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Conversation about Health Care No Longer Remotely about Health Care

A visual representation of the state of the ACA Please use the appropriate narrative framing vocabulary when describing this image/jon jordan

The thing itself is actual. It exists. It has substance, meaning, effects. And you wouldn’t know it from the discussion in the public sphere.

The Affordable Care Act is crumbling in stages, mismanaged and apparently unmanaged into a state of accelerating decay. The legally imposed employer mandate is postponed by the unilateral executive action of the executive branch. Ditto the small business exchange. The supposed repair of the federal exchange website is alleged to have made the thing work close to ninety percent of the time, but that number is a grade delivered on a curve so generous as to be functionally meaningless: insurers still aren’t getting reliable data from the exchange, and the payment system hasn’t failed because, more than four years after the passage of the Affordable Care Act, it hasn’t been built. State exchanges are a mixed bag: Kentucky’s appears to be working relatively well, while Oregon’s exchange website hasn’t opened yet, although you are welcome to apply through the mail along with 40,000 other Oregonians.

Responding to that decidedly mixed bag of policy implementation, Democrats are focused like a laser beam on . . . . political narrative.

Here’s the reliably inane George Lakoff
in the reliably inane Huffington Post, for example, arguing that advocates of health insurance reform need above all to consider the way their uses of language trigger the unconscious work of neural pathways:

Part of what the Cartesian theory of reason misses is the real brain mechanism that allows the conservative communication theory to be effective. By framing language to fit conservative values and by getting their framing of the language to dominate public debate, conservatives change the public’s brains by the following mechanism. When a frame circuit is activated in the brain, its synapses are strengthened. This means that the probability of future activation is raised and probability of the frame becoming permanent in the brain is raised. Whenever a word defined by that frame is used, the frame is activated and strengthened. When conservatives successfully reframe a word in public discourse, that word activates conservative frames and with those frames, the conservative value system on which the frames are based. When progressives naively use conservatively reframed words, they help the conservative cause by strengthening the conservative value system in the brains of the public.

See, Obamacare will be embraced by the public if progressives can just outgrow Cartesian conceptions of reason, and activate different neural frames with their messaging. Simple!

Lakoff lives in the land of conceptual reality, where narrative defines reality. In this, he appears to be a fairly normal contemporary political hack. What you won’t find in Lakoff’s babbling is any notice of the thing itself as it is, and as it is experienced. A family in Dayton or Sioux Falls gets a letter from their health insurance company informing them that their non-ACA-compliant health insurance coverage is being cancelled; then they go to the appropriate health insurance exchange website to replace it. What do they experience, actually here in earthly reality? If most families and individuals in this circumstance replace their old plan with better and more affordable coverage, and find it pretty easy to do so through the exchange, then Obamacare works, is perceived to work, and is sustainable; if their experience is bad, and the replacement product is a disappointment, then Obamacare is politically untenable and will die sooner or later. Trigger whatever neural pathways you want through narrative framing, but they got the cancellation letter, and they either got a better insurance deal or a worse insurance deal. The thing exists, and people notice it.

If you don’t implement the policy effectively, narrative framing doesn’t save you. You have to govern. It has to work.

Similarly, David Plouffe was building a self-destructing narrative edifice on Sunday morning when he said that Obamacare will “work really well” by 2017, seven years after the passage of the law. Eternally too cute and clever, Plouffe and the rest of the Obama team are trying to tell a story, to establish a political narrative in which the jumble of delays and failures of the ACA are the product of Republican intransigence and personal acrimony: all of this would be working if the right-wingers liked Barack.

How can they not notice that the foundation of that story is an acknowledgement that the thing isn’t working? Can anyone believe that the administration actually has seven years after the passage of the law to begin to make it work well?

A good political story is best spun from a good thing—a good reality, a functioning policy—to tell a story about. Maybe start there.