When Clintoncare was finally slain in 1994, its deathblow may have come from a pair of fretful suburbanites — Harry and Louise.
Harry and Louise were a fictional couple who appeared in a yearlong string of television advertisements between 1993 and ’94, criticizing the proposed health care plan. They directed their message at buttoned-up white-flighters in suburbs across the country, putting an “aw shucks, honey” polish on their talk of government overreach, swelling bureaucracy, and restricted consumer freedom. Today, they’re remembered as an emblem of the skeptical American people who allegedly said no to health care reform.
But a year earlier, it seemed that national health insurance was an idea whose time had come. The demand for health care reform was wildly popular among voters — so much so that during the campaign season, even George Bush voiced his support for some version of a nationwide health plan. In August 1993, a full 81 percent of Americans regarded universal health insurance as either “absolutely essential” or “very important” for the country’s future.
So a year and a half later, when Clinton’s health care bill finally died on the vine, Senate Majority Leader George J. Mitchell pointed an angry finger at the insurance industry. But his Republican rivals scoffed. No, it wasn’t industry meddling — the demise of the National Health Plan was “democracy in action,” Senator Bob Dole said. “That’s the way it’s supposed to work.”
How had Clinton’s proposal for universal health care, a centerpiece of his campaign, come to such an inglorious end in a Senate subcommittee? Had one “yuppie couple” (to quote the president) really managed to turn the American public against a once-popular policy initiative with just a few TV ads?
In reality, the story of Clintoncare’s slow assassination is hardly a whodunit. In 1993 and ’94, Clinton’s self-defeating Third Way orientation collided with a well-funded and politically shrewd media campaign orchestrated by the private insurance industry, which aimed to hoodwink Washington legislators into believing that national opinion about universal health care had changed.
Clinton’s proposed reform wouldn’t have annihilated the private insurance industry, but it would have subjected it to an unprecedented level of governmental regulation. At the time, one Democratic insider mused that reforming health care in America was like “throwing a trillion-dollar pot of gold up for grabs.” Nobody thought the private insurance industry was going to spill that pot without a fight.
But some observers might have been surprised when Clinton shot himself in the foot right out of the gate. When Clinton took office, health care reform was second on the agenda — first up was the now infamous North American Free Trade Agreement. By pursuing NAFTA, Clinton exhausted the goodwill of those coalition partners — like unions — that otherwise would have provided Clintoncare’s local foot soldiers.
An anonymous White House official admitted as much in 1996, in the Journal of Health Politics, Medicine and Law: “[AFL-CIO president Lane Kirkland] basically said, ‘We have $5 million to spend. We can either spend it supporting health care or fighting NAFTA.’” Clinton chose NAFTA over health care, and a vital slice of his coalition fell away. The millions-strong AFL-CIO, plus a number of smaller consumer groups, devoted the lion’s share of their political energy that year to fighting the president they had earlier endorsed.
To make matters even worse, the Clinton administration shied away from mobilizing mounting public pressure in support of reform, out of deference to the insurance industry. In the same 1996 issue of the Journal of Health Politics, Ira Magaziner, the president’s top advisor on health care, recalled meeting with a leading industry lobbyist early on in the process. During that meeting, he assured the lobbyist that while polls indicated attacking the insurance companies would be overwhelmingly popular, “this is not what we want or intend to do.”
But Clinton’s sweet-talking to the insurance industry did nothing to defuse their attacks. The national health care conversation soon devolved into a series of embarrassing personal squabbles, in which the Clinton White House and the Health Insurance Association of America (HIAA), the industry’s lead lobbying group, behaved like a celebrity couple on the rocks, sniping at one another on TV.
Still, the president’s special task force on health care continued to move forward with its work. But then the HIAA unsheathed its secret weapon. In September 1993, after twenty-six focus groups and two public opinion surveys, Harry and Louise hit the airwaves.
In their first commercial, the couple sit side by side at a breakfast table, absurdly reading a thousand-page congressional bill over their morning coffee. They lament the state of American health care but insist the devil is in the details: “Having choices we don’t like is no choice at all,” Louise intones. “If they” — meaning government bureaucrats — “choose, we lose.” In a later ad, they stand beneath a driveway basketball hoop, warning of freeloaders and doubled monthly payments.
It’s hardly riveting cinema. But the genius of the Harry and Louise campaign wasn’t in the particulars of its messaging — it was in the toll-free number each ad displayed in its final frames.
