Journal of Health Politics, Policy and Law 26.6 (2001) 1353-1360
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Impact of Issue Advertisements and the Legacy of Harry and Louise
Henry J. Kaiser Family Foundation
The Health Insurance Association of America's "Harry and Louise" ads have become part of the lore of the Clinton health care reform debate of 1993-1994. Anyone involved in the debate at the time, or a student of the debate, or involved in health care reform since, knows about the campaign and has likely deliberated with colleague, friend, or foe about the impact the ads had, or did not have, on the outcome. Harry and Louise was not the first ad to be used in a health policy debate. Interest groups have organized and launched professional advertising campaigns and grassroots efforts as far back as Harry Truman's national health insurance proposals in the late 1940s (Starr 1982). What made Harry and Louise so special was that the ad was launched during one of the nation's most contentious and high-profile health policy debates in recent history, bringing intense scrutiny to both it and the role of issue advertising in the health policy arena.
Since the campaign we have seen a dramatic increase in the amount of dollars spent and the number of issue ads produced and aired in every election cycle, with health care being one of the primary topics of the ads (Aday 2000; Annenberg Public Policy Center 2001). Add to this our inherent interest in better understanding the links among our political institutional structure, political actors, the political debates themselves, and policy outcomes, and it becomes clear why we are driven to ask what we can learn from Harry and Louise. Critically examining the impacts of [End Page 1353] past and future issue advertising campaigns helps us to understand the political forces shaping the future of health policy.
The Harry and Louise campaign raised three key questions: (1) Did the ads influence public opinion? (2) How, if at all, did the ads affect the political debate over health care reform? (3) What, if anything, does the campaign suggest for the future of health policy debates in this country? Most of the past work of this topic has concluded that this campaign did influence this particular policy debate (Jacobs and Shapiro 2000; West, Heith, and Goodwin 1996; Jamieson 1994a). But, as evidenced by the articles in this volume, discussion and debate continue about how the ads affected the debate. Much discussion has focused on the question of direct versus indirect impact. Did the ads directly sway public opinion by helping to turn the public against President Clinton's health reform plan? Or, rather, did the ads have a more indirect route of influence by creating the illusion of public opposition through the use of what has been termed "astro-turf" mobilization?
In attempting to think about the ads' potential impact and the legacy they leave in helping to shape our thinking for the future, we can map out an even broader range of conceivable mechanisms falling into these two categories of direct and indirect influences. First, the ads could directly influence the views of the individuals who see them and thus influence public opinion by summing those individual effects. In this issue, Raymond Goldsteen, Karen Goldsteen, James Swan, and Wendy Clemeña make a laudable effort at exploring the extent to which this mechanism operated in the specific case of Harry and Louise. Despite my inclination to believe that ads such as those in the Harry and Louise campaign could influence viewers' opinions of President Clinton's health care reform proposal, I do not find the empirical evidence offered in this case necessarily convincing, and I encourage readers to judge the data for themselves.
Two issues particularly struck me. As Goldsteen et al. note, the model leaves out measures that might capture the influence of national media attention focused on health reform. Others have documented the substantial amount of news coverage and have pointed to the likelihood that...