The Great Health Care Debate

The Great Health Care Debate

BILL CLINTON: [September 1993] This health care system of ours is badly broken, and it is time to fix it.

TV COMMERCIAL: Bill Clinton wants to socialize our health care. TV

COMMERCIAL: We shouldn't have to wait. We shouldn't let the Republicans play politics with it.

RUSH LIMBAUGH, Radio Talk Show Host: Anybody who disagrees with any aspect of their plan is being attacked.

PETER JENNINGS, ABC News: The political fight over health care reform is becoming downright ugly.

BILL MOYERS: [voice-over] It was called the biggest piece of legislation since Social Security.

JOHN COCHRAN, ABC News: This is John Cochran on Capitol Hill, where the noise level over health care is rising.

BILL MOYERS: [voice-over] And it generated more press, polls, ads, PR and lobbying than anyone can remember seeing before. Tonight, how media and money helped to bury "The Great Health Care Debate." I'm Bill Moyers. Pennsylvania, 1991. Harris Wofford's campaign for United States Senate turns health care reform into the hot button of national politics.

HARRIS WOFFORD, (D) Senatorial Candidate: The Constitution says those accused of a crime have the right to a lawyer, yet millions of Americans aren't able to see a doctor. They either .don't have health insurance, or they're afraid medical costs will bankrupt them. If criminals have the right to a lawyer, I think working Americans should have the right to a doctor.

BILL MOYERS: [voice-over] Wofford won, upsetting the highly

favored Dick Thornburgh, who knew what hit him.

RICHARD THORNBURGH, (R) Senatorial Candidate: Uncertainty and anxiety about the costs and coverage of health care' obviously commanded much greater attention in this campaign than we anticipated.

Sen. HARRIS WOFFORD, (D) Pennsylvania: The people of Pennsylvania, on this one glorious day, have used the power of the ballot to send a wake-up call to the President, to the Congress, to the Republican Party, to the entire federal establishment.

BILL MOYERS: [voice-over] Presidential hopeful Bill Clinton heard that message loud and clear. On a cross-country caravan, he preached health care reform to cheering crowds.

BILL CLINTON: Let me tell you that in Germany today, the average factory worker works a shorter work week, makes 20 percent more than the average American, and, they've still got affordable health care, because their health care costs went up less than half as much as ours did for the last six years. We can do it. We've got to have the guts to take on the interest groups to make these changes.

BILL MOYERS: [voice-over] That was the summer of '92. This is the summer of '94. Two years later, the cheers for health care reform had turned to boos. When President Clinton spoke in New Jersey this summer, opponents of health care reform were so vociferous, he had to shout to be heard.

BILL CLINTON: You want to repeal Medicare, ma'am?

Do you think that's socialized medicine? I don't.

BILL MOYERS: [voice-over] At one point, he banged the podium so hard the presidential seal fell off.

BILL CLINTON: I've given you my answer. Let's ask the American people to give health insurance to everybody.

BILL MOYERS: [voice-over] Opponents also drowned out Hillary Clinton this summer, as she tried to rally support for reform. She, too, had to shout over noisy and strident demonstrators, these turned out by a local radio talk show host urging defeat of the Clintons' proposal. What had exhilarated the crowds during the campaign two years ago has now become an ugly and divisive issue in the body politic. In Kentucky, the First Lady was even burned in effigy.

Sen. ROBERT DOLE, Minority Leader: It's gonna get kind of ugly, I think, in the next few weeks..

BILL MOYERS: [voice-over] The debate in Congress was more than ugly; it turned, in the end, into a theater of the absurd.

JOHN COCHRAN, ABC News: Republicans are obsessed with the weight of Mitchell's bill, which Phil Gramm weighed at 14 pounds. Sen. PHIL GRAMM, (R) Texas: If we took out three pounds of taxes, if we took out the 10.8 pounds of dead-weight government, that would leave us 0.2 pounds where we are reforming insurance, making it portable and permanent.

JOHN COCHRAN: Mitchell then borrowed Gramm's scales to, as he said, weigh the Republican bill.

Sen. GEORGE MITCHELL, Majority Leader: Now, of course, it registers zero on the weight scale, because there is no bill.

Sen. BOB OREGON, (R) Oregon: This weighs just roughly twice as much as Bill Clinton did at birth, and you know the way he grew up, so.

Sen. BOB KERREY, (D), Nebraska: If he called Bob Dole right now on the telephone and said, "Okay, Iíll do your deal with five changes, Phil Gramm would have diarrhea for a week.

Sen. PHIL GRAMM: The Mitchell bill is deader than Elvis.

ROBIN LEHRER, "MacNeil/Lehrer Newshour": Senate Majority Leader George Mitchell said today health care reform legislation is dead for this year.

BILL MOYERS: Dead, indeed, but death was not due to natural causes. The Clintons had brought forth a nightmarish creature from Jurassic Park, so frightening in size and strangeness that people panicked. Powerful rivals, unwilling to share their turf, rained down boiling propaganda on the beast, and Republican holy warriors, eager to finish off the creature and bleed its master, too, scorched the earth with nuclear-tipped faxes. When the smoke cleared, nothing stood but the same old costly health care system that had started the fracas in the first place.

Kathleen Hall Jamieson watched the brawling from her post as dean of the Annenberg School for Communication, and director of the Annenberg Public Policy Center at the University of Pennsylvania. Democracy and public opinion are subjects she's studied for most of her adult life, and over the past year, she and her team followed the health care debate through the media coverage, news, advertising, polling and talk radio. Well, now that it's over, as you look back on the ruins, what stands out for you about this debate?

KATHLEEN HALL JAMIESON, Annenberg School for Communication: You know, it's interesting to watch the clips from Wofford and Thornburgh, because they both acknowledged that the central issues are cost and coverage. That was the problem that Clinton was trying to address. That's the problem the Michel bill, which existed before Clinton ever put together his reform package -the Republican alternative -these are the problems that bill was trying to address. In the debate, we lost track of the problems, and in the process, conducted the debate that didn't ultimately offer solutions to them. And the tragedy is, those problems aren't going to go away. So the bottom line is, we had a debate that ignored the problems, and as a result we didn't stay focused on what we need to deal with.

BILL MOYERS: Why? What happened between then and now to totally disregard the main reasons the debate started in the first place?

KATHLEEN HALL JAMIESON: The first problem is represented in your opening clip. You saw the Senate Majority Leader weigh the Republican alternative, and he said, "See, there's nothing there." Well, if you read the press, you'd believe that he was right. There was a Republican alternative. It was the Michel bill. It existed before the Clinton reform package. It had more sponsors through most of the debate than any other bill, and it got virtually no press attention. And so the-

BILL MOYERS: Why?

