the public's fear about Republican plans for Medicare, just as Republicans were successful during 1993-94 in raising the public's fear about the changes in the U.S. health care system implied in the Health Security Act. The Republican proposal on Medicare and Medicaid ultimately failed. Throughout 1996, President Clinton enjoyed a job approval rating that ranged from 52 to 60 percent (see Table 6.4). President Clinton, portraying himself as a champion of the elderly standing-up against the Republican- controlled Congress, was easily able to win reelection in 1996 against the Republican challenger, Bob Dole.
This chapter has examined the role of the mass media in the policy process with specific reference to the health care reform periods of 1993-94 and 1995-96. The mass media, wittingly or unwittingly, have become major players in the policy process. The result has been more scrutiny and critical analysis of the mass media for the role they play in our political and policy processes.
The scholarly literature suggests that the mass media agenda, that is, what is considered news and how it is presented, is influenced by a variety of factors that include access to news, cost, time, space, preference for visual events, and a tendency to emphasize conflicts over agreement, among others. The bias present in the news includes a tendency on the part of reporters to give preference to individual actors and human-interest angles without providing the context, the tendency to dramatize news by emphasizing crisis over continuity, image over substance, presenting isolated stories without any continuity, and providing normalized news. The literature also suggests that the mass media agenda in turn influences the public agenda, that is, what the public perceives or views as important issues at a given point in time. The mass media play the role of "gatekeeper" by controlling the public's access to news and the type of information it receives.
Our analysis of the role of the mass media in the health care reform debates in 1993-94 and 1995-96 suggests that the media indeed played a significant role in shaping and influencing the nature of the debate. Nevertheless, a great deal of the role played by the mass media was of a negative variety, and the media must be given a low grade for their performance. As our analysis has demonstrated, the mass media's agenda was influenced by access, cost, time, and space. While in general the mass media dedicated extensive coverage to health care stories, the stories were fragmented, normalized, personalized, and dramatized, emphasizing the politics of health care reform, rather than offering an explanation and analysis of the prob-