In the spring of 2009, a Republican strategist settled on a brilliant and powerful attack line for President Barack Obama's ambitious plan to overhaul America's health insurance system. Frank Luntz, a consultant famous for his phraseology, urged GOP leaders to call it a "government takeover."
"Takeovers are like coups," Luntz wrote in a 28-page memo. "They both lead to dictators and a loss of freedom."
The line stuck. By the time the health care bill was headed toward passage in early 2010, Obama and congressional Democrats had sanded down their program, dropping the "public option" concept that was derided as too much government intrusion. The law passed in March, with new regulations, but no government-run plan.
But as Republicans smelled serious opportunity in the midterm elections, they didn't let facts get in the way of a great punchline. And few in the press challenged their frequent assertion that under Obama, the government was going to take over the health care industry.
PolitiFact editors and reporters have chosen "government takeover of health care" as the 2010 Lie of the Year. Uttered by dozens of politicians and pundits, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats' shellacking in the November elections.
Readers of PolitiFact, the St. Petersburg Times' independent fact-checking website, also chose it as the year's most significant falsehood by an overwhelming margin. (Their second-place choice was Rep. Michele Bachmann's claim that Obama was going to spend $200 million a day on a trip to India, a falsity that still sprouts.)
By selecting "government takeover' as Lie of the Year, PolitiFact is not making a judgment on whether the health care law is good policy.
The phrase is simply not true.
Said Jonathan Oberlander, a professor of health policy at the University of North Carolina-Chapel Hill: "The label 'government takeover" has no basis in reality, but instead reflects a political dynamic where conservatives label any increase in government authority in health care as a 'takeover.' "
An inaccurate claim
"Government takeover" conjures a European approach where the government owns the hospitals and the doctors are public employees. But the law Congress passed, parts of which have already gone into effect, relies largely on the free market:
• Employers will continue to provide health insurance to the majority of Americans through private insurance companies.
• Contrary to the claim, more people will get private health coverage. The law sets up "exchanges" where private insurers will compete to provide coverage to people who don't have it.
• The government will not seize control of hospitals or nationalize doctors.
• The law does not include the public option, a government-run insurance plan that would have competed with private insurers.
• The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.
PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. We have concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers.
It's true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.
Republicans who maintain the Democratic plan is a government takeover say that characterization is justified because the plan increases federal regulation and will require Americans to buy health insurance.
But while those provisions are real, the majority of Americans will continue to get coverage from private insurers. And it will bring new business for the insurance industry: People who don"t currently have coverage will get it, for the most part, from private insurance companies.
Consider some analogies about strict government regulation. The Federal Aviation Administration imposes detailed rules on airlines. State laws require drivers to have car insurance. Regulators tell electric utilities what they can charge. Yet that heavy regulation is not described as a government takeover.
This year, PolitiFact analyzed five claims of a "government takeover of health care." Three were rated Pants on Fire, two were rated False.
'Can't do it in four words'
Other news organizations have also said the claim is false.
Slate said "the proposed health care reform does not take over the system in any sense.' In a New York Times economics blog, Princeton University professor Uwe Reinhardt, an expert in health care economics, said, "Yes, there would be a substantial government-mandated reorganization of this relatively small corner of the private health insurance market (that serves people who have been buying individual policies). But that hardly constitutes a government takeover of American health care."
FactCheck.org, an independent fact-checking group run by the University of Pennsylvania, has debunked it several times, calling it one of the "whoppers" about health care and saying the reform plan is neither "government-run" nor a "government takeover."
We asked incoming House Speaker John Boehner's office why Republican leaders repeat the phrase when it has repeatedly been shown to be incorrect. Michael Steel, Boehner's spokesman, replied, "We believe that the job-killing ObamaCare law will result in a government takeover of health care. That's why we have pledged to repeal it, and replace it with common-sense reforms that actually lower costs.”
Analysts say health care reform is such a complicated topic that it often cannot be summarized in snappy talking points.
"If you're going to tell the truth about something as complicated as health care and health care reform, you probably need at least four sentences," said Maggie Mahar, author of Money-Driven Medicine: The Real Reason Health Care Costs So Much. "You can"t do it in four words."
Mahar said the GOP simplification distorted the truth about the plan. "Doctors will not be working for the government. Hospitals will not be owned by the government," she said. "That's what a government takeover of health care would mean, and that's not at all what we"re doing."
How the line was used
If you followed the health care debate or the midterm election – even casually – it's likely you heard "government takeover" many times.
PolitiFact sought to count how often the phrase was used in 2010 but found an accurate tally was unfeasible because it had been repeated so frequently in so many places. It was used hundreds of times during the debate over the bill and then revived during the fall campaign. A few numbers:
• The phrase appears more than 90 times on Boehner's website, GOPLeader.gov.
• It was mentioned eight times in the 48-page Republican campaign platform "A Pledge to America" as part of their plan to "repeal and replace the government takeover of health care."
• The Republican National Committee's website mentions a government takeover of health care more than 200 times.
Conservative groups and tea party organizations joined the chorus. It was used by FreedomWorks, the Heritage Foundation and the Cato Institute.
The phrase proliferated in the media even after Democrats dropped the public option. In 2010 alone, "government takeover” was mentioned 28 times in the Washington Post, 77 times in Politico and 79 times on CNN. A review of TV transcripts showed "government takeover" was primarily used as a catchy sound bite, not for discussions of policy details.
In most transcripts we examined, Republican leaders used the phrase without being challenged by interviewers. For example, during Boehner's Jan. 31 appearance on Meet the Press, Boehner said it five times. But not once was he challenged about it.