KATHLEEN HALL JAMIESON: -American people didn't realize it was there. Because the press focused like a laser on the Clinton reform package, and in the process, it didn't let us see that, to the left of the Clinton bill, there was a Canadian-style single-payer bill -it didn't get much coverage, either -and to the right of the Clinton bill was the Michel bill, a market-reform-driven package. All of those bills tried to grapple with cost and coverage. If we'd looked at all three, we might have asked the question, which better addresses the problem? But since we focused solely on Clinton, the press brought to bear its typical means of covering a campaign and asked: ''What are the strategies?" ''What are the tactics?" "Is he going to win?" ''What will the costs be to his political career if he doesn't?" ''What about all those Democrats in Congress?" "Are they being jeopardized by supporting the Clinton bill?"

On the other side, they focused on the Republicans, and asked whether or not they were gaining tactical advantages that might let them take the White House if they could dismember the Clinton bill. So by focusing on Clinton, the press treated this as if it were a campaign, the goal being to win Clinton, not a problem to be solved by alternative plans.

BILL MOYERS: You said this concentration of attention by the press and the media on the strategy, the horse race, who's up, who's down, led to cynicism. And one of your reports I read from the Annenberg school says that it increased the cynicism of the public. How?

KATHLEEN HALL JAMIESON: The-the press basically covered the campaign strategically, the way it tends to cover elections, looking at tactics, outcomes, focusing on what the polls said. When it didn't do that, when it focused on issue, it didn't look at problems and alternative solutions. Instead, it looked at attack and counterattack, and what that invites the person and the public to say is, "Gee, everything is awful. I have nothing I can believe in. Let's just reject the whole bunch of them, let's just reject the whole process."

BILL MOYERS: What role did the polls play in this?

KATHLEEN HALL JAMIESON: The polls should have been ignored completely throughout this process for this reason.

BILL MOYERS: They weren't. I mean, the news media, the evening news, everybody kept saying, "The polls today show Clinton's plan is favored by," or " ... rejected by."

KATHLEEN HALL JAMIESON: We were reflecting uninformed opinion. But The Wall Street Journal did something important. It conducted' a poll in which it described the various bills, instead of labeling them, and found that more people supported the Clinton bill when it was described, but not named, than when it was named. There is a way to poll that gives public-the public the information it needs to tell you what it thinks. But simply asking, ''What do you think about X plan?" isn't it.

BILL MOYERS: We took some informal polling of our own, just to see, over the last six "months, what people were learning, or how much attention they were paying to the health care debate. We did went out in our own neighborhood, because we wanted to find out what the folks we know were saying about the debate. Look at this video.

[Spring 1994]

INTERVIEWER: Can you tell us what are the principles of Clinton's proposal?

1st RESPONDENT: Coverage for everyone, corporations and small businesses bear a fair share of providing coverage for their employees.

2nd RESPONDENT: Making it easier for people to get health care coverage from the time they're born to the time they die.

3rd RESPONDENT: Small business owners to pay at least 80 percent, cover the cost of 80 percent of the cost of health care for their employees.

4th RESPONDENT: Coverage for-for a wider spectrum of people, and-and making the costs lower.

INTERVIEWER: Can you tell me two or three specifics about the Clinton plan?

5th RESPONDENT: Well, I haven't really been keeping up with it, so I can't really comment on it.

6th RESPONDENT: Dh, this is embarrassing, because I haven't been paying attention to the-to anything about it.

7th RESPONDENT: I don't know too much about the details.

8th RESPONDENT: I'm not-I'm not too much into politics. I really don't keep up with it at all.

9th RESPONDENT: It's very, very complicated.

10th RESPONDENT: You know, there's too much stuff that I feel like we don't know about it.

INTERVIEWER: Are you familiar with some of the other competing proposals in Congress?

9th RESPONDENT: No.

10th RESPONDENT: I know the Republicans have their own plans, but I don't-have no idea.

11th RESPONDENT: No, not too much.

7th RESPONDENT: No, not really.

5th RESPONDENT: No.

4th RESPONDENT: No. No. Sorry.

12th RESPONDENT: You know, you read so much about it, and my feeling is, wait until they iron all of it out, and let me read the rest of it.

INTERVIEWER: 'Do you know what he means by managed competition?

13th RESPONDENT: Dh, yes. Well, I think that would be a ,great idea.

1st RESPONDENT: And 1 guess it's some kind of price control.

14th RESPONDENT: What?

INTERVIEWER: Portability?

15th RESPONDENT: Not a clue.

2nd RESPONDENT: Portability? I never heard of that term.

16th RESPONDENT: What's portability?

INTERVIEWER: Do you know, when people speak of singlepayer, what they mean by that?

12th RESPONDENT: Dh, you mean somebody like me, who's a single payer?

17th RESPONDENT: You know, I guess the word single means like a person who's single would pay more than a person who's married, which is unfair, too.

INTERVIEWER: Do you support the Clintons' health care plan?

18th RESPONDENT: I thought I did. I don't know how complex it got, I didn't understand-I don't know where it went. It went haywire.

19th RESPONDENT: Every week, it seems like it changes. His original idea was to have coverage for everybody, and then when he saw that it couldn't be done, he changed it, and-and from week it changes, to another week, and-and people don't understand it, you know?

20th RESPONDENT: If I could really fathom it, I probably would, or maybe I wouldn't. It's--it's really gotten too confusing for the average Joe, you know.

BILL MOYERS: Can we conduct public policy debates like this when the average Joe and Jane are confused?

KATHLEEN HALL JAMIESON: No, and the problem with this level of confusion is that it's very easy for advertising and for demagoguery to frighten people, and to frighten them needlessly. In an environment in which you don't really know what's in the plan and you've lost track of the problem that the plan is trying to solve, it's easy to frighten you with words such as socialized medicine. It's easy to suggest, falsely, that your choice of doctor is going to be taken away. The Clinton plan, among its benefits, preserved fee-for-service medicine, which means it preserved the access to a doctor. But the public didn't have enough information to know that, and as a result, was very vulnerable to scare tactics.

And there's a second problem that's reflected in your clip. The language in which the debate was offered to the American people was all but incomprehensible, and so we talked about employer mandates and individual mandates, we talked about soft and hard triggers, we talked about portability.

BILL MOYERS: Alliances.

KATHLEEN HALL JAMIESON: Alliances. We made an arcane distinction between access and coverage. Now, all of those things made sense to the public policy junkies, but they didn't make a lot of sense to the American people.

BILL MOYERS: By the time the language got down to the street level, it had really been transformed. I took a forced vacation this summer and had lots of time to listen to talk radio, and almost every talk radio host and every call-in was anti-Clinton and anti-the Clinton proposals. What's your explanation for that?

