How Obama Tailors Health Care Reform Pitch for Different Audiences

BY Anna Shoup  March 15, 2010 at 12:03 PM EDT

This week could make or break the Democratic health reform plan. In hopes of the effort succeeding, President Obama has stepped up his involvement considerably in recent weeks.

In fact, Mr. Obama has put his entire presidency on the line with health care, said Mark Shields on Friday’s PBS NewsHour. “This is the signature item of his presidential agenda. He said that passing this is more important to him than winning a second term.”

He takes his health reform on the message to Ohio on Monday afternoon. Last week, Mr. Obama made campaign-style stops near St. Louis and Philadelphia — both representative cities for the “Industrial Metropolis” community type in Patchwork Nation. However, the speeches themselves were delivered outside the city hubs in two different community types: a “Monied ‘Burb” (in Glenside, Pa.) and a “Boom Town” (in St. Charles, Mo).

His message was also different, reflecting the different audiences that the president must win over to gain public support.

In Pennsylvania, President Obama spoke at Arcadia University in Montgomery County, where the median household income is $65,987 — higher than the national average, as is the case in most “Monied ‘Burb” communities. Unemployment isn’t as big a problem here as it is in other places: The rate was 6.8 percent in December. Also, there were 0.36 foreclosures per 1,000 households.

Contrast that with St. Charles County, Mo., where the average household income is $59,048, unemployment is 8.5 percent and there are 1.49 homes in foreclosure for every 1,000 households. The numbers could be worse, but on the other hand, they indicate that St. Charles County is not in the same situation as Montgomery County.

So what was different about the president’s speeches in those places? We combed through the texts of the speeches to find out. The structure was the same, but some of the word choices were not. For example, he said “insurance” more in Glenside and “health care” more in St. Charles.

Visualize President Obama’s speech in harder-hit St. Charles, Mo.:
Word cloud of President Obama's speech in St. Charles, Pa.

Visualize President Obama’s speech in wealthier Glenside, Pa.:
Word cloud of President Obama's speech in Glenside, Pa.

Images created using http://www.wordle.net/

Compare these two sentences, which fell in the same place in the speeches. In St. Charles, he said, “I want to give you more control over health care in America,” and in Glenside, he said, “I believe it’s time to give you, the American people, more control over your own health insurance.”

In St. Charles, more people are out of jobs, and likely out of health insurance. What they really want is affordable health care — before they can even think about insurance. Meanwhile in Montgomery, the word “insurance” may hold more meaning. With a higher employment rate, more residents may be thinking about how health care reform could affect their own insurance arrangements.

In St. Charles, Mr. Obama quoted President Lincoln and said that “people have lost faith in government.” He began his speech by vowing to stop wasteful spending, and he praised Democratic Missouri Sen. Claire McCaskill for pinching pennies. Then he went into health care, framing it as a wasteful system that needs to be fixed and shaped into something more affordable.

President Obama’s message is on track for Patchwork Nation blogger Eric Madkins in St. Louis. “It is a problem that needs a workable solution. Families are suffering and enduring one of the worst recessions since the Great Depression,” he wrote in an e-mail. “In essence, we have to complete this legislative process in an efficient, timely, and methodical manner, where the end result is affordable access to health care for all Americans.” Mr. Madkins is the senior housing director at the Urban League of Metropolitan St. Louis.

In Glenside, Mr. Obama took a different opening approach, talking about the challenges America faces – citing the jobs picture, two wars, the cost of a college education, and retirement planning. Then he jumped into health care, working in mentions of Goldman Sachs and Wall Street. Those financial references may be a little closer to home in a “Monied ‘Burb” than in a “Boom Town.”

These different approaches hint at the range of concerns held by Americans about health care. If Democrats want broad support for reform, they’ll need to make sure they address these different concerns.

This entry is cross-posted on the Christian Science Monitor’s Patchwork Nation site.