Reframing the Language of #Trumpcare

#Taxcutsfortherichcare #Worsecare #Meancare

Doctor as Designer
5 min readJun 26, 2017


Professor George Lakoff writes about the use of language and framing in politics. In his book, “Don’t Think of an Elephant!: Know Your Values and Frame the Debate” he defines what a frame is:

“Frames are mental structures that shape the way we see the world.” -George Lakoff

He provides further explication in his book:

“When I teach the study of framing at Berkeley, in Cognitive Science 101, the first thing I do is I give my students an exercise. The exercise is: Don’t think of an elephant! Whatever you do, do not think of an elephant. I’ve never found a student who is able to do this. Every word, like elephant, evokes a frame, which can be an image or other kinds of knowledge: Elephants are large, have floppy ears, tusks, and a trunk, live naturally in jungles, are associated with circuses, and so on. The word is defined relative to that frame.

When we negate a frame, we evoke the frame. Richard Nixon found that out the hard way. While under pressure to resign during the Watergate scandal, Nixon addressed the nation on TV. He stood before the nation and said, “I am not a crook.” And everybody thought about him as a crook.”

Lakoff goes onto describe how the Republicans are superb at “framing”. Witness the language about the Senate healthcare bill to repeal and replace Obamacare:

The “Better Care” Reconciliation Act

This is the Senate version of the GOP healthcare bill that is under consideration this week. The term “better care” would imply that it leads to better care, but according to the health policy wonks, that clearly not the case:

“Here Is How Senate Republicans Try To Hide The Damage Of Their Repeal Bill”

-Jonathan Cohn

The “American” Health Care Act

This is the name of the GOP House bill that was passed and now sits in the Senate. It makes it sound so patriotic, despite the fact that it could leave 23 million Americans uninsured.


“It’s time to repeal Obamacare and replace it with patient-centered health care”

-Tagline on the American Health Care Act website.

“Patient-centered reforms that put the American people back in charge of their own healthcare decisions.”

-Tom Price, HHS Secretary, speaking about the Better Care Reconciliation Act

Is it patient-centered when not a single patient group supports the health bill?

According to Professor Lakoff:

This gives us a basic principle of framing: When you are arguing against the other side, do not use their language. Their language picks out a frame — and it won’t be the frame you want.

So how can we reframe the message about #Trumpcare?

Perhaps these are more accurate terms to describe the health bill:


23 million people to lose health-care coverage by 2026

-John Wagner, Abby Phillip, Jenna Johnson


There will be deaths.

-Dr. Atul Gawande


the GOP is using the debate over health care to conceal an assault on Medicaid

-David Perry


People with disabilities who rely on home- and community-based services through Medicaid — such as personal-attendant care, skilled nursing, and specialized therapies — could lose access to the services they need in order to live independently and remain in their homes

-Rebecca Vallas, Katherine Gallagher Robbins, and Jackie Odum


The bill fails children by dismantling the Medicaid program, capping its funding, ending its expansion and allowing its benefits to be scaled back. The bill fails all children by leaving more families uninsured, or without insurance they can afford or that meets their basic needs. This bill fails children living in or near poverty, children in foster care and children with complex health care needs whose parents have private insurance — all of these children depend on Medicaid, and if this bill passes, Medicaid will no longer be there for them.”

-Fernando Stein


“Medicaid Cuts May Force Retirees Out of Nursing Homes”

-Jordan Rau


4 Ways the Senate Health Care Bill Would Hurt Women

“Many women could lose basic benefits like…maternity coverage, contraception, mammograms, cervical cancer screenings, well-woman visits, breast pumps and domestic violence screening and counseling.”

“With the elimination of Medicaid reimbursement, however, women on Medicaid would not be able to use any of Planned Parenthood’s services, which include well-woman visits, cervical cancer screenings, access to low-cost contraception and testing for sexually transmitted infections. Funding cuts could also lead more Planned Parenthood locations to close.”

-Amanda MacMillan


The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else. Those with private insurance will experience higher premiums and higher deductibles, with lower tax credits to help working families cover the costs, even as their plans might no longer cover pregnancy, mental health care, or expensive prescriptions. Discrimination based on pre-existing conditions could become the norm again. Millions of families will lose coverage entirely.
Simply put, if there’s a chance you might get sick, get old, or start a family — this bill will do you harm

-Barack Obama


The bill asks low- and middle-income Americans to spend significantly more for less coverage. The bill would roll back the Affordable Care Act’s expansion of the Medicaid program, which currently covers millions of low-income Americans, and include additional cuts to Medicaid. It would rework the individual market so that enrollees get less financial help to purchase less generous health insurance with higher deductibles.”

-Sarah Kliff


“The Senate health bill: poor people pay more for worse insurance”

-Ezra Klein


And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.

-Barack Obama

Use the Trumpcare toolkit:

Use Resistbot:

I tweet and blog about design, healthcare, and innovation as “Doctor as Designer”. Follow me on Twitter and sign up for my newsletter.

Disclosures: JAMA Pediatrics, Unitio, Grant funding from Lenovo.



Doctor as Designer

Joyce Lee, MD, MPH, Physician, Designer, ACMIO, #EHR, #learninghealthsystems, #design, #makehealth