KATHLEEN HALL JAMIESON: Overall, the callers for talk show radio are more conservative than the norm for the population, and as a result, the voice you heard as you went around the country was the conservative voice. But this is a very influential channel for the conservative voice.

BILL MOYERS: Yeah.

KATHLEEN HALL JAMIESON: Remember the protests, when the bus tours were organized to try to support the Clinton plan? City by city, the buses were met by protesters. Those were largely organized through talk radio.

BILL MOYERS: No one on radio waged war with more relish against Clinton than Rush Limbaugh. Take a look at this video.

["The Rush Limbaugh Show," WABC-Radio, New York City]

1st ACTOR: She's a doctor with a prescription for disaster. She's Hillary Clinton, and she's Dr. Hildare.

2nd ACTOR: I donít know, Doctor, I tend to get, ooh, a little heartburn after eating spicy food. What do you recommend I do?

3rd ACTOR: Heart transplant.

BILL MOYERS: On his daily radio program, Limbaugh uses skits , and songs to parody the Clintons and to ridicule their health care plan.

["The Rush Limbaugh Show'']

1st ACTOR: Dr. Hildare, she specializes in fixing things that aren't really broken.

4th ACTOR: A prosthetic hand replacement for a hangnail? I don't know if I can go along with that now, Honey.

3rd ACTOR: You know what happens when you question my judgment, Willie.

4th ACTOR: Okay, I'll get the scalpel.

1st ACTOR: Dr. Hildare, she wants to overhaul the best health care system in the free world, and you better hope she doesn't do house calls.

BILL MOYERS: [voice-over] In voicing partisan and industry opposition to the Clintons, Limbaugh has also repeatedly resorted to fear and scare tactics.

["The Rush Limbaugh Show"]

ANNOUNCER: You're somebody special. You listen to Rush Limbaugh.

RUSH LIMBAUGH: Virtually no choice will exist for you if the Clinton plan passes. Virtually none. It's full of things that's going to harm freedom, it's going to harm individuals, it's going to raise costs, it's going to do a bunch of things. And I'll tell you something else, too. You know, when the government is in charge of health care, guess what else they're in charge of? Your behavior.

If you don't like the federal government regulating your cable company, wait till they start regulating your mammograms. What have the two people who claim to care more than anybody else done in their lives that gives them the qualifications to orchestrate, to write, and to implement and then carry out such a massive undertaking? It-see-I mean, every-it just-it just hit me last night, and I got-forget the money for a minute. I'm talking about the lack of freedom, I'm talking about the shack-les, I'm-I mean, it's-it's as though you have to ask everybody to do something for you, or to get permission from the government before you can do anything in-in regard to your health care, if this thing passes. It really-as I say, it scared the devil out of me.

And here's the health care plan, the Hillary health care plan, in rap.

ANNOUNCER: You'll soon be missing some of the benefits that health care now provides.

RAPPER: [Rap song] Hey, now, let's begin, new health care plan with a liberal spin / Say hail to the Chief and Mrs. Chiefette, partisan crime on the national debt / The raw deal's

cooking, it's out of control/put your hand out now, Clinton's on a roll / these four words mean you're' taken care of / womb to the tomb, hit me / Womb to the tomb / Womb to the tomb / Free health care, / Womb to the tomb / Oh, Hillary, we're saved, by cigarettes.

BILL MOYERS: Very entertaining. He's very witty.

KATHLEEN HALL JAMIESON: Yes, he is.

BILL MOYERS: But all of that wit and all of that talent, almost all of it, devoted to the political destruction of either Clinton or his health care plan.

KATHLEEN HALL JAMIESON: Mm-hmm.

BILL MOYERS: And what about the language that he's using in that?

KATHLEEN HALL JAMIESON: We talked about how complex the language of the debate was, with employer mandates and accessibility and hard trigger, soft triggers. There's none of that language here. This is the language that anyone can understand, and it's a language that plays to primal fear of government forcing things on you that you don't want, denying you things that you need. And a health care system that isn't responsive to all those things that we want to require of the medical establishment. This is extremely artful, you know, ''womb to the tomb" is much easier to remember than we have an employer mandate in order, Ultimately, to get everyone insured so that we can minimize cost-shifting.

The other thing that's important about this is that Rush Limbaugh has an audience that's essentially a captive audience,' so for three hours, you can listen to Rush Limbaugh and you don't get to hear the other side. His points would be a good point of departure for a debate with someone who shared the other point of view, and in a debate you might be able to judge whether you want to accept his claims or not. You don't get that opportunity here.

BILL MOYERS: But it's also political propaganda. You could sometimes trace the line, the-the rhetoric from the Republican National Committee or a conservative group in Washington to the editorial page of The Wall Street Journal to Rush Limbaugh, or back through the circuit.

KATHLEEN HALL JAMIESON: And it speaks to the larger problem of the debate itself. If you, as a citizen, wanted to hear both sides of the argument, pro and con, single-payer, Clinton, and the Michel Republican alternative, you had no place 'anywhere in this debate that you could turn to hear that, and that means that the average citizen had no way to say, "Yes, I favor this, over that," or, ìIíve heard all of the arguments for all three plans and' I don't think any of them solve the overarching problem.

BILL MOYERS: Well, then, that's a good point at which to move on to what, to me, was the stunning phenomenon of this whole debate, and that is the blizzard of television ads that I know you spent a lot of time studying, Look at this sample.

BILL CLINTON: [September 1993] This health care system of ours is badly broken, and it is time to fix it.

BILL MOYERS: [voice-over} The President's plan to fix it immediately triggered a counterattack from opponents.

TV COMMERCIAL: There will be rationing. Waiting lines will develop. You will have to settle for one of the low-budget health plans selected by the government.

BILL MOYERS: [voice-over} The propaganda blitz was underway.

LOUISE: [TV Commercial] (Paid for by the Coalition for Health Insurance Choices, funded by Health Insurance Assoc. of America) Make sure everyone is covered.

LOUISE'S FRIEND: But not force us to buy our insurance from these mandatory government health alliances.

ANNOUNCER: [TV Commercial} Have you seen this ad attacking the President's health care plan? You have to read the fine print to see who paid for it, the insurance industry. They've launched an ad blitz to stop the President's health care plan before he even announces it.

BILL MOYERS: [voice-over] By the spring of '94, with seven major plans competing for votes in Congress, every conceivable vested interest was in our living rooms and kitchens.

5th ACTOR: [TV Commercial} My blood pressure pills, one month, $192.

6th ACTOR: A hundred-ninety-two?

7th ACTOR: You know what Medicare covers? Nothing.

