Tag Archives: Obamacare

Health Care Metaphors

Hello! Anyone watching TV or reading the newspapers lately has no doubt seen the huge battle going on in Washington D.C. over healthcare. Barack Obama and the Democrats managed to pass the Affordable Care Act during his tenure as president. The Republicans promised for seven years to “repeal and replace” the so-called Obamacare as soon as they were in the office. Now, however, even though the Republicans control the White House, the Senate and the House of Representatives, they have not been able to pass any new legislation to replace Obamacare. Several different versions of a new health care bill have been presented but they have all been defeated by either the House or the Senate. This past week, the latest version was voted down, in part because of three Republicans who voted against it, including a dramatic “thumbs down” vote by John McCain at the last minute.

Readers of this blog may have also noticed that there has been a bewildering variety of metaphors used to describe this process. Here are a few that I have been watching in the past few weeks. I list them here by conceptual metaphor with one or two examples of each. The sources for each quotation are included in the descriptions and explanations as a hyperlink. Italics are mine.

Body Shape: skinny

One of the most unusual metaphors to describe the latest health care bill was calling it the skinny repeal version, implying that it was a thin version of an earlier more comprehensive bill. We tend to describe people (or animals) as being skinny, normal or fat (more politely heavy) thus we can metaphorically use descriptions of body shapes to describe the thickness of a legislative document. Here is a headline from the New York Post.

Example:  Trump fumes over health care reform after ‘skinny repeal’ defeat

Food: vinegar and honey

We often use our experiences with food to describe abstract processes, such as something being bitter or sweet. Some writers at the Daily Beast have described the Republican healthcare bill as being all vinegar, no honey since it seemed to be taking health care away from millions of people while increasing premiums on those who do have insurance – nothing sweet about it, only a sour taste.



Example: How Donald Trump’s “All Vinegar, No Honey” Approach To Health Care Reform Ended Up Backfiring

Journey: rocky start, bridge

Journey metaphors are very common in political speeches, and they also appear in headlines and articles about political processes. In one case, a headline in the Washington Examiner describes health care reform as being off to a rocky start, as if it is a person walking on an uneven rocky path instead of a smooth walkway. In another example from Fox Business News, Senator Ted Cruz argued that he could bridge the gap between warring factions of the Republican Party as if he could making a connecting bridge between two distant parts of a road.

Example: Bipartisan healthcare reform off to a rocky start in the Senate

Example: Ted Cruz: Amendment can bridge gap between split Republican Party




Building: collapse, fall apart

            We often describe creating processes as if they are buildings we are constructing. Conversely, when processes do not work, we can describe them as if these buildings are collapsing or falling apart. Recent headlines at politico.com and cnn.com refer to these two processes.

Example: House Republicans despair after health care collapse

Example: How the Republican health care bill fell apart

Machines and Engines: fix, overhaul, backfire

When a machine is not working properly, we must make efforts to fix it. Metaphorically, we can also fix any process that is not working out well. Political writers and pundits commonly refer to legislative processes as fixing health care. Here is one example from the Atlantic magazine. Also, if a machine or engine is broken beyond a simple repair, we may need to totally overhaul it, taking it all apart and putting it back together again. An article at cnn.com refers to the Republican efforts to replace Obamacare as overhauling it.   Finally, when the gas mixture in an engine is not regulated correctly, it may backfire or produce a loud bang from the exhaust system. Metaphorically, when an effort to do something completely fails, we may say that it backfires. An article in the Daily Beast describes Donald Trump’s efforts to repeal and replace Obamacare as having backfired.

Example: How Republicans Can Fix American Health Care

Example: “We should not put our stamp of approval on bad policy,” Moran said in a bold statement that derailed Majority Leader Mitch McConnell’s bid to overhaul the Affordable Care Act.

