Propaganda 101

Can a $125 million ad campaign convince you to change your mind about ObamaCare? A coalition of labor unions, special interests, liberal foundations and wealthy donors is prepared to find out. Get ready for TV ads, newspaper spreads and lots of Internet spam.

But before getting into that, what should we actually call this thing? That is, the Thing that Nobody Really Knows Much About (TNRKMA). At this blog, we have followed the convention of calling it “ObamaCare,” but that could be considered derisive. There is always “health reform,” but this bill will almost certainly be reformed many, many times, even before all of the original provisions are enacted.

On balance, I’m inclined to go with the acronym, TNRKMA — which is pronounced “Turkey Ma” (mother of all turkeys), with the N silent, or simply “Turkey,” for short.

Now back to the propaganda effort. What makes all this especially interesting is that the vast majority of people really don’t understand even a fraction of what’s in TNRKMA, beyond the gnawing conviction that it’s going to be bad for them. There are several reasons for this.

Consider that:

  • There never really was any national debate over TNRKMA. Despite its being heralded as “revolutionary” and compared to the enactment of Social Security and Medicare, there never was a point where the issues were clear enough to even have a debate (unless you count the Congressional spectacle on the eve of the vote).
  • There never was even a Congressional hearing on TNRKMA — not one!
  • Even at the nationally televised discussion with President Obama and the Republicans, there was never any agreement on what TNRKMA would actually do.
  • There is so much discretionary power invested in the Secretary of Health and Human Services and in various regulatory bodies that entire industries have no idea how they are going to fare under it. This includes doctors, hospitals, health insurers, device makers, employers — you name it!
  • Throughout the legislative process, the people who had the most knowledge about the worst aspects of the bill were completely silent.

This last point is especially important. In a normal legislative exercise, there are winners and losers, or pros and cons. We count on the pro side to exaggerate the benefits of the legislation and the con side to exaggerate the harms, and this back and forth helps us understand what is really going on. Yet this time around the con side was almost completely silent. (I’m not counting all the TV ads whose factual content I bet you can’t even recall.) The administration skillfully (brilliantly, I would say) kept almost all the major parties at the bargaining table from beginning to end — thereby ensuring that those who were most knowledgeable about the defects were not free to speak publicly.

That process has continued to this very day. At the very same time that Barack Obama is giving speeches excoriating the health insurance companies as money hungry and heartless, Kathleen Sebelius is negotiating with these same people behind closed doors on regulations to be put in force, and Bill Clinton is at the insurance industry trade group convention in Las Vegas thanking the insurers for all they did to make TNRKMA possible.

Okay, so why would people spend enormous sums of money to support something they don’t really understand? For the special interests, it’s protection money. It’s spending they think they have to cough up to avoid even worse outcomes. For the ideologues, as I have explained before, the details don’t matter. All they really care about is collectivism and making sure that health care decisions are made collectively. Who gets what — even who lives and who dies — is much less important to them.

Will it work? Will a big lie, repeated often enough, come to be accepted as truth? Will the administration be able to pull off the biggest lie of all — convincing seniors (who will bear way more than half of the cost of health reform) that they in fact will gain?

Maybe. But I doubt it.

Comments (32)

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  1. Greg says:

    I like the Huey Long clip. It captures the essence of what we are up against.

  2. Brian Williams. says:

    Ha! I like TNRKMA! It is such a ridiculous acronym, it is perfect to describe Obamacare.

  3. Devon Herrick says:

    I’m somewhat ill at ease with the notion of the Administration (i.e. the politicians in power) using government money to convince voters one party’s ideas are the best. Political parties are more than welcome to raise funds and mount a public relations campaign. But the government needs carry out laws without political advertising.

  4. Vicki says:

    I agree with Greg. Great video. But wouldn’t the Nazi proganda machine be more appropriate here. Aren’t they telling the big lie — especially to the elderly — and repeating it often?

  5. LAURENCE BRODY, M.D says:

    thanks again John for keeping this alive in from of the public. Power and Taxation.

    As with all insurance, you never know what you have until you make a claim. For a patient, that’s when you get really sick. And then you need someone who cares about you. I look for many slogans and continued propaganda, but most people won’t find out about this.

    I don’t think that many doctors will drop out because they have to eat, pay their mortgages and leases.

    I may be naive, but I thought the solution was to raise the actuarial age of eligibility for Social Security and Medicare. I thought that would depressurize the system.But I never thought adding millions or tens of millions to the system was an answer.

    Promoting early death is a good answer. Get rid of the formerly productive and seize their assets on death.

    This is a well thought out big government plan. I think politicians will eat well for decades, although there are histories of citizen revolt, or barbarian takeovers.

    Thanks again, John. Keep us in touch with your ideas

  6. Paul Nachtwey says:

    In my office we refuse to use the phrase health care reform, as it is anything but reform. We occasoinally refer to is as health care conform, but I prefer “that vile piece of legislation” as it better gets to the essence of the matter.

