1993-1994 health care reform campaign : the influence of political advertising and news media coverage on public opinion

132 Pages·1996·4.9 MB·English

by  Cohen, Michael David

THE1993-1994HEALTHCAREREFORMCAMPAIGN:
THEINFLUENCEOFPOLITICALADVERTISINGAND
NEWSMEDIACOVERAGEONPUBLICOPINION
By
MICHAELDAVIDCOHEN
ADISSERTATIONPRESENTEDTOTHEGRADUATESCHOOL
OFTHEUNIVERSITYOFFLORIDAINPARTIALFULFILLMENT
OFTHEREQUIREMENTSFORTHEDEGREEOF
DOCTOROFPHILOSOPHY
UNIVERSITYOFFLORIDA
1996
UNIVERSITYOFFLORIDALIBRARES
Thefollowingdissertationisdedicatedtoallofthepeoplewhohavestoodbyme
throughoutthemostchallengingperiodofrnylifesofar. Awisepersononcesaidthatv/e
shouldjudgeothersbythecompanythattheykeep. Myfamilyhasbeenagreatsourceof
strengthandshouldserveasamodelforsuccess. AnythingthatIaccomplish,indeedall
thatIam,isduetothem. AndIcannotthankthemenough.
Inaddition,Iwouldliketomentionaveryspecialgroupofpeople:myfriends.
Somewhoattempttogetadoctoratefindthemselvesisolatedduringtheprocess,sointo
theirworkthattheyneverhaveanyfunor,moreimportantly,loseperspectiveentirely. I
knowofnoonewhoisluckiertohavesuchagreatgroupofpeoplethatrallyaroundeach
otherintimesofneed. TheyarethefriendsIalwayshopedtohave. Thanksguys.
Asademonstrationofrnyincredibleluck,Imetsomeonetrulyspecialduringthis
difficultprocess. LisaHerzogisunique. Atatimeinmylifewhenicertainlydidnot
wanttobegindatinganyone,therightoneshowsup. AndthankGodshedid. Learning
aboutthehealthcaredebatewasagreatacademicexercise. Butoverthepastyear,Lisa
hastaughtmesomethingfarmoreimportant:whatlovereallyisailabout.
n
ACKNOWLEDGMENTS
Alotgoesintoaprojectsuchasadissertation. Thisworkrepresentsthe
combinedeffortofsomeoutstandingprofessionalsandscholars. First.Iwouldliketo
acknowledgethesupportofDr.StephenCraig. Heservedasmychair,editor,anddevil's
advocate,constantlychallengingtheargumentsandcontentpresentedinthisthesis. The
diligencetowhichhededicatedtothisworkisatributetohisuniqueprofessionalism.
Next,IwouldliketothankDr.M.M.Conwaywhoseunderstandingoftheoretical
conventionsfuitheredthisresearchideaintoitscurrentform.
. Iwouldliketoexpressmyheartfeltgratitudetothreeveryspecialscholars,Drs.
MichaelWeigold,WayneFrancis,andMichaelMartinez. Duringmytenureasamaster's
candidatetheDr.Weigoldtookmeunderhiswingandtaughtmehowtoconduct
publishableresearch. He,throughhispatienceandfriendship,encouragedmetopursue
thedoctorate. WithoutDr.Francis,Ibelievethatthisworkwouldhaveneverfoundits
waytotheeditor'sofficeattheGraduateSchool. Dr.Francishastheremarkableability
toconnecttheoryandmethodologyinamannerthatisbothsimpleandelegant.
Wheneverthisworkfounditswayoff-track,Dr.Francisalwayspulieditbackeverso
gently. Icannotthankhimenoughforhisefforts. Finally,IwishtoacknowledgeDr.
Martinez. Withouthim,thisdissertationwouldneverhavebeendefended,asheagreed
tojointhecommitteelateintheprocesstomyeternalgratitude.
