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The GOP War on Doctors, Patients and Health Care Reform

May 8, 2009

Back in 1993, Bill Kristol mobilized Republicans to block the Clinton health care plan with an infamous two- word talking point, "no crisis." Now 16 years later, GOP pollster and master of double-speak Frank Luntz is offering conservatives a new lexicon for scuttling President Obama's health care initiatives. While feigning support for "reform," Luntz insists, Republicans should oppose Obama by warning of threats to the "doctor-patient relationship."
Of course, the President is threatening no such thing. And as it turns out, George W. Bush not only used the same language Luntz now advocates. As its draconian positions over abortion policy and the Terri Schiavo case showed, it is the Republican Party which is intent on abridging the doctor-patient relationship.
But you'd never know from the Luntz memo designed to buck up his beaten and battered Republican allies. Desperate to block success on health care which could help solidify a Democratic majority for years, Luntz suggests different rhetoric for the Republicans' 21st century obstructionism. Unlike Kristol's denial of the crisis, Luntz warns GOP officials, "You simply MUST be vocally and passionately on the side of REFORM."
And by "passionately on the side" of reform, Luntz means "actively working against." Although he concludes by telling GOP candidates, "It's not enough to just say what you're against" and insists "if you offer no vision for what's better for America, you'll be relegated to insignificance at best and labeled obstructionist at worst." Needless to say, he never says what that vision might be.
Instead, the Sun Tzu of the Republican art of rhetorical war recycles decades-old spin in ten new talking points. Among the lowlights:

The arguments against the Democrats' healthcare plan must center around "politicians," "bureaucrats," and "Washington"...not the free market, tax incentives, or competition. Stop talking economic theory and start personalizing the impact of a government takeover of healthcare...
The idea that a "committee of Washington bureaucrats" will establish the standard of care for all Americans and decide who gets what treatment based on how much it costs is anathema to Americans. Your approach? Call for the "protection of the personalized doctor-patient relationship."

If that sounds familiar, it should. Throughout his presidency, George W. Bush said the same thing.
A quick look back shows that "protecting the doctor-patient relationship" has been the Republican Party mantra for selling the full range of its health care privatization schemes. In May 2006, President Bush told an RNC gala:

"Ours is a party that understands the best health care system is when the doctor-patient relationship is central to decision-making. That's why we're strong believers in health savings accounts...And so we reformed Medicare. We said to our seniors, we trust you; we trust you to make decisions that meets your needs."

That same drumbeat provided the rhythm for the entire Bush presidency. In March 2001, the President told the American College of Cardiology, "I want to talk about protecting the doctor-patient relationships with a patients' bill of rights." In 2004, the President Bush pushed for malpractice liability reform, claiming that "one of the most vital links of good medicine is the doctor-patient relationship." In February 2006, the White House introduced its ill-fated proposal "Reforming Health Care for the 21st Century" by claiming its intent to "strengthen the doctor-patient relationship." Pitching his plans two months later for association health plans, medical savings accounts and malpractice litigation curbs, President Bush declared:

"The best way to reform this health care system is to preserve the system of private medicine, is to strengthen the relationship between doctors and patients, and make the benefits of private medicine more affordable and accessible for all our citizens."
Government has a role to play...We have a major role to play in strengthening and reforming this health care system, but in a way that preserves the doctor-patient relationship."

But when it comes to the reproductive choices of American women, not so much.
From the beginning, the Republican war against so-called partial birth abortion sought to preclude American doctors from utilizing the extremely rare intact dilation and extraction procedure. Used to protect the health of the mother in only about 2500 of the 1.25 million pregnancies terminated annually, the viscerally gruesome procedure became a strategic marketing weapon for abortion foes to whittle away the reproductive options available to American women and their doctors. As President Bush erroneously claimed:

"As Congress has found, the practice is widely regarded within the medical profession as unnecessary, not only cruel to the child, but harmful to the mother and a violation of medical ethics."

The evidence, of course, as well as the American medical establishment, makes precisely the opposite point. For example, the American College of Obstetricians and Gynecologists opposed the 2003 law, arguing its members must have the flexibility to choose the intact D&E procedure in those extremely rare cases when it is necessary:

"The intact variant of D&E offers significant safety advantages over the non-intact method, including a reduced risk of catastrophic hemorrhage and life-threatening infection. These safety advantages are widely recognized by experts in the field of women's health, authoritative medical texts, peer-reviewed studies, and the nation's leading medical schools."

During oral arguments before the Supreme Court on November 9, 2006, Planned Parenthood Federation of America's Eve Gartner concurred. "What Congress has done here is take away from women the option of what may be the safest procedure for her," Gartner said, adding "this court has never recognized a state interest that was sufficient to trump the women's interest in her health."
In her emotional dissent, Justice Ruth Bader Ginburg laid bare the Bush administration's unprecedented disruption of the relationship between a woman and her doctor:

"The Court's opinion tolerates, indeed applauds, federal intervention to ban nationwide a procedure found necessary and proper in certain cases by the American College of Obstetricians and Gynecologists. For the first time since Roe, the Court blesses a prohibition with no exception protecting a woman's health."

Sadly, Justice Kennedy's majority opinion joined the Republican Party in substituting the views of abortion opponents for those of a patient's doctor. Kennedy rejected that the 2003 Act "imposes an undue burden on a woman's right to abortion based on its overbreadth or lack of a health exception," adding:

"The Act is not invalid on its face where there is uncertainty over whether the barred procedure is ever necessary to preserve a woman's health, given the availability of other abortion procedures that are considered to be safe alternatives."

But as Planned Parenthood's Gartner protested, "This ruling tells women that politicians, not doctors, will make their health care decisions for them."
Which is to say, exactly the kind of decision to be made in the doctor-patient relationship Frank Luntz, George Bush and their Republican amen corner claim to protect. Meanwhile, for the 45 million Americans lacking health coverage and the 25 million more underinsured, Republicans hope to ensure they have no doctor-patient relationship at all.


Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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