HERMAN CAIN, President & CEO, Godfather's Pizza: [TV commercial} Nine million people work in restaurants. Waitresses, cooks, managers, hard-working people who are typically single parents or young people working their first job. They want good health care, but they need a plan that doesn't eliminate jobs because the cost and bureaucracy are too high.

ANNOUNCER: [TV Commercial} A giant social experiment.

BILL MOYERS: [voice-over} Keeping us scared seems to be the goal of many ads.

ANNOUNCER: [TV Commercial] Everything good about your health care is at risk.

ANNOUNCER, DNC Ad: [TV commercial] Republicans on health care:

ROBERT DOLE: There isn't any crisis, an American crisis, in health care.

BILL MOYERS: [voice-over} Some ads have misinformed, like this one from the Democratic National Committee. The ad was criticized for using a quote out of context.

Gov. CARROLL CAMPBELL, Republican: [TV Commercial} There's not a crisis.

ANNOUNCER: The Republicans. First they said there was no recession. Now they say there is no health care crisis. They just don't get it.

8th ACTOR: [TV Commercial} Honey, bad news.

BILL MOYERS: [voice-over} It is our emotions and values that most ads are appealing to.

8th ACTOR: [TV commercial} [Paid for by AARP] My diabetes.

I'm locked into my old job.

ANNOUNCER: Congress is getting ready to vote on health care reform, and the special interest groups, are telling them we can't ,afford it. Of course, these groups don't care if you're trapped in your job by a health condition.

BILL MOYERS: [voice-over] As the propaganda war heated up, the ads got tougher, like this one from the American Association of Retired Persons. .

ANNOUNCER: [TV Commercial} [Paid for by AARP] If you think health care reform will be expensive, wait till you see life without it. .

[Harry and Louise Ad]

HARRY: Well, Iím glad the President's doing something about health care reform.

LOUISE: He's right. We need it.

BILL MOYERS: [voice-over] The most expensive and talked-about series of ads have come from the Health Insurance Association of America.

HARRY: [TV Commercial} What if our health care plan runs out of money?

LOUISE: There's got to be a better way.

BILL MOYERS: [voice-over] More than $14 million was spent on this ad campaign.

[TV commercial} [Paid for by Coalition for Health Insurance Choices, funded by Health Insurance Association of America]

LOUISE: That was covered under our old plan.

HARRY: Oh, yeah, that was a good one, wasn't it?

[TV commercial] [Paid for by Coalition for Health Insurance Choices, funded by Health Insurance Association of America]

HARRY: So, the paper says Congress is moving ahead on health care reform.

LOUISE: If they can just cover everyone.

HARRY: But they're talking price controls.

LOUISE: Right. Government-imposed spending limits for every region of the country.

HARRY: So if our plan runs out of money?

LOUISE: Rationing, the way I read it.

JERRY STILLER, Actor: [TV commercial. Paid for by Single Payer Across the Nation (SPAN)] What's wrong, honey?

ANNE MEARA, Actor: I'm confused about Harry and Louise.

JERRY STILLER: You mean that worried couple on the insurance companies' commercials?

ANNE MEARA: They're so confused about health care.

BILL MOYERS: [voice-over] Harry and Louise was so effective, they inspired a dialogue among ads.

JERRY STILLER: [TV commercial. Paid for by Single Payer Across the Nation (SPAN)] Everyone is covered, you get full benefits, and you choose your own doctor.

ANNE MEARA: Harry and Louise, there is a better way.

ANNOUNCER: [TV Commercial] You've probably seen a yuppie couple named Harry and Louise on TV.

BILL MOYERS: [voice-over] This one was produced by a Hollywood friend of the Clintons.

ANNOUNCER:. [TV Commercial] Well, I thought I'd bring you up to date. Harry lost his job and also his insurance. Louise owned a small struggling company that couldn't afford group insurance, so she'd always depended on Harry's policy. Unfortunately, she had a preexisting condition that prevented her from obtaining new coverage. Now, it's true, Louise should have gone into the hospital earlier, but she didn't want to eat into their savings. Eventually, she and Harry gave up their country club memberships and sold their expensive foreign car, but by then, it was too late. Very nice service.

BILL MOYERS: [voice-over] The dueling ad blitz even influenced prime-time entertainment.

["Picket Fences, " CBS]

8th ACTOR: We have two sons who are extremely fragile right now, emotionally, psychologically. This is a bad time for their father to get fired. And-and the Clinton health plan is going to cut my salary by 30 percent. If we lose your income,-Jimmy, then-

TOM SKERRIT: I'll get another job.

["Northern Exposure," CBS]

ADAM ARKIN: Oh, national health insurance. Here we go down the sinkhole of socialized medicine.

9th ACTOR: Like in England.

ADAM ARKIN: Yeah, and look what wonders it's done for them, how to flush an empire down the toilet.

BILL MOYERS: That dialogue could have come right out of the ads, the television ads.

KATHLEEN HALL JAMIESON: Mm-hmm. And it raises the same questions the -ad raised. How do you rebut something that's in-, sinuated into prime-time television? The advertising largely opposed things, and you didn't hear a response from the people who favored them. And, at the same time, advertisers took little pieces of reform and, piece by piece, they nibbled it to death, and so the National Federation of Independent Businesses went after the employer mandates. The Health Insurance Association of America went after premium caps and mandatory alliances. The pharmaceutical companies went after price controls on drugs. Company after company, group by group, took one little piece after another out of reform, and in the end, there was nothing left.

BILL MOYERS: So if somebody shoots down something, pretty soon all the somebodies have shot down everything.

KATHLEEN HALL JAMIESON: And nobody has taken on the burden of answering the question what alternative do you favor to solve the pressing problem?

BILL MOYERS: How do you explain the effectiveness of the Harry and Louise ads?

KATHLEEN HALL JAMIESON: The Harry and Louise ads aren't

effective as advertising. They are effective as a public relations phenomenon. Most people who watched the ads in our focus groups didn't consider them as effective as most of the other ads on health care on the air. In fact, most of the people who saw the ads thought that Harry and Louise opposed reform totally, or opposed government based reform, rather than the intent of the ads, that they opposed mandatory purchasing alliances; opposed premium caps. What gave Harry and Louise their power was the fact that the news media imputed effectiveness to them. Harry and Louise got over five and a half minutes of free airtime. Most of the coverage-

BILL MOYERS: On the network news?

KATHLEEN HALL JAMIESON: -on the network news. Most of the coverage of Harry and Louise is' based on strategy, it examines their potential effectiveness, rather than the accuracy or, ultimately, how they fit into the problems and the solutions. And as interesting, Louise, the woman in the ad, got more headline space in the nation's major newspapers than the Senate Majority Leader or the Senate Minority Leader on the topic of health care reform. Harry and Louise, Louise and Harry are mentioned over 700 times in newspaper articles in a one-year period. .

