Improving American Healthcare: The Implications of Politics and Communications

By: Madeleine Shin – January 18, 2017

Reform in America doesn’t come easy. Look no further than the U.S. healthcare system. The debate over the American public’s right to healthcare emerged in the early 20th century, and it remains divisive to this day. Sweeping reforms that made it to law—from Medicare to ‘Obamacare’—have faced staunch opposition and calls for repeal.

Even during instances of healthcare bipartisanship, which was attributed to the passage of the Medicare Modernization Act that created Part D, public polling told a different story.1 In a poll taken the week that President George W. Bush signed the legislation, 47 percent of senior citizens opposed the changes, with only 26 percent in favor.1

There’s no question that the U.S. healthcare system needs reform of some kind. According to a 2014 report from the Commonwealth Fund, the U.S. “ranked last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity and healthy lives.” But the question of exactly how to fix it leaves our country deeply divided and has made change a struggle for any administration brave enough to tackle it.

Following the 2016 presidential election, 68 percent of voters stated that healthcare was a major factor in their choice for President. As we head into another inauguration, we’ve outlined a few reasons why the healthcare system will continue to be a hotly contested debate and communications issue for the foreseeable future.

It’s Highly Partisan

While some voters may cross party lines on the issue, Democrats and Republicans fundamentally disagree over the issue of healthcare access and under whom or what this responsibility should fall. This debate originates from the fact that the U.S. Constitution has no language specifically assuring the right to healthcare, only that it is the responsibility of the government to ensure the public’s “general welfare.” The issue is compounded by political rhetoric from both sides of the aisle regarding “big government,” socialism, choice and death panels.

Medical politics and health reform challenges or universal healthcare system stress concept as a group of opposing ropes pulling on a doctor stethoscope as a medicine management symbol with 3D illustration elements.

In fact, partisan rhetoric has historically played a major role in confounding the public’s views on healthcare and in driving us further away from compromise.2 Together, partisanship and rhetoric may explain why the majority of the electorate who voted for President-elect Donald Trump in the 2016 election have favorable attitudes toward many provisions in the Affordable Care Act, while half of these same voters would like to see ‘Obamacare’ repealed.

It’s Personal

Healthcare and health status are highly personal, particularly when they involve a life-altering illness or injury. Many of us establish a rapport with our healthcare providers and instill our trust in them; some patients have had these relationships for years. When someone or something, including changes to health policy, threatens to alter that relationship it can feel like a personal attack. Additionally, certain healthcare issues—like reproductive rights or stem cell research—conflict with many Americans’ personal and religious beliefs, making communications and rhetoric that much more influential.

Finally, personal experience often impacts an individual’s view of the healthcare system. For example, those who live in or near a city, have a steady job and have never been denied coverage for a pre-existing condition might not be privy to the countless coverage and access barriers in our healthcare system. It is thus often difficult to convince these individuals of the need for change to address these barriers. These and other examples make healthcare an emotionally charged issue that’s difficult to reform, or even communicate about, without striking many nerves.

It’s Obscure

The U.S. healthcare system is bloated and disjointed. In fact, Martin Sipkoff compares it to the story of the blind men and the elephant. “Doctors holding the tail perceive the system as constraining as a rope, purchasers touching the leg find it as immovable as a tree, and plans holding the trunk see it as devious and unmanageable as a snake,” he writes.

According to Don Berwick, M.D., M.P.P., former Administrator of the Centers for Medicare and Medicaid Services, the fragmented nature of our healthcare system makes it hard to understand and fix. “It’s impossible to isolate one element of it and say that’s what’s wrong,” Berwick said. “Most of us don’t think in systems terms, so it’s very difficult to gain momentum for change across the whole enterprise.” The magnitude of—and multitude of players within—our healthcare system not only contributes to its cost, but makes reform a formidable task. Without being able to collectively, and effectively, explain to these players what, how and why change needs to occur, silos will persist and a path forward will remain elusive.

Our Role as Communicators

As healthcare communicators, we play an important role in educating the public and policymakers about the challenges facing patients, physicians, payers and innovators that keep our healthcare system at lowly #11. It is our charge to learn from the communications mistakes of the past and understand what has led us to this politically and emotionally charged gridlock. To influence change—big and small—we must challenge ourselves to create an environment that welcomes healthy debate and introduces new perspectives than can move us forward. As such, here are a few things to consider when telling your respective stories:

Focus on the facts: Use data where possible to make your case. Rhetoric can only go so far against facts that are supported by well-crafted messages backed by hard numbers.

Forge unconventional partnerships: The phrase “preaching to the choir” often rings true when dealing with controversial issues like healthcare. Instead of forming like-minded coalitions, push yourself and your clients to think outside of the box and partner with atypical allies on initiatives that can forge compromise and meaningful change.

Don’t oversimplify: Streamlining messages in an effort to make healthcare easier to understand can instead perpetuate misunderstanding and misperceptions among politicians and the general public. Instead of watering down your message, identify supportive metaphors or visual tools that clearly depict your challenge or point of view.

Be responsible with your emotions: Storytelling and emotionality are powerful tools that can be abused when communicating about healthcare. As communications professionals, we are accountable for the authenticity of personal accounts and narratives that use emotion to evoke change.


1. Oliver, T. R., Lee P.R., and H. Lipton. “A Political History of Medicare and Prescription Drug Coverage.” The Milbank Quarterly 82.2 (2004): 283-354. Web.

2. Freed, G. L., and A. Das. “Nixon or Obama: Who Is the Real Radical Liberal on Health Care?” Pediatrics 136.2 (2015): 211-14. Web.