Health Care Debate: Why So Much Yelling?

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While many town hall meetings about health care reform have gone smoothly, others have boiled over with anger and chaos. Talk radio and cable news channels have repeatedly rebroadcast the most raucous portions of the meetings. The sounds and images have prompted concerns about the ability, or desire, for civil discourse.

MICHEL MARTIN, host:

I'm Michel Martin and this is TELL ME MORE from NPR News.

Just ahead, can a few hundred dollars really make a difference? It can for small business owners who can't get conventional loans. We'll talk about how micro-finance, a strategy for fighting poverty in the developing world, is catching on in this country. That conversation in just a few minutes.

But first, we're going to continue our conversation about the health care debate. Lawmakers around the country have been hosting town hall meetings to talk over health care plans with their constituents. And while many of the meetings have gone quite smoothly, others have exploded with pushing and shoving, yelling and name calling.

(Soundbite of crowd)

Unidentified Man #1: When the government takes over the health care and you're going to have people in the streets dying without insurance, we're going to end up evolving into socialized medicine.

Unidentified Woman #1: I'm surprised at how some of the people have been. We did - one person with our signs who would not walk away from us because he really wanted to tell us about how Obama (unintelligible).

(Soundbite of protesting)

MARTIN: Like many Americans watching all this, we've been asking, why? Is there something about this topic that's causing people to want to give their vocal chords a work out? Is it the media attention or is this just the way Americans think they're supposed to debate issues these days? For some answers, we've called a group of people who studied communications, media and history. Georgetown University linguistics Professor Deborah Tannen. She is the author of the book "The Argument Culture," about the decline of civil discourse. Also with us, Associate Professor Daniel Durbin, who teaches media, image management and rhetoric at the University of Southern California's Annenberg School for Communication. And Yale University Professor Jennifer Klein who teaches 20th century American History. Welcome to you all. Thank you all so much.

Professor DANIEL DURBIN (Media, Event Management and Rhetoric, University of Southern California's Annenberg Scholl for Communication): Hello, Michel.

Professor DEBORAH TANNEN (Language, Georgetown University; Author, "The Argument Culture"): Nice, pleasure to be here.

Professor JENNIFER KLEIN (American History, Yale University): Hi, thanks for having me.

MARTIN: Professor Tannin, I'm going to start with you because you wrote your book "The Argument Culture," in 1998, where you talked about this very phenomenon. So, I wanted to ask how the current health care conversation is striking you.

Prof. TANNEN: I think it fits right in. We have a confluence of forces in politics and media that come together. For politicians, Republicans have been very clear that they feel that if Democrats succeed in bringing universal health care, it will make them - this is in the words of Newt Gingrich way back before Clinton took office and we heard it from Rush Limbaugh before Obama took office, they will be unbeatable. So, for Republicans we need to get - they feel they need to get people worked up so that Democrats won't succeed in this. And fear, this again I'm quoting now Frank Luntz(ph) who has been an advisor to Republicans in their use of language. In his words, fear is a saleable commodity. So…

MARTIN: So, you feel this is mainly part of an inspired rage?

Prof. TANNEN: I do. You know, just as we had the inheritance tax referred to as death tax, death panel is exactly like that. And fear of government is something you can work up very easily. So, I think there's that political piece of it and then we also have the piece of the media. There has been, there are so many media outlets that each one is really afraid of losing the audience. And so there's a belief that you can keep your audience if you focus more on these kinds of shouting and, you know, if you start discussing policy, then maybe they're going to switch to another channel.

So, the impression of that noisy shouting is more than actually, as Mr. Harris just said, it's out of proportion to what really was there, although, it was there. So, I think it's those two forces in politics and the media that come together.

MARTIN: Professor Durbin, let's get your take on this. Do you think this is partisan, sort of manufactured partisan outrage? This is just part of culture? What's your take on this?

Prof. DURBIN: With many respects, I mean, historically there has been in many ways a healthy distrust of government on both sides of the political spectrum. And the language has - and rhetoric in American discourse has often been very, very angry and has a lot of tension in it. Certainly recently, the access to a number of media outlets has led to the ability for people to get across a lot of communication very quickly. Now the media itself does have to report on this and within the media confines, it's not just trying to find the most extreme forms of rhetoric. If you are at a media - or if you are at a major function and you're a media member and somebody is doing something that seems outrageous, in many respects it's almost your job to report on that.

You have to reflect what's going on in the situation. And if something is going to gain notice in that situation it's almost incumbent upon you to report on it. So, a lot of journalists see it as necessary to report some of the more extreme forms of the…

MARTIN: Okay…

Prof. DURBIN: …the more extreme forms of rhetorical outrage.

MARTIN: …what's the chicken and what's the egg? Is it, Professor Tannen is positive the fear that this is kind of - it's intentionally partisan and I'm not gonna use the word manufactured because, you know, you just heard our guests earlier say that they believe what they believe. And we're not going to…

Prof. DURBIN: Mm-hmm.

