009, 7:17 AM
Comment by: Orin Hargraves (CO)Visual Thesaurus Contributor
I was noticing the other day how often the verb "dictate" came up in criticism of the reform: how we were not all going to be dictated to, and the government would dictate the terms of coverage, etc. Try "dictate health" in Google News for a sample. Did this go out in a Republican talking point? It is interesting to observe how much emotional charge gets spun into the debate just by the choice of words.
Friday August 21st 2009, 8:09 AM
Comment by: Ben Zimmer (New York, NY)Visual Thesaurus ContributorVisual Thesaurus Moderator
Orin: The "dictating" talk is straight out of the Luntz memo. Luntz writes:
" Washington Takeover" beats " Washington Control." Takeovers are like coups — they both lead to dictators and a loss of freedom. What Americans fear most is that Washington politicians will dictate what kind of care they can receive.
Friday August 21st 2009, 9:18 AM
Comment by: Kevin T. (Bartlesville, OK)
I was looking for a thesaurus, not a blog on politics or political correctness. Just give me the option of similar words and not pablum from the idealogue pretend pulpit. Debate is and must be the cornerstone of a republic. Outrage does not belay authentic debate but rather enhances it and is historically congruent with the Amercan ethos in public debate. Please keep the monolouge for the blogosphere were I then have the choice to ignore the paltry aloofness that would be an accurate critique of the pablum I read. I am looking for a "Treasury" not a beginners level indoctrinaire.
Friday August 21st 2009, 10:01 AM
Comment by: Jane B. (Winnipeg Canada)Top 10 Commenter
Kevin, I'm not disagreeing, but could you 'rewrite' a bit to give an example?

Perhaps it's that I've been reading so much that is very politically charged, but this seemed relatively neutral.
Friday August 21st 2009, 11:19 AM
Comment by: Christopher W. (Rochester, NY)
Great post, Ben! I enjoyed this very much. Word Routes is an excellent compendium on the popular parlance and a welcomed addition to the thesaurus. I never feel that it interferes with my use of the tool. But every time I take the detour and read your postings. I learn something interesting and am glad that I did.
Friday August 21st 2009, 11:28 AM
Comment by: Becky C.
I agree with Christopher that Word Routes is a welcome addition, I just didn't realize that I don't have a CHOICE to ignore it. I guess I had better make sure that I read every single one.
Friday August 21st 2009, 11:59 AM
Comment by: Hawk (CA)
I enjoyed the relevance. If we capsulate the choices of word derivation it may lead to jokes like "your an eight". I love the seriousness of these posts. I am a new subsciber and a newby but I enjoyed this immensely. Hawk
Friday August 21st 2009, 1:03 PM
Comment by: Graeme R.
Re Kevin T's comment: "Outrage does not belay authentic debate but rather enhances it and is historically congruent with the Amercan ethos in public debate."

Outrage is at times a natural and fitting reaction. But too often it leads to hip-shot inaccuracy and destructive attack. There are magnitudes of difference between, "I am outraged!" and, "You're a Nazi." To the former I can reply reasonably. To the latter, a sign of a closed mind, Barney Frank's reply was accurate: "Talking to you is like talking to a dining room table."

Reasonable discourse is a way I'm glad to tout as American. Outrage can be part of it. Loud and obnoxious responses from reptilian minds do not fit the model. They are literally ignorant -- ignoring available data and the principles of sound reason.

I'm outraged at such waste of time and abuse of media attention.
Friday August 21st 2009, 5:01 PM
Comment by: Jon D. (King of Prussia, PA)
A couple other health care debate terms include:

:single-payer
:Trojan Horse (appropriated by the Right to indicate that the public option is a cover for a larger-scale government program in the future)
:town maulers (the disruptive, shouty folks at town hall meetings)

I'm sure there are others as well...
Saturday August 22nd 2009, 1:01 AM
Comment by: Mo (Wanganui New Zealand)
hello america
not that i follow indepth what is happening in once a great nation and yes we do get a lot of American news here, but the language of your debate as reported is not so much different to the reporting in my home town of wanganui, when dissedent points of view are put forward.

the use of the word socialism is the one that seems to catch my attention. for myself it is the situation when the common good comes from the greater good, in terms of assistance for those that are unable to meet on a common playing field financially. my question as a matter of course is "how is it not ssocialism in the USA when excessively large companies take ludicrous amounts of tax payers money but when tax monies is to be used for the common group it is bandied as socialism?"

as an aside - team sport. "the Team". this is the collective working toward a common desirable goal for the betterment of the group as a whole. how can this be anything but an active example of communisim in daily practice? yes i know a play with words.
Saturday August 22nd 2009, 2:18 AM
Comment by: Scribe
I am always fascinated by the use of loaded language in political arguments. I am not above resorting to such language myself when I have to counter its use by opponents in debate.

That aside, I think a more effective tool for countering gross distortions and outright lies is to challenge those who rely on mendacious secondary information sources to compare them to the primary source. For example, anyone who goes to the Thomas web site ( www.thomas.gov) can go right to the language of the legislation itself to see firsthand the violence many columnists have done to the truth. I want a different form of medical care reform from that proposed by the administration, but even I can see that many of the most vociferous bashers of administration proposals are just making things up.

By the way, "health care reform" is a misnomer. People who take the term "health care" seriously know that not only does our present system not deliver it, but neither will any system based on the proposals before Congress. Medical care, not health care, is the current focus of debate. No system under consideration will do much to improve the health of Americans, but that is what is really needed to end the health crisis in this country.
Saturday August 22nd 2009, 1:23 PM
Comment by: Jane B. (Winnipeg Canada)Top 10 Commenter
Perhaps this is the way Ben was hoping the discourse wouldn't move.
Scribe, there are many examples, like my sister's treatment for Breast Cancer in the past few years, that show how the system you have (I'm in Canada) works well.

Like me, she is a senior, and very worried.

I would agree that there has been some media distorition, on both sides of the issue, but there are real grounds for fear among the people who are going to those meetings.

It is impossible to handle single payer health care efficiently in all instances in the simpler political structure of Canada. I shudder to think of what would happen should single payer be applied to 50 states!

And with a different sort of national mentality and heritage from Europe than what we have, I can't see people being so happy with single payer, and I understand the fear.

Don't think I have any loaded words there, but this is opinion on the issue and Ben might not want that!
Saturday August 22nd 2009, 1:26 PM
Comment by: Jane B. (Winnipeg Canada)Top 10 Commenter
I just noticed that the 'VT Word of the Day' is deprecate... And it's closest relative, so the notice says, is 'imprecate'.

We just won't have any imprecating here! (smiling)
Saturday August 22nd 2009, 10:48 PM
Comment by: paul B. (jackson, MS)
Words are powerful. They can move mountains. I am skeptical of almost ever word that originates in DC.
Sunday August 23rd 2009, 6:36 AM
Comment by: Bruce (Florence, SC)
This of off subject. Does anyone abhor "buzz" words as much as me?
"Tipping Point" and "Channel" make my skin crawl. More off subject.
It's hurricane season. Recently I heard a well known news anchor say
"... now getting reports pressure is dropping but, hey, we still got a
serious storm out there."

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