If anyone ever doubted that advertising works, the latest example of its persuasive power, documented in The New York Times Thursday, should prompt them to reconsider. A piece by Abby Goodnough strongly suggests that money spent by opponents of the health reform law has helped color public opinion in negative shades.

Goodnough reported that the success of opponents in framing the law negatively “may stem in large part from more than $200 million in advertising spending by an array of conservative groups” that include the US Chamber of Commerce; Karl Rove’s Crossroads GPS; the American Action Network, founded by Fred V. Malek, a prominent Republican fund raiser; and the 60 Plus Association, which bills itself as a conservative alternative to the AARP. Goodnough totaled the amount these groups have spent—$235 million—and compared that sum to spending by the president, his Department of Health and Human Services, and a handful of less well-heeled contributors. The result? Opponents outspent supporters—who spent only $69 million—by more than three to one.

Whether it was lack of money or for other reasons, the administration didn’t promote the law, and the lack of public enthusiasm for it was evident among the men and women on the street in Pennsylvania who Goodnough interviewed
Those were similar to the conclusions Campaign Desk reached in a post on Wednesday, in which we argued that president Obama and his allies have so far failed to explain to ordinary people the heart of the reform law, the individual mandate requiring everyone to have health insurance. Gary Schiff, a retired teacher and businessman, said it best in Goodnough’s story: “All you hear about it now is the Republicans saying what’s wrong with it: that it’s socialism, that it’s going to bankrupt the country. I’ll give them credit; they’re great at framing the debate.”

In my own CJR Town Hall conversations, held in several states in recent months, I found people frustrated, angry, and sometimes unsure and uninformed about the law. Goodnough did also. Richard Tems, a businessman and member of the Bucks County Republican Committee, told the Times about his hip replacement surgery, about which he was very satisfied indeed. He offered what the Times called “grim predictions about what might transpire under the law.” Good medical experiences like his would disappear under the Affordable Care Act, he said. “If you look at any nationalized health program, whether it’s Canada’s or England’s, they ration everything.” That would be news to people in Canada and England, but it continues to be the mythology in America about foreign systems.

Goodnough interviewed a cardiologist (cardiologists are among the highest paid medical specialists) who didn’t like the “accountable care organizations”—groups of doctors and hospitals working together, which the law encourages in order to coordinate care, improve quality, and perhaps reduce costs. This physician said these groups would strip doctors of their autonomy and “patients will lose their advocates”—a debatable proposition. Another man Goodnough spoke to said the law would put taxpayers in a position of footing the bill for overly generous insurance plans people could not afford on their own. “It creates a sense of entitlement and expectation.,” he said. “You want to be on birth control? Buy your own damn birth control. You want to get eye surgery? Pay for it yourself.”

Goodnough found the old arguments used for decades against health reform are alive and well in Doylestown, PA, many of them nourished anew by a big, big-money ad campaign. Has the Affordable Care Act made any progress in changing the public perception of American health care? If it hasn’t, whose fault is that? Or does an ad campaign of this size trump every effort? These are some of the questions the Times’s story raised.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.