Standing in a medical exam room, a neurosurgeon in a white lab coat stares solemnly into the camera and warns that President Obama's health care plan "will hurt our seniors" and "end Medicare as we know it." Two networks, NBC and ABC, declined to run the 30-second ad, but it has probably reached millions of people on Fox, CBS and local stations as well as on the Web.
How this ad - one of dozens of health care spots making the rounds -- came to be produced and distributed provides a case study in modern American political advocacy. It shows how a quickly assembled group with uncertain origins and funding can make a mark on one of the most contentious public policy debates in memory.
The group that says it paid for the campaign- the League of American Voters - incorporated less than two weeks before the ad was released online. The League's executive director, its only employee, declined to identify its founders or donors but claims that in less than two months of existence it has built a membership of 16,000 and raised about $1.7 million in donations. The group says it rents space inside a downtown Washington, D.C., office, an address shared with at least four other conservative groups.
Interviews and a review of public records show that a wide-ranging group of people coalesced to launch the League or its ad campaign: Dick Morris, a former aide to President Bill Clinton and one of the nation's more flamboyant political operatives; a one-time West Virginia political candidate; a New York City public relations executive with ties to health care groups; a New York rabbi; a filmmaker best known for an ad questioning the patriotism of Vietnam War veteran and then-Georgia senator Max Cleland; and a Florida doctor who once settled a state medical board allegation that he had operated on the wrong site during a spinal procedure.
From the start, it was clear that Morris had a strong hand in the video titled "Protect American Healthcare." The spot debuted on Morris' YouTube site on Aug. 3. That day, Morris appeared on Sean Hannity's Fox News program and talked up the ad, saying he had created it with what he called the "American League of Voters."
In his long career as a political consultant, Morris is perhaps best known for being chief political advisor to President Clinton, a post he resigned in the wake of news reports that he let a prostitute listen to his conversations with the White House. In recent months, the health care debate has helped raise Morris' profile in Washington again and propelled his latest book, "Catastrophe," onto the best-seller list.
Morris has been moving easily between roles as activist and journalist-commentator on the health care issue. He explained to Hannity his strategy for stoking opposition to Obama's reform plan: "If senior citizens are united in their opposition to this and they really go crazy on this issue, this is dead." At the same time he has been writing columns in The New York Post and The Hill newspaper, once offering the analysis that the elderly are working themselves into "a fever pitch" about Obama's plan.
Less than two weeks before Morris' appearance on Hannity's show, the League of American Voters incorporated in Delaware and launched its Web site. By mid-August, the League began identifying Morris as its "chief strategist" and the writer of its first ad.
Precisely when and how Morris connected with the group is not known. He did not respond to requests for an interview.
The League's executive director, Bob Adams, did agree to an interview. He declined to say exactly how and when the group formed, but he did say that Morris was involved from the beginning and came on board as a volunteer. "I don't want to get into too many of the nuts and bolts in terms of how we put the organization together," Adams said.
Adams said that the League's office on 12th Street in downtown D.C. affords him space "a little smaller than a cubicle" and a mail drop. "I believe in a very light, lean and trim operation," Adams said. "Do I have a big staff and a big office? No. Not at all."
The address is registered to at least four other conservative nonprofit groups, including Americans for Tax Reform, led by Grover Norquist, the longtime anti-tax activist. The League has "no affiliation whatsoever" with Norquist other than as a tenant, Adams said.
Adams lives in West Virginia, where he twice ran for public office, including for state treasurer in 2004. At the time, the Associated Press reported that Adams was late filing campaign finance reports, a violation of state law. He also worked as an aide to former Republican Congressman J.C. Watts Jr. of Oklahoma and for the American Legislative Exchange Council, a conservative group that drafts model legislation for state legislators. At one point Adams campaigned to build support among Latinos for bans on same-sex marriage; the League's Web site is registered to Latinos USA, a nonprofit venture that Adams said never got off the ground.
On the site, leagueofamericanvoters.com, the group says it is a 501(c)(4) nonprofit, meaning it is exempt from paying taxes so long as it operates "exclusively to promote social welfare," according to Internal Revenue Service rules.
Since Delaware does not require its corporations to publicly list names of employees and board members, or even an address, until June 1 of the year following its incorporation, the League will not have to make that disclosure until the current health care debate is over.
In the interview, Adams had difficulty coming up with the names of his board of directors. He said they included Alexandra Preate, a New York public relations consultant, a rabbi from New York and a third member whose name he could not recall. Several days after the interview, names of the board members were added to the League's Web site: Preate; Rabbi Morton Pomerantz, a retired New York state chaplain; and Phil Brennan, identified as a onetime aide to President Gerald Ford.
'Right on Message'
Nonprofits are not required to disclose their donors, and the IRS does not require social welfare organizations like the League to apply for tax-exempt status. Adams said he saw no reason to offer names of any donors beyond himself. He said he made the first contribution to the League's bank account while on vacation in late July, walking into a branch with his incorporation document and depositing a $20 bill.