  7. John Goodman says:

    Vicki: I was going to use a short from Charlie Chapin in “The Great Dictator” but I was overruled by the NCPA internal censors.

    It was the scene where he plays with a baloon that represents a globe.

  8. Larry C. says:

    Paul, I like your characterization. It is indeed “vile.” Very vile.

  9. Harv Randecker says:

    Until at least November (and then, next January to feel the effects of November’s election) we have NO representative government, period! This was amply illustrated on March 21, 2010 (the vote to pass TNRKMA)when Congress upstaged representative government and gave American Democracy a black eye!

  10. Sid Bondurant, MD says:

    Their strategy for passage was brilliant. Most of us who tried to follow the actual contents of the legislation know that it truly is a turkey. Like other aspects of the Obama Administration this legislation is brilliant in the campaign but will fall apart quickly when it has to be implemented and the voters see the reality of what BHO signed into law.

    The key is that to keep even the fig leaf of fiscal responsibility BHO starts collecting the taxes this summer but keeps the major “benefits” from going into effect until 2014. In this economic environment the taxpayers, at least those who fall into Lincoln’s group who were fooled some of the time, will quickly figure out that they have been conned and will express their rebellion at the polls. The November, 2010, results will show us if there are enough of them to send this spoiled turkey to the garbage can.

  11. Maggie says:

    If a person does not know enough about this Obamacare, they should find out Immediately! It is nothing that this adinistration told us. It will cost millions of dollars more, we will have a cut in our healthcare and Medicare patients will lose thousands of doctors that have taken care of them for years. Doctors pay,from Medicare will be cut and doctors cannot continue with the amount Medicare is going to pay them. We will not be able to get an appointment as we have our entire lives, because there are going to be many, many less doctors. There is ONE main thing you should know. That is that you cannot continue with your present Health Insurance, because you will have to change to what the federal government approves of.

  12. MOEY says:

    If it walks like a duck and talks like a duck – it obviously is a duck — or a TURKEY in this case.

    It is exactly like Ms. Pelosi said as she waved her hands in the air like a windmill: “We have to pass the bill in order to see what is in it and how it will work.” And this was out of the mouth of the Speaker of the House — how stupid. IMHO

  13. Virginia says:

    I think that the majority of the public will believe things that are repeated over and over in the media. The only reason for them to disbelieve is when they feel the consequences of poor policy-making. So, in the short term, I think most people won’t care. It’s those that were already skeptical that will resist the media.

  14. Chris Ewin, MD says:

    In the book, Switch: How to change things when change is hard, Dan and Chip Heath point out that change has been painless with many things like texting, iPhones, recycling, etc…. Big change is getting married, having children, etc…
    We’re seeing big changes with physicians that are dropping Medicare because of the difficulties running their businesses. I have to disagree with Dr. Brody’s point that many doctors will not drop out of Medicare.
    The results of recent surveys (in Texas) reveal that many won’t except any more Medicare patients. These innovative physicians (actually old school) who are dropping Medicare are jumping off the cliff and finding that their is a ledge only 3 feet below them.

  15. CR says:

    Mr. Goodman,

    Your post brings up many shortcomings of the passed legislation both in terms of its prescriptions and in the way that it was developed.

    If you had been in President Obama’s position, with the political climate in Washington, how would you have consulted the true experts on the matter? How can these experts be brought in going forward to fine tailor the bill?

  16. Chris Ewin, MD says:

    True experts….
    Been their, done that as past-president of AAPP, the concierge society..It’s very hard to eat at the table when many of us are not at the table.
    The AMA demonstrates their disconnect with physicians seeing that less than 14% of physicians are members.
    They don’t speak for us…
    Please define “true experts”.

  17. rgomes says:

    We know that people with health insurance consume twice as much as health care as the uninsured, and the command and control aspect of the bill will compromise the availability of physicians. However, we should look out for special interest and fight them with the same energy we use to criticize the flawed current administration.

    The Health Insurance Association of America (HIAA) had its most effective lobbyist (Karen Ignagni) to strike a deal with the president’s cabinet and include the mandate that requires everyone to be insured. This was their way to address the problem of adverse selection.

  18. CR says:

    Chris Ewin, MD –

    If your response is related to mine, “true experts” was my attempt to refer to Goodman’s fifth bullet in the original post:

    “Throughout the legislative process, the people who had the most knowledge about the worst aspects of the bill were completely silent.”

  19. Frank Timmins says:

    Yes, the Huey Long clip is appropriate. It reminds us of the utter disaster demagogues can ignite(and have ignited historically). Obvious examples are Hitler and Mussolini, but there are many others who have plagued societies with glib oratory.

    The insincerity seems so clear that one wonders how a public as informed as ours can possibly buy into the propaganda. It may be that the healthcare problem is so complex and wrongly defined to the public for so many decades that people are willing to believe anything that seems to benefit themselves in some way.

