The Fourth Branch of Government: The Role of Interest Groups, the Media, and Political Advertisements in Contemporary Health Policy Debates

Abstract

The first part of this dissertation explores whether interest group-sponsored political advertising campaigns influence how journalists frame health policy debates. The paper employs propensity score matching techniques, media content analysis and a modified version of the Herfindahl-Hirschman Index to discern whether a prodigious and concentrated advertising campaign that aired during the health care reform debate under President Obama influenced newspaper coverage of the Affordable Care Act in markets that were exposed to the advertisements. The second part of the dissertation investigates public attitudes toward the various groups in the health care industry. It leverages data from an extensive public opinion survey conducted during the health care reform debate under President Obama, and employs survey weighted ordinal logistic regression models to understand public trust and confidence in a broad spectrum of interest groups, ranging from the American Medical Association to Blue Cross/Blue Shield to the U.S. Chamber of Commerce. The findings are particularly important and timely as the implementation battles surrounding the Affordable Care Act begin because citizens frequently take cues from interest group leaders to make sense of the political world, and public opinion frequently depends on how elites frame a particular issue. The final portion of the dissertation compares and evaluates several competing policy options designed to promote viewpoint diversity in extant policy debates. Several evaluative criteria are developed and applied to existing regulatory approaches to improving viewpoint diversity, and a novel approach is offered to better serve this ideal. Specifically, I propose a "marketplace of ideas tax" that would be levied on all political advertisements to endow a "marketplace of ideas trust fund," which would then be used to subsidize speech from underrepresented viewpoints. This approach leverages insights garnered from models of political learning and social science research concerning the role of political advertisements in contemporary health policy debates.