For decades, presidential campaign advertisements have used the Medicare issue as a powerful tool to influence voters. The common theme in these ads? A vote for one candidate is a vote to preserve the program, while a vote for his opponent is a vote to destroy it.

Political ads: Using Medicare to jab an opponent

Medicare campaign advertisements calling for protecting the entitlement while portraying opponents who would destroy it are as old as the program itself.

By Charles Fiegl amednews staff — Posted Jan. 21, 2013

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» View slide show: Medicare political ads, 1964 to present

The 1964 presidential election featured the most infamous political ad in U.S. history — a young girl picking the petals off a daisy in a bucolic outdoor scene that is wiped away seconds later by the detonation of a nuclear weapon.

Democratic President Lyndon Johnson's campaign ran the television ad a single time without mentioning by name his opponent, conservative Republican Sen. Barry Goldwater. But the spot was influential in raising fears that a vote against the president would have dire consequences for national security. Johnson would go on to win in a landslide, and the “Daisy” ad became a lasting symbol of the brass-knuckle, win-at-any-cost nature of presidential campaigning.

The 1964 campaign also is noteworthy for another television spot that featured what may have been the earliest use of the Medicare program in a negative political ad. Johnson slammed Goldwater for his earlier vote against the establishment of what was described as a hospital insurance program for the elderly, and he insisted that the Arizona Republican lacked serious answers to solve the nation's health problems.

In the decades since, presidential campaigns have continued to feature Medicare prominently in ads that use voter fear to hurt their opponents. The frequency of Medicare political advertising appears to have increased in recent years. Candidates and interest groups use it as a wedge issue to divide the electorate because it has proved so effective.

Both sides combative

Medicare political ads are used universally, regardless of party affiliation, said Shawn Parry-Giles, PhD, a professor at the University of Maryland and director of its Center for Political Communication and Civic Leadership. They don't provide much policy substance or aim to arm voters with facts. Most attempt to scare seniors, and those relying on Medicare to care for them when they reach retirement, away from voting for opposing candidates.

“They state that 'My plan will work and others will not' or 'My plan offers hope while the other plan offers fear,' ” Parry-Giles said. “It can be very confusing to voters.”

Unlike the “Daisy” ad, these messages are repeated throughout an election cycle. The Washington Post tracked spending on TV ads for the race between President Obama and Republican challenger Mitt Romney, the former Massachusetts governor. The campaigns and political groups supporting the candidates spent nearly $1 billion. Obama's camp alone purchased time to run 562,664 ads in television markets across the country, according to the Post. Romney's campaign bought 223,584 ads.

While not every ad focused on Medicare, many did. Each candidate chose to state in his advertising that the other candidate would jeopardize Medicare's future with deep cuts and harmful policy changes.

Using similar playbooks

The 1992 presidential campaign didn't involve nearly as much as money as the campaign two decades later, but it did involve some of the same type of scare tactics. One TV spot run by President George H.W. Bush's campaign against candidate Bill Clinton showed a Soviet-style physician waiting room scene in which a harried government-run staff struggled to keep up with the patient load. The unsubtle message: Vote for Clinton, and this is what the state of Medicare and the health system in general will become.

The messages are condensed, targeted and repeated, and this is crucial to their resonance with voters. Key phrases uttered in 30-second commercials often are repeated verbatim by voters participating in exit polls, Parry-Giles said.

“They are simple, and people pay attention to it,” she said. “You see them over and over again, and it has an impact over choices.”

In 1996, when Clinton was running as an incumbent, one particular Medicare ad from his re-election campaign had run often enough that Sen. Robert Dole's campaign addressed it head-on in a TV spot of its own. The Dole ad insisted that the Clinton claim about the senator's proposed cuts to the program was factually incorrect and merely an attempt to frighten senior voters into backing the president.

Most of the ads featuring Medicare in the past 50 years do not employ a positive tone, said Michele Claibourn, PhD, assistant professor in the Woodrow Wilson Dept. of Politics at the University of Virginia.

“Medicare ads are negative ads and are meant to create concern about the opponent,” Claibourn said. “It's an entrenched program that people are counting on. There's language that 'This promise was made to you.' There is no reason to bring it up unless it's to scare the public about someone's intentions.”

Medicare political ads use tried-and-true methods to invoke fear of the opponent. In 2012, commercials from Obama and Romney, for example, showed images of the other candidates in gloomy shades of gray accompanied by ominous music. The ads then switched to vibrant colors and employed triumphant music when they mentioned the candidate backing the spot.

Light on policy, long on rhetoric

Medicare political advertising tends to reflect broad party platform ideas and sweeping rhetoric used during campaign stops. Because the messages in the ads are designed to be light on policy specifics, they tend not to box a winning politician into a particular position or directly influence future policy decisions, Parry-Giles said.

At least one set of Medicare ads in the 2000 presidential election, however, sought to make the election in part a referendum on which candidate had the better plan for adding a prescription drug benefit to Medicare. Many observers called this reform the biggest change to the entitlement since its inception. Three years later, President George W. Bush's preferred version of the benefit — offered by private insurers with prices negotiated by private pharmacy benefit managers — was cleared for enactment in a House vote that was nearly as close as the election itself.

As government spending on the program has risen rapidly — along with concerns about budget deficits and the national debt — Democrats and Republicans have been compelled to offer proposals to reform the health care entitlement and slow future growth rates, exposing them to having their own policies used against them in future advertising.

Republicans used the 2010 enactment of the Affordable Care Act, for instance, to challenge congressional Democrats and win back the House in a wave election that year. Obama later used Republican proposals to change Medicare from a guaranteed benefit structure into an insurance voucher system against Romney and his running mate — defined contribution champion Rep. Paul Ryan (R, Wis.) — in the 2012 campaign.

Despite the heavy reliance on Medicare advertising, Democrats have not had success winning the senior demographic since the 1970s, Obama administration officials said during a Harvard University Institute of Politics forum on Nov. 29, 2012. However, messages about Medicare's future resonate among younger members of the middle class who will rely on the program once they retire.

Advertising becomes less effective the deeper you get into a race, waning after the political conventions and having diminishing returns from there, said David Axelrod, a top official in the Obama campaign. That's why the president front-loaded his advertising from May through August.

Still, Obama spent heavily on ads in key swing states during October and the beginning of November, many going negative on the Medicare issue, on his way to winning re-election.

“My regrets are what we collectively did to the poor people of Ohio,” quipped Obama adviser Jim Margolis.

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