Thisstudyinvolvedpullingtogethersomefairlydiversesourcesofdata. Thanks
gotonewfoundfriendsatseveralagencies,publicandprivate,forkeepingthecostofthis
studyataminimum. SpecificmentionincludesMauraStrausbergatGallup,DavidCrane
andAliceCheseboroughatHarris,MichaelKegeyattheNewYorkTimes,Wendy
in
HolkumatPrincetonSurveyResearchAssociates,AmyBohmfromtheCenterforPublic
Integrity,TiffanyVillagerattheFreedomForumatVanderbiltUniversityforpioviding
methedatatocrunchandanalyze.
IV
TABLEOFCONTENTS
page
ACKNOWLEGMENTS
iii
ABSTRACT
vii
CHAPTERS
INTRODUCTION
1 1
AmericanHealthCare 1
OtherIndustrializedNations 2
AmericaAttemptsHealthCareReform 3
AnImportantElection:UnitedStatesSenate,1991 6
AnotherImportantElection:President,1992 6
PresidentBillClinton'sTurn 3
ExplanationsandHypotheses 17
Summary !9
2 LITERATUREREVIEW 2!
AmericanRepresentation ,...21
PoliticalActors 23
PublicOpinion 32
MassMedia 37
Summary 41
3 . METHODOLOGY 42
Positioning 42
ChapterOutline 43
Hypotheses 43
DependentVariable 44
IndependentVariables 49
Controls 57
VariableConsiderations 59
Design 60
Summary 57
v
4 FINDINGS 68
Time 69
Sample 69
Reliability 71
AnalysisofIndependentVariables 72
FirstHypothesis 79
SecondHypothesis 81
Summary 87
5 DISCUSSION 88
StudyLimitations 88
StudyImplications 91
FutureHeaithCareReform? 97
FutureResearch 100
Conclusion 105
APPENDIX „ 107
LISTOFREFERENCES 108
BIOGRAPHICALSKETCH 122
VI
AbstractofDissertationPresentedtotheGraduateSchool
oftheUniversityofFloridainPartialFulfillmentofthe
RequirementsfortheDegreeofDoctorofPhilosophy
THE1993-1994HEALTHCAREREFORMCAMPAIGN:
THEINFLUENCEOFPOLITICALADVERTISINGAND
NEWSMEDIACOVERAGEONPUBLICOPINION
By
MichaelDavidCohen
August,1996
Chairman: Dr.StephenCraig
MajorDepartment: PoliticalScience
The1993-1994healthcarereformeffortledbyPresidentBillClintonwasbom
of,anddieddueto,publicopinion. Althoughseveralnationalleadershadattemptedand
failedtoshepherdnationalhealthcoveragetolaw,Clintonattemptedtosettheagendaby
appointingtheFirstLadytoheadanunprecedentedhealthcaretaskforce. Thefinal
reportwas1,354pagesanddetailedalmosteveryconceivableelementofanewsystem,
inwhichthenationalgovernmenthadasubstantialrole. InSeptember1993,President
Clintondeliveredaprime-timehealthcareaddresstotheCongress. Initialpublic
reaction,andpresscoverageoftheHealthSecurityActof1993wasstronglyfavorable.
Fifty-ninepercentofpersonssurveyedsaidthattheysupportedtheplan. Bytheendof
summer,thefollowingyear,supportfortheplandroppedto40percent,leadingClinton
toshelvehisplan. Regressionandtime-seriesanalyseswereconductedtodetermineif
the"HarryandLouise"advertisingcampaignagainsttheClintoninitiativewascorrelated
to,ormayhavecaused,increasinglynegativenewscoverageandadeclineinpublic
vn
supportoftheplan. ShiftsinnewsreportingoftheClintonhealthcareplanwerefoundto
occuraftermajoradcampaigns. Decliningplansupportwasfoundtofollowincreasesin
negativenewscoverage. Othervariableswerefoundexplanatoryincludinglagged
indicatorsofvalencednewsmediacontent,theeconomy,andtime. Astheeconomygot
better,publicsupportfortheClintonplandropped. Astimepassed,supportfell. The
completemodelexplainedover85percentofthevarianceinsupportfortheHealth
SecurityActof1993.
