Wednesday night’s presidential debate provided both President Barack Obama and Republican presidential candidate Mitt Romney with a forum for deliberating one of this election’s most prominent issues — health care.

Some of the lines were predictable, such as Romney stating his desire to repeal and replace the Affordable Care Act, or as he labels it, Obamacare (a term Obama himself has since embraced for different reasons). But other back-and-forth exchanges between the two about health care, especially Medicare, were framed in a much more nuanced and strategic manner.

For instance, Obama referred to Social Security and Medicare as “entitlements” that millions of people depend on, like his grandmother did. The word entitlement is viewed by some as a derisive term used by those who seek to curtail social welfare programs, yet the comment raised few eyebrows among the press and pundits. Romney mentioned entitlements after a query by moderator Jim Lehrer but generally avoided the term and focused on the “benefits” conferred by programs such as Medicare.

Why did both candidates purposefully use some phrases and lines of attack but shy away from others? It’s all about gaining a strategic advantage. According to research by scholars Regula Hänggli and Hanspeter Kriesi, politicians employ three types of issue framing to garner positive media coverage and sway undecided voters — substantive frames, oppositional frames and contest frames. All three were on display at the presidential debate.

Substantive frames are the central campaign messages and policy prescriptions that candidates tout and stand by, regardless of pressure from journalists or the opposing campaign. On the issue of Medicare, Obama highlighted the $716 billion his administration will “save” from Medicare by not overpaying healthcare providers. The president couched the savings as essential to lowering costs and long-term deficits. Romney promoted his plan to grant future beneficiaries the option of purchasing traditional Medicare or a private plan, asserting that the only way to lower costs and “save” Medicare is to introduce choice and competition.

While candidates typically prefer their own substantive frames, Hänggli and Kriesi suggest that they will engage their opponent’s frames if they anticipate them to be successful. The candidates will then transition into using oppositional frames. Sensing that Romney’s argument about using market-oriented reforms to lower Medicare costs might gain traction, Obama cited a statistic that the former governor’s premium support plan (government subsidies for seniors to purchase a health plan) would still cost the average senior $6,000 a year and “collapse” traditional Medicare. Romney countered that the president’s $716 billion in across-the-board “cuts” to Medicare are a “mistake” that will hurt seniors by reducing the number of health care facilities willing to accept Medicare patients.

In addition to presenting the substantive framing of their own plans and rebutting the opposing frames of the other, both candidates sought to stress certain underlying themes and phrases with contest frames. Contest frames are less about policy than the politics of the matter. A perfect example is the aforementioned difference between “entitlements” and “benefits.” Obama knows that entitlements often have a negative connotation, so he sought to use a positive narrative about dependency that was independent from his policy proposals. The president also hit out at Romney for his “voucher” program, another loaded term that suggests benefits won’t be guaranteed. Romney never described his plan with the term voucher, instead using the word “choice” three times in one segment to drive home his point of increased options, competition and quality. Aside from his policies, Romney knows that Americans are an individualist people who like choices and don’t like to be told what to do.

Framing abounded at the debate in Denver, with the ultimate results on viewers still to be determined. Democratic pollster Doug Schoen offered the perspective that Romney effectively neutralized Obama’s lines of attack on Medicare and won the healthcare debate. We shall see. But it’s important to remember that (almost) every slogan and phrase each candidate utters is no mistake.


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