Trumpcare would kill people, and Democrats aren’t shy about saying it. After Senate Republicans released their health care bill last week, top Democratic leaders warned about its deadly consequences, employing rhetoric that might seem hyperbolic were it not supported by strong evidence.
Sanders and Clinton weren’t alone. Elizabeth Warren took to the Senate floor and declared, “People will die. Let’s be very clear. Senate Republicans are paying for tax cuts for the wealthy with American lives.” House Minority Leader Nancy Pelosi told CBS News that deaths would number in the “hundreds of thousands.” And when White House counselor Kellyanne Conway suggested Americans stripped of coverage under this plan could simply get jobs, former Governor Martin O’Malley responded bluntly:
On substance, Democrats are on firm footing. The Center for American Progress and Harvard researchers estimated that the Senate bill could cause between 18,100 and 27,700 additional deaths in 2026. The Washington Post’s Philip Bump reported that it’s “hard to pin down” exactly how many people would lose their lives, but acknowledged, “The available evidence suggests that there will be a human toll from an increase in the number of uninsured.... In broad strokes, Sanders’s assessment that thousands more would die annually appears to be supported by the data.” PolitiFact similarly “found ample evidence in the academic literature to suggest that legislation on the scale of the House bill would produce ‘thousands’ of additional deaths.” It’s also just simple logic that being uninsured imperils one’s health, which can lead to death (an obvious example being someone discovered to have late-stage cancer, which could have been caught earlier through a routine medical checkup).
And yet, in today’s hyper-polarized climate, the GOP views even the prospective death of fellow Americans through a partisan lens. That’s why experts on political messaging are split over Democrats’ death rhetoric, and whether it’s futile in terms of persuading conservatives to oppose Trumpcare.
For many top Republicans, dealing with the lethality of this legislation has meant simply ignoring it. Asked by Fox News about Warren’s warnings, President Donald Trump responded with racist name-calling: “I actually think she’s a hopeless case. I call her Pocahontas, and that’s an insult to Pocahontas. I actually think that she is just somebody who has got a lot of hatred, a lot anger.” Senator Orrin Hatch invoked the recent push for comity following the shooting of Representative Steve Scalise:
Even if GOP partisans weren’t shrugging off the stakes of Trumpcare, Berkeley linguist George Lakoff believes Democrats’ messaging wouldn’t win over conservatives. “It’s not raising ire throughout the red states,” he said, for a variety of reasons. There’s the pull of tribalism: GOP voters would “rather believe whatever the Republicans tell them.” There’s also “in-group nurturance,” an impulse on the right to care more about their own communities, as opposed to the broader public. And “conservatives have a very hard time with systemic causation.” The health care bill, Lakoff explained, would set up a system ultimately resulting in death, but wouldn’t dole out death immediately and directly. It wouldn’t be seen as purposefully killing people, in contrast to the old Republican lie that the Affordable Care Act would result in “death panels.” He said, “They were understood as more direct. When you call them ‘death panels,’ the assumption is that the panels would decide who would die.”
Lakoff offered advice for Democrats hoping to persuade these conservatives. “Talk to people about people they know in these groups—their social groups, their community groups,” he said. “You have to bring it down to moral human values for people they know. You get pastors, people in church groups, neighbors.” For now, though, he concluded, “It’ll play to the Democratic base, but I don’t see the Democratic base effectively going out and organizing. I don’t see the Democratic base and independents getting their neighbors passionate.”
“George doesn’t respond very well to data or doesn’t learn very much from data,” countered Stan Greenberg, a prominent Democratic pollster and strategist. His firm recently conducted opinion surveys on the Republican health care bill, turning up evidence that the current Democratic messaging can work. According to a memo on the surveys, “The strongest attack [on the bill] is elemental—it will push people with pre-existing conditions to go without treatment and ‘some will die’—and that is unacceptable to ‘anyone who respects and cherishes human life.’”
Greenberg says “there was no pushback on believability” when his firm talked in its survey about the Congressional Budget Office score of the House health care bill. “When the Republicans pulled the bill and couldn’t get the votes after the CBO report, that made the attacks on the bill very credible,” he said. “People just didn’t doubt those facts. The CBO reports are seen as very credible.” That helps to explain why the House reworked their bill and passed it without waiting for a new CBO analysis.
“Quite simply, fear appeals work,” said Jennifer Mercieca, an historian of American political discourse at Texas A&M University. “I’m not sure that the Democrats are trying to persuade anyone. Democrats seem like they’re on the side with the people—they’re trying to keep people energized and activated.”
That’s valuable, according to Bob Lehrman, a speechwriter for Vice President Al Gore in the ’90s. “If I were a speechwriter for a major Democratic senator, I would say there are ways they should use rhetoric like that, because it’s true,” he said. It may also “energize the people that are on our side to work on campaigns and contribute money, and that would be a good thing.”
But Lehrman doesn’t think death rhetoric will change many minds. He believes the consequences of political rhetoric are “way overblown”—that even inaugural or State of the Union addresses have marginal, fleeting effects on public perception. But sometimes, he said, changes at the margins are all that you need: “It’s not like you have to get everybody on your side. You switch two percent of the vote and you can go from being a loser to being a winner.”