Episode 134: The 80-Year PR Campaign that Killed Universal Healthcare

Citations Needed | April 21, 2021 | Transcript

Citations Needed
51 min readApr 21, 2021


Hillary Clinton, then First Lady of the United States, promotes a healthcare reform plan in 1993. (Joe Marquette / AP)


Intro: This is Citations Needed with Nima Shirazi and Adam Johnson.

Nima Shirazi: Welcome to Citations Needed a podcast on the media, power, PR and the history of bullshit. I’m Nima Shirazi.

Adam Johnson: I’m Adam Johnson.

Nima: You can follow the show on Twitter @CitationsPod, Facebook Citations Needed, become a supporter of our work through Patreon.com/CitationsNeededPodcast with Nima Shirazi and Adam Johnson. All your support through Patreon is so incredibly appreciated, we are 100 percent listener funded and cannot thank you enough for your generous support.

Adam: And as always, you can rate and subscribe to us on Apple Podcast, that is always very much appreciated.

Nima: Despite the fact that every other wealthy country has some type of universal healthcare system, the United States of America stands alone in the world as the only one that doesn’t. With over 170 million of its citizens left to fend for themselves in a sprawling and complex maze of Medicare, Medicaid, private insurance, tax credits, child care subsidies, co-pays, deductibles, and cost-sharing, Americans have not only the largest uninsured population, but also the most expensive system on Earth per capita.

Adam: Why America doesn’t have a universal healthcare system has historically been explained away with a reductionist mix of pathologizing and circular reasoning. “America hates big government”, “we love choice”, “Americans distrust anything that reeks of socialism,” and while this is true in some limited sense, it avoids the bigger question of why has American so-called democracy rejected the numerous proposals to enact a single payer or other forms of universal healthcare?

Nima: While there may be some innate Protestant work ethic, rugged individual cultural reasons, there’s also been a decades-long multimillion dollar campaign funded by big business, doctor, pharmaceutical and hospital industry interests, and the insurance industry to convince the public to reject universal public healthcare. Indeed, if Americans were somehow intractably opposed to the notion, if they were hardwired to reject socialized medicine, these forces would never have had to spend so much money in the first place.

Adam: On today’s episode we want to explore the almost century long campaign by capital to convince you to not support universal health programs, how these campaigns have historically fear mongered against communist, immigrants and African Americans, who benefits from a precarious, employer-controlled healthcare insurance system, and how the propaganda war on the American mind on this most important of issues is anything but over.

Nima: Later on the show, we’ll be joined by Ben Palmquist, Health Care and Economic Democracy Program Director at Partners for Dignity and Rights. His work has been featured in publications such as In These Times, Jacobin, the Journal of Law, Medicine & Ethics and The Progressive. He is the author of the report, “Parroting the Right: How Media and Polling Company Adoption of Insurance Industry Spin Warps Democracy.”

[Begin Clip]

Ben Palmquist: And I think it’s an open question why frame it as government run healthcare. I’ve read some political science research that suggests that journalists tend to be really, just repeat a lot of whatever is said in Congress as sort of deemed within the political playing field and so as more and more republicans shifted their language they first, and I saw this in the reporting, they first quoted it, then they paraphrased and then the next step was just to start using it directly themselves as the defining terminology.

[End Clip]

Adam: So it’s, of course, I’m sure no mystery to the people who listen to the show that demagoguing against big government or The Government is a central pillar of right-wing propaganda, it has been for a very long time, and this, of course, is summed up in Grover Norquist who’s the ultimate right-wing, anti-tax crusader: “I don’t want to abolish government. I simply want to reduce it to the size where I can drag it into the bathroom and drown it in the bathtub,” and this idea that “big government” or “The Government” or “government-run” is inherently a pejorative is somewhat unique to the United States. There’s obviously reactionary forces in every country, but there really is no other country where the idea of government as a pejorative as such is sort of taken for granted and in many ways, up until just recently, I think, was even bipartisan in nature.

Nima: This is so embedded, I think, in the not only right-wing ecosystem, but also it really does bleed into other parts of the media into political discourse. It’s the reason why, you know, on Facebook, you’ll see all these memes being shared with quotes from the founding fathers of The Government quotes from Thomas Jefferson that say: “My reading of history convinces me that most bad government results from too much government.” Or this quote: “That government is best which governs least.” Now, those two Jefferson quotes are fake, Thomas Jefferson never said them — yet — these are used again and again, even the founding fathers, even Thomas Jefferson who wrote the Declaration of Independence, was antagonistic toward the idea of a government that actually had control in certain ways.

Jefferson never said or wrote this.

Adam: So yeah, we live in a culture of course that’s antagonistic towards the concept of government. So today we’re going to examine the word government or big government or government-run in the context of healthcare because when you explain to people what you have to go through who live in other countries, what you have to do, what you have to pay for to get healthcare in this country, they’re shocked and appalled. Now, I know that there are plenty of countries in the world who don’t have universal healthcare, but most of them are middle income or wealthier do because it’s the ultimate no-brainer. But the United States which has 340 million people, doesn’t and not only doesn’t but has a massive, completely predatory and totally parasitic private insurance healthcare industry wrapped around it and so the question you sort of come to is you say, okay, if you started a country tomorrow, if I built a system tomorrow, you would never ever, ever come up with this system. It is completely irrational, it’s completely immoral, it leads to thousands of needless deaths a year and yet, for the most part, people sort of just kind of accept it, with some tweaks around the margins we’ll get into later.

Nima: Well, that’s what’s so fascinating. The idea that a private insurance industry that handles our healthcare needs, is assumed to be the default status of just the way things operate in the United States, right? Not that it was created, not that it was established in reaction to something else, and I think that what we find when you actually look at history, and certainly the history of anti-universal public healthcare systems, you see that there was a concerted effort, indeed, a very well funded, public relations and political consulting effort to demolish the idea of universal healthcare, and that universal healthcare and the system that we could all have been benefiting from for decades was strangled in its crib, literally by the same interest that lord over this system today.

Adam: So we want to start by the first real effort on a federal level to introduce what was then called compulsory health insurance, something that approached universal healthcare, a national health insurance program. So back in 1945, just seven months into his presidency, Harry Truman proposed a universal national health insurance program. In front of Congress, he stated, quote, “Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.” And he framed it as a way of battling communism. From a 1949 report in the Associated Press, they reported, quote:

A physically fit nation not only is essential to economic prosperity, but is our first line of military defense, President Truman told a group of medical, labor and civic leaders who called to discuss the administration’s pay-as-you-go health-insurance program.

This really began to pick up steam in 1948, 1949.

We cannot afford to be handicapped as in the last war, when “thirty to forty percent of our draftees were rejected on medical grounds.” Truman reminded his callers, who included AFL President William Green, CIO Vice President James Carey and Dr. Channing Frothingham, past president of the Massachusetts Medical Society.

“A great many of those rejections were due to lack of medical treatment in childhood,” declared the President. It is the basic responsibility of the government, he added, to provide our children with the medical care needed to make them healthy citizens.

So from the beginning, what they realized, I think it’s fair to say, Nima, is that post World War II, you have the NHS that was created in 1946 in the United Kingdom, which it didn’t really come into play for a few years later, you had Sweden 1946, there was a real fear, I think, amongst the capital class in the United States that there was something inevitable to having, especially after the creation of social security in the ‘30s, about having a universal healthcare system, and of course, the backlash was immediate.

