Back in 1993, when Bill Clinton introduced his ambitious healthcare reform plan, one factor in its defeat was the ubiquitous TV campaign "Harry and Louise". It featured a white, middle-class couple, who were against reform, complaining about the bureaucratic nature of the plan and urging viewers to contact their representatives in Congress.
The series of 14 ads was funded by a group of insurance companies worried that they would be cut out of the market by larger rivals. It worked. The Clinton Health Care Plan never saw the light of day.
Well, guess what? Fourteen years later, with a new healthcare plan on the table, Harry and Louise, a tad greyer around the temples, are back, and this time they are actually pro-reform. In July, the couple appeared in a new TV commercial.
"It sounds simple enough," Harry tells Louise, drinking coffee at a kitchen table, just as they did in the earlier ads.
"A little more co-operation, a little less politics and we can get the job done this time," Louise says.
They go on to discuss a need for affordable health coverage that people can keep if they change or lose their jobs. They don't mention some of the divisive issues such as a government-run insurance plan, or how to pay for it.
The campaign is sponsored by Americans for Stable Quality Care, a group consisting of a number of pro-reform bodies, including the American Medical Association, Families USA, the industry lobby group the Pharmaceutical Research and Manufacturers of America and Service Employees International Union. Together, they are spending some $150 million to convince Americans of the need for reform.
Confused? Join the club. It's just one of the hundreds of disparate ad campaigns hitting the US airwaves in an attempt to persuade somebody, somewhere, of something.
It represents just one of the circuitous twists and turns on the labyrinthine road to President Obama's ultimate goal of affordable, universal healthcare. The stakes are high, and ads, along with more grassroots methods, are the chosen tactics being used in order to get across often complicated arguments and points. More than $60 million has been spent on TV ads in just the past few months, according to the Campaign Media Analysis Group, which tracks the spots.
The ads range from the macro to the micro, and are often aimed at tiny demographic slices of public opinion. As they attempt to sway public opinion, nothing and no-one is off limits, including taking swipes at the British NHS.
According to Ben Goddard, of the cause marketing company Goddard Claussen, which is behind the "Harry and Louise" ads: "Back in 93, people didn't want to hear about this issue from so-called experts and policy wonks. They wanted to hear from people like themselves, and Harry and Louise were an approachable couple that people could identify with."
The reason they returned, Goddard says, is that groups who now support reform thought that the media would pay attention to them. He was right: "We've got a clip reel of about 100 TV stories and 100 newspaper articles."
Goddard sees no apparent conflict of interest in the two opposing Harry and Louise stances. "There is a significant difference between this time and previous efforts," he says. "This time you have PhRMA, SEIU, which is one of the largest labour unions in the country, and the Washington-based healthcare advocacy group Families USA. All these people were fighting each other 15 years ago. Now they've joined together to try to get some sort of reasonable reform passed."
The purpose of the buy, Goddard explains, "was to make the point to members of Congress that the American people want healthcare reform. They didn't want the partisan bickering." The ad ran for the three weeks before the Congressional recess. Did it have the desired effect? "It certainly did on Capitol Hill; the buy was not heavy enough to have a significant impact with the general public," he says. "But among folks who watch Fox News, it had a lot of impact. It also ran on national cable and on broadcast TV in Washington, DC, so we were speaking primarily to members of Congress and US senators."
He continues: "When we did the first campaign in 1993/94, there had never been a national advertising communications campaign on a public policy issue, so we had the field to ourselves. Now you have half-a-dozen groups on either side, and some who are in the middle."
Goddard says no decision will be made on whether to continue the campaign until Congress is back after Labor Day next Monday.
Counteracting such pro-reform tactics are the anti-reformists, led by the Republican National Committee. One Republican ad, for example, mocks healthcare reform by mimicking the imagery found in most pharmaceutical ads - couples frolicking on the beach, soft music in the background. Called "Reforma", the narrator says: "Not recommended if you like your own doctor, want to keep your own doctor or want to avoid the government prescribing your medical treatments."
Special interest groups have also joined in, including the US Chamber of Commerce, representing individual businesses. According to its spokesman, Blair Latoff, the Chamber's approach is bi-partisan.
"While we are pro-health reform, we are anti a government-run healthcare system and want to keep the existing employee-run healthcare," she says.
The Chamber first launched a campaign in July, initially in five states, and then expanded it to states where senators have expressed concern with the existing proposals. It uses a variety of methods to get its message out including direct mail, and TV and print ads targeting specific states.
One TV ad called "red balloon", shows the US economy as a red balloon that gets bigger and bigger as more issues are added to it until it finally bursts. Print ads urge Congress not to tax small businesses with additional healthcare taxes.
Then there's the obscure Club for Growth, which is anti any kind of government-run healthcare. The Washington-based Republican group is spending $1.2 million on four ads.
One, running in Colorado, Arkansas and North Dakota, compares the Obama plan to government-run healthcare in the UK and cites what it argues is the failure of Britain's socialised healthcare to cover life-saving medical treatments.
But none of this is likely to result in a bonanza for the US ad industry, largely because of the spot nature of the buys and the limited budgets of many groups. What's more, only selective states are benefiting. And so far, most ads have been created either by cause marketing agencies such as Goddard Claussen or GMMB - which was responsible for the acclaimed "Obama for change" marketing campaign - or else they're done in-house.
Traditional ad agencies are unlikely to get involved because declaring partisanship would result in a possible client or shareholder backlash. And unlike in political elections, few individual admen have yet emerged on either side of the debate.
Meanwhile, the spending goes on. Though exactly how much will eventually be spent before the issue is resolved is anybody's guess.