Example: How Donald Trump’s “All Vinegar, No Honey” Approach To Health Care Reform Ended Up Backfiring

Chemistry and Physics: litmus test, pressure

In chemistry, one way to test whether an element is an acid or a base is to put a small solution on a piece of special paper called litmus paper. This procedure is called a litmus test. Metaphorically, any process that determines if something will be successful may be called a litmus test. A recent NBC News story describes the efforts of the Democrats to retain Obamacare as federal law as a litmus test. In physics, the amount of force exerted upon an object is called pressure. We can talk of air pressure, barometric pressure, etc. Metaphorically, the power for a group of people to influence other people can also be called pressure. The Press Herald newspaper in Maine describes how the Maine senator, Susan Collins, withstood the pressure of her fellow Republicans to vote against the health care bill.

Example: Government-Run Health Care: Democrats’ New Litmus Test

Example: Susan Collins withstood intense pressure, ultimately voted against health care repeal

Boxing: round one, slam

Sadly, we also describe many aspects of the political process as if the politicians are fighting each other in a boxing ring. Most boxing matches last a total of 15 rounds. The preliminary battles between two opponents are often called round one. An article at cnn.com describes the defeat of the health care bill as a loss for Donald Trump in round one. Several weeks ago, an article in USA Today even described the diplomatic Bernie Sanders as slamming the Republican version of the health care bill.

Example: Health care defeat confirmed it: Trump has lost round one

Example: Bernie Sanders slams GOP health care bill, calls Trump CNN tweet ‘an outrage’


Military: kill, dead, blast, implode, torpedo

Even more violent metaphors can be found in military descriptions of political processes. An article at msnbc.com described how the health care bill was killed, while in an article in the New York Post, the authors describe the health care repeal process as a dead issue.   Other writers describe the process in terms of explosions or cannon fire. CNN describes President Trump as blasting the Senate rules that contributed to the defeat of the Republican bill, while a story at politico.com reports that Trump himself claims he wanted Obamacare to implode. Finally, another CNN story claims that the Senate has torpedoed the heath care bill.

Example: The stunning drama of killing the GOP health care bill

Example: President Trump hasn’t given up on health care reform — even though the Senate’s GOP leader say [sic] it’s a dead issue for now.

Example: Trump blasts Senate rules in Saturday morning tweets

Example: After health care loss, Trump tweets ‘let ObamaCare implode’


Example: House Republicans rail on Senate GOP for torpedoing health care

Science Fiction: the twilight zone

Last but not least, we find a metaphor derived from the name of a popular 1960s TV show called the Twilight Zone. In the TV show, the title referred to the time between day and night when normal rules of science are twisted into bizarre or unexpected occurrences. The term was originally was used as early as 1909 to describe the time between lightness and darkness when nothing could be seen clearly. Metaphorically the twilight zone refers to a situation in which normal social rules do no apply. Several articles reported that Missouri senator Claire McCaskill referred to the healthcare reform process as being in the twilight zone.

Example: “We’re in the twilight zone of legislating,” Democratic Sen. Claire McCaskill of Missouri said Thursday of the GOP’s strategy.


As you can see, one political process may be described with a wide variety of conceptual metaphors. These examples offer more proof that the use of metaphors is a normal part of human cognition, not a specialized type of language. As always, comments, questions or additional examples are welcome. Thanks for reading!



Obamacare Part 3: “Rollout,” “Bugs” and other Metaphors in the Media

Hello again!  In the last of my three-part series on the language of Obamacare, I will analyze several metaphors used by the national media to describe the Affordable Care Act.


A rollout is a term used to describe the process of bringing an aircraft out of a hanger for a flight or launch.   Metaphorically, the delivery of a new product or government program may also be called a rollout.

Example:  Many Americans were frustrated that the rollout of Obamacare was filled with glitches.


When a rocket takes off towards space, this is known as a launch.  Metaphorically, starting a new program may also be called a launch.