MARTIN: …diminish what they're saying by saying that they don't really believe it. But that it's partisan, it's inspired, it's organized. And there are other people who would say, well, you know what, because the cameras are there, people are behaving in this way. They're doing it in order to act out. What do you say?

Prof. DURBIN: Well, the, you know, classically the expression of kind of extreme rhetoric often - typically, especially in conservative resistance rhetoric, comes from a fear of loss of social status or a fear of the loss of social position. And when you get that, you're going to have a lot fairly strong responses to it.

What happens when that begins is that people who do have a political bent can manipulate that for their own, their own political interest. And so, you do have some manipulation of that, some use of that. But fear exists first. And as Richard Hofstadter wrote at one point, that fear is natural in American discourse when people - or is a natural expression in American discourse when people see something threatening their social position or their social situation.

So, this is not - this is - the beginning of the expression is a natural in American discourse. The - it is something that is easily manipulatable, if you will. And can be manipulated by people on either side of the political spectrum. But the initial expression of rage typically comes from people who really do have some fear of a loss of their social position or fear of a loss of their social status because of some change that they see occurring and a change they see as threatening them.

MARTIN: But Professor Klein, can you put this in some historical context for us? Obviously one the things we have today is that we have a 24-hour news cycle, we have 24-hour cable and so forth. But, can you compare the kinds of conversations we're having now about health care to other big debates that we've had in this country? You know, not to discuss my age, but I was little then, but it strikes me that the conversations about the Civil Rights bill probably weren't, you know, all tea and crumpets.

Prof. KLEIN: No, certainly, alarmist language has been employed. But, I think we also have to - when we bring in a historical perspective, really think about the legacies we have in terms of how we conceptualize what health care is and what insurance is and what risk is? And this really does emerge out of the historical moment actually of the 1930s and '40s, when health insurance first became something that people began to organize in a systematic way. And initially when community groups started to form health care projects in the late 1930s, they really saw this as an expansion of the Social Security Act that it passed in 1935.

MARTIN: But was it, was it hard fought? Was it nasty? Was it hard fought? Did people, you know, socialist treason, that sort of thing? Burning people in effigy, did it have…

Prof. KLEIN: Yeah, well, I think…

MARTIN: …that kind of flavor?

Prof. KLEIN: …I think the important point I want to bring up here is - the way in which groups had supported an idea of pooling, you know, the risk to pay for health care saw this as a Social Security benefit and expanding the rights of Social Security. I think as insurance companies came into this and saw this as a market and a product that they could sell, that they changed the notion from social risk, that, you know, we all are going to face medical care and we have to share it together, to one of - well, you know, this is just an individual risk. And it's basically your own problem and your own medical history. And we can help you buy something that will, you know, put the burden back on you.

And I think by changing that notion of risk from a Social Security project that we all share in, that we can plan for in a really rational way together, to one of - you better be afraid, you face an individual risk and if you're lucky and if you have the right medical history, you might be able to buy into something that will help you. And I think that heightens the ability to play on people's fears and anxieties, especially in a period of economic insecurity like we have now.

MARTIN: If you're just joining us, I'm sorry, I've to jump into just to say if you're just joining us, this is TELL ME MORE from NPR News. We're talking about the health care debate, and specifically the town hall meetings, some of which have erupted into yelling and screaming and people being sort of hung in effigy. And we're asking whether - is this the way civil discourse, is this the way public discourse is conducted in America these days? Or is there something about this topic that stimulates this or is this just part of the culture? And we're speaking with Professors Daniel Durban, Jennifer Klein and Deborah Tannen. Professor Tannen, I wanted to go back to you, did you want to jump in on this point of historically, how do you think this - the kind of conversation we're having now fits in? Is this a relatively recent phenomenon? Do you think this is, in fact, sparked by the 24-hour news cycle? I'm curious, like, what's the chicken, what's the egg? Professor Durbin was raising this point. Is the media attention kind of what stimulates this? Or is the media just capturing what is?

Prof. TANNEN: I agree that we have a long history of this in our country. It goes back to the revolution: Don't tread on me. So there's nothing new about that. And we can give examples of even more opposition, where people were shooting each other, having physical fights in the Congress. But what's new, I think, is television and radio are in the home.

Radio comes right into your head, as if you're driving in the car, for example, it's in there in the car with you. If you're watching television at home, the TV is like a member of the family. So I think it's both the 24-hour news cycle and the immediacy of the news always being there. It's not just at 6:30 or 10 o'clock at night but around the clock, whenever you turn the TV on. So I think it's that pervasive feeling of that tension that is perhaps new.

MARTIN: There are two things I wanted to ask about in the time that we have left. And one is that that there are sort of two competing strains here. You've seen that there have been a number of commentaries written about the lack of civility in this debate that many people are seeing. And they're saying, you know, why is it that the loudest voices are the ones getting heard, that people who come to these meetings just wanting to get information aren't able to really hear a sustained conversation?

