"Greed is good."
-- Gordon Gekko
Lobbyists That the Founders Just Never Dreamed of
The "right ... to petition the government" has come a long way in over
200 years, and health care organizations are not shy in exercising it.
By Maureen Glabman
"Those who are organized, have the most money, the most influence, the
most mobilized member****ps are the ones whose viewpoints are being
most heard."
=97 Charles Lewis
Founder, Executive Director, Center for Public Integrity,
in a speech to the National Press Club, 1994
Cynthia Berry rises at 6 a.m. to dress for the $500-a-plate
fundraising breakfast she arranged for Arizona Sen. Jon Kyl at La
Colline, a French restaurant near Capitol Hill. By 9:30 a.m., the
health care lobbyist and lawyer is back in her Wa****ngton office at
Wexler & Walker Public Policy Associates, returning calls and e-mail
messages and arranging educational briefings for congressmen and staff
members.
A medical client is in town, so she dashes out to Capitol Hill,
darting from office to office to introduce the client and to talk
about the client's issues.
At 4 p.m., Berry, former Wa****ngton counsel to the AMA, has arranged
for Erik Lindbergh, grandson of Charles, to talk to congressmen and
staff members in a briefing room about early diagnosis and treatment
of rheumatoid arthritis.
At dinner, she reconvenes with her morning client to *****s how the
meetings went and to discuss follow-up.
Such is a day in the life of one of 17,800 registered Wa****ngton
lobbyists upon whom interest groups spent $1.56 billion last year to
sway Congress and the executive branch =97 numbers that are grossly
understated due to the narrow definition of "registered lobbyist,"
says Jeffrey Birnbaum, author of The Lobbyists: How Influence Peddlers
Get Their Way in Wa****ngton.
An estimated 40 percent of those 17,800 lobbyists promote health care
agendas, according to James Albertine, president of the Alexandria,
Va.-based American League of Lobbyists. To put it another way, there
are 13 health care lobbyists for each of the 535 members of Congress.
Among their most passionate causes this year are Medicare
reimbursements and tort reform.
Health care agendas
Hundreds of medical groups have a lobbying presence in Wa****ngton. The
AMA =97 the third-largest lobbying group (based on expenditures) =97 spent
about $17 million in 2000, the latest year for which figures are
available.
On the other hand, there's the American Association for Cardiovascular
and Pulmonary Rehabilitation, which spent less than $10,000.
Collectively, health care groups spent $209 million in 2000 to gain
passage of bills that benefit their members or to sideline legislation
that might harm them. That places health care interests third in
lobbying expenditures, behind power brokers for finance, insurance,
and real estate, who spent $229 million, and manufacturers and
retailers, who invested $224 million in their work.
In Wa****ngton, a vote in Congress, a presidential directive, or new
regulation can positively or adversely affect the pocketbook of an
entire industry.
For example, in 2000, just before he left office, President Clinton
issued an executive order mandating, among other things, that doctors
and hospitals that receive federal Medicare and Medicaid funding make
translators available to patients who do not speak English.
One result of that: Physicians whose practices depend on federal
reimbursement will have to endure huge expenses, or "sick taxes," to
learn the languages of the communities in which they practice, or else
hire translators or multilingual staff. The alternative is to refuse
to accept Medicare and Medicaid patients. The AMA and the medical
societies of all 50 states lobbied =97 to no avail =97 to force the
federal government to find the cash somewhere other than physicians'
pockets.
Despite this failure, the AMA has chalked up at least one sick-tax
victory. The association averted a proposed $1-per-claim surcharge on
Medicare claims that are not sent electronically. "Our most im****tant
role is to prevent things from happening to doctors," says Timothy
Flaherty, MD, who chairs the AMA board of trustees.
In 1994, when the not-for-profit, nonpartisan Wa****ngton-based Center
for Public Integrity tracked them, there were at least 660 medical
organizations lobbying Congress. Besides the AMA, some of the
physician groups include the American College of Physicians-American
Society of Internal Medicine, which spent $2.1 million in 2000; the
American Academy of Family Physicians, which spent $1.6 million; and
the American College of Obstetricians and Gynecologists, which funded
$450,000 in lobbyist activity, according to the Wa****ngton-based
Center for Responsive Politics (CRP), an organization that tracks such
expenditures.
"A number of interests compete against doctors in Wa****ngton. Without
the lobbyists, doctors and their patients would not have the same
rights," says Christian Shalgian, senior government affairs associate
at the American College of Surgeons in Wa****ngton.
Big spending
Nonphysician health groups with sometimes similar interests are the
American Hospital Association, the sixth-largest spender in 2000 at
$12 million; Blue Cross, the 18th largest at $8 million; and the
American Association of Health Plans, whose $4 million made it the
67th-largest spender. The re****ted numbers account only for what
lobbyists spend on Congress and the executive branch, says Therese
Foote, a CRP researcher. They do not include advertising, PR, state
lobbying, or grass-roots efforts.
Member dues, some of which sup****t lobbying, can add up to hundreds =97
or hundreds of thousands =97 of dollars annually per member. Member****p
is $420 for the AMA, up to $25,000 for the AHA, and from $2,500 to
several hundred thousand dollars for the AAHP.
What are these lobbyists fighting for? Tort reform has been on the
AMA's list for years, but it may never have bee/n so high as it is
this year. Malpractice premiums have shot up at least 30 percent in
eight states, including Texas and Illinois, according to the
association's analysis of state insurance department and insurer
records.
The association wants Congress to pass legislation that would put a
$250,000 cap on noneconomic damages (pain and suffering), often seen
as the key to holding down malpractice premiums. The thrust is similar
to California's 1975 MICRA (Medical Injury Compensation Reform Act)
legislation. Many other groups consider the cap a top priority too,
including the American Association of Obstetricians and Gynecologists,
the American Hospital Association, and the American Association of
Health Plans.
On this issue, state medical groups and hospital associations are also
putting some lobbying clout to work on Capitol Hill. Then there are
the many coalitions, such as the Health Care Liability Alliance and
the American Tort Reform Association =97 organizations that push
professional liability insurance limits.
With the tremendous financial resources of these groups, why hasn't
Congress passed a tort reform bill? Indeed, between 1995=962001, a tort
reform measure that included a $250,000 cap on noneconomic damages
passed in the House alone six times. Only once has a similar bill, one
with a $500,000 cap, reached the Senate floor; it was defeated 56=9644
in 1995.
Cont'd
http://www.managedcaremag.com/archives/0208/0208.lobbying.html
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