    On the other hand the facts seem to be that the great majority of Americans did not (and do not) buy into this program. Whether or not the coming propaganda barrage by the government can turn the tide in their favor remains to be seen. It seems the preponderance of available evidence to the contrary will certainly prevail (especially given this administration’s track record in the last 18 months). We should certainly continue to be diligent and support those who get the truth out to the public.

  20. John Goodman says:

    CR: Good point. I’ll send them my email address.

  21. Chris Ewin, MD says:

    John did hit the nail on the head. The unfortunate reality is that many practicing PCP’s are silent b/c of time constraints. They are seeing patients. Many (the AMA comes to mind) aren’t thinking “out of the box” for change on the local level for primary care.

  22. Chris Ewin, MD says:

    I would love to have this bill repealed. The reality is that it isn’t going away and the different players will have to morph themselves to accommodate the many changes on the way (including insurers). The best we can do is to make some headway within the bill itself.

    Some are doing their best to work on our little piece of the pie that we may be able to change. One is working on a wrap around product to allow direct practices to work in concert with Obama’s. We’re also trying to get direct practices recognized as health care by Congress. At least, we are trying to execute on a vision that may benefit our patients b/c talk is cheap….

  23. Don Levit says:

    I was at exercise the other day when I heard a fellow talking about the 80% loss ratio.
    Then, it hit me, in my heart and head this time.
    How can insurers make a profit between 80% and 100% on a regular basis?
    Reason tells me that insurers will have some years with 120% loss ratio, and some years with a 60% loss ratio.
    To fine tune the premiums to garner enough profits between 80% and 100% loss ratios, every year, seems to be very difficult.
    Don Levit

  24. Arnie Poutala says:

    I have not seen the comments her of Ewe Rheinhart lately. Is he all right? Or does he think that TNRKMA is the solution. I wonder how he thinks it is going to work for seniors?


  25. John Goodman says:

    Uwe, where are you? We need your reaction to Huey Long.

  26. George says:

    TNRKMA captures the essence. Vicki’s comparison to Nazi propaganda is appropriate. It’s likely there will be an enforcement division known as the “General Enhancement of Standards and Technology for Affordable Progress Office” (GESTAPO) to make sure everyone is getting their fair share.

  27. Uwe Reinhardt says:


    Alas, I’m in London at a fascinating conference and can’t open the video clip on my BlackBerry. Hence my silence.



  28. Patrick S says:


    I am a member of the National Assn of Health Underwriters – #20,000 health insurance agents and brokers around the country. I was extremely dissappointed at our Ntn’l Convention last year when I heard the association message of ‘we have lost the war and are negotiating the settlement’. It seemed they valued ‘being at the table’ more than saying and doing the right thing – stopping the madness and getting the true message out.

    What the Dem’s have done is similar to a 100% rise in Jet Fuel making airfare too expensive for the masses. The Fed’s have dictated the airlines improve baggage handling, wait times on the tarmac, and on time schedules – but done nothing about the problem of too expensive airfare – JET FUEL PRICES!

    I’ve been real dissappointed that no one at the table seems to be willing to say ‘the emperor has no clothes!!!

  29. Elizabeth A. Reid, MD says:

    The administration’s work is more complicated and expensive than sending Squealer out to explain Napolean’s edicts to the rest of the Animal Farm,or scratching out and rewriting the rules on the barn wall. We, the taxpayers, will pony up the money just as Orwell’s hapless animals fed their masters.

  30. Stephen C. says:

    Patrick: that is what all the inside the Beltway organizations did last year. They all negotiated the terms of their surrender. What a pitiful spectacle!!

  31. Frank Timmins says:

    Dr. Ewin, why do you think that the bill cannot be repealed? I don’t agree. It is true it cannot be repealed until after the next presidential election, but if we are diligent we will have a president and a congress at that time which will have an incentive to repeal. In the meantime, we can give that ultimate effort a boost by winning enough congressional seats in November to keep this mess from being funded next year.

    Giving in and working with them(Dems)to try to mitigate “some” of the provisions is exactly what they hope for. That is a very divisive for us, but it will be Chicago business as usual for them as they give out favors to certain groups of dissenters in exchange for support. Doctors sell out the insurance companies and the insurance companies sell out the doctors and everyone sells out the public. Not a good strategy for us.

  32. Bob Blades says:

    Every day now we see the benefits of Obamacare like keeping the chidren on the plan or life time limits being removed but at what costs. As I talk to people about health care for the most part they have no idea. When the cost of insurance comes out of the paycheck after a couple of checks its OK. The real grabber comes with the uninsured and Medicaid at the state level. Everyone pays then.
    I have outlined a roadmap for real reform in my book Help! Your health care Hanging in the Balance. We are going to see a decrease in quality as we move ahead.