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How "Harry and Louise" Could Still Take Down Health Care Reform

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After more than a decade of academic, media, and popular analysis, the failure of the Clintons' 1993 health care proposal is still best captured by this old Harry and Louise ad in which a white middle-class couple sit down at their kitchen table "sometime in the future" and lament the good ol' days before the bureaucratic government took over their health care system and eliminated their ability to control their own care (my words).

Paid for by the powerful Health Insurance Association of America, this ad galvanized public opposition to health care reform -- confirming the widespread notion that interest groups and media experts can easily manipulate a susceptible public in order to benefit their own bottom line. Of course, this media strategy is found on both sides of the debate. In fact, during the Democratic and Republican conventions this summer, a set of pro-reform interest groups (American Cancer Society Cancer Action Network, Families USA, etc.) aired a new multi-million dollar ad campaign in which the same Harry and Louise return to lament out-of-control health care costs and urge the next president and Congress to put health care reform at the top of their political agenda.

Now, we see a new "Bulldozer ad" from Conservatives for Patent's Rights. In it we watch a bulldozer labeled "Government Run Insurance Plan" rush forward while hearing that Congressional reform proposals "could crush all your other choices, driving them out of existence."

Among others, Newsweek quickly posted a fact check memo pointing out holes in this ad's argument, most notably the fact that for most Americans choices are already incredibly constrained. But, despite the "truthiness" (a la Colbert) of this type of ad, it remains powerful by effectively evoking emotional, rather than rational, responses from viewers. In short, it does not matter if you're really being bulldozed; only if you feel like you are.

It is easy to dismiss this ad effect as superficial smoke and mirrors generated by well-compensated media types manipulating an apathetic and ignorant American public. Instead, it represents something much more fundamental -- and hence, much more powerful.

The fact that we can be swayed, scared, and moved by a minute or two of well-staged political rhetoric illustrates the deeply-conflicted and emotional nature of American public opinion. Rather than simply adopting a liberal or conservative ideology, most Americans embrace a broad set of deeply-held moral beliefs about justice, fairness, freedom, and opportunity. Our problem is not apathy or ignorance, but the complexity of our social problems that requires making really hard trade-offs among values that we really do not want to trade-off.

These tensions were illustrated in the recent June health tracking poll from the Kaiser Family Foundation, in which respondents were provided with counter-arguments after expressing their initial position on aspects of health reform. Not surprising, like political ads, these counter-arguments had a big impact on public preferences. For example, although 71% of respondents favored requiring an individual mandate, the vast majority of these respondents changed their mind when asked, "What if you heard that this could mean that some people would be required to buy health insurance that they find too expensive or did not want?" Additionally, among those opposing the individual mandate, 78% changed their mind when asked, "What if you heard that without such a requirement, insurance companies would still be allowed to deny coverage to people who are sick?"

Kaiser concludes that public support for reform is "somewhat fragile." And that much is clear. But, this fragility does not stem from indifference and confusion as many assume. It stems from the inherent conflict we all face in maximizing conflicting goals, such as broad coverage for the sick and disadvantaged and our desire to make our own choices for how we care for our health. These are not pedestrian concerns for most Americans; but represent deeply-emotional and powerful notions of what is right and wrong -- for themselves, their families, and for others. Harry-and-Louise-Style ads are powerful, not because they tell ignorant Americans what to worry about, but because they remind well-meaning Americans of what could be lost in the name of progress.

When considering the power short TV ads hold to shift public preference, reform proponents may be tempted to talk down to the American public, to focus-group-test even more sound bites, and to sweep complexities under the rug in an effort to hold together the "somewhat fragile" support for reform. But, real efforts to counter this style ad campaign require just the opposite: acknowledging the trade-offs that will occur and leveling with the American public about why they are so necessary.

Elizabeth Rigby, Ph.D. is an Assistant Professor of Political Science at the University of Houston and a Research Associate at the National Center for Children and Families at Columbia University. Her research examines the politics of health, education, and welfare policy making in the US.