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Now that the summer is winding down and all the hyperventilating by the right-wing fringe is coming to an end, perhaps we can actually sit down and take the time to understand the what's so scarey about health care reform. Good idea, right?

Over at Newsweek, Sharon Begley lays out what has been going on. It starts out:

Which phrases inspire you to grab a pitchfork, or at least e-mail your congressman: bending the cost curve, or stopping the government from condemning Grandma to death because treating her cancer is too expensive? Exactly.

It's primal scare tactics 101:

At this time last year, if you had asked people whether the federal government would effectively nationalize AIG and Fannie Mae, and whether the Dow would plummet to 6,627 in March 2009 after reaching 14,093 in October 2007, most would have confidently said no, that will never happen in my lifetime. And yet, "In a world gone crazy, the impossible -- even 'death panels' -- suddenly seems possible," says psychologist Drew Westen of Emory University, author of the 2007 book The Political Brain.

She continues:

In fact, what the House bill does is require Medicare to cover appointments for elderly people who want to talk about end-of-life care with their doctor. If you have terminal, untreatable cancer and your heart stops, do you want chest compressions, which will likely break your ribs and cause excruciating pain? If you have a massive stroke and fall into a coma, do you want to be fed through a tube? As things now stand, the elderly have to pay for such consultations out-of-pocket unless they are covered by some Medicare Advantage plans. The House provision does not "compel seniors to submit to a counseling session every five years," as former New York lieutenant governor Betsy McCaughey wrote in the New York Post. But the idea of requiring Medicare to pay for the counseling (saving Grandma money!) morphed into Palin's Facebook post that people "will have to stand in front of Obama"s 'death panel' so his bureaucrats can decide, based on a subjective judgement of their 'level of productivity in society' whether they are worthy of health care."

The power of "death panels" as a phrase and a scare tactic also works because Americans are deeply uncomfortable with death. We don't like to think about it or talk about it, says bioethicist Tom Murray, president of the Hastings Center. Only 29 percent of us have a living will. As a result of that discomfort, reminding people of death sends them off the deep end, into the part of the neuronal pool where reason cowers behind existential terror.

Yup...that sounds about right when you look around at your fellow American, doesn't it?

But wait...there's more:

Still, it is a long-established fact of psychology that fear of losing what you have, even if what you have is less than great, always overpowers the hope of getting something better. Sure, Obamacare might keep insurers from denying you coverage for preexisting conditions, offer you a Medicare-like option similar to the plan that millions of seniors love, eliminate insurers' annual and lifetime spending caps, and reduce your premiums. But it just might -- who really knows? -- take away something you have now. "What scares people is the devil they don't know," says Westen.

And now for the rationing lie:

Which brings us to outright rationing. In his memo on "10 Rules for Stopping the 'Washington Takeover' of Healthcare," Luntz -- and let me say the man is a psychology genius -- tells clients to say that "the plan put forward by the Democrats will deny people treatments they need." This has much less plausibility than the longer-waits specter. But it has emerged from confusion over a separate White House initiative: spending $1 billion to compare the effectiveness of different treatments for various diseases. Somehow that has morphed into cost (rather than medical) effectiveness. That is, bureaucrats will decide if it is worth treating you based on some calculation about the value of your life or health.

It's not in any of the bills. But the rationing lie sticks for two reasons. One is that people who should know better keep repeating it. In an editorial on July 31, Investor's Business Daily warned that health-care reform would produce a system like Britain's, where the government decides who gets medical treatment based on whether "your life is considered worth saving People such as scientist Stephen Hawking [who has been paralyzed with Lou Gehrig's disease for decades] wouldn't have a chance in the U.K." But Hawking lives in the U.K., and regularly gets expensive care -- because the U.K. doesn't do anything like what the editorial claimed. (Decisions on what drugs and surgeries to pay for are not determined patient by patient, but on whether scientific studies show that they save lives or improve health. What a concept, not paying for stuff that doesn't work.)

And yet, of all the reasons outlined in Begley's column, this one seems to be the most powerful:

And we have been told for a quarter century that government is the problem, not the solution -- a cesspool of incompetence and unaccountability. As a result, says linguist Geoffrey Nunberg of the University of California, Berkeley, "the phrases 'government takeover' and 'government committees in the operating room' have power. They evoke the government as this inefficient, self-serving, paternalistic entity."

You can thank good 'ole Ronald Reagan for the lasting effect of demonizing government that is alive and well today. It's a seemingly Herculean task Obama faces, this debunking of the meme, "Government is bad, Capitalism is good." Reversing 30 years of anti-government propaganda in 6 months? Good luck with that one...

And yet...supporters of health care reform could be using arguments such as these:

Westen suggests the Democrats "should say that, since health insurance is tied to employment, 'the current system takes away your freedom to quit your job.' "Berkeley linguist George Lakoff thinks the White House could win hearts and minds by emphasizing that in the current system, "insurance companies deny you care." And the administration could score extra points by describing people who have been bankrupted or killed by that denial. There is no shortage of examples, from Blue Shield denying high-tech cancer surgery that oncologists said was patients' only hope, to Cigna nixing a liver transplant that was a 17-year-old's only chance of survival. She died. (Wall Street rewards insurers for denying claims; a company with a claims-paid rate of, say, 80 percent is viewed as better run than one with a rate of 85 percent.) "If you told the story of how greedy insurers deny coverage to sick people, you could whip up emotions in favor of reform," says Westen.

Read the Sharon Begley's entire column at Newsweek. It's worth the 10 minutes of your time.

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