Issues Management through Distortion

August 7, 2009

The health care debate of 2009 provides an almost endless supply of examples of public relations messages in action.  Health care is an issue with a vast number of constituents with varying interests and stakes in the issues.  As a result, there are an amazing amount of issues management efforts and messages appearing in traditional and online media.  No case can cover the entire debate so this case focus on one, minor point in the proposed health care reform:  advance directives.

Advance directives help people to spell out their wishes for life-extending measures related to severe brain damage and terminal illness scenarios.  Many people have living wills that provide such directives.  It is important for family members to know these desires so that a person’s wishes can be honored.  Family members may not be aware of an existing living will or try to disregard it thus creating a conflict.  In one version of the 2009 health care proposal, the government would pay for counseling sessions on advance directives.  These sessions are purely voluntary.  Unfortunately, the advance directive became a point of confusion and conflict.

Opponents distorted the advance directives proposal.  There were two key distortions:  (1) the counseling was mandatory every five years and (2) the proposal would promote euthanasia.   People were told they would be forced to meet with government representatives to discuss how they wanted to die.  The meetings were voluntary and with health care providers, no government representatives would be involved.  Advance directives were to be covered as a benefit people could choose to use or not.  Mandatory meetings with the government over end of life sounds very ominous as opposed to voluntary counseling sessions.  The distortion was designed to create fear.  The idea was to convert the fear into opposition to health care reform.  Politifact, a group of journalists that tries to assess the truth in political claims, considered the claim of mandatory meetings with government officials as incorrect  There is more on Politifact at the end of the case.


The worse distortion was the link to euthanasia.  Some opponents claimed the government, during these forced meetings, would tell you the best way to die and to encourage people to die earlier rather than later.  Critics claimed it “may start us down a treacherous path toward government-encouraged euthanasia” (   The justification was cost savings—the government wants you dead so that they can save on health care costs.  Some issue managers went as far as to call it “death care” and an effort to “kill Granny.”  This distortion is more clearly fear inducing.  Again, fear is created to generate opposition to the health care reform proposal.  Distortions are being used by issue managers on both sides of the health care reform issue to build support for their side of the issue.  This is not the only distortion but it is one of the most obvious.

So why would people be taken in by distortions over advance directives?  All rumors have a kern of truth and must seem plausible.  Advance directives counseling coverage is in the health care reform proposal—the kern of truth.  Most health care costs occur at the end of life so they are expensive and cost savings could occur if people died sooner or requested less care—plausible motive for government wanting to kill granny.  Add to this so many critics repeating the claims in traditional and online media and you have the potential for fear to spread.  And public relations is seen a fanning the flames of this fear.

“PolitiFact is a project of the St. Petersburg Times to help you find the truth in politics.

Every day, reporters and researchers from the Times examine statements by members of Congress, the president, cabinet secretaries, lobbyists, people who testify before Congress and anyone else who speaks up in Washington. We research their statements and then rate the accuracy on our Truth-O-Meter – True, Mostly True, Half True, Barely True and False. The most ridiculous falsehoods get our lowest rating, Pants on Fire.”

 Here is one more example is distortion from Sarah Palin as reported by the National Ledger.  The first paragraph is from Palin’s Facebook posting. 

“‘And who will suffer the most when they ration care?’ Palin asks in her online argument against the policy. ‘The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.'”

“The Washington Monthly writes, ‘As a substantive matter, this might be the stupidest thing ever written about health care policy. Just two weeks after she implored journalists to “quit making things up,’ Palin has manufactured the idea of a “death panel” out of thin air.”

For a funny but insightful look at the distortions around health care discussion see the August 10, 2009 Daily Show with Jon Stewart  He addresses the disruption of town hall meetings and the idea of “death panel.”

Questions to Consider:

  1.  How do each of the advance directives distortions violate guidelines for ethical risk communication (Chapter 11)?
  2. Why does public relations get connected to these distortions?
  3. What is the risk when distortion is used by issue managers to win support?
  4. How do such efforts feed into the negative perception of public relations (Chapter 2)?
  5. Who are some of the main constituents in the health care reform issue and what do they stand to gain or lose?
  6. How can the online media be used to both create and debunk distortion is risk communication and issues management?
  7. What happens to the marketplace of ideas when distortion substitutes for reasoned arguments?
  8. Does transparency provide any useful insights into problem of using distortion as an issues management strategy (Chapter 3)?  If so, what might they be?

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