BILL MOYERS: Well, how do you explain that? What's that phenomenon?

KATHLEEN HALL JAMIESON: The-because the press was driven by attack and conflict, Hillary and Bill Clinton made Harry and Louise. Harry and Louise went on the air early, with-well, it was purported, at that point, to be a large time buy, $2 million was their initial time buy. That attracted some press attention, but the real press attention came when Bill and Hillary Clinton started to attack them. The press gravitated toward the attack, featured Harry and Louise as an important enemy of the Clinton plan as a result, assumed, because the Clintons were treating them as if they were a serious player, they must be, and they must be highly effective. Key legislators accepted this press interpretation and acted on it.

The interesting thing about the whole range of advertising is that many people did not see the ads at all. About a quarter of the country received concentrated advertising attention,. and most people were in the key districts of members of the major committees that were going to act on health care legislation. Harry and Louise had very carefully targeted those key legislators.

BILL MOYERS: You said, in one of your studies, concluded in one of your studies that most of this, almost 60 percent of this advertising was -and this is a direct quote -"...unfair, misleading or false." Let's take a look at some of the individual ads and you tell me what was either unfair, misleading or false in them. Here's one by an outfit that calls itself Empower America. This group was bankrolled by a rich Wall Street investor as a base for conservative operators such as William Bennett, Newt Gingrich, Jack Kemp and Yin Weber.

WILLIAM BENNETT, Empower America: [TV commercial]

Bill Clinton wants to socialize our health care, and many members of Congress support him. Every small business in America will be forced to pay the bill. His plan creates the largest government bureaucracy in history. Your doctor won't decide what care is right for you, the bureaucracy will. The bureaucracy will never examine you, never talk to you, never even see you, yet it, will severely limit your choice of doctors. The bureaucracy will dictate what treatments are necessary. The bureaucracy will decide when and even if you can see a specialist. Under this plan, you will lose choice and control. Remember, it's your health care they're socializing. There is a better way. Call Empower America, 1-800-4-EMPOWER.

BILL MOYERS: Bill Clinton of Hope, Arkansas, a socialist?

KATHLEEN HALL JAMIESON: Bill Clinton, the new Democrat, deliberately moved away from a government-driven program to preserve the private insurance industry in his plan. He thought, in the process, he was moderating toward the center. Of course, the right then moved from the center further to the right, and made the same claims against him they would have made had he sponsored a Canadian-style single-payer plan, for example.

The problem with the ad is very straightforward. First, it continues to air after the mandatory purchasing alliances are gone, so a big piece of the bureaucracy decried here was gone at the point at which this ad continued to air. But secondly, Clinton specifically made the choice to preserve fee-for-service medicine, which would guarantee choice of doctor, although at a higher cost, and so the ad is just simply deceptive. And at the end, when the EKG goes flat, it visually invites the inference either that you're going'to die under the Clinton plan, or that the health care system is going to die, and that's just palpably false.

BILL MOYERS: I thought this group was for traditional values, moral values, for the Ten Commandments. This is false witness, right?

KATHLEEN HALL JAMIESON: Well, the-more than 50 percent of the advertising is vulnerable to your charge of false witness.

BILL MOYERS: And not only conservatives.

KATHLEEN HALL JAMIESON: And not only conservatives.

BILL MOYERS: Not only Republicans. In fact, let's look at one by the Democratic National Committee.

10th ACTOR: [TV commercial] [Democratic National Committee] The Republicans came up with a plan that's not--that's not universal, and it's not going to help me, as ,a farmer, it's not going to help small individual businessmen, it's not going to help laboring people, the middle-class people, no matter who they are. It's just--it's not going to help them. And if it doesn't help the middle-class people who pay the brunt of the bill of.-of this country, then what are we gonna do? My final answer is, you've got to have the universal health care. That's all there is to it.

KATHLEEN HALL JAMIESON: The-both sides refused to assume the good will and integrity of the people on the other side, and this is an instance of that. This would suggest that the Republicans just don't care, and that's just not true. The Republican plan, the Michel plan, would have provided portability, so you would have been able to that move you would have been able to move from one job to another without the waiting period in your second job. If the second job carried insurance. It would have meant that you could have been covered with a pre-existing condition, although you might have had to pay more for it. It would have meant that you could have had deductibility if you self-insured, and that's a big help for the small businessman and for that farmer, and it would have given you ,access to voluntary purchasing, cooperatives, which will bring the cost down for those who now go into the market alone and could go into the market as a group. This is the Democrats being very unfair to the Republicans. There is a coherent philosophical-philosophically coherent alternative in the Republican plan.

BILL MOYERS: But, as you said earlier, the press itself, the news media, never gave the Michel plan the light of day.

KATHLEEN HALL JAMIESON: And so if you know nothing about the Republican alternative and you see this ad, you'd assume, it must be true. '

BILL MOYERS: Another one, created by another conservative group called the American Council for Health Care Reform. This, by the way, is one of the groups that sued to have the Clinton task force deliberations open to the public'.

11th ACTOR: [TV commercial] All rise. This court is now in session. You have been found guilty of violating section 5434 of the Health Security Act of 1994. This court finds you did willfully, and with premeditation, attempt to purchase health care services from a doctor without permission from the U.S. government national health board. You are sentenced to a maximum of two years in federal prison. Your doctor is sentenced to not more than 15 years because 'he accepted your payment for un-authorized medical treatment. '

12th ACTOR: Unfortunately, this is no joke. The Clinton plan would ration your health care and grant the .federal government unprecedented control over your life and liberty. There's got to be a better way.

BILL MOYERS: You seem to think that's funnier than Northern Exposure.

KATHLEEN HALL JAMIESON: Well, I liked the Jack Webb sense of music in the background.

BILL MOYERS: But jail? Prison?

KATHLEEN HALL JAMIESON: Jail, prison. Well, they're citing the infamous 5434 of the Clinton plan. This is the bribery and graft section of the Clinton plan and it essentially says that you can't do things that are illegal if you're a doctor. Now, I think it's a good idea to not have doctors do illegal things. The Clinton plan is also criticized with ,a section and title listed in other advertising for trying to insure patient privacy and fining doctors who violate it, for fining and potentially imprisoning doctors who give unauthorized treatments' or who double-bill, who try to bill when they haven't given treatment. Much of what is in the Clinton plan in these supposedly controversial sections also applies to doctors under Medicaid right now, and conservatives don't find that too alarming.

BILL MOYERS: So, what do you make out of this?