Nima: Yeah. So, almost as soon as Truman introduced this idea of a universal national health insurance program, the American Medical Association, the AMA, really capitalized on the post World War II paranoia about Communism, about public programs, socialism, of course, and despite what we just heard Truman’s protestations, his saying this is really important for the country, the AMA and their supporters really attacked this idea as this great threat from outside even explicitly, as PBS noted in 2014, the AMA derided the Truman Administration itself, because of this bill, as “followers of the Moscow party line.” During congressional hearings in 1946, the AMA proposed its own plan, emphasizing — what else? — private insurance options, which actually represented a political shift from its previous position that opposed any kind of third party members and the delivery of healthcare. So, you see, the default did not have to be a private insurance system and yet the backlash to what was seen as a communistic public program turned into the intense lobbying efforts for what we see today.

Adam: Yeah, one thing we’re going to beat over your head in this episode is that private health insurance as an alternative to a public national health insurance is a response to that effort, it is not organic, it emerged in response, and we’re going to talk about the importance of a little-known company in 1930s California called Campaigns, Inc.

Nima: Founded by a husband and wife team, Clem Whitaker and Leone Baxter, Campaigns, Inc. was the first political consulting firm in the US, possibly the world. It was based in California, and the firm primarily worked in the ‘30s and then ‘40s for Republican Party causes, campaigns and certainly candidates. Their most famous, or perhaps infamous, for running the campaign preventing socialist candidate Upton Sinclair, the author of The Jungle from being elected governor of California in the 1934 election. Campaigns, Inc. not only ran that campaign, but used the playbook from that campaign, the repeating lies until they are embedded in the media, of buying op-eds, of intense, relentless pamphleteering, of running propagandistic newsreels before films and movie theaters.

Sinclair’s campaign was the frequent target of editorial cartoons. (Source: EPIC Project)

They used these campaign tactics again and again and again through the ‘30s and ‘40s. Now, a really great and comprehensive presentation about the history and the rise in power of Campaigns, Inc. was put together by the California State Archive in a presentation curated by Lisa Prince, Jeff Crawford, Kira Dres, Chris Garmire, Veronica Lara, Sebastian Nelson, and Paul Rendes, with assistance of Juan Ramos and what it does is it really shows how all the tropes that we talk about all the time on Citations Needed have been used forever. It has all your greatest hits, it has ‘Made in Russia,’ it has ‘you won’t have choice,’ it has ‘watch out for immigrants and poor people coming to your state and your town to take the things that you’ve earned.’ It really is unbelievable.

Upton Sinclair delivering a speech during his 1934 run for California governor. (Source: Associated Press)

Adam: So their first campaign, which they made a fuckload of money off of, they made about $100,000 in the first six months alone, was to prevent the election of Upton Sinclair. Basically, every rich person in California got together to destroy the man, because he was very popular, very popular with the masses, and one of the things they created, one of their early marketing gambits was this thing called the Sinclair Dollar, where they passed out, they called it the red currency, it looked like money but when you looked closer it had “Endure Poverty in California,” and it said, “Not very good anywhere.” So it sort of looked like a bill, but it had “Only good in California or Russia.”

Nima: Sinclair is misspelled so that the last four letters are not l-a-i-r, but l-i-a-r, so it turns Sinclair into Sinc-liar, liar.

Pamphlet made by Whitaker and Baxter. (California State Archives)

Adam: Liar, right, the ‘30s. “Redeemable, if ever, at the cost of future generations,” “A vote for Sinclair will put California on the bum and the bums on California.” And so this is and Sinclair, of course, partially ran, as running socialist, as part of his platform was healthcare, and so early on, there was this idea that they could use mass media, radio, television, newspapers, pamphlets, getting op-eds in newspaper journals and Sinclair ended up losing the election and that was, whereas he was expected early on to have a real chance of winning, but the amount of money that went into derailing him, including films, by the way, which you can see in the film Mank.

Nima: Yeah, it’s the central plot point of Mank.

Adam: So they were involved in other anti-progressive measures. There was a “Ham and Eggs” movement, in 1938 on Proposition 25 to give hot meals to the poor. They helped defeat that. They compared efforts to do so to the dictatorships of Hitler and Stalin. In 1945, towards the end of the war, then California Governor Earl Warren, who himself was a Republican, who once he was in office for a certain period of time, I think realized that he had to actually do something for people, he decided to create, which would have been the first ever statewide universal compulsory health insurance. So this was the testing ground for both the idea of universal healthcare and the United States, and also the testing ground for the campaign against it. And so the California Archives tells us that, quote:

Whitaker and Baxter’s campaign against Governor Earl Warren’s health plan not only vilified compulsory health care, but also strove to promote an alternative to government-funded medicine: voluntary, pre-paid medical coverage. The duo billed voluntary health insurance as ‘The Precious American 5th Freedom.’

The California Medical Association had already organized the California Physicians Service in 1939.

This would go on to be known as Blue Cross Blue Shield. So in 1939, was when you really saw an emergence of prepaid health insurance. So health insurance, again, from the beginning existed in relationship as a way of preempting and preventing the creation of a national health insurance policy. So in 1939, they launched a pilot program providing prepaid healthcare, Whitaker and Baxter sought to expand a service to diminish support for compulsory health insurance. So they went across the country enrolling people in private healthcare. So their ad campaign in addition to demonizing Warren’s plan to create a state run health insurance program, was about signing people up for these private insurance plans, which they presented as a nonprofit but really what they were was the California Medical Association, which was a constituent group of the American Medical Association. They were a way of redirecting people away from state run health insurance plans into this private industry that the AMA themselves could basically control and that way they would prevent a government takeover because the doctors and physicians and other healthcare professionals feared, probably not unjustified, that if the state took it over, they would not be able to charge people a ton of money and would themselves not be able to become very rich and I think they knew that and so they preempted it by putting it into this third party healthcare industry that would not take over their jobs, much like we see with the NHS, which of course was being discussed at that time in the UK. So, in 1947 Campaigns, Incorporated, this is pretty funny, they created a historical drama radio show called California Caravan, which was sponsored by the California Medical Association, the radio show presented commercials designed to sell the voluntary health insurance and encourage enrollment in the California physician service, Blue Cross Blue Shield. By 1948, the California physician service, the private health insurance, had increased its membership from 100,000 to nearly 600,000, the number of persons enrolled in the quote-unquote “voluntary health insurance plan” had doubled from 2.5 to 5 million, about half the population of California.

Nima: Now this of course made Campaigns, Inc., run by Whitaker and Baxter, quite a lot of money at this time. The California Medical Association paid them an annual fee of $25,000, which at the time was a ton of fucking money, and you start to see how language gets used, how messaging is used in these political campaigns, in these PR pushes to posit on one side what we’re hearing, you know, “compulsory” insurance with “voluntary” insurance. And if there’s one thing Americans love it’s when they volunteer for things, they get to choose things and it really comes from their own personal decision making to fend off what Whitaker and Baxter coined as being the evils of quote-unquote “politically controlled medicine.” Now all of this has been really well covered in Jill Lepore’s 2012 New Yorker piece called “The Lie Factory,” which is what Upton Sinclair called Campaigns, Inc. in his memoir, he didn’t even name them by name, he just called them the lie factory. So Whitaker and Baxter then take what they’ve done to Sinclair, they take what they’ve done to Earl Warren and his proposed health insurance system, and they turn their sights later to Truman’s 1948 health insurance plan. They are paid this time by the American Medical Association, the AMA, a $100,000 retainer with an annual budget of more than a million dollars. Now when we put that into today’s bucks, that’s about a $956,000 retainer, and a budget of nearly $10 million and all of this was to produce a campaign “to arouse and alert the American people in every walk of life until it generates a great public crusade and a fundamental fight for freedom.” That was the way that they framed this fight against — god forbid — universal health care.

