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The manufacturing of biased framing on reform

July 1, 2019

Topics: Quote of the Day

How media and polling company adoption of insurance industry spin warps democracy

National Economic & Social Rights Initiative

Mainstream media and public-opinion polls commonly state that the country has a choice between government and private insurance. This portrayal is inherently biased because it invokes government control while rendering insurance companies invisible, warping democratic discourse and policy-making. As leaked memos and decades of news reports and polls reveal, most journalists and pollsters only adopted this framing after the health insurance industry crafted it and, along with partisan strategists and right-wing think tanks and media, pressed it into common use. To balance their reporting, nonpartisan media, polling, and policy organizations must drop the insurance industry’s biased framing and instead contrast private with public insurance or name the role of both government and insurance companies in the health care system.

In the first section of this report, we trace how this biased framing was strategically constructed by the health insurance industry and mainstreamed by the industry along with other business lobbies, Republican strategists, and right-wing think tanks and media. In the second, we reveal how the mainstream media and public-opinion polls adopted this language following the insurance industry’s messaging campaign. In the third, we offer specific recommendations on how journalists, editors, and public-opinion pollsters can balance their language.

Any use of the word “government” as an adjective therefore invariably activates negative associations in people’s minds. Who would want to eat government food or go on a government-run vacation? It is no surprise that when polling companies ask people if they want “government-run health care” most people say no, even as large majorities of people celebrate Medicare and the Veterans Administration and support Medicare for All.


  1. Pair equivalent subjects: There are two choices: name the actors on both the public and private sides of the health insurance and health care systems or leave them both out. If describing “private” insurance or insurers, stick with “public” insurance and insurers. If naming “government-run insurance plans” or the role of “government,” point to “corporate-run insurance” or “insurance companies” too.
  2. Pair equivalent verbs: Today “government” is often paired with the verbs “run” and “controlled,” which in comparison to softer verbs like “administered,” “financed,” “managed,” “offered,” operated,” “provided,” and “sponsored,” imply a loss of control for the individual. Whichever tone of verb is used should be used on both sides of the comparison.
  3. Pair equivalent sentence structures: Sentence constructions that turn a noun into an adjective, such as “government-run program” or “government plan,” imply more control than a passive sentence construction like “a program run by the government.” Whichever construction is used should be employed on both sides of the comparison.
  4. Be careful about personalizing administrative mechanisms: Using possessives (“your” insurance, “their” plan, etc.) tends to individualize, personalize, and convey a misleadingly sense of ownership of the administrative mechanism through which an individual’s care is presently covered and payed for. When public-opinion polls personalize private insurance as “your insurance” or “your plan,” they introduce a bias that skews their results. If you are specifically asking about an individual’s current coverage, use another phrase (“the insurance plan you are enrolled in,” for example) or if using a possessive, use it for both private and public insurance.


Journalists, editors, and pollsters play a hugely important role in society, and these days especially are under a great deal of strain. Health care is also an enormously complicated economic sector with competing stakeholders, making it difficult to understand and even harder to reform. Yet as this report has shown, well-intentioned professionals in media, polling, policy, and academia who strive to explain how the health care system works now and the choices the country faces moving forward have been manipulated. Through a well-funded, highly orchestrated campaign, the insurance industry and its allies have manipulated the media and public-opinion polls, and thereby warped American democracy. In light of the findings of this report, independent media, polling, and policy organizations have an obligation to drop the insurance industry’s spin. They must present a balanced picture of American health care by comparing private and public insurance (and health care, programs, etc.) and, when naming government as the public insurer, must also name insurance companies.



By Don McCanne, M.D.

This report reveals the staggering amount of funds that have been used to introduce simple but politically charged words into our common parlance on health care reform. Particularly, they have shown that using the term “government” or “government-run” in referring to a public health care financing program elicits a negative response when that is paired with “private,” as in private insurance. Reading the full report can provide you with an understanding as to why and how that came about.

The recommendations of the report are quite straightforward. Use “public” instead of “government” when contrasting with “private” insurance. On the other hand, when “government-run” is used, contrast that with “corporate-run” insurance.

However, we need to look at the question that was asked during the debates of the Democratic presidential candidates. “Who here would abolish their private health insurance in favor of a government-run plan?” Here not only was there the bias of pairing “government-run” with “private,” but there was introduced the additional bias of having your private insurance taken away from you. Regardless of how the candidates may have stumbled over their rehearsed responses, the national audience certainly was hit with two negatives on public insurance (“government-run” and “abolish” choice) along with the positive of “private,” giving them a triple reason to reject the government-run model. Even several of the candidates who had cosponsored single payer Medicare for All legislation declined to raise their hands in the affirmative. Not only did this confirm the finding of the report that showed that journalists and pollsters have adopted the framing of the right, whether intentionally or not, but it also shows how effective this campaign has been (read the full report to understand).

The rhetoric discussed here is quite simplistic, but it can certainly have a major impact. The lesson seems to be that we need to become acutely rhetoric-aware so that the truth is always communicated. We can’t let bad policy be driven by subliminal communications of those without a single pristine soul amongst them.

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About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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