KATHLEEN HALL JAMIESON: It's an attempt.to frighten people and to suggest that the big government bureaucracy is doing new and frightening things under the Clinton plan that it doesn't do otherwise. Now, there's another way to construct this, and it's to say that the Clinton plan is very concerned about fraud and abuse and has sections to ensure that they don't occur. But what intrigues me about' this is the appeal is still alive. In the Santorum-Wofford senatorial race-

BILL MOYERS: In Pennsylvania, right now.

KATHLEEN HALL JAMIESON: -in Pennsylvania, right now, Santorum has sent a piece of direct mail out to doctors, and it says, "You're under arrest," under the plan Wofford supports, any physician who gives care not - that exceeds the recommendations outlined can be arrested, fined up to $10,000, even sent to prison. He's citing the same section as this ad. We ought to have a public debate about how you cope with fraud and abuse. Most Americans think there's a lot of it in the health care system. Most would like it taken out. Well, the way you take it out is to put penalties in place for people who abuse the system, and you get language like that section of the Clinton plan, as a result.

BILL MOYERS: Our next ad was intended to run in Washington, D.C., but it was never broadcast there. It was sponsored by a coalition favoring reform, calling themselves the Health Care Reform Project. They included labor, medical and consumer groups, and they were going after Pizza Hut.

13th ACTOR: [TV commercial. Health Care Reform Project] At Pizza Hut, something new to order up. You see, Pizza Hut pays health insurance for their workers in Japan and Germany, but for many workers in America, Pizza Hut pays no health insurance, zero. Pizza Hut makes $370 million in profits while stiffing American workers. Now they're lobbying Congress to defeat health insurance at work. Place your order with Congress. Tell them to serve American workers, not huge companies that favor workers overseas. Because if Pizza Hut wins, American workers lose.

BILL MOYERS: Was that fair?

KATHLEEN HALL JAMIESON: Yes, and it raises an important question that should have been the beginning of a debate. Why is it that some large corporations are able to insure workers abroad, but say they can't afford to insure them here? But the debate never took place. The ads were not being responded to by other ads, and this ad didn't air, for two reasons, in the Washington, D.C. market. First, because Pizza Hut is a big advertiser in the Washington market, and as a result, the stations saw an economic disincentive to alienate its big advertiser. But secondly, advocacy ads -that's what this sort of thing is, ads by groups not for candidates -don't have any legal protection. Stations don't have to advertise-use these ads. And if they do, and the ad is false, they can be sued for libel. So Pizza Hut basically said, "We think this is misleading. It might be libelous." The implication was, "Our limitless law budget might be used against your station." The stations caved in and didn't air the ad. So, in Washington, D.C., the audiences didn't have a chance to hear what should have been the opening line or an important debate.

BILL MOYERS: And yet, paradoxically, because it was censored, because the stations did not carry it, the news media picked it up.

KATHLEEN HALL JAMIESON: Yes. A major intent of all of the advertisers in the health care reform debate has been to get free airtime. This ad got much more publicity than it would have gotten if the stations had. aired it, and as a result, it got network news time, it got articles in all the major newspapers. And so the Health Care Reform Project, which sponsors the ad, was actually pleased by the fact that the stations said no...

BILL MOYERS: And ultimately, the gatekeepers primarily were corporations and powerful interest groups that had the money to buy ads or to bring pressure against those whose ads they didn't want to run.

KATHLEEN HALL JAMIESON: Yes. Approximately 70 percent of the advertising dollar was spent against reform, of some sort. Now, that doesn't mean that any of those people favored the totality-or opposed the totality of the Clinton plan. Most opposed little elements of it. But that's what we were talking about earlier. Their opposition to little elements nibbled reform to death.

BILL MOYERS: We have another ad that was also censored, never saw the light of day where it was intended to air, and' it was sponsored by people in favor of the single-payer plan, like the one in Canada.

14th ACTOR: [TV commercial. Paid for by the Campaign for Health Security] Listen, why don't we get rid of the health insurance companies? Let's go to the blackboard. Here's what we spend on health care. It's a lot. But if we get rid of health insurance companies, we can have complete coverage for everyone for the same money. But any plan that keeps these guys in business will cost billions more in taxes, taxes, taxes. To me, it's a no-brainer.

ANNOUNCER: It's time for them to go. Call Congress today.

KATHLEEN HALL JAMIESON: Insurance agencies are major advertisers in broadcast news. What that means is, they can put economic pressure on stations not to air ads such as this, and because those ads aren't protected legally; they can threaten lawsuits against stations who air them, saying they're misleading. Now, what that means in the debate is that this ad, which says let's get rid of insurance companies, won't air, but the HIAA ads for the insurance industry, the small and mid-sized insurers, will. It also means, in Pizza Hut's case, that that Pizza Hut ad raising-that ad about Pizza Hut, raising the question about employer mandate, will not air, but ads arguing against the employer mandate, sponsored by the National Restaurant Association, will. That means we have incentives that are legal incentives inside this system for large corporations to be given access to the airwaves and those who oppose them, not, and that's a problem if one believes in balanced debate.

BILL MOYERS: Political ads have been around a long time now, but was there anything unique about all of these ads in the health care debate?

KATHLEEN HALL JAMIESON: In the health care debate, the ads, particularly radio, ask constituents to call a member of Congress. They often gave a number to call. Some of them gave a number, and when you called the number t/:ley hooked you directly up to your member of Congress provided you said, when you called in, that you opposed health care reform. If you said you didn't, they didn't put you through.

BILL MOYERS: So lobbying is the main purpose of these ads.

KATHLEEN HALL JAMIESON: In this public policy debate, advertising became a lobbying vehicle.

BILL MOYERS: Let's talk about how lobbying affected the whole health care debate. Take a look at this video.

15th ACTOR: [TV commercial. Paid for by the Health Care

Reform Project] You can spot them. They're all over Washington, D.C. health insurance lobbyists.

BILL MOYERS: [voice-over] Money spent to influence health care reform has become so vast that one party to the debate produced TV spots about it.

15th ACTOR: [TV commercial. Paid for by the Health Care

Reform Project] Call to make sure your member of Congress is siding with us for real health care reform, and not joining the health insurance companies in taking us all for a ride.

BILL MOYERS: [voice-over] So far, more than $100 million has been spent by almost a hundred PR and lobbying firms to influence the debate,

DEBORAH NORVILLE: The health care reform debate is

producing the biggest lobbying blitz ever.

BILL MOYERS: [voice-over] Their tactics were primarily focused on winning the hearts and minds of these folks sitting on key committees, deliberating over the various bills.

Sen. EDWARD KENNEDY, (D) Massachusetts: Of health

care and health reform, we have reached the time to decide.