Adam: So, Jill Lepore at The New Yorker dug into the California State Archives, and unearthed a document that really kind of explains the relationship between private health insurance and efforts to quote-unquote, “socialized medicine.” So, Lepore would write:

The first thing Whitaker and Baxter always did, when they took on a campaign, was to ‘hibernate’ for a week, to write a Plan of Campaign. Then they wrote an Opposition Plan of Campaign, to anticipate the moves made against them. Every campaign needs a theme. Keep it simple. Rhyming’s good. (‘For Jimmy and me, vote ‘yes’ on 3.’) Never explain anything. ‘The more you have to explain,’ Whitaker said, ‘the more difficult it is to win support.’ Say the same thing over and over again. ‘We assume we have to get a voter’s attention seven times to make a sale,’ Whitaker said. Subtlety is your enemy. ‘Words that lean on the mind are no good,’ according to Baxter. ‘They must dent it.’ Simplify, simplify, simplify. ‘A wall goes up,’ Whitaker warned, ‘when you try to make Mr. and Mrs. Average American Citizen work or think.’

So from the get-go I can see how much faith they have in the American people.

Nima: It’s super duper cynical, right? And so the actual plan of campaign that they put together, this confidential plan, reads in part:

The immediate objective is the defeat of the compulsory health insurance program pending in Congress. 2. The long-term objective is to put a permanent stop to the agitation for socialized medicine in this country by (a) awakening the people to the danger of a politically-controlled, government-regulated health system; (b) convincing the people, through a Nationwide campaign of education, of the superior advantages of private medicine, as practiced in America, over the State-dominated medical systems of other countries; (c) stimulating the growth of voluntary health insurance systems to take the economic shock out of illness and increase the availability of medical care to the American people.

Adam: Yeah, so it’s not just that convincing people to not want socialized medicine is literally a corporate conspiracy made up by ad makers, the existence of private healthcare itself as a mechanism and a tool was designed, because again, it predated it but not by a lot and it was not very popular, it existed as a tool as a way of selling people to not only buy an instrument, but to get them on your side politically because if I have a private healthcare plan, of course, I’m not going to want a public healthcare plan, because then they’re going to come and take what’s rightfully mine and so this is reflected in most of the propaganda that they created.

Nima: Yeah, they used, you know, pamphlets that were entitled, “The Voluntary Way Is The American Way,” the general campaign slogan was, “Keep Politics Out Of Medicine.” I mean, it really might as well be stuff that you still hear right now in our political discourse.

Adam: So by the end of 1949, Whitaker and Baxter had recorded 1,829 organizations as being opposed to the compulsory health insurance plan presented by Truman. By the end of the campaign in 1952, they had secured support of more than 8,000 groups. In addition to the successful endorsement drive, the National Education Campaign produced significant amounts of campaign literature. This was their front group, the National Education Campaign. In 1950 alone, they generated over forty different publications and distributed 43 million pieces of campaign material at local events, fairs, conferences. So they did a lot of pamphleting and one of the pamphlets is a picture of an old-timey doctor with what appears to be a very sickly or dying daughter and a remorseful looking father and the ad says, “Keep politics out of this picture.” So it’s very much about freedom of choice, which we discussed previously on the show and this idea that it’s socialist takeover, but of course, the the private insurance was presented as an alternative to basically take the wind out of its sails and it was successful, both the California plan lost by one vote in the California State House and the Truman plan died while it was in committee. Now, one important factor here is also racism. Much of the ads themselves were anti-Okie, which I know is not racism, but they were explicitly anti-immigrant, and then later on, we’ll discuss, there was an effort to try to get some kind of movement for some kind of universalized healthcare in the 1960s, which is where we saw the drive to get Medicare and Medicaid. So once again, the American Medical Association pops up to begin the demonization process. So they started running ads in 1964, 1965. Here’s one article from The New York Times in 1965, “A.M.A. Criticizes Medicare In Ad. Says it Would Be ‘Beginning of Socialized Medicine.’” You know, I love when people say, ‘Oh it’s a socialist plot,’ these incremental steps to get universal healthcare and they’re right, it is, because we’re socialists and we’re plotting. It is, they’re totally right, they’re not wrong. Things like Medicare and Medicaid are absolutely something the left supports as a stepping stone once people see how great it is which, you know, over 80 percent of people who have Medicare like it, so yeah, it’s pretty fucking sweet. Quote:

Chicago, June 8 — The American Medical Association said today that it was placing an advertisement in 100 newspapers to make its position clear on its opposition to Medicare. The advertisement calls Medicare “the beginning of socialized medicine.”

And so throughout the 1960s, civil rights groups were actually, specifically Black-majority unions of nurses and hospital workers, were central to pushing Medicare and Medicaid and a lot of the movement at the time for civil rights viewed Medicare and Medicaid as being a major civil rights issue, which is why it was passed roughly around the same time as civil rights. It was seen as a kind of concession to the civil rights movement, because obviously a disproportionate amount of people who were left out of private insurance — spoiler alert, as we like to say on the show — were African American. So from the beginning, the minimal amount of federal spending and state spending on healthcare excluded Black people.

Nima: As Jeneen Interlandi wrote for The New York Times Magazine in 2019:

“As the Columbia University historian Ira Katznelson and others have documented, it was largely at the behest of Southern Democrats that farm and domestic workers — more than half the nation’s black work force at the time — were excluded from New Deal policies, including the Social Security and Wagner Acts of 1935 (the Wagner Act ensured the right of workers to collective bargaining), and the Fair Labor Standards Act of 1938, which set a minimum wage and established the eight-hour workday. The same voting bloc ensured states controlled crucial programs like Aid to Dependent Children and the 1944 Servicemen’s Readjustment Act, better known as the G.I. Bill, allowing state leaders to effectively exclude black people. In 1945, when President Truman called on Congress to expand the nation’s hospital system as part of a larger health care plan, Southern Democrats obtained key concessions that shaped the American medical landscape for decades to come. The Hill-Burton Act provided federal grants for hospital construction to communities in need, giving funding priority to rural areas (many of them in the South). But it also ensured that states controlled the disbursement of funds and could segregate resulting facilities. Professional societies like the American Medical Association barred black doctors; medical schools excluded black students, and most hospitals and health clinics segregated black patients. Federal health care policy was designed, both implicitly and explicitly, to exclude black Americans. As a result, they faced an array of inequities — including statistically shorter, sicker lives than their white counterparts. What’s more, access to good medical care was predicated on a system of employer-based insurance that was inherently difficult for black Americans to get.”

Adam: I think this point can’t be emphasized enough, employer based health insurance today, as well, but especially when it was contrived in the 1940s, it was designed to exclude Black people both by its design and also to reinforce existing inequities and the AMA, which sold these policies, did not sell them directly to Black people, they sold them to white people, they did not include Black doctors. And then in the 1960s, when the American Medical Association was opposing Medicare and Medicaid, the National Medical Association, which was the leading Black medical society, the Black version of AMA, because they were excluded from AMA, got in direct conflict with the AMA because they supported it. The Black National Medical Association has supported a nationalized health plan for decades and the reason of course they have is because they know that a nationalized health plan would absolutely benefit both Black doctors and Black people, in general. So from the beginning, race was a huge component in this and by leaving it in the private sector, you create both de facto and de jure segregation, you eliminate undesirables, so not only is racism used to propagandize against universal healthcare, the alternative system they set up is used to reinforce those inequities by design.