In rare cases when the point was questioned, the GOP leader would recite various regulations found in the bill and insist that they constituted a takeover. But such followups were rare.
An effective phrase
Politicians and officials in the health care industry have been warning about a "government takeover" for decades.
The phrase became widely used in the early 1990s when President Bill Clinton was trying to pass health care legislation. Then, as today, Democrats tried to debunk the popular Republican refrain.
When Obama proposed his health plan in the spring of 2009, Luntz, a Republican strategist famous for his research on effective phrases, met with focus groups to determine which messages would work best for the Republicans. He did not respond to calls and e-mails from PolitiFact asking him to discuss the phrase.
The 28-page memo he wrote after those sessions, "The Language of Healthcare 2009," provides a rare glimpse into the art of finding words and phrases that strike a responsive chord with voters.
The memo begins with "The 10 Rules for Stopping the 'Washington Takeover' of Healthcare.” Rule No. 4 says people "are deathly afraid that a government takeover will lower their quality of care – so they are extremely receptive to the anti-Washington approach. It's not an economic issue. It's a bureaucratic issue."
The memo is about salesmanship, not substance. It doesn't address whether the lines are accurate. It just says they are effective and that Republicans should use them. Indeed, facing a Democratic plan that actually relied on the free market to try to bring down costs, Luntz recommended sidestepping that inconvenient fact:
"The arguments against the Democrats' healthcare plan must center around politicians, bureaucrats and Washington ... not the free market, tax incentives or competition."
Democrats tried to combat the barrage of charges about a government takeover. The White House and House Speaker Nancy Pelosi repeatedly put out statements, but they were drowned out by a disciplined GOP that used the phrase over and over.
Democrats could never agree on their own phrases and were all over the map in their responses, said Howard Dean, former head of the Democratic National Committee.
"It was uncoordinated. Everyone had their own idea," Dean said in an interview with PolitiFact.
"The Democrats are atrocious at messaging," he said. "They've gotten worse since I left, not better. It's just appalling. First of all, you don"t play defense when you"re doing messaging, you play offense. The Republicans have learned this well."
Dean grudgingly admires the Republican wordsmith. "Frank Luntz has it right, he just works for the wrong side. You give very simple catch phrases that encapsulate the philosophy of the bill."
A responsive chord
By March of this year, when Obama signed the bill into law, 53 percent of respondents in a Bloomberg poll said they agreed that "the current proposal to overhaul health care amounts to a government takeover.”
Exit polls showed the economy was the top issue for voters in the November election, but analysts said the drumbeat about the "government takeover" during the campaign helped cement the advantage for the Republicans.
Rep. Earl Blumenauer, an Oregon Democrat whose provision for Medicare end-of-life care was distorted into the charge of "death panels" (last year's Lie of the Year), said the Republicans' success with the phrase was a matter of repetition.
"There was a uniformity of Republican messaging that was disconnected from facts," Blumenauer said. "The sheer discipline . . . was breathtaking."
Government Printing Office, The Patient Protection and Affordable Care Act, March 23, 2010
Interview with Dr. Jonathan Oberlander of University of North Carolina - Chapel Hill
The Wonk Room, the Frank Luntz memo, "The Language of Health Care 2009.”
PolitiFact Florida, Florida Republican Party claims Democratic health care plan is government takeover, March 19, 2010
PolitiFact Wisconsin, Says "Tom Barrett supports a government takeover of our health care", Oct. 17, 2010
PolitiFact Florida, Bill Young claims House plan was 'government takeover' of health care, Feb. 24, 2010
PolitiFact Wisconsin, Republican group says Julie Lassa pushed for a Canadian-style health care system in Wisconsin, Oct. 30, 2010
Slate, What "Government Takeover"?, March 29, 2010
The New York Times, "A ‘government takeover" of health care?”, Feb. 26, 2010
Factcheck.org, The "Government-Run” Mantra, Nov. 6, 2009
Factcheck.org, A final weekend of whoppers?, March 19, 2010
Factcheck.org, Voting for a Health Care Takeover?, March 3, 2010
E-mail interview with Michael Steel, spokesperson for Rep. John Boehner
Interview with Maggie Mahar, author of Money-Driven Medicine: The Real Reason Health Care Costs So Much
House Republican Leader John Boehner, Economists Agree: Government Takeover Of Health Care Is A Massive Job Killer, March 18, 2010
House Republican Leader John Boehner, Detailed Analysis: House Democrats" Government Takeover Creates 53 New Government Programs, Offices, & Bureaucracies, Sept. 3, 2009
Republican in Congress, A Pledge to America, 2010
The New York Times, Health Insurance: A Fight for Survival, Oct. 30, 1977
The Republican National Committee, Dems celebrate their latest government takeover, March 23, 2010
The Kaiser Health Family Foundation, Kaiser Health Tracking Poll -- November 2010
The White House, Still Not a "Government Takeover," Jan. 31, 2010
The White House, Remarks by the President to a joint session of Congress, Sept. 9, 2009
Speaker Nancy Pelosi, Health Insurance Reform Mythbuster - ‘Democrats" Health Insurance Reform Is Socialism and a Government Takeover", March 19, 2010
Interview with Howard Dean, former head of the Democratic National Committee
Interview with Brendan Nyan of the University of Michigan
Bloomberg Poll, via PollingReport.com, March 19-22, 2010
CNN, 2010 exit polls
Interview with Rep. Earl Blumenauer
Interview with Gail Wilensky, health care economist