The phrase “government takeover” is one that has tested extremely well over the years and has been central to every campaign the industry has conducted in recent decades to defeat reform efforts, including the Clinton proposal in 1994. The industry has paid McInturff and other consultants and pollsters millions of dollars to craft and test such phrases in focus groups and surveys. Knowing from that research that many Americans react negatively to more government involvement in their lives, particularly if it involves higher taxes, AHIP ensured that a warning against a government takeover was included in the briefing packets for lawmakers in Washington, the industry’s business allies, and conservative pundits, talk show hosts, and editorial writers.
Two weeks after the Philadelphia meeting, I was on a cross-country reconnaissance mission of my own. Although the AHIP staffer who saw the movie in Cannes provided a pretty good report, he did not give many details about how CIGNA was portrayed in the film.
After hearing that the first public screening of the movie would be held in Sacramento on June 12, I asked the head of our state government affairs unit if she could finagle a ticket for me. I wanted to be as prepared as possible to answer questions from the media when they began to flood in. The best way to do that would be to see the movie myself. Terry McGann, CIGNA’s longtime lobbyist in Sacramento, was able to score a couple of tickets for a colleague and me from California State Assembly speaker Fabian Núñez, a Democrat from Los Angeles.
The screening was an unofficial premiere. The official premiere would be held four days later in the Michigan town of Bellaire, which is near where Moore and his wife live. Moore had been persuaded by the California Nurses Association and Physicians for a National Health Program—both advocates of a single-payer health care system in the United States—to show the movie in Sacramento first because California lawmakers had twice approved bills creating a single-payer system in the state. Had Governor Arnold Schwarzenegger not vetoed both bills, California would have been the first state in the nation to ban private insurance companies and operate its own government-run health care system, like many of those depicted in Sicko.
After picking up our tickets in McGann’s office, my colleague and I walked to the theater, trying to blend in with the thousands of politicians, state government employees, doctors, and nurses who were already in line to see the movie. Once inside, we went to the very back row and took out our pens and notebooks, ready to capture the details of the stories told in the movie by people who claimed that CIGNA had refused to pay for care their doctors had said they needed.
It seemed as if there were more stories about CIGNA than about any other company, although I didn’t pay as much attention to how badly Moore treated our competitors. Probably one of the most memorable vignettes in the whole movie was about a hearing-impaired little girl, Annette Noe, whose doctors said she needed cochlear implants in both of her ears. CIGNA initially paid for only one, saying that implantation in both ears would be “too experimental.” The girl’s father, Doug Noe, was one of twenty-five thousand people who had responded to Moore’s call for health insurance horror stories. Undoubtedly, one of the reasons Annette’s story made it into the movie is that her father told the CIGNA representative he had been dealing with that he had been in touch with Moore.
“Has your CEO ever been in a movie?” Noe asked the CIGNA guy.
The next scene showed CIGNA’s fifty-eight-story glass-sheathed headquarters in Philadelphia, where I worked. What viewers heard next was the CIGNA representative calling back and leaving good news on the Noes’ answering machine. CIGNA would pay for both implants after all.
I cringed when I heard that, but I wasn’t surprised. The squeaky wheel gets the grease in the managed care world. That wasn’t the first time CIGNA had delivered good news after a member had complained to the media about a denial. It would not be the last, either.
But the movie had an effect on me that I didn’t expect. Because of all the experience I’d had handling “horror stories” like the ones depicted, I knew that they were a common occurrence—that many Americans found themselves in similar situations every day. I also found the film very moving and very effective in its condemnation of the practices of private health insurance companies. There were many times when I had to fight to hold back tears. Moore had gotten it right. If I hadn’t been with a colleague, I probably would have joined all the others in the audience in giving the movie a standing ovation, just as the people at Cannes did when it was first screened.
The next day, the front group that APCO had set up to discredit Sicko issued a statement warning against “a government takeover” of health care:
“Health Care America, a non-partisan, non-profit health care advocacy organization, released the following statement in response to a California rally held by Michael Moore and a variety of advocates in support of a government takeover of our health care system.
“The reality is that government-run health systems around the world are failing patients—forcing them to forgo treatments or seek out-of-pocket care in other countries.”
Bill Pierce was listed as the contact person for Health Care America, but if you had dialed the phone number listed for him at the organization, you would have reached him at his desk at APCO in Washington.
A week later, Moore held another screening, this one in Washington. He invited members of Congress, but few showed up. He also invited the heads of the big health care trade associations. None of them attended.
The industry, however, was prepared for the event. An ad targeting the movie appeared in Washington’s newspapers. The message: “In America, you wait in line to see a movie. In government-run health care systems, you wait to see a doctor.” The sponsor: Health Care America.
For several weeks after that screening, APCO sent me and other PR chiefs daily reports of the stories it had placed in the media via Health Care America as well as the commentaries and op-eds APCO’s recruits had had published in newspapers and other media outlets from coast to coast.
