Print Advertising in the Health
Care Reform Debate
by Eric M. Appleman/Democracy in Action revised April
4, 2010
view a sampling of ads
Given the significance of health care spending in
the American economy it is
not surprising that interest groups of all stripes ranging from various
segments of the health care sector, to business, labor, and religious
organizations, to ideological and partisan groups weighed in on the
debate during 2009-10.
Major
stakeholders include patients, employers, providers, and payers as well
as
government at all levels. Within these groupings there are many
subcategories.
For example, patients include seniors, children, people with chronic
conditions, the disabled, and more broadly victims of malpractice and
by
extension trial lawyers. Employers include small businesses and large
corporations; governments are also employers. Providers is a very broad
category encompassing hospitals (including university hospitals, public
hospitals, religious hospitals, children’s hospitals, etc.), HMOs,
nursing
homes and hospices, doctors ranging from general practitioners to
specialists,
nurse practitioners, nurses, home care personnel; pharmaceutical
companies
(including brand and generic manufacturers as well as biotech
companies); and
medical device and equipment manufacturers. Payers include insurance
companies
and the government.
There are many different ways in which groups can seek to influence legislation, for example by organizing supporters to make calls, holding a rallies, lobbying, and advertising. For example an Americans for Prosperity “Hands off My Health Care” bus tour made appearances in the summer. Organizing for America responded with a “Health Insurance Reform Now” bus tour. Groups were very busy on the lobbying front. According to a Center for Responsive Politics’ analysis of lobbying reports, by the fourth quarter of 2009 over 1,500 clients were lobbying on health reform at least to a minor degree compared to just shy of 400 clients in the first quarter.
Dozens of groups ran broadcast, print and internet campaigns for and against health care reform legislation. Much of the money went into television. For example, Health Care for America Now (HCAN), a progressive coalition which launched in July 2008, spent $12 million on TV, print and online advertising in 2009-10 (through late March), of which about half a million dollars was for print ads. Some organizations ran coordinated print, broadcast and internet campaigns, while others focused on just broadcast or just print.
Different media work better for different approaches. Television and radio ads can be more emotional and punchy. Print ads allow for more detail and are more affordable than television. Special web sites allow for even greater detail.
This very limited survey examines a narrow sliver of the overall advertising pie, looking at print advertising primarily in three Capitol Hill publications: Roll Call, Politico and The Hill. As described in their media kits, these publications target an elite audience. Roll Call notes that its “award-wining reporting and insightful analysis have a dedicated place in the hearts and minds of anyone who works on Capitol Hill.” The open rate for a full-page four-color ad is $12,900. Politico claims it “reaches more influentials than any other Capitol Hill news source.” The open rate for a full-page, four-color ad is $12,200 and a black and white ad runs $10,740. The Hill is “known among those who influence policy as a ‘must read’ in print and online;” the newspaper also claims it is “read more regularly than any other congressional publication.” The open rate for a full-page four-color ad is $11,900.
This survey thus does not consider organizations and ad campaigns that focused exclusively on broadcast media. It largely misses national focus ads that ran in the Washington Post, New York Times, Wall Street Journal and USA Today, although I have included a few of those to give a sense of what was run. Ads by groups such as the American Medical Association and the American Hospital Association appeared in one or several of these national publications, but not in the Capitol Hill papers. The survey also misses the targeted district ads, and there were many of those. Finally, this is not even an exhaustive survey of every health care ad in every issue of the three Capitol Hill publications—the sample is thin in the early months and in the summer. Despite these many limitations the survey does give a good sense of what different groups were doing and may hopefully serve as a starting point for further research.
In addition to the choice of media, advertising strategy and tactics varied in other aspects. Groups targeted ads towards a national audience, more narrowly inside the Beltway, or towards key members of Congress in their districts. Their ads addressed the broad ideological thrust of the reforms or specific provisions. In terms of timing, some organizations had ongoing campaigns while others made the most of limited resources by pegging ads to specific events. Some ran simple text-only ads produced in house while other ads were more designed, including imagery of doctors and patients, seniors, and hospital scenes.
Sometimes groups joined together or coordinated to
run ads.
The American Association of Homes and Services for the Aging
spearheaded a
coalition that grew from about 15 sponsoring organizations in March
2009 to
dozens a year later. One of the more unusual groupings was the pairing
of PhRMA
and Families USA, which on April 21, 2009 announced at three-point
advertising
campaign “to help achieve high-quality, affordable health coverage for
all
Americans.” On the progressive side HCAN pooled the resources of dozens
of
coalition members; its ads strongly condemned the insurance industry.
Health
insurers ran few prints ads. America's Health
Insurance Plans (AHIP), the
national trade association, did have an effective web campaign “The
Campaign
for an American Solution” and according to news reports put resources into
third party
ads, for example by the Chamber of Commerce.
As noted
above, many groups ran ads on specific provisions of the bills being
considered. AARP focused its ads on the doughnut hole and coverage for
people
aged 50-64. Labor unions came out strongly against the excise tax on
“Cadillac”
plans contained in the Senate Finance Committee bill. Abortion language
prompted a spate of ads. A more general ad from the National
Coalition on Health Care emphasized
cost containment as a necessary component of health reform. There were some very
political
ads; American Future Fund ran an aggressive campaign warning Members
that
voting for big government health care would jeopardize their chances
for
re-election.
Finally, there was a lot of “background” advertising. Various sectors of the health industry ran general campaigns arguing in effect that they were already leading the way on reform.
A good example of such background advertising was
PhRMA’s
ads promoting its Partnership
for
Prescription
Assistance.
(Another PhRMA ad campaign highlighted the
industry's importance to the economy). In a similar vein Pfizer ran ads
throughout the period of the debate promoting Pfizer Helpful AnswersTM.
Early
ads
showed
the Statue of Liberty and later ones a light house;
according
to the copy the company was providing over 100 medicines for free or at
savings.
Premier, an alliance of 2,100 non-profit hospitals (whose trademark is “Transforming Healthcare Together”) also ran ads throughout much of the period of the debate noting that they are “innovating and integrating best practices.” The ads featured smiling people, had the headline “Guess who wins when hospitals pull together? Everyone.”
Another example of background advertising came from the Foundation for Chiropractic Progress. The Foundation’s mission is “to promote positive press for the profession in national, regional and local media.” In an Aug. 20, 2009 press release the Foundation announced a $1 million media blitz to “reinforce the role of chiropractic care as it impacts the delivery of quality, cost-effective health care nationwide.”
In sum, this survey documents the print advertising messages of many players in the health care reform debate. In these ads one can see arguments made for and against the reform proposals by groups ranging from health providers and consumers to business and labor to ideological groups. Some ads address broad reform objectives or specific provisions of particular bills, others are more political, and still others are more generic background advertising.