CREDIT: ‘Patients First’ advertising clip from YouTube

The battle for American hearts and minds on the issue of health care reform now moves from Washington—where Congress is in recess—into the states, where it will be discussed at kitchen tables, church picnics, senior centers and almost nightly in television and radio ads.

“Washington now runs your banks, insurance and car companies,” proclaims one ad from the Americans for Prosperity Foundation. “Do you trust Washington—with your life?” it asks. “If we don’t act … he won’t get the chemo he needs,” counters an ad from Healthy Economy Now as it flashes an image of a dejected little boy walking away from a swing.

In an effort to sway lawmakers and public opinion, millions of dollars will be pumped into an advertising blitz during recess. And sifting through the conflicting information in the deluge is no small feat.

“It isn’t always obvious when a person views a commercial who is behind the message,” explains Dave Levinthal, spokesperson for the Center for Responsive Politics, a nonpartisan lobbying and influence tracking group. “It is incumbent on Americans to research the organizations producing the advertisements to find where the money lies behind these organizations’ platforms.”

$1 million a day on ads

Spending to lobby the federal government on health care has surpassed spending on all other issues this year, totaling about $263 million, according to analysis from the Center for Responsive Politics. And those numbers don’t include ad dollars.

As of the beginning of August, roughly $52 million had been funneled into television ads on health care reform this year, according to the Campaign Media Analysis Group (CMAG). Half of that was spent last month.

The largest portion of the money spent on TV ads—$23 million—has been spent on advertising in favor of general health care reforms but not specifically linked to any plan on the table. Of the remaining ad dollars, spending from groups supporting President Obama’s health care plan is roughly double that of the opposition groups, notes Evan Tracey, chief operating officer of CMAG.

In late July, more than $1 million a day on average was spent on television ads discussing health care reform, he says. And both supporting and opposing groups are raising the stakes with carefully targeted campaigns in states with moderate Republican and conservative Democrat legislators.

Opposing groups face off

The health care issue has opened the wallets of a wide range of groups.

Leading the opposition to proposed reforms are groups including Conservatives for Patients’ Rights, a nonprofit group founded and funded by former hospital executive Rick Scott; Americans for Prosperity Foundation, a conservative group that supports small government and low taxes; the U.S. Chamber of Commerce; the Republican National Committee; and the Cato Institute, a libertarian think tank.

Supporters of the major health care reforms include Healthy Economy Now (funded partly by AARP and the Pharmaceutical Research and Manufacturers of America, or PhRMA); Health Care for America Now, a coalition of unions, community groups and nonprofit groups; the Democratic National Committee; and Organizing for America (the successor to Obama’s campaign arm).

Some groups fiercely opposed to reforms in the past have changed sides. The American Medical Association endorsed the House bill for health care reform and launched ads last week in the Chicago Tribune, the New York Times and the Wall Street Journal. “Difficult issues must still be resolved. But it’s time for results, not rhetoric” the ads read.

The nonprofit Families USA and the drug industry group PhRMA have partnered to resurrect the iconic Harry and Louise characters as their spokespeople, who this time favor general health care reform. “A little more cooperation, a little less politics, and we can get the job done this time,” Louise tells Harry from across their kitchen table. They’ve clearly changed their stance. In 1993 the same couple—with a little more hair and a little less paunch—helped torpedo the Clinton administration’s health reform legislation in ads funded by the Health Insurance Association of America, now America’s Health Insurance Plans.

Often the ads target Congress as well as the public, supplementing formal lobbying.

Commuting congressional staffers couldn’t help but notice the ad campaign sponsored by the American Cancer Society Cancer Action Network last month, which highlighted its message with pictures of cancer patients plastered across the Metro stop closest to congressional offices. One sign, part of its seven-figure ad and lobbying campaign, featured a married couple with the slogan, “Now, doctors can catch his cancer in time to save his life. Later, she could be paying off the medical debt for the rest of hers.”

Truth in advertising?

Advertising spending is just a small portion of the total dollars spent on the reform issue, but ads can be a powerful tool for mobilizing voters and influencing wavering legislators.

While 95 percent of Americans find the issue of health care reform important, according to a recent PEW survey, 63 percent find the issue hard to understand. Part of the problem may be how it is presented in the avalanche of ads.