The campaign cost hundreds of thousands of dollars, all of which came from premiums paid by health-plan members, but industry executives felt this was a good and appropriate use of those premium dollars. Though Sicko grossed nearly $25 million at the box office in the United States, that figure wasn’t even in the same ballpark as the $120 million that Moore’s Fahrenheit 9/11 had made on U.S. screens just three years earlier. We believed the industry’s behind-the-scenes campaign against the movie might have had something to do with the comparatively small box office numbers. We were pleased that AHIP and APCO had succeeded in getting their talking points into most of the stories that appeared about the movie, and that not a single reporter had done enough investigative work to find out that insurers had provided the lion’s share of funding to set up Health Care America.
We were also relieved that centrist Democrats had not embraced Sicko. All in all, the movie, in our view, had not succeeded in altering the “collective opinion.” Spending the extra money to push Moore off the cliff had not been necessary.
More important, we considered the campaign against Sicko to be a warm-up act to the health care reform debate that all of us knew would begin in Congress soon after the next president took office. And most of us still believed that person would be the industry’s former nemesis, Hillary Clinton.
C H A P T E R I I I
Perception Is Reality
BEFORE I take you with me on my unexpectedly life-changing trip to Tennessee and describe the last horror story I ever worked on for CIGNA, I should explain how public relations evolved into such a powerful yet largely invisible force in our society. I also want to give you an idea of what I actually did on a day-to-day basis as head of PR at one of the country’s biggest insurers.
To understand why you believe some of the things you believe and do some of the things you do, it’s important for you to understand what PR people do and how they do it.
It’s actually nothing new. Human beings hav
e distorted information for as long as they’ve communicated—with gestures, sounds, nuanced words, or whatever it takes to bring other people around. Whether it’s as brazen as a pyramid or as subtle as a white lie, this art form—often called spin—has become as much a part of our culture as the media we depend upon to connect and inform us.
The “spin doctors” who shape much of what we see and read today are often shadowy figures in the multi-billion-dollar industry we call “public relations.” The most successful of them hobnob with royalty and presidents, CEOs and movie stars. They are experts in every medium, and they use their considerable resources to build and maintain strong, positive images for their clients. They cultivate contacts and relationships among journalists and other media gatekeepers. They walk a fine line between contributing to the so-called marketplace of ideas and warping public understanding to their clients’ ends. Oftentimes, this line is so creatively blurred as to disappear.
What exactly is PR? What are the boundaries, the restrictions, the rules? The first question is easier to answer. Cutlip & Center’s Effective Public Relations, the encyclopedia, if not the bible, of the industry, defines PR as “the management function that establishes and maintains mutually beneficial relationships between an organization and the publics on whom its success or failure depends.”1 That definition emphasizes the two-way nature of PR, as opposed to the one-way communication that characterizes propaganda or advertising.
The Public Relations Society of America describes what PR does rather than what it is: “Public relations helps an organization and its publics adapt mutually to each other.”2 Again, an emphasis on two-way exchange, although PRSA’s highest organizational award is the Silver Anvil, “symbolizing the forging of public opinion.” Either way, PR is the middleman, whose loyalty to the client often supersedes everything else.
To be sure, PR has been—and is being—used to good ends. Even the noblest of causes can benefit from the services of a communications expert to clarify facts, disseminate information, and counter unfair arguments. And there are plenty of ethical PR people out there to do this.
But with PR so intricately woven into every major industry and movement in today’s mass media reality, the stakes of spin have become incredibly high. And ethics do slip. PR often crosses the line into misleading, withholding, or simply lying. And when it does, society suffers—sometimes tragically so.
THE BEGINNING OF SPINNING
In what may be the first recorded discourse on public relations, Aristotle spoke of “rhetoric” in ancient Athens and urged that everyone be taught how to use it in order to tell truth from lies. His insight remained relevant over the millennia as the methods for distorting information evolved everywhere in the world. For example, in eighteenth-century Russia, Grigory Potemkin went to extremes on behalf of his empress (and supposed lover), Catherine the Great. A field marshal and adviser to Catherine, Potemkin made sure foreign leaders were impressed when they visited Russia by having artificial villages built throughout the countryside to create the impression of growth and prosperity. In so doing, he unwittingly ensured that his name would live throughout the ages—the term “Potemkin village” is still used to describe things that falsely imply substance.
Gossip, innuendo, and deception were common in publications and politics in the earliest years of the United States. Businesses manipulated the new nation’s mass media as early as the 1830s, when the New York Sun, one of the early penny presses, offered to publish free “puff” stories (promotional material presented as regular news) for its advertisers. In the same period, American showman P. T. Barnum regularly pushed the limits of spin to a point that seems shocking even today. Barnum had no qualms about inventing outrageous claims and carrying them as far as possible by way of promoting his business or himself. In 1836, he “bought” an elderly woman—a slave named Joice Heth—and claimed she was the 161-year-old nursemaid to George Washington. When she died and doctors estimated her age to be only 80, Barnum said he was “shocked, deeply shocked” at the deception visited upon him.3
While Barnum was exceptional as his own promoter, it was publicists and press agents who handled most of the functions that would come to be grouped under the banner of PR, which emerged as a defined, distinctly American profession in the early twentieth century.
