THE POWER OF PR: ANALYSIS - Political PR - How healthcare won against reform, twice. Presidents Truman and Clinton fought for healthcare reform and in doing so, spurred intense PR counteracts. Steve Lilienthal reports

Over the past half century, PR has been the prescription to protect lobbies from comprehensive national healthcare. In the two instances when serious drives were mounted, the lobbies that believed their members’ livelihood would be adversely impacted launched counterattacks. Their success has left the US and South Africa standing alone among major industrialized countries in not offering their citizens universal health insurance.

Over the past half century, PR has been the prescription to protect lobbies from comprehensive national healthcare. In the two instances when serious drives were mounted, the lobbies that believed their members’ livelihood would be adversely impacted launched counterattacks. Their success has left the US and South Africa standing alone among major industrialized countries in not offering their citizens universal health insurance.

Over the past half century, PR has been the prescription to protect

lobbies from comprehensive national healthcare. In the two instances

when serious drives were mounted, the lobbies that believed their

members’ livelihood would be adversely impacted launched counterattacks.

Their success has left the US and South Africa standing alone among

major industrialized countries in not offering their citizens universal

health insurance.



President Harry Truman included national healthcare as part of the Fair

Deal agenda in 1948 and sought to advance it legislatively the following

year. But the American Medical Association (AMA) had been girding for

battle. After the 1948 election the AMA assessed its 140,000 members an

extra dollars 25 to build a fund to beat back national health insurance,

and the California PR firm of Whitaker & Baxter was hired.



The birth of political PR



The husband-wife team of Clem Whitaker and Leone Baxter was described by

Carey McWilliams in The Nation as the operators of the ’first public

relations firm to specialize exclusively in political public relations.’

McWilliams asserted that the partners had brought about ’a new era in

American politics - government by public relations.’ When California’s

governor, for instance, advocated ’compulsory’ health insurance in 1945,

it was W&B that managed the campaign for the California Medical

Association that defeated the legislation.



Newsweek described W&B’s efforts for the AMA as ’simple, folksy,

cliche-ridden, and bristling with italics and exclamation points.’ W&B’s

plan called for county medical societies to start committees to handle

press and speakers to help get the message out. Literature warning of

the pitfalls of national healthcare was placed in doctors’ waiting

rooms. One pamphlet’s cover showed Sir Luke Fildes’ famous painting of a

doctor and child and urged: ’Keep Politics Out of This Picture!’ Right

before the 1950 election, AMA-sponsored newspaper ads that reached 60

million Americans promoted voluntary health insurance and warned of

’socialized medicine.’



Jonathan Greenberg wrote in The New Republic in 1993 that Truman had

consistently argued the plan was not socialist. Hospitals and doctors

would not become part of the Federal government. Patients would simply

receive reimbursement for their healthcare costs. However, other

important lobbies fell in line against the Truman plan and its

supporters could not match the AMA’s efforts. Frank Campion, writing in

the AMA’s authorized 1984 book, The AMA and U.S. Health Policy, noted

that ’in the perspective of 30 years’ hindsight ... the 1949-50 AMA

effort was an exercise in overkill.’ Campion quotes AMA official Dr.

Ernest B. Howard: ’The (congressional) votes for a compulsory health

insurance bill were never there.’ Yet, Howard also admitted that W&B

’did a superb job.’



The debate then shifted to a smaller program aimed at protecting the

aged. Once again, the AMA opposed the program. Not until after the 1964

election created overwhelming Democratic majorities in Congress was

Medicare passed.



Advocates for national health insurance made some noise in the

intervening years, but the next big push did not come until a generation

later, when post-Cold War economic anxiety led to Bill Clinton’s

election. Both proponents and opponents of ’Clintoncare’ waged massive

PR campaigns in what a study by the Center for Public Integrity called

’the most heavily lobbied legislative initiative in recent US

history.’



But it was the concerted PR campaign waged by the Health Insurance

Association of America (HIAA), which represents small and medium

insurers, that drew national attention.



HIAA turned once more to a California-based firm, Goddard Claussen

(acquired by Porter Novelli last month), that specializes in political

PR. Ben Goddard says his firm had gained a favorable reputation by

turning back a sweeping auto insurance reform ballot measure in Arizona

that had passed earlier in California.



He admits it may be more than coincidental that California PR firms

played key roles during both healthcare debates: ’Arguably, we have a

better understanding of how to communicate an issue to the public than a

firm that works with candidates,’ he says.



GC’s advertising campaign launched two weeks before the Clinton plan was

officially unveiled. ’We felt we needed to frame the debate and had to

start raising questions that we hoped people would focus on,’ Goddard

says. TV spots featured an average suburban couple - the now-famous

Harry and Louise - questioning the plan. The spot’s true impact came in

the reaction it provoked.



First Lady Hillary Clinton’s criticism of the advertising drew a front

page New York Times headline in November 1993. That personalized the

issue, claims Goddard, helping to turn the debate into one of Bill and

Hillary versus Harry and Louise. The month before Senate Majority Leader

George Mitchell declared the health plan dead, Kathleen Hall Jamieson,

dean of the University of Pennsylvania’s Annenberg School for

Communication, notes that Harry & Louise had received more than 700

newspaper mentions in less than a year.



Clinton White House communications aide Jeff Eller, now with Public

Strategies, contends the healthcare plan had engendered ’a lot of

opposition by interest groups even before those spots hit the air.’ But

Eller noted, ’There were very few reporters who really understood the

plan. The HIAA let the press in general simplify the reporting of the

plan to being a government-run program.’



Jamieson argues that the ads provided more the perception than actual

results in changing opinion. But the reaction they incited in Washington

gave them ’the presumption of effect.’ Indeed, the HIAA actually

achieved a deal with House Ways & Means Committee chairman Dan

Rostenkowski to temporarily stop airing the advertising in return for

legislative concessions.



But that deal ended when Rostenkowski’s legal problems resulted in a

new, less compromising chairman.



Healthcare opponents prevail



While the claims regarding the Clinton plan’s merit and scope are open

to serious debate, once again the opponents of national healthcare

prevailed.



National healthcare’s proponents employed PR in both efforts. But the

sweeping change sought by Truman and Clinton mobilized an intense

opposition with the money and expertise that enabled them to make more

effective use of PR.



And judging from these results, there is no doubt that PR will be

employed in future battles over the governments’s role in healthcare.



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