A major problem in politics is that it is not optimal for any party to say what they mean. People pound the table as to how innocuous a certain policy is, and how 'crazy' anyone must be to be against it. Others highlight a different endgame, a principle, or the insincerity of the policy. This is why Michael Kinsley famously said a 'gaffe' is when a politician accidentally says the truth. Ignorance, and bad faith, make truth-telling a dominated strategy.
It is important to distinguish between private and public sphere here, as in my private life I can adopt a truth-telling strategy because when I encounter the ignorant and those of bad faith, I can simply avoid those neighbors and friends going forward. In contrast, one must build coalitions in public, and one cannot simply abstain from interacting with such parties. Thus, insincerity is needed much more in public contacts than private contacts [one still needs some insincerity in private, like saying 'your butt doesn't look big in that' to your spouse].
Ignorant people will misinterpret your assertions or plans. The idea that getting rid of the minimum wage helps the poor or that giving people money to destroy old cars is a waste of money, is a complex assertion that takes an equilibrium argument, and is primarily theoretical. The benefits are seen and the costs are unseen. Alternatively, the idea that it is optimal for governments to have 5-year plans for industrial production at one time seemed obvious, based on the fact one plans before building a bridge. In this case, the error is not in undercounting the unseen, but a flawed analogy.
Then there are those with bad faith. Often these aren't people out to get you, but rather, see your immediate aim as not in the best interest of their overall plan, and so want to stop it at all costs. Your failure is not their direct aim, but rather, consistent with their objective. Their opposition can be direct ('no new taxes!), but it can also be indirect, helping the ignorant develop antipathy by clever caricature ('he wants to hurt small businesses!').
Thus, people often speak in metaphors based on principles no one is against. For example, in litigation, when asked 'what is your endgame?', an honest response would state one's direct claim against the defendant. This would be a specific demand, but that presents a problem. Perhaps your endgame is something that an ignorant person would find highly dubious or self-serving if discovered. For example, you could merely want to effect a noncompete agreement, stifling a new competitor. Perhaps your endgame is costing your ex-employee a lot of money to signal to current employees the futility of trying to negotiate for more within the firm. Clearly, these are not sympathetic aims, even if your plan for crushing some plebes is part of a greater good via using your ultimate booty to fund a charity in Africa. So instead of saying something specific you say 'to protect our intellectual property and enforce valid contracts'. You start broad, and when pressed, get less broad, but always keep at a level where any Sunday school teacher would agree with your goals.
In health care, I think the bottom line is that most people see this as a foot in the door to greater government control of a large segment of our economy, one that will be used for more egalitarian, and politicized, allocation of resources. Democrats in this country like egalitarian redistributions, and 'politicized' is just a pejorative for 'democratized'. Republicans emphasize the inefficiencies of egalitarian distributions, the violations of liberty. As health care is expensive and already highly regulated, it's sort of like the Balkans of historical Europe, a good place to start a fight on this more fundamental issue.
As Greg Mankiw has noted:
To judge whether my conjecture [that this is not mainly about health care] is correct, ask your favorite pundit of the left the following: What health reform would you favor if the reform were required to be distribution-neutral?
Intentions, people's end games, are very important, because if you know what someone wants, that makes what they say mean something very different. I think all people understand this at a deep level, which is why old people suffering from dementia have prominent paranoid beliefs about people wanting to 'get' them. They know that the intentions of people are very important, and this knowledge is deep in the cranium, not at the edge.
In observing the public debate, one has to arrange one's argument in a way that makes it more likely the ignorant will be on your side because they are always a decisive block in any policy debate. As Keynes said, right policies are invariably chosen for the wrong reasons, so one must anticipate that. This makes a lot of discussion on these issues confusing, because some people are commenting on statements as if they were not part of a broader context.