While Clinton was alienating the coalition partners that could have backed up his national push with local organizing efforts, the insurance industry was building a ground game of its own. The Harry and Louise number connected viewers with a well-oiled network of phone bankers whose purpose was to generate constituent calls to cherry-picked members of Congress. “You don’t have to turn around public opinion as long as congressional offices are getting flooded with hundreds of calls,” explained Mark Isakowitz of the National Federation of Independent Business (NFIB), one of the HIAA’s collaborators.
Besides, the anti-reformers didn’t have to inundate every congress-person’s office with phone calls — instead, they could zero in on individual legislators at each point in the deliberative process by broadcasting Harry and Louise in select districts. “We moved around our focus depending on what committee or subcommittee was considering a bill at a particular time,” recalled HIAA president and former Ohio congressman Bill Gradison. “We tried to reach the swing members of those committees on a serial basis depending on when they would be taking things up.”
The hyperlocal strategy worked: a twenty-six-month study of several Oklahoma municipalities, for example, shows public opinion in Harry and Louise-targeted areas diverging sharply from national polling numbers, despite a previous trend in those areas towards favoring universal health coverage. And phone operators were remarkably successful at amplifying those local shifts to exaggerate the scale of public mistrust. Nationwide, the HIAA managed to convert almost 10 percent of the 500,000 callers they fielded into “performing members” of their campaign by connecting them to congressional offices, sometimes even patching the callers through directly.
These “performing members” were pressured to call repeatedly — enough to give legislators the impression that there would be a political cost at home for supporting the president’s plan on Capitol Hill. The HIAA estimates that the 45,000 people recruited through the Harry and Louise phone number contacted Congress as many as a quarter of a million times over the course of the year.
Meanwhile, the wider public was too uninformed about the proposed legislation for opinion to shift dramatically — a full 76 percent of Americans still reported knowing “nothing” or “very little” about Clintoncare at the time of its defeat. As a matter of fact, there were strong indicators that, despite fatigue from all the coverage, voters remained largely supportive of the president’s plan.
An estimated $60 million, more than half of all lobbying spending against health care reform, went to television advertisements like Harry and Louise. And it’s true that people who saw the ads — about 58 percent of the country — were on average about 33 percent less likely to voice support for Clintoncare than people who weren’t exposed to Harry and Louise. (Well under half of those people understood the insurance industry was behind the characters.)
Information was less important than anxiety: however misleading, the ads did succeed in tapping into misgivings about the role of government in a society without a robust universal safety net. By fretting over their kitchen table, Harry and Louise created doubts, and doubts generated confused phone calls, which could easily be converted, with just a little coaching, into calls to Congress.
Clinton’s allies knew the ad campaign was wreaking havoc on their ability to whip votes. But with no ground game to get their own message out there, they were reduced to groveling before the insurance lobby. In what at least one observer called “an unprecedented spectacle,” Ways and Means Committee chair Dan Rostenkowski actually tried to indulge the HIAA’s blackmail: he would alter the legislation to better suit the industry, he said, in exchange for their promise not to run ads in particular states.
“We know you guys are sore about the ads,” Gradison recalls telling the White House. “I don’t want them to stand in the way of our working together.” Still, he warned the White House that the industry was watching “very carefully, to see if you stop beating up on us” — and he made sure to mention “a couple of new ads in the can,” which could hit the airwaves at any time.
Harry and Louise stayed on television. Clinton tried to counter the industry’s message with some broadcasts of his own (including a cringeworthy sketch, originally performed at that year’s Gridiron dinner, with the first couple in the role of Harry and Louise), but it was too little, too late.
It was the swindle of the decade in a decade full of swindles. In the early 1990s, support for universal health coverage was a ticket to Washington for candidate after candidate — from Senator Bob Kerrey of Nebraska, to Harris Wofford of Pennsylvania, to the president himself. But just a few years later, all of Washington was convinced that health care reform was a toxic conversation, suicide in the polls — an issue to punt, if not disavow entirely.
With their deep pockets and single-issue focus, the insurance industry had demonstrated a chilling reality about American lobbying: well- funded special interests can easily manipulate legislators just by creating the perception of shifting public opinion.
Harry and Louise weren’t foot soldiers, winning territory in the battle for hearts and minds. They were snipers scanning Capitol Hill, artfully picking off key votes until even the mention of health care reform made members of Congress quake in their foxholes and duck their heads.