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I really can’t take credit for discovering what you are about to read, since a good friend brought it to my attention. But I think for those involved in the politics of health care, it ought to be required reading.

First a little primer from Bruce Reed on the differences between wonks and hacks.

Strip away the job titles and party labels, and you will find two kinds of people in Washington: political hacks and policy wonks. Hacks come to Washington because anywhere else they’d be bored to death. Wonks come here because nowhere else could we bore so many to death. These divisions extend far beyond the hack havens of political campaigns and consulting firms and the wonk ghettos of think tanks on Dupont Circle. Some journalists are wonks, but most are hacks. Some columnists are hacks, but most are wonks. All members of Congress pass themselves off as wonks, but many got elected as hacks. Lobbyists are hacks who make money pretending to be wonks. The Washington Monthly, The New Republic, and the entire political blogosphere consist largely of wonks pretending to be hacks. “The Hotline” is for hacks; National Journal is for wonks. “The West Wing” is for wonks; “K Street” was for hacks.

That was just an appetizer. That quote was included in a most interesting and humorously insightful paper written by David A. Hyman. The paper, which is excerpted below, is a critique of the same two Duke professors I took to task in an earlier post. Hyman provides some ‘advice’ to the scholars that is priceless and worth some serious consideration. In his paper he refers to an article by the Duke duo. It seems while their hearts are in the right place, they need some ‘education’ on the rules of the game if their message is to get anywhere. Hyman writes:

Rule Number One: People hate numbers but love a good anecdote.

It is one thing to quantify distributive injustice in health care, and quite another thing to get anyone to care about it. The key is to find and popularize a sad story—or better still, multiple sad stories—of people who suffered death or significant injury through no fault of their own but because of some aspect of the problem Havighurst and Richman are concerned about. It does not matter whether the stories are representative or not—only wonks would care about that question. If a story is good enough, it does not even matter what really happened! Havighurst and Richman need some anecdotes.

Rule Number Two: A good slogan is half the battle.

If you want to sell reform, you need a slogan with some zing to it. It is no accident that one political party is against “death taxes,” “partial-birth abortion,” and the “nanny state,” while the other is in favor of putting social security into a “lockbox,” being “pro-choice,” and working “for the people, not the powerful.” These slogans work because they have a normative resonance that attracts voters who are rationally ignorant of the details of the particular proposals and issues. If Havighurst and Richman’s slogan is that they are opposed to “distributive injustice in health care,” they might as well just give up the ghost right now. Anyone who hears those words will, at best, have no idea what Havighurst and Richman are proposing—and, at worst, will think Havighurst and Richman are proposing a new-fangled lawsuit they want nothing to do with. Telling people we’re going to make health care less expensive by making it more expensive” is even worse. Havighurst and Richman need a good slogan.

Rule Number Three: Find allies.

Havighurst and Richman’s diagnosis ensures they will have plenty of enemies. If they want to win the war over distributive injustice in health care, they need some allies. Where are those allies to be found? If consumers were an effective interest group, the status quo would not look the way it does. The challenge for Havighurst and Richman is to find allies among those who are currently disaffected, or to create allies by making those who are currently happy disaffected. One good way to create allies is to expand the pool of people participating in alternatives to the current, “somebody else is footing the bill” health-insurance system. Another good way is to enlist the assistance of providers who are marginalized by the current system, such as alternative health-care providers. Hacks will also try to find the invisible victims of the status quo and use them to “name and blame” their oppressors, a strategy that dovetails neatly with Rule Number One. Ideally, the result will be allies in Congress and the state legislatures—a necessary but not sufficient precursor for reform. Regardless of how it is done, Havighurst and Richman need to find some allies.

Rule Number Four: Pick a good enemy.

It is good to be for something, but better to be for something while simultaneously being against something much worse. Just as every cowboy movie needs a villain (in a black hat) for the hero (in a white hat) to defeat, every good reform movement needs to have a good—that is, bad—enemy to oppose. One difficulty with picking an enemy in the health-care context is that the most likely candidates are either popular (physicians), not really responsible for the problems that are identified (insurers and pharmaceutical companies), or too inchoate to be effectively demonized (elites). Lawyers are an obvious candidate for the enemy, but it is unlikely that Havighurst and Richman will get much mileage out of that choice. Picking a good enemy is going to be a challenge for Havighurst and Richman.

Rule Number Five: Have a simple solution.

If a reform proposal can not be summarized in a few words, it is not worth pursuing. It does not matter if the ultimate legislation runs to hundreds, or even thousands of pages. What matters is whether the solution can be described on a bumper sticker. “Fixing the regressive distributive injustices of the American health care system” is not going to cut it. Havighurst and Richman may or may not have a simple solution—it is hard to tell because they do not actually spell out what their solution is, beyond the few cryptic hints noted earlier. Once they figure out what their solution is, they need to boil it down to a short slogan. Havighurst and Richman’s article weighs in at seventy-five pages and 220 footnotes—a long way from a simple solution.

Rule Number Six: Never give up, never surrender.
Winning the hack portion of the campaign requires iron discipline. Every day, a hack gets up and hammers away on his issue, regardless of what else is going on in the world. When a hack sees an opening, he runs as far and as fast as he can toward the goal line. When he gets knocked down, he gets up, dusts himself off, and tries something different. When he starts to feel paranoid because he spends a lot of his time anticipating traps laid by his enemies, he reminds himself that “even paranoids have enemies.”Most importantly, when he sees his opponents drowning, he throws them an anchor.