Example:  Critics of Obamacare claim that the website should not have been launched before all the software problems were resolved.

blog - ACA - rocket


Rockets shoot towards space at incredible speeds.  In a compound word metaphor, to say that something skyrockets indicates that it is increasing at a great rate of speed.  In politics and economics, skyrocketing usually refers to quickly increasing prices of some commodity.

Example:  Some experts believe that Obamacare will result in skyrocketing prices for insurance policies.


Prices of items in a store are often indicated on a sticker attached to the item.  More expensive items such as cars and trucks also have stickers on the windows of the vehicles indicating the prices.  When one is surprised at a high price of an item, we may say that the person is suffering from sticker shock, such as when gas prices go up at your local gas station.  In politics, government programs with unexpectedly high costs may be described as causing sticker shock among politicians or consumers.

Example:  Although many critics of Obamacare claim that consumers will have sticker shock when they see the prices of their new policies, other experts maintain that the cost of policies will actually go down.

cap costs

The word cap has its origins in the same word as cape, meaning a covering, especially for the head.  Later the term was used to indicate any item that is used to cover the top of something.  Thus we have caps for pens, or caps for oil wells.  Metaphorically we can also have salary caps for professional sports teams or efforts to cap rising costs of some government program.

Example:  Supporters of Obamacare contend that it will work to cap out-of-pocket health care costs.


Government programs are often compared to machines.  When they work well, no one complains; however, when something goes wrong, we may say that the program is broken.

Example:  President Obama maintains that he created the Affordable Care Act because the previous health care system with millions of uninsured Americans was completely broken.


In keeping with the idea of a program as a machine, we may also that the system needs to be fixed or repaired.

Example: It was clear from the early days of Obamacare that the website needed to be fixed although the necessary repairs would take several weeks.

blog - ACA - bugsbugs

            The word bug is another word for insect. As a verb, it means to annoy people in the same way that an insect annoys someone at an outdoor gathering.  As a noun it can mean problems in a system that are also very annoying or difficult to fix.

Example:  When the Obamacare website did not work very well, software experts scrambled to fix all of the bugs as soon as possible.

shut down the website

When a machine is working properly, mechanics may need to turn it off or shut it down to make the necessary repairs.  Metaphorically, we may also say we need to shut down a government program.

Example:  When the Affordable Care Act website was first launched with many bugs, the government decided to shut it down every night to make the necessary repairs.  Hopefully, it will be running smoothly soon.

Next time: Metaphors are for the Birds!

Obamacare Part 2: “Donut Holes” and “Navigators”

In my last post, I explained several of the most confusing literal terms and phrases in the health care debate.  In today’s post, I will describe some of the common metaphors used in the policy descriptions of the Affordable Care Act.

blog - ACA - spider webwebsite

I am sure no one considers the word website to be a metaphor, but it is actually a metaphor from the world of insects.  When the Internet was first invented, it was called the World Wide Web, comparing the computer connections around the world to the many strands of a spider’s web.  Now we don’t even talk about a “place” on the World Wide Web as anything other than a website.

Example:  Critics of Obamacare complained that the website was not working properly when they started the enrollment procedures on November 1, 2013.


Another word we probably don’t think of as a metaphor is coverage.  We can physically cover one object with another, such as covering a person with a blanket or covering a pot with its lid.  Metaphorically, we talk about geographic areas being covered by cellphone service, a debt being covered by a payment, or illnesses being covered by an insurance policy.

Example:  Some people with Medicare will have expanded health care coverage under Obamacare.

blog - ACA - sextantnavigator

A person on a ship or aircraft who controls its direction is known as a navigator.  Metaphorically, in the new Obamacare program, the people who help the public choose and enroll in a new health care plan are also called navigators.

Example:  At the website healthcare.gov, a navigator is defined as a “An individual or organization that’s trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms.”


blog - ACA - riderrider

            A person who controls a horse or who operates a motorcycle or bicycle is called a rider.  In the world of insurance, a rider is a clause added to a current policy to provide additional coverage for a specific set of circumstances.  So-called exclusionary riders can be written to exclude people from having health care because of previous health problems.