BILL MOYERS: [voice-over] During the past two years, organized interests donated more than $25 million to federal election campaigns, and they picked up the tab for at least 85 members of Congress to take trips. They did all this with the help of the revolving door. Clinton's friend, Democrat Beryl Anthony, quit Congress in 1993 to join a lobbying firm representing the American Hospital Association and the American Insurance Association. Republican Guy Vander Jagt left Congress after 27 years to join a firm that represents hospitals, insurance companies, and health care providers. At least 80 former members of Congress, staffers and other officials have passed through the revolving door to serve the nation's health , care industry. One of them is former Republican Congressman Bill Gradison.

BILL GRADISON, President, Health Insurance Association of America: [TV Commercial] I'm Bill Gradison, president of the Health Insurance Association of America, the sponsor of Harry and Louise. Before taking this job, I served 18 years as a member of Congress from Ohio. I was the ranking member of the Ways and Means Health Subcommittee, so I know a little about health care and the Congress.

BILL MOYERS: [voice-over] In six months, Gradison's lavish ad campaign changed the course of the health care debate. [TV Commercial. Paid for by the Coalition for Health Insurance Choices, Funding by Health Insurance Association ofAmerica]

HARRY: [through interpreter] So why can't Congress write a law like that?

LOUISE: What can we do?

BILL GRADISON: If you call, they'll listen. Believe me, I've

been there.

BILL MOYERS: We're joined now by the director of the Center for Public Integrity, Charles Lewis. He was an investigative producer for CBS and ABC before setting up the center in Washington to study ethics and public policy. The center released a massive study this summer, tracking contributions to members of Congress from groups with a stake in the health care debate. What did you conclude, after looking so intensely at the lobbying?

CHARLES LEWIS, Center for Public Integrity: Well, the amount of lobbying is unprecedented, historically. No one has ever seen this much money spent, this many lobbyists hired, taking to the airwaves as a tool of lobbying, the amount of trips that were taken, the amount of PAC money and other individual contributions. It-it's off the scale in virtually all of those categories.

BILL MOYERS: Was it hard to track this money?

CHARLES LEWIS: It was incredibly difficult. If Metropolitan Life lobbies the White House, there's no record anywhere in Washington. If Mitsubishi does it, they're a foreign agent and they have to register with the Justice Department. But records are very, very spotty. If one trade association spends $14 or $15 million with TV 'ads, there's no record in Washington today. So; to say it's difficult, is an understatement, and it was a nightmare.

BILL MOYERS: Do you really know who's paying for these ads?

KATHLEEN HALL JAMIESON: I do, but it took us an enormous amount of trouble to find out, and it is virtually impossible for the typical citizen to know. For example, Taypayers Against a Government Takeover is a group now in California opposing Proposition 186, which is a single-payer proposition. It turns out to be highly paid nurses, a conservative senior citizens group, and a traditional anti-tax group, but you wouldn't know that by the title, Taxpayers Against a Government Takeover.

BILL MOYERS: These high-sounding names, "all-American" names, are designed to make, you feel good about the source without holding it accountable.

KATHLEEN HALL JAMIESON: Mm-hmm. We-we actually found a number of names that were so close to each other that we couldn't tell who they were, and we couldn't distinguish the two, although one group was a conservative group and one group was a liberal group. Their messages were different. Their names were very close.

BILL MOYERS: So it's-you know, it's hard to find out who's, paying for these ads, even though you know that name.

KATHLEEN HALL JAMIESON: You-there's no disclosure requirement for advertising. There is for direct lobbying. And so, to some extent, it's easier to find out when someone gives a campaign contribution to a member of Congress, much easier to find out, than it is to determine how much money is being given by whom to these various groups that are advertising.

BILL MOYERS: Even though you say this advertising was for lobbying purposes.

KATHLEEN HALL JAMIESON: It accomplished a lobbying intent, yes.

BILL MOYERS: But it wasn't accountable under the lobbying laws.

KATHLEEN HALL JAMIESON: Right.

BILL MOYERS: You've been in Washington several years now. You were there through the NAFT A debate, which was an intense and heated and money-driven conflict. Was this one more so? Was this one exceptional?

CHARLES LEWIS: Well, now, it was exceptional. In NAFTA, there were 44 firms retained by, for example, Mexico and Mexican interests. In this debate, there were about 100, roughly, firms, double the size. In terms of advertising, it was a few million dollars in NAFTA. This time it was, what, $50 or $60 million?

KATHLEEN HALL JAMIESON: Sixty-two.

CHARLES LEWIS: And so the number, in every dimension -number of firms, amount of money spent for those firms, campaign contributions, you name it -there's no comparison, really. I mean, it's multiple times greater.

BILL MOYERS: Are you suggesting that this is unethical?

CHARLES LEWIS: I'm suggesting that the outcome is unethical, because we have this facade or this illusion of democracy. We have the suggestion that everyone has been consulted and that there was a great debate when, in fact, there wasn't, and I think that is dishonest and that is unethical in a general sense, in terms of our society.

Most of.-the thing that's so frustrating about all this is every one of these specific things -the right to lobby, the right to give money to a campaign -all those things are legal, and we accept them in our society as legitimate ways of expression. And so what is so insidious about this is that folks can use the tools that are available to them in our open society to distort a democracy or get their-manipulate it to their own ends, and that is something that we've always cherished the right to do, and folks are more adept at doing it today, between technology and money, than they've ever done in the past, I think.

BILL MOYERS: Bill Gradison, 18 years in Congress, became a sort of symbol to me of how these cards were being played. Gradison still is insured by the federal government plan that he had when he was in Congress -nothing wrong with that, most members of Congress continue those plans -but he did become the symbol of the fortunate and the endowed, working against the less-fortunate and not so quite endowed. Is that a fair comment?

CHARLES LEWIS: Well, it is, and actually, Gradison is a metaphor for the whole thing. On Sunday, he was a member of Congress. On Monday, he was a lobbyist for the insurance companies. He worked out a deal with the chairman of the Ways and Means Committee and used his ads as a blunt instrument to bludgeon public policy in the direction of his industry, and he did it, in part,-because he had been on the Ways and Means Committee and he knew Dan Rostenkowski very well, as an old former colleague.

BILL MOYERS: So he could get to Rostenkowski pretty easily, compared to, say, whoever was lobbying for the 30 million uninsured.

CHARLES LEWIS: Right, and you'd have a hard time finding out who that is.

BILL MOYERS: Your report points out that the American Medical Association took members of Congress on some 55 different trips.

CHARLES LEWIS: Right. Well, there are different ways to get to a member of Congress. It's not always a political action committee contribution or an individual contribution. Sometimes you take folks on trips to, quote-unquote, "educate" them about an issue. In this case it's health care. There were 181 trips taken by 85 members of Congress. Over half the trips were to California and Florida in the wintertime, and most of the work that was done on these trips was done in a one-or two-hour period in the morning, and it's a way to schmooze these people up close, and to get access. In Washington, as we know, access is everything. You get close to power, you talk to these people, and things happen, or don't happen.