As I noted earlier, one of the first and most notable public relations men was Ivy Lee, who is credited with developing the concept of “crisis management,” the organized, orchestrated communications response to a negative event—one of the basic practices of today’s PR. Lee, born in 1877 to a Methodist minister, graduated from Princeton and worked as a reporter for several newspapers, including the New York Times, before cofounding the Parker & Lee agency in New York.
While working for a group of coal mine operators in 1906, Lee seized an opportunity to define his agency’s role and increase his credibility. Going against the prevalent Wall Street attitude that “the public be damned,” Lee issued his famous “Declaration of Principles,” emphasizing the public’s need for accurate information. The statement (now part and parcel of most modern public relations textbooks) proved to be a milestone in establishing the new field of PR—separating it from the old image of publicity pushers, who by then were considered little more than hucksters and snake oil salesmen.4 The declaration, which Lee sent to newspapers, read in part, “This is not a secret press bureau. All our work is done in the open. We aim to supply news … In brief, our plan is, frankly, and openly, on behalf of business concerns and public institutions, to supply to the press and public of the United States prompt and accurate information concerning subjects which it is of value and interest to the public to know about.”
Lee’s approach made it “easy” for reporters to cover a coal miners’ strike against his clients. Rather than dodge their questions, Lee issued handouts, which came to be known as press releases, during each strike—and reporters responded by using them to create positive coverage about the mining companies. As his reputation grew, Lee attracted new clients, including John D. Rockefeller Jr., who hired him as an adviser in 1914.
Rockefeller was being vilified for the strike-breaking tactics of his Colorado Fuel and Iron Company against miners in Colorado. People were using terms like “Ludlow Massacre” and “Bloody Ludlow” to describe a company-sponsored offensive against strikers that killed not only miners but also women and children. Lee’s first assignment was to diffuse public outrage. Among other things, he reduced public opposition by producing pro-company bulletins with titles like “The Struggle in Colorado for Industrial Freedom.” Concurrently, Lee reportedly advised Rockefeller to improve his personal image by carrying dimes in his pockets and giving them to children in public.
Lee worked for Rockefeller again years later, this time in the wake of full-blown battles against striking coal miners in West Virginia. After seventy miners were killed, Lee turned once more to publishing bulletins that portrayed his client in a positive light. They emphasized the charitable work of mine owners and claimed that company stores—the only places where miners were able to spend the scrip they received as wages—were in business not to force miners to return their earnings to the company, but to help protect the hapless miners’ assets.
The approach worked. Public opinion softened, and by the time of his death, Rockefeller was remembered mostly as a generous philanthropist.
While Lee is considered by many to be the father of modern public relations, a contemporary of his, the flamboyant Edward Bernays, engineered some of the most far-reaching, successful, and outlandish PR campaigns in history. He was derided by many of his colleagues for his brazen tactics and tireless self-promotion, but there is no doubt he was proud of his work. Bernays kept almost all of the notes and documents that crossed his desk during a career that spanned eighty years, and he left more than eight hundred boxes of them to the Library of Congress, with the stipulation that they be made public only after his death.5
Bernays was said to thin
k of himself as a “unique counselor” to organizations, someone who melded the influence of the media with the science of psychology. He is generally credited with coining the term “public relations counselor,” which he used in his 1923 book, Crystallizing Public Opinion, the first book devoted to PR. He also taught the first class on public relations, at New York University in 1923. Bernays’s skill with the media was the result of dogged work and innate talent, but his bent toward psychology was grounded in family—he was a nephew of Sigmund Freud, with whom he had a close relationship.
Bernays was sophisticated and, like Lee, well educated. He was born in Vienna in 1891 but grew up in New York City. His first job after graduating from Cornell was as a writer and editor for a medical journal. From there, he ventured to Broadway, where he was a press agent for a variety of productions and celebrities, including Russian ballet dancer Vaslav Nijinsky and Italian tenor Enrico Caruso.
The Roaring Twenties brought profitability to a large number of new or revitalized industries, including one that became a mainstay for Bernays: tobacco. The American Tobacco Company, manufacturer of Lucky Strike, the United States’ fastest-growing cigarette brand, was one of his biggest clients. Bernays said later that the head of American Tobacco, George Washington Hill, was determined to expand his company by tapping the potential of the women’s market. The percentage of women smokers had been rising since the Great War, but Hill wanted to pick up the pace. According to Bernays, it was Hill’s idea to tout cigarettes as a low-calorie alternative to sweets.
Bernays orchestrated a campaign that equated cigarettes with slenderness, grace, and beauty. He enlisted third-party “experts” to warn against the adverse effects of desserts, in terms of both weight gain and tooth decay, and to declare that cigarettes were a great alternative and could do everything from clean your teeth to make you a better dancer. Bernays’s staff even distributed menus that substituted cigarettes for desserts. Despite some backlash against Bernays and American Tobacco, Hill wrote to Bernays in December 1928 that the company’s revenue was up by thirty-two million dollars that year and that sales of Lucky Strikes had increased more than those of all other brands combined.
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