Example: One of the main benefits of Obamacare is that insurance companies can no longer write exclusionary riders to policies denying people health care because of preexisting conditions.


Metaphors based on family members are common in politics and history, such as George Washington being referred to as the father of our country, or the sisterhood of female Senators in Congress.  The concept of grandfathering is common in many company and government policies.  It dates back more than 100 years to the time when black voters were exempt from voting restrictions (later ruled unconstitutional) if their ancestors had voted before the civil war.  In modern times, a grandfather clause exempts employees or other persons from being subject to new rules that are taking place.

Example:  According to the glossary of healthcare.gov, grandfathered is defined as follows:  “As used in connection with the Affordable Care Act: Exempt from certain provisions of this law.”  https://www.healthcare.gov/glossary/grandfathered/

blog - ACA - poolpool

A pool is a small body of water.  Originally it referred to small, enclosed inlets or bays near a larger body of water.  More commonly today we think of the term referring to a swimming pool in a backyard or community center.  Metaphorically, the term pool refers to a collection of money in a betting game or poker match.  It can also refer to the amount of genetic material available in a certain population, a phenomenon known as a gene pool.  In insurance, a pool is a group of people who share the same health care policies.  Consumers can save money by belonging to a large pool of people whose premiums keep the costs low for everyone who has the same policy.

Example:  The Affordable Care Act provides an opportunity for people to purchase a high-risk pool plan if they have preexisting conditions and require more health care than the average person.

donut hole

Donuts are a very popular breakfast item all over the world. Some donuts are solid while others are made with a hole in the middle.  The idea of a donut hole is used metaphorically in some cases to indicate a gap in insurance coverage. SONY DSC

Example:  According to the website healthcare.gov, “Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a “donut hole”). This means that after you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit. Once you have spent up to the yearly limit, your coverage gap ends and your drug plan helps pay for covered drugs again.” https://www.healthcare.gov/glossary/donut-hole-medicare-prescription-drug/

Next time:  Obamacare, Part 3:  “Rollouts,” “Fixes” and other Media Metaphors

Obamacare Part 1: “Single-Payer,” “Exchanges” and Other Literal Glitches

For the past several weeks, I have been researching the metaphors used in the discussions of the Affordable Care Act, more commonly known as Obamacare.  There are many different types of metaphors being used as well as many confusing literal names and phrases, so I have decided to break the analysis up into three separate sections. Today I would like to explain some of the names and literal phrases.  Perhaps some readers will benefit from a clearer explanation of some of these important terms.  In the next two posts I will analyze metaphors in policy descriptions and then in media discussions.  I will add the links to the government websites if the reader would like more information on these important terms and policies.

The critics of Obamacare have been complaining that the website and enrollment procedures are filled with glitches.  After analyzing these literal terms, it seems that even the ways that terms are explained by government officials are also filled with glitches.

single payer

Conservative critics of Obamacare complain that it is too much like socialized medicine.  Liberal critics complain that it is not enough like the socialized medicine of other industrialized countries.  These other plans are sometimes called “single payer” health care systems.  However, many people, including myself have been confused as the meaning of this phrase.  Some politicians like to compare government programs and budget analyses to personal experiences and family budgets.  However, in some cases, there are no real world experiences that seem to match the processes the government terminology is trying to explain.  For example, if some friends go out to eat, and big spender Jim picks up the tab, Jim would be a single-payer.  And yet, here is the definition of “single payer” according to the PNHP (Physicians for a National Health Program): “Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or ‘payer.’ In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs.”  http://www.pnhp.org/facts/what-is-single-payer

blog - ACA - bill payer

Well, I guess that makes sense, but a government agency acting as the “payer” strikes me as being strange.  For health care, people normally either pay a medical clinic or hospital directly or they pay their insurance premiums and then the insurance company pays the clinic.  Having the government pay your medical bills is a new concept to most people.  Moreover, calling a government a single payer probably confuses more people than it helps.  Nonetheless, PNHP adds, “In a single-payer system, all hospitals, doctors, and other health care providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don’t have it.”  Perhaps proponents of the single-payer system can come up with a better name for the program the next time it comes up for a vote in Congress.