The most prominent television ad campaigns opposing the health care overhaul have been funded by Scott, of Conservatives for Patients’ Rights. Scott’s former hospital company, HCA Inc., holds the record for paying the largest health care fraud settlement in U.S. history—a $1.7 billion settlement in 2003 for submitting false Medicare claims and for paying kickbacks to physicians who sent patients to its facilities.

Over the July Fourth recess, Scott’s group targeted 14 senators in 11 states with ads partly paid for by $5 million of his own money. His Internet, television and radio ads opposing the current health care reforms were organized by CRC Public Relations, previously known for its involvement in the “Swift boat” campaign against 2004 Democratic presidential candidate John Kerry, which questioned the decorated war veteran’s patriotism and even his medals.

“Imagine waking up one day and all your medical decisions are made by a central national board,” Scott says in one radio ad. “Bureaucrats decide the treatments you receive, the drugs you take, even the doctors you see,” he adds.

Alluding to single-payer health care systems misrepresents the proposed reforms, administration officials say. On Hardball, White House senior adviser David Axelrod dismissed this as a straw-man argument, since the current overhaul proposal does not have a single-payer option on the table.

Jenny Gold, of the nonpartisan, nonprofit Kaiser Health News service, reported the misuse of facts and sources in Conservatives for Patients’ Rights ads that charge the reforms would result in higher taxes for poorer coverage. Gold writes, “The facts are largely taken out of context, come from biased industry groups or have been discredited.”

This week, AARP will launch a national series of television, print and online ads to counter what it sees as the myths and distortions of some opposing groups’ campaigns.

“Our point is to tell the truth about health care reform plans,” says Cheryl Matheis, AARP’s senior vice president of health strategy. “We will point out the myths and then give the real facts.”

Conservative ad charges government takeover

Michael Cannon, director of health policy studies at the Cato Institute, says that the pro-reform ads set up a false choice. The ads “presume the reforms out there solve all our problems and won’t cause others. They oversell the reforms,” he says. “I don’t think anyone says we shouldn’t do any reform. Some of the ads try to paint opposition to the president’s reform as anti-reform, which I would have to say is a lie.”

The institute launched its own $200,000 print and radio ad campaign through August, calling the proposed reforms “a government takeover.” Adopting Uncle Sam as its spokesman, it has run ads depicting Uncle Sam wearing his trademark tall hat, with a medical cross across the brim, a stethoscope around his neck, and the tag line “Your new doctor?” The Cato Institute plans to buy more ads in September, says its spokesperson.

‘Make people afraid of change’

In the onslaught of ads, even the name of an organization can confuse what issue is at stake. The coalition of beverage and restaurant associations called Americans Against Food Taxes has topped the charts for spending on a particular measure of the bill, according to the Campaign Media Analysis Group. Though the group embraces the need for health care reform, it opposes paying for reforms with taxes on its products.

The ads warn against a proposal to levy a tax “on simple pleasures we enjoy like juice drinks and soda” to help pay for health care reform. The proposed tax, which has gained little political traction, would add several cents to the price of sugary drinks (though not fruit juices or most diet sodas). Proponents of the tax argue that sugary drinks have been linked to obesity and adult-onset diabetes, which drive up medical costs.

Dual ad campaigns from the right-leaning Americans for Prosperity Foundation and its project Patients United Now warn that proposed reforms may mean “$400 billion cut from Medicare and Medicaid.”

“The commercial is disingenuous because it equates budget cuts with quality and benefit reductions,” explains Darrell West, vice president and director of governance studies at the Brookings Institution. “Most experts believe that there are administrative savings to be obtained from these programs that won’t compromise benefits. ... The ad uses scare tactics to make people afraid of change,” he says.

Organizations like the Democratic National Committee and the Republican National Committee are also running carefully targeted campaigns in states such as Arkansas, Montana and North Dakota that have key moderate senators.

“There is a lot of money available on both sides,” CMAG's Tracey says. And as both sides prepare for a showdown after the August recess, this may just be the beginning of the ad battle.

Dina Fine Maron covers health, science and politics. Her work has appeared in Newsweek, the Boston Globe and Science News magazine.