During the campaign, Barack Obama promised his cheering crowds that, when he rolled up his sleeves to work on health care, he would “have insurance company representatives and drug company representatives at the table. They just won’t be able to buy every chair.” Now is a good time to look at just what kind of seats special interest groups will have at Obama’s table, and what they’re doing to bring the public around to their ways of thinking. This is the fourth of an occasional series of posts that will analyze their activities and how the media are covering them. The entire series is archived here.

The last graph of a relatively recent New York Times story hinted at the politics of health reform. The story, a rather routine piece about a Congressional Budget Office report, described the potential savings from various cost containment nostrums. At the end of its story, the Times revealed what’s at stake. Medicare is scheduled to cut doctors’ fees by 21 percent in 2010 and by 5 percent in each of the next few years. If those cuts materialize, the government would save $318 billion over the next decade, far more than would be saved by other remedies.

In a presentation to Congress, acting CBO director Robert Sunshine amplified this point: “Significantly reducing the level of growth of health care spending would require substantial changes in the incentives faced by doctors and hospitals to control costs,” he said. Translation: to really reduce medical spending, doctors and hospitals might face cost controls that could lower their incomes. The American Medical Association successfully fought this possibility every time health reform rose on the national agenda, and it’s a good bet they will fight again, while angling for a prominent place at Obama’s table.

In the current round of reform mania, the media have hardly discussed the role of doctors and other health professionals. For starters, they have given gobs of money to Obama and to those legislators who will be gatekeepers for reform. According to Opensecrets.org, the Web site of the nonpartisan Center for Responsive Politics, health care professionals—including doctors with lucrative specialty practices as well as dentists and nurses—rank sixth out of eighty-some industries in campaign donations this year, spending nearly $87 million on various candidates, with more than $10 million going to Obama. Senate recipients include influential Republicans John Cornyn and Mitch McConnell, who got about half a million dollars each, and Senate Finance Chairman Max Baucus, who got almost $360,000. That’s not chump change.

In the House, key players Pete Stark, John Dingell, and Frank Pallone each received more than $250,000. Opensecrets.org shows that the doctors’ primary lobbying organization, the American Medical Association, has spent freely on lobbying as well as donations. Out of various powerful interest groups, the AMA ranks second over the last ten years in the amount it has spent to influence Congress. Its $195 million is a little less than half of what the top-ranked U.S. Chamber of Commerce spent on lobbying.

Money isn’t the only thing the press should examine. Like its insurance industry brethren, who have tried to make themselves look conciliatory and helpful this year by crafting their own health proposal, the AMA is also professing its concern for the uninsured, even calling itself the “Voice for the Uninsured.” “Being uninsured isn’t just a statistic or a problem—it’s a tragedy,” says the AMA Web site, going on to promote the AMA’s remedies, which the association calls “common-sense solutions designed to empower American families.” Its proposals, called the “three pillars of reform”:

Provide all Americans with the means to purchase health care coverage.

Give families choice in selecting appropriate coverage.


Promote market reforms that enable this new approach.

While the Web site says the AMA’s work on cost containment is “ongoing,” it lays out some broad strategies, such as reducing preventable disease, making health care delivery more efficient, and promoting value-based decision making at all levels—whatever that means. There’s not much here that would keep a well-heeled radiologist from sleeping at night. The AMA’s “pillars of reform,” however, probably sound reasonable to ordinary patients whom the AMA is enlisting to bolster its underlying agenda—stopping any proposal that would threaten doctors’ incomes.

Through its Patient Action Network, the AMA is looking for willing patients to receive “important updates on issues” that will affect their access to quality health care. The AMA says it will notify them when they can make a critical difference in legislative outcomes. Sounds to me like they’re ginning up a letter-writing machine and building a stable of “fly-ins”—people who can come to Washington and make their concerns known, an tactic used effectively by the insurance industry.

How is a poor soul in Congress to know which of these “grassroots ambassadors” have been coached by advocacy groups, and which are honest-to-goodness representatives of the public? How are reporters to know before they interview them for their stories? A member of Congress may throw up his or her hands and listen to the group that gave the most money. Reporters can’t do that. Their work requires some hard digging before they pass along quotes from fake agents of the grassroots.

Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.