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
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
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
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
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
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
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.