A mother stands outside her house, ushering two adorable kids into the family minivan. A gray-haired man sits in a diner, his newspaper in front of him. A fresh-faced young guy in a button-down shirt pushes a bicycle out of an office building. A doctor stands in an examining room, surrounded by the tools of her trade. All four characters look straight into the camera, wearing the kind but concerned expressions of people who know you might not love what they have to say but feel a solemn duty to tell you anyway, for your own good.
Minivan mom starts: “Every American deserves access to affordable, high-quality health care.” Cut to the doctor: “But one-size-fits-all government health-insurance systems like Medicare for All, Medicare Buy-In and the public option do the opposite.” Cut to diner man: “American families would face higher taxes, longer wait times and lower-quality care.” Cut to bike yuppie: “They take choice and control away from patients and give it to politicians.” Back to Mom: “We can’t afford a one-size-fits-all system.” Back to doctor: “Let’s build on what’s working and fix what’s broken. Not start over.”
The 30-second ad, titled “Opposite,” was shown during the Democratic primary debate in Nevada; another, “Priorities,” ran during the one in South Carolina, part of a multimillion-dollar ad campaign in early battleground states. They were promoted online, across Facebook, Snapchat and Twitter, and in paid slots on YouTube’s home page. A similar ad, in Spanish and featuring a Hispanic mother and daughter, ran on Univision and on Spanish-language websites. All this was purchased by the Partnership for America’s Health Care Future, a group formed in 2018 and funded, you will not be shocked to learn, largely by groups representing the hospital, insurance and pharmaceutical industries.
“Opposite” is notionally about health care, but if the sound was turned off, you would hardly know it. There are no hospitals or patients, no sickness or injury, no healing. (Yes, there’s the doctor, but she’s alone.) It’s as if the ad knows, deep down, that presenting a rosy picture of an actual American health care access scenario would risk too many viewers erupting in laughter. We see nothing that alludes to the process of obtaining or paying for care; there’s not a single piece of paperwork, let alone medical bills, coverage denial letters, medical bankruptcy proceedings or tired people sitting at their computers, trying desperately to make sense of what their plans will and will not cover.
The obvious ancestor of this ad is a famous series of commercials that ran in 1993 and 1994, during the heated health care reform debates of the Clinton administration. Today, they are known as the “Harry and Louise” ads, after their main characters: a husband and wife, both working professionals, who recognized a need for some improvements in the system but found themselves increasingly alarmed by things they learned about proposed reforms, most of all their potential to reduce “choice.” These spots were funded by the Health Insurance Association of America, which later merged with another group to become America’s Health Insurance Plans, which later helped found the Partnership for America’s Health Care Future, which later paid for “Opposite.” Almost 30 years have passed, but the approach remains similar: healthy, professional-class people acknowledge that the health care status quo isn’t perfect but worry that the changes on the table are a bridge too far.
Still, there are palpable differences between the two campaigns. The Harry and Louise ads were shot through with loud notes of fear: The spots used the stylistic conventions of soap opera and were often backed by haunting piano melodies of the type that, in a soap, signal that an awful secret is about to be exposed. Their most iconic image was of the couple sitting at their kitchen table, sorting through bills. One spot transported viewers to “Sometime in the future,” when Louise stares at a bill and sighs, “But this was covered under our old plan.” The ads were willing to acknowledge that insurance can be a nightmare, but only obliquely and only in the service of making you scared that politicians would make it even worse. The thrust of “Opposite” may be near-identical, but the mood is vastly different: no ominous music, no primal scenes of middle-class worry. Everyone seems more or less happy. “Things are pretty good,” they seem to say. “Don’t let the government mess it up by confining you to a one-size-fits-all straitjacket!”
This approach takes some chutzpah, given that, in the years since Harry and Louise aired, private health care spending has risen considerably, even among Americans with employer-sponsored insurance plans. According to a CBS News survey conducted late last year, three in four Americans think the country’s health care system requires either “fundamental changes” or “to be completely rebuilt”; 43 percent described the cost of basic medical care as a “hardship.” American discourse, both political and personal, is full of tales of medical debt, the frustrating vortex of insurance bureaucracy, even deaths linked to coverage gaps. To argue with a straight face to voters that insurance as we know it is mostly working seems like a risky strategy.
But what if “Opposite” isn’t taking voters as its primary audience? One of the most fascinating aspects of the Harry and Louise saga is that, according to many scholars, the couple had little direct effect on how the general public felt about health care. Surveys didn’t find a correlation between exposure to the ads and negative opinions about health reform; in focus groups, people who watched the ads had difficulty recalling their core themes. Instead, the campaign seems to have paid off by influencing people close to the levers of power — legislators, journalists and even the Clintons, who publicly criticized Harry and Louise and even recorded their own parody. Rather than changing how “real” people felt, it seems, the campaign worked by molding elites’ worries about how real people felt — or at least how they were being persuaded to feel, in no small part by the ads themselves.
Similarly, “Opposite” seems only peripherally interested in convincing people that Medicare for All is bad policy. Instead, it feels like an attempt to persuade reform-minded people that “the public” — minivan mom, yuppie bike guy, diner grandpa — feels differently. It sounds like a threat from one group of high-level political actors to another, hissed between the lines of what appears to be a message for viewers at home: Keep pushing these changes and we’ll keep running these ads. Do you really want to fight this fight again? Don’t you know how rich we are? Are you so confident we can’t convince the public to hate you?
In 2008, incidentally, the advertising agency that came up with Harry and Louise deployed them again, using the same actors — this time in ads urging voters to demand that the year’s presidential candidates make health care a priority. In 2009, they returned again, now supporters of President Obama’s Affordable Care Act. I wonder if, as 2020 continues, we’ll see them again, taking another paycheck to add their scripted health care worries to our dysfunctional political system.