The League now solicits donations through Morris' Web site and its own, seeking support for its "media campaign to expose the Obama health care plan." The largest donations have been between $5,000 and $10,000, Adams said, but the League is mostly funded by individual donations in the range of $25 to $50 rather than by "industries, by corporate interests." Some individuals have written checks from corporate accounts, he said.
"We've been attacked by, you know, some outside groups saying we're a front for this or a front for that," he said. "I get the mail and I see where the money is coming from. . .They're coming from all walks of life, all over the country. Republicans, Democrats, independents."
The donations have been used in part to circulate the group's ad. Adams said the ad was "right on message" and "hit the President's proposal right between the eyes." But he declined to say much more about it because he "wasn't involved in crafting and creating" it.
Adams said that Preate, the board member and New York public relations specialist, helped arrange the marriage between the League and the ad's creator, Morris. Contacted for an interview, Preate referred the Investigative Fund back to Adams. "He tells me he spoke with you," she wrote in an e-mail.
According to the Web site for Preate's firm, CapitalHQ, she "works with clients ranging from high level government officials domestic and foreign to Fortune 500 companies, Wall Street firms and national and international media organizations."
The site does not name her clients but states that the firm has secured news coverage for them in several health care media outlets, including Health Care News and Insurancebroadcasting.com. According to news accounts and press releases, her firm has represented at least two health care groups. One is Duravest, Inc., a public holding company that invests in and develops medical technologies. The other is the Center for Medicine in the Public Interest, a nonpartisan think-tank that focuses on health care policy. The center's president, Peter Pitts, recently wrote an op-ed published by Reuters that described Obama's proposed public health insurance option as "expensive, radical and unnecessary."
Preate's site also links to The Galen Institute, which describes itself as "a research organization focusing on free-market health care reform."
Without assistance from Preate, Adams or Morris, the Investigative Fund tracked down the producer of the ad on its own.
The trail led to a conservative Tallahassee-based media consultant named Rick Wilson. Wilson has produced a number of political TV ads for Republican and conservative causes. One of his most controversial projects was the 2002 spot that flashed a picture of Osama bin Laden and questioned the patriotism of Georgia Democratic Sen. Max Cleland, a decorated veteran who lost both legs and an arm in Vietnam. Cleland was defeated in his bid for reelection.
Wilson said he was paid to produce the health care ad before Bob Adams was involved in the League of American Voters -- which raises the question: who hired and paid Wilson?
Wilson declined to say. "I treat my clients with the confidentiality that they expect from me," he said.
The physician who stars in the League's ad, Mark J. Cuffe, also works in Tallahassee. He is a neurosurgeon who has practiced in Florida since 1993. In the ad, Cuffe begins: "How can Obama's plan cover 50 million new patients without any new doctors? It can't. It will hurt our seniors." Cuffe also was advertised as a panelist on health care policy at a recent local public forum. Florida records show that in 2007, he settled a complaint by the state medical board that he had operated on the wrong site during spinal surgery. Without admitting to wrongdoing, Cuffe agreed to pay $7,500 and perform 50 hours of community service, which he spent working at a hospice. He did not respond to requests for comment.
After Wilson was finished producing the ad, it appeared on two YouTube sites, one operated by Morris and the other by the National Republican Trust PAC, where the meter showed it was viewed more than 60,000 times in about six weeks.
Federal election records show that the National Republican Trust has worked with both Morris and Wilson in the past. When contacted, however, the group's director, Scott Wheeler, said the Trust had nothing to do with the health care ad. The ad was removed from the group's site shortly after the interview.
Morris himself is not among those distancing themselves from the spot or the League. He continues to tout his role in his TV appearances and on his Web site. The League's site promises a free autographed copy of his latest book to anyone who donates $250 or more.
Morris also continues to straddle the worlds of advocacy and journalism, using his Web site and TV appearances to stoke opposition to health care legislation among senior citizens while reporting in a recent column for The Hill: "fears of rationing and the denial of care are stoking opposition to a fever pitch among the elderly."
Until this week, The Hill identified Morris as a bipartisan insider: "Morris, a former adviser to Sen. Trent Lott (R-Miss.) and President Bill Clinton, is the author of Outrage." Asked on Monday whether Morris' involvement in the League should also be mentioned, Hugo Gordon, the newspaper's editor, said only that he has been pleased with Morris' columns. The following day, however, Morris' column carried a new disclosure to his biography: "In August he became a strategist for the League of American Voters, which is running ads opposing the president's healthcare reforms." Morris' columns in the New York Post do not carry a similar disclosure.
Meanwhile, the ad Morris created has raised a new problem for the League of American Voters. The spot shocked a member of the League of Women Voters, a 90-year-old nonpartisan group that supports health care reform, who confused the names of the two organizations. The League of Women Voters then wrote Adams a letter asking him to "cease and desist from using a name so deceptively similar."
"Your organization is playing on our good name and reputation and thereby seeking to add credibility to yours, which clearly has none," wrote Mary Wilson, the president of the League of Women Voters.
Adams has not responded to Wilson. "I don't work for her; she's not entitled to a response from me," Adams said. "It was a hysterical, obnoxious letter."