How the phantom of ‘socialized medicine’ came to be

A Laurel to The New Yorker for exploring the roots of modern political consulting

Jill Lepore deserves a Laurel for her engrossing tale of how political communications came to be so toxic. In “The Lie Factory,” Lepore describes the work of the firm Campaigns, Inc., founded in 1933 by Clem Whitaker and Leone Baxter, and outlines the antecedents for the slash-and-burn, repeat-the-lies, cutthroat campaigning so evident in current political races. “No single development has altered the workings of American democracy in the last century so much as political consulting,” she writes.

Whitaker and Baxter invented modern political consulting in the course of defeating Upton Sinclair, the socialist and author of The Jungle, when he ran for governor of California; sprucing up the image of Earl Warren when he was a right wing candidate for governor, also in California; teaching Ike how to use TV as a weapon; and guiding the American Medical Association (AMA) in its fateful campaign that has for six decades prevented America from having a national health system. “Socialized medicine” is what the PR duo called it. Sound familiar?

I knew Whitaker and Baxter had coined the term “socialized medicine” to help their million-dollar client, the AMA, but Lepore’s piece connected a lot of dots for me, and explained why so many of the twenty-something students I’ve taught use the term and have feelings about the concept even through they clearly were not around in the late 1940s when Whitaker and Baxter used it to defeat Harry Truman’s plan for national health insurance. Their grandparents were, and the purported evils of a government-managed plan have been handed down for generations. Lepore wrote “They turned the President’s sensible, popular, and urgently needed legislative reform into a bogeyman so scary that, even today, millions of Americans are still scared.” Their success has made it impossible to discuss health reform except in the narrowest of terms.

The bogeyman surfaced this summer in the Massachusetts Senate race between Elizabeth Warren and Scott Brown. Warren co-authored a chapter in a health policy book a few years ago advocating “universal, single-payer healthcare.” When a cable TV anchor asked her about that, Warren ran for the hills. “No,” she did not support single payer, Warren told him.

Before they destroyed Truman’s plan, Whitaker and Baxter cut their teeth defeating Earl Warren’s compulsory, comprehensive health insurance proposal for all Californians. The California Medical Association paid them an annual fee of $25,000, and they ignited a war, with the help of newspaper editors and pamphlets that scared the public about the evils of “politically-controlled medicine.” Says Lepore: “Whitaker and Baxter took a piece of legislation that most people liked and taught them to hate it.” To this day, the California Medical Association has lobbied fiercely against bills for single-payer health insurance, which have passed the legislature several times but never got a governor’s signature and became law.

In 1948, Truman proposed a health insurance scheme similar to Warren’s in his State of the Union address. Soon after, the AMA paid Whitaker and Baxter a $100,000 retainer with an annual budget of more than $1 million—a $956,000 retainer and a budget of some $9.5 million in today’s dollars—for a campaign “to arouse and alert the American people in every walk of life until it generates a great public crusade and a fundamental fight for freedom.” Whitaker and Baxter carried their fight to every nook and cranny of America—to doctors; to doctors’ wives, who held parties to explain the evils of socialized medicine; to small town pharmacists; to journalists and newspapers—and to Washington where they persuaded members of Congress to let them read constituents’ mail. When they began their attack, mail was running four and a half to one in favor of Truman’s plan. Nine months later it was running four to one against.

Lepore dug into the California State Archives and unearthed a document that explains some of the roots of what became our health system today. The goal of Campaign, Inc. was to put a “permanent stop to the agitation for socialized medicine in this country,” and one way of doing that was “simulating the growth of voluntary health insurance systems to take the economic shock out of illness.” For several reasons, private insurance indeed grew, with a handful of giant companies controlling the health insurance market in the US. Whether in the long run private insurance will replace the social insurance model that is Medicare, which is a key election issue with footprints you can trace back to Whitaker and Baxter.

The New Yorker piece makes clear that Whitaker and Baxter wrote the bible that pols and their advisers read today. To me, their simple rules for political effectiveness suggest why fact-checking operations, which point out this lie or that—as admirable as that is—may have little impact in changing voters’ minds and not pack the same persuasive wallop as Whitaker and Baxter’s admonition to clients: Say the same thing over and over again.

“We assume we have to get a voter’s attention seven times to make a sale,” Whitaker said. Baxter advised: “Words that lean on the mind are no good. They must dent it. A wall goes up when you try to make Mr. and Mrs. Average American Citizen work or think.”

Which has more effect?—an 11-graph story from Washington Post fact checker Glenn Kessler, explaining whether or not Medicare is going broke, or an ad from Marco Rubio who simply says “Medicare is going broke. It’s not politics. It’s math.” The gospel according to Whitaker and Baxter preaches that Americans remember that kind of short, pithy phrase, not Kessler’s discussion of what the word “depleted” means in government-speak. It explains why the GOP keep claiming Obama cut $716 billion from Medicare, as Mitt Romney did Sunday on 60 Minutes after many outlets including CJR have shown that the construction is highly misleading.

To show where a claim falls short requires more explanation and a lot of words, as fact checkers know. But Whitaker and Baxter have instructed their disciples, “Never explain anything. The more you have to explain, the more difficult it is to win support.” Perhaps that explains why Romney and Ryan are vague on details of their voucher plan, or why Obama isn’t explaining where he might cut Social Security.

And it explains why he didn’t tell Americans much about the individual mandate and penalties in his health reform law, an omission that has come back to haunt him when the Republicans used it against him. Discussing it might have turned the public against the law even before it passed.

There’s a message in Lepore’s piece: journalism versus the spin machine can be a long war. Writing one true story on Social Security cuts or Medicare vouchers, climate change, or any other issue doesn’t do the job. We have to do more, and just as important we have to understand the communications dynamic around us. In an interview in the 1960s, Baxter was asked, “Does political public relations actually transfer political power into the hands of those who exercise it?” Baxter replied that the profession “must be in the hands of the most ethical principled people or else it will erode into the hands of people who have no regard for the world around them. It could be a very, very destructive thing.” No kidding.

Related stories:

True Enough: The second age of PR

Churnalism Exposed: A new website identifies press release copy in the news

Medicare and the $716 billion bogeyman

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Trudy Lieberman is 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. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.