BILL MOYERS: Lobbying, you know, the critics are going to say, lobbying is an all-American activity. So what? You know, that's what people .should be doing to keep government from doing bad things.

CHARLES LEWIS: Well, I don't think anyone disputes the right to petition the government. I think it's a wonderful thing, and everyone from the Girl Scouts to General Motors has lobbyists. I think what happens, though, is not all lobbyists or not all groups are created equal. In Washington, money is the big arbiter about who gets heard and whose message gets amplified, and in this instance, very clearly, you can look at specific groups that had specific concerns. They unloaded millions of dollars and they got certain things gutted from the bill. The tobacco companies were upset about the cigarette tax. At the onset, it was going to be $2. By the time it was over, it was 45 cents. The pharmaceutical companies were accused of profiteering by Hillary Clinton and Bill Clinton in the early ~onths. By the time the thing was over, there were no rigid price controls on drugs. You had the insurance companies worried about mandatory alliances. Within six months after the President's initial speech, those were out the window. They targeted specific parts of the bill and they succeeded in getting rid of them.

BILL MOYERS: So the people who spent the most money on the lobbying got what they wanted?

CHARLES LEWIS: They did.

BILL MOYERS: Do you-what does it mean when you see that Senator Phil Gramm of Texas, over the last several years, has collected $1,200,000 from industry sources and he was one of the most articulate and persistent opponents of the Clinton plan? Do you draw , a conclusion from that, or is that just people giving to someone who represents their views, that they're not buying his vote?

CHARLES LEWIS: Well, I look at campaign money sort of like country club fees. If you want to play on the course, you've got to pay your dues just to get heard. It doesn't mean you'll get a hole in one or you'll win the game. Most of the people that got the money were on the five key committees. Ifyou were on that committee, it was a very good year to get money from lots of folks who were trying to get your attention. You can't make a direct correlation at all times, but there certainly are some fairly glaring cases of folks who did get a lot of money and seemed to be supporting certain interests.

BILL MOYERS: There is a school of thought that says this was a pretty good debate, that-that the messages got through, sooner or later, and the plan, the Clinton plan, really fell of its own weight, that once the people found out, through all this advertising, what were the defects of it, they gave it the old Bronx cheer, and that this was, after all, a pretty good debate, in a rough and crude way.

KATHLEEN HALL JAMIESON: If one asks whether an unworthy alternative was dispatched, one could say that it's a good debate, but one should expect more than that of a debate. It was a bad debate, if what one asks is, were the problems that faced the country addressed systematically? Were the alternative solutions evaluated? The single payer alternative never got serious consideration. The Republican alternative never got serious consideration. And in the closing days of the debate, the compromise position of the so-called mainstream group never got serious consideration. A debate needs to evaluate all of the alternatives, and we need to select the best. We shouldn't simply put up one and shoot it down.

BILL MOYERS: So what do you conclude about the state of democracy from the great health care debate?

CHARLES LEWIS: The state of democracy is in poor health today. It's-

BILL MOYERS: No pun intended.

CHARLES LEWIS: -in terms of forces at play that can spend large sums of money and can distort the debate to their own ends, there is more of that today, I think, than we've probably ever seen in history. In terms of John Q. Public in Kansas or any other state who is not part of a group, who wants to meet with their elected representative, who cares about a public policy issue, who is not part of an organized trade association already, good luck being hear a in Washington. That's what the state of the country is, to me.

KATHLEEN HALL JAMIESON: We've taken the norms of campaigning that are bad, and we've moved them into governance. Reporters are covering public policy as if it's a campaign, focusing on strategy instead of focusing on substance, focusing on conflict instead of focusing on consensus, focusing on attack rather than the solutions that are being offered, and forgetting to keep a focus on problems. Advertising is being used in its worst form, to oppose rather than to advocate, and not to engage. And we didn't find a way to do the one good thing that general elections do, to have a debate that gives at least two of the sides, possibly three, a chance to see the alternatives.

BILL MOYERS: What happens to the democratic process? "

KATHLEEN HALL JAMIESON: We become crisis-driven. At a certain point, we are going to have to address the health care problem, because coverage "is declining and costs are not coming under control, and that is causing a lack of global competitiveness, because it costs us more to manufacture goods and services because our costs are higher to produce those. They're higher than competitors around the world. And so we bear a consequence that is real, but we haven't addressed it now, we're going to wait and address it later, at a point at which the crisis is so real that we're going to be driving public policy out of crisis, not out of reasonable planning about a deliberative future.

BILL MOYERS: What does this say about governance?

CHARLES LEWIS: Well, it says that in this democracy, those who have the most money generally are heard the loudest, and their message is amplified in the most elaborate way, and those who don't are left on the outside. And it means that deception is a common practice. Well, we've seen that for years at all levels. That's why government as an institution is pretty low, along with journalists and every other field in their society-

BILL MOYERS: Don't get personal.

CHARLES LEWIS: -no, I wo~'t.

KATHLEEN HALL JAMIESON: And educators.

CHARLES LEWIS: But-and educators, and everybody, I guess. But I think what it says is, governance is increasingly difficult, and government is almost intractable, in terms of trying to achieve reform. It's much easier to defeat legislation, than it is to ever achieve any kind of change in our democracy, in our system, and I think that part of that is that we have a mercenary culture in Washington.

BILL MOYERS: A mercenary culture?

CHARLES LEWIS: A mercenary culture of private interests that basically, their own vested interest becomes more important than the broad public interest, and they are able to push the buttons of Washington in a way that keeps it from working, or makes sure it works for them. And frankly, I think we saw that in this instance.

KATHLEEN HALL JAMIESON: I'm not as pessimistic as the two of you are. I think that what the health care reform debate delivered is not yet public, but it delivered it. We have an unprecedented amount of new information about the costs and consequences of the available solutions. The Congressional Budget Office has delivered that on the major reform plans, as have major consulting firms. There's an emerging consensus, as a result, about the available solutions. If reporters will now continue to ask what are the costs and, ultimately, how many people are covered, we could enter the 1996 presidential campaign prepared for a debate between candidates that would be honest, based on facts that reporters, as well as the public, would-would understand, and'as a result, we might see an outcome that would lead to governance that would be positive and in the public good.

BILL MOYERS: Well, yours is the last word, but surely, this is not the last round, so thank you Kathleen Hall Jamieson, and thank you, Chuck Lewis.

And thank you for joining us. I'm Bill Moyers.