Nima: And so, you know, we’ve seen how propaganda and PR has been used to really set the terms of the debate from the ‘30s into the ‘40s, and then the mid ’60s, but then flash forward to the early 1990s, the Clinton years. Now the health insurance industry itself had grown so large by the 1990s, that by the time Democrats were floating universal healthcare again, they, the insurance industry, as well as a consortium of right-wing think tanks that had emerged in the ‘70s and only grown more powerful during the Reagan years of the ‘80s, really took over this propaganda campaign to influence media discourse on healthcare. So around 1990, healthcare was re entering US political discourse amid a recession and rising insurance costs. At that time, health insurance companies began a campaign of circulating healthcare polls and crafting public messaging that would favor a corporate-run healthcare system, while at the same time, most importantly, stigmatizing the government involvement in healthcare. So that year, 1990, the Health Insurance Association of America, HIAA, published a paper allegedly based on public polling that argued that while people in the United States wanted some change in the healthcare system, they did not want, quote, “government-run approaches such as Medicare,” end quote. Now this idea of government-run healthcare, much like its 1940s equivalent from the Campaigns, Inc. days of socialized medicine, is something that we now hear all the time in our media and political discourse. It is ubiquitous, you don’t even really think about it when you hear government-run and yet this was deliberately infused into our media discourse, into the opposition messaging to universal healthcare by the health insurance industry itself. Prior to the 1990s really, if you look at the historical record, public healthcare programs were rarely if ever characterized as quote-unquote “government-run.”

Adam: A survey of Newspapers.com and Google’s Ngram shows that the term really took off between 1990 and 1994, and one of the ways it did this is it did this by running the now infamous Harry and Louise ad campaign, which was in the 1990s, the health insurance industry sponsored a lot of ads which ran a lot, while the Clinton administration — Hillary Clinton was leading the charge of universal healthcare for her husband, President Bill Clinton — at the time, even before this campaign, or the senator congressional hearings could begin, there was already two characters that were created. Harry and Louise were a middle class couple who were constantly very concerned about the future of US healthcare. So we’re gonna play with some of those commercials and notice the framing at this point hadn’t changed in fifty years, which is choice, vague kind of socialist appeals, freedom. So why don’t we listen to a few of those ads right now?

[Begin Ad 1 Clip]

Harry: Well, government should police the plans, keep everyone honest, but I’m not comfortable with government-run healthcare.

Louise: That’s not the reform we want and Congress needs to get that message. What can we do?

Harry: Tell Congress keep working to get healthcare reform that’s right for everyone. Private insurance, but no government-run healthcare, no tax on benefits and no government imposed spending limits. If you call, they’ll listen. Believe me, I’ve been there.

[Begin Ad 2 Clip]

Woman: Louise, do you know anything about this tax on health benefits?

Louise: Congress may load on a bunch of new taxes for their healthcare plan, including a tax on plans they think are too expensive.

Woman: Too expensive?

Louise: You know, the quality we like, the doctors we want, plans like ours.

Woman: Wait a minute, I thought healthcare reform was supposed to save us money.

Louise: Don’t count on it.

Woman: Well, this isn’t the reform we want.

Louise: We need to send Congress that message.

Man: Tell Congress no benefits tax. Call today.

[Begin Ad 3 Clip]

Harry: Well, I’m glad the President’s doing something about healthcare reform.

Louise: He’s right. We need it.

Harry: Some of these details —

Louise: Like a national limit on healthcare.

Harry: Really?

Louise: The government caps how much the country can spend on healthcare and says, that’s it.

Harry: So what if our health plan runs out of money?

Louise: There’s got to be a better way.

Man: There is a better way to reform. Call this toll free number for the facts. Call today.

[Begin Ad 4 Clip]

Louise: This was covered under our old plan.

Harry: Yeah, that was a good one, wasn’t it?

Man: Things are changing and not all for the better. The government may force us to pick from a few healthcare plans designed by government bureaucrats.

Louise: Having choices we don’t like is no choice at all.

Harry: They choose.

Louise: We lose.

[End Ad Clips]

Adam: I love the final one, because it’s ‘the government’s going to force us to choose between plans’ and it’s like what does your employer do? Do they offer you like 500 plans you usually have, if I’m not mistaken, the one one job I had that health insurance ever —

Nima: Yeah, if you have a job, you don’t really get a choice. Maybe there are tiers, but you’re not choosing, you’re not really choosing different plans. You have your employer’s plan.

Adam: Right, but it’s bullshit, right? So they hit all the sort of, they hit all the buzzwords like “choice,” “freedom.”

Nima: A bad choice is no choice at all. “Taxation,” “freedom,” “choice.”

Adam: The general messaging hasn’t changed since Whitaker, and Baxter in 1945. It’s the same basic plot points.

Nima: And yet these ads also ushered in an era, as The New York Times put it in 2009, “of political issue advertising as a major component of lobbying,” that, you know, the pamphleting of yesteryear had been turned into these TV ads as a way of really moving congressional legislators to make certain decisions based on the propaganda that was being pushed down American throats.

Adam: Right, because the thing is that around the time in the early ‘90s, late ‘80s and ‘90s, I think one thing that’s important to know is that the health insurance industry became very unpopular. There was a huge crisis in the health insurance industry, because healthy people were moving to better plans or they were dropping off altogether so they had a real kind of crisis and there was some gesture towards an effort towards reform and much like the healthcare industry wanted to be the ones reforming themselves, through these other kind of exotic private insurance gimmicks, in the ‘90s, when they tell you to call your legislator, you’re gonna call and they’re going to give you the industry’s version of quote-unquote “reform,” which is just more handouts to the industry itself.

Nima: You could also call a toll-free number for the facts, Adam.

Adam: Just for the facts, yeah.

Nima: We’ve seen the trajectory from the ‘30s to the ‘60s to the ‘90s, and this is still with us today. A 2020 election explainer from The Washington Post, had an excerpt under the section titled, “What is Medicare for All?” This quote, “Some versions would dramatically rethink how the nation’s insurance system works by replacing the current health insurance system with a single government-run system that provides insurance for all Americans.” End quote. Now, you’ll see here that the current health insurance system is just deemed the nation’s insurance system. It doesn’t say it’s private, it doesn’t say it’s corporate, it doesn’t say that people don’t have it, it’s just that as opposed to the single government-run system. You have this from February of 2017 in The Atlantic in an article called, “A Political Opening for Universal Health Care?” This quote, “Senator Bernie Sanders had also made the case for government-run health care in a CNN debate on Obamacare just the night before.” And then, you know, the next year Gallup poll from 2018 uses the same government-run phrase to present single-payer as overreach and anti the current system. It also justifies policymakers’ toothless foot dragging on publicly funded healthcare by calling healthcare, quote, “a complex challenge.” So the conclusions of this Gallup poll say this:

The majority of Americans, 57%, continue to believe the federal government should be responsible for ensuring that all Americans have health insurance. At the same time, a majority reject a government-run healthcare system, with 40% in favor and 54% preferring a system based on private insurance. These attitudes help underscore the complex challenge facing policymakers attempting to address problems with the nation’s health system.

Adam: Notice how there’s no symmetry in that language. It’s government-run and private versus government-run, corporate-run or health-insurance-company-run, right? Which we’ll get into with our guest, but there’s a reason why this term government-run is chosen because it has a certain connotation and exists in parallel with a very sophisticated PR machine that wants you to think anything that vaguely smacks of government is at best incompetent and at worst sinister.

