Scientocracy

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When Harry and Louise Met Hillary

Lessons from the Pope on health care reform?

As part of the Duke undergraduate course I teach on health care policy, I recently prepared a lecture on Bill Clinton's ultimately futile efforts to reform the US health care system early in his first term of office, back in 1993. This preparation gave me an excuse to read Theda Skocpol's wonderful book, Boomerang. If you want to understand our dysfunctional health care system, and the current state of our dysfunctional democracy, you should pick up this book, because many of today's problems, if not born during the fight over "Hillarycare," were at least stretching their miserable little adolescent wings back then.

Skocpol's book is rich and thick with powerful details and trenchant analyses. Many of these details confirm what we all know about the Clinton reform efforts - that he and his team screwed it up. Over the course of six months, they managed to turn the public against their plan, with public support for health care reform plummeting from 59% in September of 1993 to barely over 40% a half year later.

One example of the Clinton team's mistakes struck me as especially poignant. Those of us who remember the Clinton presidency probably recall the famous Harry and Louise commercials, aired by the Health Insurance Association of America (HIAA) in an attempt to thwart Clinton's health care reform efforts. The ads depict a comfortably middle class white couple sitting together around the breakfast table doing what most happily married couples do in their free time – reading a draft of proposed federal legislation. The couple is reading through the Clinton bill, with furrowed brows as they worry about what such legislation, if it passes, will mean for their own health care. After discussing the bill at some length, Louise concludes pithily "They choose, we lose."

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Powerful stuff.

But did you know that the Harry and Louise ad did not have much impact initially, because the HIAA had only a small budget to put the ads on TV? That all changed, however, when Hillary Clinton publically attacked the ads, causing national news shows to report on the controversy and, consequently, to provide free airings of the ads.

Hillary made the classic Vatican mistake, which normally runs something like this:

"Your Holiness, Hollywood has made another offensive film."

"Defaming Christ? Mocking Christians?"

"All of the above, your Popeliness."

"Is this a major blockbuster film with a marketing budget?"

"No, your Excellency. It is a low budget art film."

"Then by all means let's order our flocks to boycott the movie. That way we can guarantee it will neither receive publicity nor pique the interest of filmgoers who would otherwise have never known it existed!"

Sigh...

In the end, I would like to think policies (and movies) stand or fall on their own merits. But I know that's not how the world works. And Boomerang reminds us of this fact, in a readable and engaging way even for those of you not obsessed, as I am, with health care politics.

 

Peter Ubel, M.D., author of Critical Decisions and Free Market Madness, is a physician, behavioral scientist, and Professor of Business and Public Policy at Duke University.

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