Other people are critical because they feel that the protesters, the antis, have kind of seized the moment, and I want to play - I want to play a clip from a town hall meeting that Congressman Barney Frank held in Dartmouth. And here's an exchange that he had with a constituent. Now, and just to set it up, it's going to take a couple minutes to play, but there's a woman who's talking about an issue that's been much discussed, these so-called death panels, and the information she's giving is wrong, and Barney Frank's responding to that, but here it is. Here's the exchange.

(Soundbite of town hall meeting)

Unidentified Woman: They say we need to limit Medicare expenditures in order to do that, in order to reduce the deficit. That's the origin of this policy. This is the T4 policy of the Hitler - of a Hitler policy in 1939, where he said certain lives are not worth living. Certain people, we should not spend the money to keep them alive. Why do you continue to support a Nazi policy, as Obama has expressly supported this policy? Why are supporting it?

Representative BARNEY FRANK (Democrat, Massachusetts): When you ask me that question, I am going to revert to my ethnic heritage and answer your question with a question. On what planet do you spend most of your time?

MARTIN: And, of course, this is an edited version of this. Barney Frank went on to call her comments vile, contemptible, nonsense, and said that this would be - you know, arguing with this lady would be like arguing with a dining room table.

There's been a lot of discussion about this. Was he right to challenge misinformation with a very strong response, or does this just kind of keep the cycle going? So I'm going to ask each of you your take on this, and Deborah Tannen, I'll start with you.

Prof. TANNEN: I think referring to Hitler and Nazis is almost a literary conceit now. Anything people don't like, they say it's like Hitler. And clearly, Barney Frank had an emotional response because the claim was so extreme. I don't think it would have been very different had he responded a different way. I kind of wish he had, but I'm not sure it would have changed things very much had he done that.

MARTIN: What would change the dynamics of these discussions, do you think? Would anything change the dynamics?

Prof. KLEIN: I think if we stopped acting as though we're going to pit people against each other and really get back to talking about what would universality mean? We have to stop, you know, pitting union members against non-union members, people in Medicare against people who are out of it, people who have insurance already against those who don't and really start talking about what does it actually mean to have a universal system the way that we have Social Security.

I think we have to remember, there's always been an assault by the profit-holding, you know, stakeholders in this debate in every era of the last century. Groups like the National Association of Manufacturers and the U.S. Chamber of Commerce, at the height of the Cold War in the 1950s, invoked alarmist language also. Instead of invoking Hitler, what they said was this would be the widespread destruction of all free enterprise.

MARTIN: Professor Klein, don't they have the right to express that point of view if that is, indeed, their point of view?

Prof. KLEIN: Absolutely. And that's why I think that we need to start to recognize the fact that the insurance companies, the managed-care companies, the pharmaceutical companies who have a huge, profit-making stake in this, have created an ideology that lays over all of this that acts as though the government is the problem, when really what we know is the private insurance system is the problem, and we need to really puncture that language, I think.

MARTIN: Okay. Professor Durbin, I'm going to give you the last word. What would change the dynamics of these conversations to more productive ones, if indeed that is possible, or perhaps in your view, this is productive if people are just expressing themselves, you know, according to their constitutional right to do so.

Prof. DURBIN: Well, I agree with Professor Tannen that invoking Hitler is almost a literary conceit now. Allan Bloom, in the "Closing The American Mind," said that we can no longer conceive of evil because the only word we have for evil is Hitler, and that's become much of the political discourse.

So it's a very easy name to invoke. By the same token, what has to happen is - at this point it's, you know, it's very difficult on the media to change the shape of the debate because you have such a run of negative language. What needs to happen is that those who really are seeking change need to be able to come up with a language for those who are scared of any kind of what they see as sweeping change that indicates the incremental nature of this. And, of course, you have to respond to - it's just the nature of the beast. You have to respond to any wrong information also and show again and again and again that this information is inaccurate, and you are not seeking the kinds of change that people are identifying.

MARTIN: Well, unfortunately, we have to leave it there. Time is the one thing they're not making any more of. I thank you all so much. Associate Professor Daniel Durbin teaches media, image management and rhetoric at the University of Southern California's Annenberg School for Communication. He joined us from the studios at NPR West.

We were also joined by Jennifer Klein, professor of 20th century American history at Yale University and author of "For All These Rights: Business, Labor and the Shaping of America's Public-Private Welfare State." She joined us from the studios at Yale University. And Deborah Tannen teaches linguistics at Georgetown University. She's author of the book "The Argument Culture." Her latest book is "You Were Always Mom's Favorite: Sisters in Conversation Throughout Their Lives." That'll be in stores next month, and she joined us from Stanford, California. Thank you all so much.

Prof. TANNEN: Thank you.

Prof. KLEIN: Thank you.

(Soundbite of music)

MARTIN: Still to come, the method used to infuse small businesses with cash in developing countries catches on here in the U.S.

Mr. ANTHONY PACE (Executive Director, The Plan Fund): Entrepreneurship has helped the U.S. be what it is, and I think, you know, the little guy needs that support so they can become something bigger and better.

MARTIN: Microfinance, that's just ahead on TELL ME MORE from NPR News. I'm Michel Martin.

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