Nima: To discuss this more we’re now going to be joined by Ben Palmquist, Health Care and Economic Democracy Program Director at Partners for Dignity and Rights. His work has been featured in publications such as In These Times, Jacobin, the Journal of Law, Medicine & Ethics and The Progressive. He is the author of the report, “Parroting the Right: How Media and Polling Company Adoption of Insurance Industry Spin Warps Democracy.” He’s going to join us in just a moment. Stay with us.


Nima: We are joined now by Ben Palmquist. Ben, thank you so much for joining us today on Citations Needed.

Ben Palmquist: Thank you for having me on. I’m a fan of the show and glad to be here.

Adam: Oh, thank you. I want to talk about this excellent report, which gets to some of the core issues. I think kids these days, you know, we work on Medicare for All, we talk about Medicare for All, you have Democratic candidates supporting Medicare for All. I think the Zoomer kids don’t appreciate how bad it was 25 years ago and how much progress has been made. We don’t usually do optimism on the show, but I do think the conversation has changed a lot. The report you authored offers many insights as to why and how bad it is. So obviously, I wanted to discuss the broad outlines of what’s at stake here. So post World War Two, obviously, a lot of capitalist countries in Europe and Asia began public healthcare, some form of the other. President Johnson obviously in the ‘60s had Medicare and Medicaid, and then around the so-called Reagan revolution, I think there was a real sense that a universal healthcare system could happen in the United States at some point and that if it did big business insurance, the US Chamber of Commerce crowd, they had a lot to lose, and so they began to sort of aggressively frame the issue almost preemptively. I want to sort of begin by talking about the sort of origins of capital’s pushback, I mean, I know what even begins before that, I know groups like the American Enterprise Institute, which was preceded by the American Enterprise Association in the ’40s, was railing against FDR socialism, but I want to talk about the origin of capital’s paranoia, justified paranoia, given again, all throughout Europe, and Asia and other countries, Latin America, they had these programs, I want to talk about the origins of that paranoia, and where they really started to concentrate their money and messaging to sort of pushback against a potential universal healthcare system.

Ben Palmquist

Ben Palmquist: Yeah. So the capital pushback, I think, was tied up in a larger capital pushback against, you know, the environmental regulations and consumer regulations and things that movements have been pushing for in the ‘60s and ‘70s, and what happened over the course of the ‘70s and ‘80s was Medicare and Medicaid had passed, but most people were on private insurance and all forms of healthcare just kept on getting more and more expensive, because there was no regulation whatsoever of hospital prices, drug prices, or anything, which of course, is still the case today, and so they really decided to figure out what they could do to undercut, at the time, which still seemed like a powerful labor movement and then the beginnings of an ascendant single-payer movement to push for more robust forms of universal healthcare. So I think what they did is they realized they had common cause with other sort of new reactionary movements, the racist reactions to civil rights and Black Power and urban uprisings of the ‘60s and the conservative reactions to gender and sexual revolutions and the neocon reaction to anti-colonial movements, and were able to really form this anti-government attack on sort of all the ways in which the federal government had been starting to make some progress to actually protect people with healthcare and other things as well.

Nima: Something that’s so great about the report that you wrote on this very issue is kind of how it reminded me of when all this stuff really took off in earnest in the early ‘90s and how that was a time when, despite us now really thinking about the Clintons and the Clinton dynasty as, you know, the centrist wing of the Democratic Party, but in the early ‘90s, there was this real fear that President Bill Clinton and of course, then First Lady Hillary Clinton, would usher in this socialistic era of universal healthcare — God forbid — this was a real fear, especially on the right, and as a result, there was a ton of money, and certainly PR muscle poured into reframing the issue of healthcare with this specific kind of linguistic focus on calling it government-run healthcare, right? And so you really, I mean, dissect this wonderfully in your report, but can you give us an overview of how this weaponized, sinister phrasing “government-run” was chosen and how it then spread throughout the media?

Ben Palmquist: Yeah, I was really curious about this, because today, you see the right-wing using this phrasing “government-run healthcare” all the time to talk about Medicare for All, but even public options, or just anything really, any kind of remotely public program and healthcare. But I had read enough history to know that back in the ‘60s and ‘70s, that phrase just wasn’t showing up, and so I dug into things, and found that the insurance industry actually had a very concerted campaign where they message tested different kinds of phrasing, they did surveys and focus groups and that kind of thing, right around 1989, 1990, as they were starting to get worried that there was sort of a burgeoning pressure on them, people were not fans of the insurance industry, of course, and the messaging they realized worked was if they just called anything that they opposed, California at the time was building towards a ballot initiative for single-payer, and of course, the Clinton plan came along, which was not unlike the Affordable Care Act today of having this market model. But they really focused on calling it “government-run healthcare” as a way I think to tap into what, over the course of the last several decades, reactionary movements had really built into this concept of government as these unaccountable forces, this set of actors who’s giving undeserving people, you know, code word for Black people and immigrants, things that they don’t deserve, and that, you know, this is sort of un-American. This was right at the tail end of the Cold War, of course, so it was coded as socialist or even communist. But the flip side of what they did in framing it as government-run healthcare was they never mentioned insurance companies, hospital or drug companies or employers and the power they had in the healthcare system and so it really created this skewed one-sided perspective of how power operates in healthcare, and really, I think, morphed and warped the public understanding.

Nima: There’s no symmetry in the language, it’s private healthcare, or the healthcare you get through your employer or the one that you choose. So, you know, we’ve talked about this on the show before the choice, right? ‘You’ve chosen this,’ as opposed to Big Brother deciding what your healthcare is, and government doctors that obviously must be sinister, which isn’t really a thing, and so I just think it’s this fascinating thing that, you know, much like big tobacco or much like other major PR goals, the infusion of this linguistic tick, “government-run,” really just took over and so much so that the media fell in line in a way that I think now, it is so ubiquitous that you don’t even realize that that was literally a PR push into an editorial decision.

Ben Palmquist: Yeah, it was a really stark change. I actually looked at usage, word usage for this phrasing in the media and public opinion polls and academic journals and in the Congressional record and in every case you see this, the word phrasing was basically non existent until right in the early ’90s and then you start to get this tick up.

Adam: And you note that there’s a huge leap in adoption around 2007, around 2008, after Michael Moore’s film Sicko came out, which, you know, that was back when Moore released a movie it had sort of a cultural impact. Obama was elected, obviously had the recession. You note here there’s a real pivot to where there’s kind of peppering of usage into widespread usage. You write within months of the latest PR push in 2007, quote, the Washington Post, New York Times, Wall Street Journal, Politico, The Hill, Kaiser Health News, CNN, ABC News, CBS News, NBC News, NPR, The Atlantic, Slate, and Time were all labeling the Affordable Care Act’s soon-to-be-defeated public option as ‘government’ or ‘government-run.’” This was the public option cop-out that Obama somewhat half-assedly proffered in lieu of fully socialized medicine, because of course, when you do the ACA and you say, ‘Well, we’re going to tax people and put it in a pool,’ the logical follow up is, ‘Wait a second, how are people going to afford this?’ ‘Well, there will be a public option, but not really,’ and that was when you really started to get this, like you said, sort of explicitly Koch brothers manufactured language about government-run. What do you think is the reason why that really took off and how effective was it?

Ben Palmquist: Yeah, I think it was both a dynamic of it being really pushed by the right and then the senators are saying, being in this place of just being complete pushovers, so that, as you said Nima, they actually borrowed the playbook initially from big tobacco and really piloted it in the early ’90s and then just sort of sat on it because, you know, the late ’90s and 2000s the right was so ascendant, there just wasn’t any attempts to actually expand healthcare access significantly.

