Bill Vickery, who Bloomberg said was paid by the Chamber to help run the opposition in Arkansas, told Armstrong that he organized about fifty events targeting incumbent Senator Blanche Lincoln, a Democrat who was a key supporter of the health-care law. Lincoln lost by 21 percent in last November’s midterm elections.

“I talked to a lot of consultants, pollsters,” Armstrong said. “They said this was one of the most sophisticated operations, akin to a presidential campaign, that they had ever worked on.”

Steve Patterson, the Lincoln campaign manager, said most of the ad money for the health-care fight actually hit the state the year before the midterm election while the battle over the Democratic plan was in full cry. “Most of it was educational in nature,” he said. “Call Senator Lincoln and tell her to vote no.”

But Patterson knew early on that the heath-care fight was likely to be the defining issue of the Senate race, and many of the ads were already targeting Lincoln’s position in favor of change to the health-care system. So he asked the campaign’s ad buyer to track the spending. They found $6 million in issue advertising was spent during the period—a very large amount in a small media market state.

From October to early December, Lincoln’s buyer found that the US Chamber of Commerce spent $2 million in advertising. Americans for Stable Healthcare—a coalition of liberal groups, the pharmaceutical industry, and unions in favor of the plan—spent $1.2 million. And the 60 Plus Association, a conservative senior citizen group opposed to the plan, spent $650,000.

“I think it was the critical issue that turned voters against Senator Lincoln,” he said. “Her numbers started turning when this process began.”

Tom Collamore, who ran Fred Thompson’s presidential campaign before becoming senior vice president of communications and strategy at the US Chamber of Commerce, likened a modern issue campaign to a presidential race. “There are all the elements,” he said. “You test the message and then you push the message out through all the outlets.”

“If you are really serious about something you have to make a big investment,” Collamore continued. “It involves research and focus groups and proper messaging that will lead to highlighting things that resonate.”

In the heath-care battle, the Chamber created a web hub, healthreformimpacts.com, to continue the fight. It set up coalition groups like Employers for a Healthy Economy. Collamore said much of the effort also involved old-fashioned PR work as well. “We did a lot of online pushing of the message through stories, columns,” he said. “A lot of interaction with the press, a lot of interviews.”

Although the fight over health care was larger than most campaigns, Collamore said it was not fundamentally different than several other public relations efforts the Chamber is working on.

One of the largest is the Chamber’s $100 million “Campaign for Free Enterprise,” an effort to fight government involvement in business matters. Besides the traditional effort of advertising, press releases, and position papers, the Chamber has set up groups like Students in Free Enterprise and the Extreme Entrepreneurship Tour to target college campuses.

It’s also making an online push. The Chamber kicked off part of the campaign with $100,000 in prize money for a video contest on its Facebook page. The campaign received one hundred thousand views, recorded ten thousand votes, and collected four thousand e-mail addresses to add to the Chamber’s database. Right now, it has 146,000 fans—not Lady Gaga level (more than thirty million at press time) but not bad for a business group.

“The news cycle never ends. There is a lot of space, there is a lot of competition for people’s attention,” Collamore said. “It’s not just press releases anymore.”

This article has been co-published with ProPublica.

Correction: In John Sullivan’s “True Enough: The second age of PR,” the author picked up a set of decimal-place errors from the book The Death and Life of American Journalism (which the book will correct in the next edition). The piece should have said, “In 1980, there were about 45 PR workers per one hundred thousand population compared with 36 journalists. In 2008, there were 90 PR people compared to 25 journalists”—instead of the figures .45 and .36 for 1980 and .90 and .25 for 2008. The ratios remain the same. We regret the error.

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John Sullivan , a former reporter for The New York Times and The Providence Journal, is a freelance journalist. This story is being jointly published with ProPublica.