Lobbyists want to limit federal intervention in health care

Business & Health, Sept 15, 1992 by Joyce Frieden

Interest groups and their lobbyists are hard at work in Washington. Most want to prevent Congress from adopting a single-payer system.

Lobbyists have been blamed for slowing the health care reform movement by stalling every proposal in the halls of Congress. But they also have helped keep government intervention in health care to a minimum.

For physicians, insurers, and hospitals, a move to any sort of government-run national health insurance system could mean a loss of revenue. Groups that represent their interests argue also that such a change would be detrimental to the health of Americans and would lead to rationing of care and a slowing in the development of new drugs and medical technology.

Almost every group concerned about health care has a proposal to reform the system. Some favor wholesale changes; others prefer limited reform. And many find that making contributions through political action committees enables them to air their views.

Many of these groups have vigorously opposed single-payer national health care proposals introduced in Congress by Rep. Marty Russo (D-I11.) and Democratic Sens. Howard Metzenbaum of Ohio, Paul Wellstone of Minnesota, and Paul Simon of Illinois. The opposition comes in the form of testimony at Senate and House hearings, as well as studies showing how much money a singlepayer plan would cost. For instance, the Health Insurance Association of America, a Washington lobbying group representing the 290 commercial insurers, has published a book titled Canadian Health Care: The Implications of Public Health Insurance. It notes that at most, a Canadian-style single-payer insurance system would increase taxes by $252 billion.

Wielding influence

Lobbyists use a variety of methods to influence members of Congress, including making campaign contributions, proposing legislation, educating the members, and organizing support for or against particular proposals. Most health care lobbying groups do play the money game, contributing large sums to congressional candidates and incumbents. (See "Top medical industry PAC contributions to Congressional candidates," page 47.)

The largest health care political action committee contributor, according to a recent report by Common Cause, a lobbying organization in Washington that favors campaign finance reform, is the American Medical Association. During the period beginning Jan. 1, 1981, and ending June 30, 1991, the AMA contributed $11.94 million to congressional candidates. The National Association of Life Underwriters, a lobbying group in Washington that represents 500 life insurers, is the second largest contributor with $5.56 million, followed by the American Dental Association, a lobbying group based in Chicago representing 140,000 dentists, with $4.03 million. But although many groups make such contributions, their opinions on the purpose of the financial donations are mixed.

The AMA says such contributions are a way of life on Capitol Hill. Raymond Scalettar, M.D., an internist in Rockville, Md., and chair of the AMA's board of trustees, says contributions "allow the medical profession, real estate people, labor unions, and others to get their point of view across."

At the AFL-CIO, a candidate's standing on health care is only one of several issues the AFL-CIO considers when it decides which politician to contribute to, says Calvin Johnson, the organization's legislative representative. The AFL-CIO supports a single-payer solution.

Johnson says contributions are an expression of gratitude rather than a means for influence. "We have less of an access concern, because we're already visible. I don't think I've ever been turned down when I asked for a meeting to explain what our position is on an issue, even by people we haven't contributed to."

Gordon Wheeler, director of federal affairs at the Health Insurance Association of America, agrees. "We're not under any illusion that these contributions are buying votes, and I don't know that it makes it easier to get in to see them. But we are interested, as a political action committee, in seeing certain members of Congress either gain election or retain a seat, especially when they tend to share many common ideals with us, such as a market-based solution to health care reform as opposed to a government-based solution. It's not a partisan PAC, but more of a philosophical orientation."

The National Association of Manufacturers, Washington, doesn't have a PAC. "We don't support one candidate over another,'' says Sharon Canner, assistant vice president of industrial relations at NAM and its only health care lobbyist. "Our attitude is, 'We're not here to buy your vote; we're here to tell you what our members think.'" The size of the group guarantees an audience with congressional members and their staffs, she adds. Of course, the 12,000 individual members of NAM may make their own contributions.

Some groups find it easier to lobby Congress if they have their own reform plan to propose. The American Medical Association, for example, which is based in Chicago and has 297,000 member physicians, is one of the largest health care lobbying groups, with seven lobbyists devoted to Congressional affairs, four devoted to federal affairs (White House and federal agencies), and four people devoted to "issues management," doing research on areas of interest and helping develop legislation.