Another confusing term is the “exchange” where people are allowed to sign up for their new health care policy.  Once again, the meaning in government policy does not seem to match the meaning in everyday life.  For example, if our friend Jim buys a shirt at a department store, and discovers when he tries it on at home that it is the wrong size, he may return to the store to exchange it for the correct size.  In this case, he would be exchanging one shirt for another of equal value.  If Jim and his wife go on a European vacation, they may need to do a currency exchange, meaning they exchange American dollars for European euros, again changing one thing for another.  And yet, in the government, what is being exchanged when one buys health insurance? It is not clear.  However, it seems that the government is using the term exchange in the sense of the stock exchange, in which people buy and sell stocks, bonds, or other financial investments.  To gain some clarification on this confusing term, I consulted the glossary at healthcare.gov.  Sadly, when I clicked on the term exchange, the glossary only stated: “See Health Insurance Marketplace.”  Even more perplexing is that when I looked up Health Insurance Marketplace, they never mention the word exchange!  I guess I am not the only one who is confused.


For a change, the term marketplace actually makes sense.  A market is a place where people have bought necessary items for hundreds of years.  It is natural that a place to buy health insurance may also be called a marketplace.  The website defines the Health Insurance Marketplace as follows:  “A resource where individuals, families, and small businesses can learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage.”  (For more details see https://www.healthcare.gov/glossary/health-insurance-marketplace-glossary/).

blog - ACA - marketI find it interesting, however, that the marketplace is defined as a “resource.” In cyberspace, even a marketplace cannot be defined as a “place” since it does not actually have a physical location.  This must be a difficult task for copywriters on websites trying to describe something that exists only in cyberspace.


Cost Sharing

Yet another confusing phrase in Obamacare is “cost sharing.”  The website healthcare.gov defines this phrase as follows:  “The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost sharing in Medicaid and CHIP also includes premiums.”  https://www.healthcare.gov/glossary/cost-sharing/

Is this confusing to anyone else?  The first sentence seems to contradict itself.  It the costs are covered by insurance, why does the policy holder need to pay them?  This does not make any sense to me.  Moreover, if the cost sharing does not include premiums, why are premiums included in Medicaid and CHIP (another acronym for Children’s Health Care Program)?  This could be explained in much clearer language.


People who lose their health insurance for various reasons can buy new health insurance through a government program called COBRA.   The healthcare.gov website defines COBRA in the following way:  “A Federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee.” https://www.healthcare.gov/glossary/cobra/

blog - ACA - cobra            However, they never explain the origin of the word COBRA.  I should note here that a word such as COBRA is known as an acronym, a name whose letters can be pronounced as a word.  Acronyms differ from abbreviations in which the letters are spelled out individually.  For example, the ABC television network is an abbreviation that refers to the American Broadcast Company.  However, NASA is an acronym meaning the National Aeronautics and Space Administration.  Thus COBRA is an acronym defined at a different government website as follows:

“The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events.”  http://www.dol.gov/dol/topic/health-plans/cobra.htm


The final confusing name in Obamacare is a program called TRICARE.  According to healthcare.gov, this is “A health care program for active-duty and retired uniformed services members and their families.”  That is easy enough to understand, but given the name with the prefix “tri,” I wondered what the three parts of the program are.  After all, a tricycle has three wheels, triplets are three children born at the same time, etc.  What is TRICARE named for?  I was never able to find out. I looked through the TRICARE website and could not find an answer.  Why are all these government programs given such confusing names?



Next time:  Obamacare Part II:  Metaphors in the Policy