Nima: They didn’t have to worry about it.

Ben Palmquist: Yeah.

Nima: They didn’t have to use their weapons.

Ben Palmquist: Exactly.

Adam: Because the era of big government is over, right?

Ben Palmquist: (Laughs.) That’s right. But then, you know, the public, I think, was clearly getting more and more frustrated with rising healthcare prices and uninsurance and everything else, such that by the time of the 2008 election momentum was building and Michael Moore did happen to come out with this film Sicko, really arguing strongly for Medicare for All and so the industry developed this playbook and we know this because there was these leaked memos. I think they were leaked by Wendell Potter, who is a former insurance industry executive turned Medicare for All advocate. It’s all written out of how they sought to get the mainstream press to pick up on this rhetoric and so they did more focus groups and more public opinion polls and this time, it wasn’t just the insurance industry, but they got Chambers of Commerce and right-wing think tanks and really GOP elected officials, Fox News, they were all on board fully of really hammering home this message such that Fox managing editors were coaching, you know, instructing all the reporters on exactly how to frame it as government-run healthcare and then in the GOP political operatives were doing the same thing. On the receiving end then, I think, you know, it’s still a bit of a question to me why, I will say that elected Democrats didn’t pick up this language, but the mainstream press and public opinion polls really did, and I think it’s an open question why frame it as government-run health care. I’ve read some political science research that suggests that journalists tend to be really, just repeat a lot of whatever is said in Congress is sort of deemed within the political playing field and so as more and more Republicans shifted their language, they first and I saw this in the reporting, they first quoted it, then they paraphrased and then the next step was just to start using it directly themselves as the defining terminology.

Adam: So it was the “officer-involved shooting” trajectory. So one thing you mentioned that I want to know before we move on is you talk about how it’s not just insurance companies, it’s the US Chamber of Commerce and big business and corporate donors, and this is true by the way of corporate donors, Democrats as well. One thing I think people overlook is that the people who benefit from an employer-run, non socialized medicine system is not just the insurance company, the sort of parasitic insurance company — which again, is objectively no reason to exist, right? It’s the definition of a racket — but the businesses have a lot to gain from this, because of the leverage healthcare gives them both in terms of retaining employment, but also holding it over people’s heads in terms of retention, in terms of labor liquidity, if I’m a union, and I’m bargaining, you piss away 40 percent of your capital, just getting a healthcare plan, right? Socialized medicine you don’t even have to do that. So I think people don’t quite appreciate how much capital, even non insurance business and corporate America benefits from this inefficient system of sort of competing healthcare plans and to what extent, and there was just this sort of pool of money that was thrown into this effort, that it goes beyond just insurance?

Ben Palmquist: Yeah, I think, I mean, in an ideal world, employers would recognize more that actually, they are arguably also being hurt by having health insurance costs rise so much, and having to be insurers as well as just being employers and running businesses, but it’s absolutely true that the major corporations as well as small business associations have been fierce opponents of health justice, time and time again, and have really pumped in money, and they’re doing it again now, and so as the demands are being made for Medicare for All, and even as Democrats are trying to push a public option, these industry associations are all organizing together. So it used to be that they didn’t see eye to eye, right? That insurers were on the opposite side of hospitals and drug companies and that employers were doing their own thing, but they’re increasingly coming together in these major associations of industry, associations like the Partnership for America’s Health Care Future, and are really pumping money in together and coordinating funding and coordinating their messaging. So there’s a major, major corporate alliance that’s opposed to any form of health justice.

Adam: Well, you can’t put a price tag on having something to lord over your employees.

Nima: Right. Priceless.

Adam: It’s an old MasterCard commercial. It’s priceless.

Nima: (Laughs.) Exactly.

Adam: Oh, you want to quit and go rock climbing with your boyfriend and you want to spend six months with your newborn child and learn to play the piano. Yeah, well how do you like not having insurance, fucko?

Nima: Yeah. I mean, so all of this, though, Ben, takes place within these deeper narratives that have already been entrenched, I think, throughout our society about what we deem to be, quote-unquote “the government,” and this has been seated for decades, if not even longer, from right-wing think tanks to media to pundits, but but also embedded in even more liberal spaces doing that, again, that kind of own goal thing of being like, ‘Oh, well, you know, government, yes, we know can’t be too big, but,’ yada, yada, yada. But it is not routinely felt universally around the world that government is a terrible, terrible thing and yet here in the US, I think this idea is fairly widespread, the idea of government as the origin of oppression, of overreach, this is how you are kept down, and that really salvation is in capitalism, right? Not that our government isn’t also capitalist, but is in private business, in industry, in your own consumer choice, your own ability as a, you know, employee somewhere to make decisions, which really just offsets the other entity that possibly could be blamed for making lives more difficult, say, corporate power or people’s bosses and something that your report does so well is actually connect all these dots between this idea of insurance propaganda, but it connects it with this larger idea, this larger push in right-wing thought of just condemning government in general, which then who would you look to to be your savior, right? And you mentioned that this was initially pushed by Bill Kristol and Frank Luntz and Newt Gingrich, like these same ghouls that have been doing this for decades, also seeded this idea in the Clinton era of, you know, being against what Kristol then deemed, quote, “big government, tax-and-spend liberalism,” end quote, which I think we’ve never really gotten away from because it is so entrenched. How do you see us trying to break through that so that government is not seen as this awful, sinister Big Brother, but possibly, could actually help people?

Ben Palmquist: Yeah, it’s such a good question. I mean, I think that really this attack on government is what has held this sort of weird, conservative, reactionary coalition together, where the racists and the social conservatives and the imperialists and the capitalists are all sort of aligned and wanting to restrain social spending and increase, you know, forms of militarization and imprisonment and control. But on the left, I mean, it is, I think, a real challenge when we recognize that there are real problems with government, with policing and so many other things and that things are not always run effectively or justly. But there’s things I think that can happen both sort of from the top and the bottom, and so at the top, I’m cautiously optimistic, I will say, that they’re starting to become a bit more awareness in DC, amongst this at a political elites, that they have to make an affirmative positive case for government and for collective action, right? That we don’t live individual lives in isolation and we actually need to affirmatively not just be letting the right-wing pull us further and further to the right but affirmatively saying, ‘This is what government can do for us and this is what we needed to do.’ You know, I’m skeptical that change starts at the top and so I think the other piece is that really as everyday people we can, and really must be, I think sort of agents of forcing that change and so coming together with other folks in movements, I think, and organizing is really, really the key of telling our stories and the ways that this system is not working for us and calling out corporate profiteers and their enablers in government and when things, public programs, private programs, whatever, are not working equitably, for people really being clear about that and sort of what a more just vision looks like and so I think this is just really the central challenge for all of our movements, not just in healthcare, but in everything else, but it feels really, really essential and I think that’s sort of what a core part of the struggle ahead is.

Adam: Yeah, one thing that makes it difficult, of course, is that to attack socialized medicine, as advocated for by candidates like Bernie Sanders and Elizabeth Warren, you saw centrists like Pete Buttigieg and Joe Biden they started doing basically just a right-wing attack. I mean, it wasn’t very creative. Instead of saying government-run, you had Pete Buttigieg’s smarmy affect about Washington, he loved to talk about Washington, the evil Washington, this is something you hear a lot that Republicans don’t talk about, ‘Oh, well, Washington’ while they, you know, sort of flick their suspenders and chew their tobacco. He said, quote, “Instead of just assuming sitting here in Washington we’re going to know what the right plan is for everybody…” what the right healthcare plan is for everybody, “We’re gonna let people figure it out for themselves.” That’s what he told The Washington Post. ‘I trust you to figure out your own health care, especially when you create these options,’ you know, ‘the clowns in Washington don’t know what’s good.’ There’s this like mugging?

