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!)