'Obamacare': More Than Just a Word


"If this health care plan is the greatest thing ever, why are Democrats so offended when you call it 'Obamacare'?" asked Joe Scarborough a few weeks ago on MSNBC's "Morning Joe," describing a rendezvous with a Democrat angry at his use of the word.

"Because you got 'Obama,'" he continued. "They like that word. And you got 'care.' Care is a good word. And you put them together and suddenly it's a vulgarity."

Scarborough's interest in the precise implications of the term "Obamacare" is important, but his rather rudimentary unpacking of the term doesn't do the topic justice. While he's right that "Obamacare" is a phrase that's not so neutral, its meaning is far from straightforward. Since coming into use during the 2008 presidential contest -- the earliest use I can find was in the Washington Times on Oct. 26 of that year -- it has come to operate as much more than just a synonym for the unwieldy to title of a health-care bill, the "Patient Protection and Affordable Care Act."

As its early use by the right of center Times makes plain, newspapers and organizations that use the term run conservative; notice the Wall Street Journal has an online "Guide to ObamaCare: A comprehensive collection of our editorials and op-eds." Furthermore, the term often is used as a negative reference to the entire program of the Obama administration, making "Obamacare" more a partisan battlefield than an abbreviation for the president's health-care policy.

"Obamacare" as a term derives from "Hillarycare," again a construct of anti-Democrat forces -- in this case those opposed to President Clinton's attempts at health-care reform in the early 1990s, spearheaded by the first lady. It was a similarly loaded term; Paul Starr, a senior health policy advisor during the Clinton administration, argued that the rhetoric of "Hillarycare" was "partly the result of right-wing misrepresentations of the plan as a 'government takeover' and malicious personal attacks on Hillary."

The rise of "Obamacare" represents the return of a handy catch-all phrase for government interference. Bill Kenyon, Political Director at Fred Davis' Republican Strategic Perception polling company, told me that the term has come to "encapsulate the unease with the government and the idea that we're trying to go too far, too fast. And it never stops, and just keeps coming." Fred Davis concurs, e-mailing that his company has used the term in advertisements because the "connotation of the name is powerful. That he pressed forward with his liberal ideals even though the majority of the country clearly disagreed."

Indeed, says Scott Gottlieb, a fellow at the American Enterprise Institute who uses the term in articles for the Wall Street Journal, "Obamacare" is simply an "easy, one-word way to refer to the totality of Obama's proposals." While he admits that it has attracted negative connotations, he thinks they are "being oversensitive."

The repeated references to "Obamacare" by Republicans have certainly had an effect on voters' opinions of the new health-care law.

Republican polling company Public Opinion Strategies (POS) found that in September 2010, 49 percent of registered voters reacted negatively to the term, compared to 29 percent who saw it favorably. That figure is made more illuminating when considered along with another poll a month later. That poll found that when voters were asked whether they support or oppose health-care reform -- the seemingly more "neutral" term, though some news outlets call it the "health-care overhaul" in the interests of pure neutrality -- the numbers were 45 percent in favor and 49 against. The term "Obamacare" would seem to dramatically decrease positive reactions to the health-care law. And a full 89 percent of voters recognized the word, according to the POS survey.

Jeff Horwitt, a pollster with the Democratic firm Hart Research Associates, contends that "Obamacare" doesn't accurately describe what the bill does, whereas its actual title shows the intent of the legislation, albeit in a rather wordy fashion. "The aim of the bill is to make health care more affordable and make sure more people are covered," he explains, "whereas, to me, 'Obamacare' is focused on one person, and literally, it's about him taking care of someone or something: a Big Brother socialist caretaker."

Perhaps the imagery that "Obamacare" conjures for those on opposing sides of the aisle differs so much because such a large amount of the term's meaning derives from its message and context. Kathleen Hall Jamieson, professor of communication at the University of Pennsylvania, explains that there is no settled definition for "Obamacare" because its meaning is set by a combination of context, message and audience. In the current debate, its context evokes the negatives attached to "Hillarycare." More importantly, it is used solely as a Republican message.

"For those whose children are able to stay on insurance," Jamieson explains, "'Obamacare' might well be something positive. However, the pro-bill forces have not cast it that way. So at the moment the term is identified with opponents because they're the ones who coined it and they're the ones who are using it."

Indeed, many in the media were quick to point to the lack of overarching narrative for Obama's policies in the first two years of his administration. The twentieth-century's great liberal leaders all came into office with goals that crucially had a label: FDR's "New Deal," JFK's "New Frontier," and LBJ's "Great Society." But what was Obama's? The president's continual reference since the State of the Union of the maxim "Win the Future" is a clear attempt to regain ground lost to Republicans. The summer of 2009 saw town hall meetings ring with opposition to health-care reform, paving the way for a Republican backlash that has used opposition to "Obamacare" as its rallying cry.

Jamieson notes that previous presidents definitely "had labels, but that doesn't mean they had any policy coherence under them. FDR famously said 'Try one idea and if it doesn't work, we'll try another.' Obama has a policy, but he needs a label."

Republican pollster Kenyon believes Obama lost the rhetorical battle when it came to health care, and that has had a knock-on effect in helping the opposition. "Three years ago when Obama was running, he was the unexamined candidate," he tells me. "Now, Obama is a defined picture. And 'Obamacare' has helped to define him."

The administration has made some effort to alleviate the problem. Already the Department of Health and Human Services has bought ad space on Google, so that when you search the term "Obamacare" the first hit is a link to the government's health-care website. And there are scattered efforts by political figures to reclaim the word as something good.

In the long run, though, criticizing "Obamacare" is likely to remain a potent message for the GOP. Republican pollster Davis says that as long as it health law exists, it will be "wise" for opponents to use the phrase "Obamacare."

Image credit: Atlantic screenshot of repealhealthcareact.com

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