Nima: What a bunch of clowns.

Adam: Yeah and Biden sort of, they both did this lie that a single-payer healthcare system would throw you violently off your healthcare without actually passing government-run healthcare, to use the right-wing phrase, and they eventually scared a bunch of seniors in Iowa that that was the case, pretty greasy stuff. And then, of course, you see that that was just the last primary, you know, the Democrats are supposedly going to the left on this issue and then you could actually see in the polling support for single-payer healthcare go down once major candidates like Biden and Buttigieg — who I think by sheer coincidence, just total coincidence happened to be the the two candidates with the most billionaire supporters, but we’ll just, you know, what are the odds, right? — the supposed left wing party is engaging in this kind of claptrap, too, I would think it kind of makes the broader project more difficult, and again, you saw this with Clinton, right? The era of big government is over. Obama, you know, government red tape. So when the Democratic Party adopts this kind of anti-government rhetoric, then of course, people are gonna say, ‘Well, why the fuck would I trust them to run, you know, a bake sale?’ And I think the part of the broader project that I think flicks activist and progressives is to really try to get people to think about the government not as this incompetent, corrupt thing that’s going to ruin your life, because it’s not, it’s not the author of your suffering for the most part, I mean, obviously, the police are, but, you know, the fucking Post Office isn’t, right? How do you sort of rewire the conversation, reprogram people’s brains to not look at these things — Washington, government — as pejoratives? Americans are so conditioned to view these things as pejoratives. How do activists for single-payer healthcare or some universal healthcare begin to sort of try to reframe that issue and you mention a lot about parallel usage in language so how would you do that if you were the press secretary for the president or for a presidential candidate or senator, how would you frame this issue?

Ben Palmquist: Yeah, I mean, so the problem with this slant, this lack of parity is that, you know, really sort of this focusing on government as an intrusive force, while completely obscuring the role of private corporate powers and so I think one of the first things to do is just start to visibilize the immense power that insurance companies, hospital, pharma employers, all these industries have over people’s lives and over what should be a democratically controlled and governed system, and so I think both on an individual level and on a collective level, part of that is visibilizing what are pretty unpopular industries that people know are screwing them over but just making that more of a public conversation. And then on the other side, I think we do need to really, and not just on healthcare, but you know, on climate and community safety, and so many other things, really emphasize the ways that people can collectively come up with solutions, like we need each other, none of us can give healthcare to ourselves, and on healthcare financing, and so much else, the way that we do that is through a government. The government should not be seen as some external force, right? That’s sort of out there on its own, but really what we want is for the government to be really a true body of the people and to reclaim that.

Nima: To be even actually more specific, something I really love about the report that you wrote, are the recommendations that it specifically gives. It speaks about a grand vision, sure, but it also gets pretty granular, which is great, and you know, you have this whole section on biased language, which I think we’d all recognize from speeches and TV, cable news, media reports, and how just having the discipline to be more honest about what people are talking and writing about, or at least have this kind of parity in the way that things are stated is, I think, really, really done well, in this piece that you wrote, rather than saying that a government-run insurer would replace the private sector — right? Private sector sounds amazing — if it actually would replace corporate-run insurers, those kinds of things really can make a difference to illuminating what we’re actually talking about here. Are there a couple other examples you can give, for all we know some journalists may listen to this show — I don’t know, I don’t know if they listen to Citations Needed, probably they’re annoyed with what we say about where they work, and them personally —

Adam: Self-righteous scolds.

Nima: What advice maybe can you give for making those changes editorially, and maybe even specifically, how the personalization of administrative mechanisms, which you talk about, the your insurance versus their plan, how these fit into language and how folks can start to shift this?

Ben Palmquist: Yeah, so there’s multiple ways in which the language gets skewed, but that we can rebalance it, and so for a journalist, editors, anyone else who’s sort of crafting words and sentences, one thing we’ve talked about, you know, if you’re mentioning government explicitly, then mention corporations explicitly, or on the flip side, if you’re saying private insurance, or something like that, and just say public insurance, right? These are various sort of comparable words. Similarly, often what happens is you get an action verb on the government side, right? So it’s government-run healthcare, the government is running this, and that, on the private side, there’s no, no action verbs at all. It’s just your insurance or something like that.

Questions from a 1993 healthcare poll conducted on behalf of WKYT-TV and WHAS-TV.

Nima: A fact of nature.

Ben Palmquist: Yes, exactly. It just naturalizes it. Exactly as you said too, these personal pronouns, people like their insurance, you can keep your insurance, right? It is this way of sort of pretending that people have some ownership of their Aetna plan or something, which is ridiculous, and of course, people are gonna feel more loss aversion and more afraid to lose something if you’re telling them —

Nima: But that’s my plan.

Ben Palmquist: That’s right. So there’s, you know, specific word choice really matters and then just the overall sentence structure matters too of saying government is running this, you know, it just in all the ways you have in sentences is thinking about these things, I think what we really want to do is try to be balanced and that’s even just to get to the centrist neutrality I’m talking about here. In an ideal world, we’d be much more explicit. Yeah, that’s a bare minimum.

Nima: Another thing you mentioned, Ben, is how insurance is so often considered to be the entirety of our healthcare system. The conflation or equation of insurance with healthcare is something that I think we see all the time that now it’s like you don’t even, you don’t even notice it when it’s in reports, you just assume it to be true, as opposed to actually seeing them as fundamentally different things. Can you dissect that just a touch?

Ben Palmquist: Yeah. So one of the things I see pop up in the mainstream press is this, this sort of defining Medicare for All or a public option as government-run healthcare, which is just patently false. It’s not just, it’s misleading to say government-run insurance, but it’s false to label the entire healthcare system and define it in terms of insurance. Healthcare includes research and development for vaccines and drugs, it includes public health, it includes hospitals and clinics and dentistry and community health and all sorts of different things and so there’s this, I think, sloppy confusion that happens in the way that things are worded and the effect of that, of course, is to sort of imply that this would be some Soviet-style takeover of doctors offices and everything that people care about and it’s just, it’s just very misleading.

Adam: Before you go is there anything you want to talk about? Your organization, what y’all do and what y’all are working on now that people can look out for and when they can expect to get single-payer healthcare? When are y’all going to take care of that man, the next 16–18 months? Let’s talk. Come on, get on it, what are you doing?

Ben Palmquist: We are working on it. So we actually work on a number of issues. We really partner closely with grassroots groups on their campaigns and so I anchor a couple of networks, the Dignity in Schools Campaign fighting the school-to-prison pipeline, and the Worker-Driven Social Responsibility Network, which is fighting for worker-driven modes of enforcing labor law in the US and around the world and on housing rights and healthcare as well. And so on healthcare we’re working with, we always a part of the Medicare for All coalition supporting state level campaigns pushing for universal healthcare, and also who are organizing around ways to get more power and protect people’s rights in healthcare, such as just basic things even like making sure all adults on Medicaid can have dental care, which is not guaranteed in many states. So folks can check us out at dignityandrights.org because we’re working with so many partners, there’s a lot going on all the time and I have no illusions that the road ahead for Medicare for all and health justice is not going to be a quick or easy one but I do think that the ground is shifting and and really the public is way ahead of politicians I think on recognizing that healthcare really is a human right and because of that our government has an obligation to protect it for everybody. So no quick and easy wins with this corporate opposition but I do think that we’re slowly moving in the right direction.