vi11
CHAPTER
1
INTRODUCTION
Modernhealthcarehasenhancedandprolongedlifeexpectancy,providingns
withextendedlibertyandhappiness. Reformofthehealthcareinsuranceariddelivery
systemintheUnitedStateschallengeseachtenetofthisuniquelyAmericanversionof
Lockeandemocratictheory. In1993PresidentBillClintonsetouttoreorganizethe
relationshipbetweenpatientsanddoctorstodecreasecostsandincreasethenumberof
citizenswithhealthinsurance. Afteraten-month"campaign"theadministrationretreated
fromitsownproposals,encouraginglike-mindedlegislatorstotakeonthebattle. Many
chosetosteerclear,andthosewnodidnotfailedtobringabilltothefloorofaCongress
controlledbyClinton'sparty.
ThefollowingresearchwillreviewthehealthcaresystemintheUnitedStates,
outliningitsstrengthsanddeficiencieswithaneyetoarationaleforreform. 1willalso
provideaglimpseathowotherindustrializednationsmanagetoprovidecaretotheir
citizens. Then,fromanhistoricalperspective,thisstudywilldiscusspreviousAmerican
attemptsatreform,settingthestageforPresidentBillClinton'sproposedHealthSecurity
Actof1993. OncethedetailsoftheClintonplanarereviewedandimportantterms
defined,Iwilltrytoexplainhowtheplanfailedtomaintainsustainedpublicsupport.
AmericanHealthCare
Todate,theUnitedStatesremainstheonlyindustrializednationwithouta
nationalsystemofprovidingguaranteedhealthcareforitscitizens(Moore1994). The
Americanmarket-basedsystemhasproducedcuresandtreatmentsformanyofthe
world'sworstailmentsanddiseases. Itprovidesapproximately85percentofitscitizens
withinsurancethathelpstocovermuchofthecostofstayinghealthy(Cranford1993).
Moreover,thesystemguaranteesindividualsthelibertytochoosetheirowninsurance
carriers(ortobeuninsured),doctors,medications,andtreatments.
Butthesystemisfarfromperfect. Nearly15percentoftheUnitedStates
population,about36.6millionpersons,wereuninsuredin1991(Cranford1993). The
UnitedStateshealthcaresystemisalsohighlyinflationaryandincreasinglyoutofthe
reachofthemiddleclass. Further,thehealthcaresystemisquitevolatileanddisparateas
qualityvariesconsiderablywiththepatient'sabilitytopay. Insurancecompaniesmay
droptheirclientsiftheyswitchjobsorrestrictcoveragetothosewhohavepre-existing
medicalconditions(Graig1993). Policymakersin1993soughttoaddressthese
problems.
OtherIndustrializedNations
Theshortcomingsofanunfetteredmarkethaveledvirtuallyallother
industrializednationstoprovidesomeformofhealthcareforitscitizens(Centerfor
PublicIntegrity1994). SystemsvaryfromtotalgovernmentcontrolintheformerSoviet
UniontocomparablylimitedpublicrolessuchasinJapan(Moore1994). Althougheach
systemisunique,mostfundhealthcarethroughacombinationoftaxesandgovernment
mandatesonprivatebusinesses(CenterforPublicIntegrity1994;Graig1993).
SincethefalloftheSovietUnion,Englandremainsthemostacuteexampleofa
centralizedhealthcaresystem(Moore1994). Thenationalgovernmenteffectively
controlsallaspectsofthemeansofprovidingcaretoitscitizens(Graig1993). Every
personinBritainisprovidedcarefreeatthepointofservicepaidforthroughtaxrevenue
(CenterforPublicIntegrity1994). Sincethegovernmentownsmosthospitalsand
employsdoctorsverylittlemoneyisexchangedbetweenpatientsandcaregivers(Center