Nima: Well, I think that’s a great place to leave it. We’ve been speaking with Ben Palmquist, Health Care and Economic Democracy Program Director at Partners for Dignity and Rights. His work has been featured in publications such as In These Times, Jacobin, the Journal of Law, Medicine & Ethics and The Progressive. He is the author of the report, “Parroting the Right: How Media and Polling Company Adoption of Insurance Industry Spin Warps Democracy.” Ben, thank you so much again for joining us today on Citations Needed.

Ben Palmquist: Thank you.


Adam: You know one of the things you hear a lot too, this is one of the things we didn’t talk about in the show, but it’s a very common cliche, it’s probably the most pop kind of things people say is, you can’t have a single-payer healthcare, universal healthcare system and a large, diverse country. Diverse, right?

Nima: Yes, diverse.

Adam: Which is code for saying, ‘I don’t want Black people to have it,’ or the liberal alternative, which is ‘I don’t think Cletus, in Kentucky, wants Black people to have it so it’s politically not feasible,’ which probably true to some extent, but it’s sort of, you know, as a matter of policy or matter of fact, there’s not much difference, right? Because either way, you’re not going to go for it and so we either have people’s racism, or people’s appeals to some other person’s racism for why we can’t have nice things.

Nima: And also why we can’t be Scandinavian.

Adam: Right. Despite the fact that several countries people reference, you know, the UK, France, Canada, these are diverse countries, they have single-payer healthcare systems and they, you know, they’re not as diverse as the United States is, but they’re, you know, they’re majority white countries with large Muslim populations, Black populations, immigrant populations. So it’s sort of this thing you say, to kind of poopoo it away, and it makes you seem hip and savvy, it’s the classic, ‘I’m not racist, but other people are so therefore we have to sort of give up on trying.’

Nima: Or again, the things that we heard in the campaign messaging that we referenced earlier in the show, you know, these are complex challenges, right? This is really, really a winding road of competing ideas and we really need to consider this more before just doing the obvious thing and giving people healthcare.

Adam: And we didn’t even talk about the deficit concern trolling, which was popularized in the ’90s as well, and the sitting democratic president did this, how we can afford it, Bernie’s plan costs $30 trillion over 10 years, blah, blah, blah. So there’s all these kinds of ready made excuses that are somehow always there despite the fact that, you know, this isn’t one of these pie in the sky things, right? This isn’t abstract. This isn’t like let’s abolish police or something that sort of maybe doesn’t have any kind of A/B tests — although you could argue that the police are already abolished in several rich neighborhoods, but we’ll set that aside for now — there are dozens of countries that do this and have done this for several decades. It’s the most studied thing on Earth, you know, it’s more studied than the light side of the moon. We know it works. We know it’s cheaper, these are settled issues and yet somehow, and this is why the best they can come up with as a matter of empirical evidence like, ‘Oh, well, sometimes in Canada, you have to wait a long time,’ ‘Oh, that’s it? That’s the thing? I have to wait a long time for elective surgery sometimes? Okay, sounds good to me.’ I mean, you know, you have a lot of push polls, it depends how you government-run, you can have public healthcare but you have to give up your private insurance, implying that you’re somehow going to have this gap without it, they keep trying to push poll these things —

Nima: You can’t choose your doctor, what’s your poor doctor gonna do?

Adam: But if you ask the question in a neutral way, or in a way favorable to public health, the numbers go up to 60, 70 percent, for Democrats it is as high as 85 percent. That’s with all the bullshit propaganda. Imagine if we didn’t have the bullshit propaganda. We would be at 100 percent.

Nima: Well, right. That’s the thing, right? That’s why these kind of bias messaging versus balanced messaging, and the balanced messaging isn’t even really that balanced, just sort of having parity of language as we were discussing with our guests earlier —

Adam: It’s a very modest ask.

Nima: It’s like the most modest ask, which doesn’t even tell all of the truth, you won’t even get the full truth that you can get on a, you know, by calling a toll free number.

Adam: Tens of thousands of people in this country to this day, still die due to lack of or being underinsured. I mean, the stakes could not be higher, and we talk about it like someone’s asking for a fucking unicorn for Christmas. Like it’s, ‘Oh, well, I don’t know,’ it’s like, the longer we put it off, you know, the longer we kick the can down the road, the more and more people die. This is a life and death matter and we treat it as if it’s some academic abstraction and when you see how much money and effort and time has gone into convincing the average person that this is some sinister Nazi-like takeover or it’s going to cost them, it is going to raise their taxes, ‘Oh it’s going to raise my taxes,’ and it’s like, you have people mortgaging their houses and selling their cars and jewelry to pay for basic surgery and you look at it and you’re like, I hate to put it in these kind of macho terms but people in other countries think we’re fucking idiots. They think we’re marks, they think we’re the biggest fucking dopes in the world that we sit here and we take this and we vote for this every single election cycle and, you know, they’re not wrong. It’s just the ultimate chumpsville, it’s the ultimate chumpsville. So you can have — what? — freedom and choice to be fired by your boss tomorrow and have no insurance? How much freedom of choice is there in that? There’s none, zero, zilch. You live at the whim in the caprice of your fucking boss. That is not freedom and that is certainly not choice.

Nima: And yet the PR spin and the propaganda campaigns that have been pushed for nearly 100 years have brought us to this place and I think it really does, you know, illuminate how powerful not only the corporate interests are that then pay for these PR pushes, but then how those influence media and how this idea that government-run is inherently fascist or is inherently evil, and therefore can be othered so that you can retain your choice, your American voluntary decision-making and how these propaganda terms really just set the frameworks of the debates that we have and are so incredibly influential. It’s the same reason why the ACA is popular but Obamacare is not. It’s the way that you talk about it, whereas we know what is actually popular and what would benefit people but the bludgeoning of our PR and propaganda campaigns has done such damage to the American mind.

Adam: Speaking of AMAs, Nima.

Nima: Yeah.

Adam: Not the horrific racist American Medical Association we’ve been talking about the whole show, we are doing a Ask Me Anything, AMA, for patrons tomorrow night Thursday, April 22 at 10pm Eastern, we are doing a live AMA on our Discord, Nima. Are you excited about that? I’m excited about that.

Nima: I am so incredibly excited, of course, we do hope that you join us on Patreon so that you can get the info to log on to join us on the AMA and we really do hope to see you there. That will do it for this episode of Citations Needed, of course, you can follow the show on Twitter @CitationsPod, Facebook Citations Needed, become a supporter of our work and join our AMA through Patreon.com/CitationsNeededPodcast with Nima Shirazi and Adam Johnson all your support through Patreon is so incredibly appreciated. And as always, a very special shout out goes to our critic level supporters on Patreon. I am Nima Shirazi.

Adam: I’m Adam Johnson.

Nima: Citations Needed is produced by Florence Barrau-Adams. Associate producer is Julianne Tveten. Production assistant is Trendel Lightburn. Newsletter is by Marco Cartolano. Transcriptions are by Morgan McAslan. The music is by Grandaddy. Thanks so much for listening again, everyone. We’ll catch you next time.


This Citations Needed episode was released on Wednesday, April 21, 2021.

Transcription by Morgan McAslan.



Citations Needed

A podcast on media, power, PR, and the history of bullshit. Hosted by @WideAsleepNima and @adamjohnsonnyc.