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 are having at Obama’s table and what they’re doing to bring the public around to their ways of thinking. This is the ninth of an occasional series of posts that will analyze their activities and how the media are covering them. The entire series is archived here.
Advocates fixated on a public option health plan as a step toward national health insurance have spent months casting the insurance companies as bad guys—fat cats who make too much profit, choke the current health care system, and shower legislators with big bucks for their campaign chests. Most stories emphasize that insurers are fighting such a plan because it could put them out of business by offering lower premiums, controlling costs, and being more efficient. For awhile, I was beginning to think that other stakeholders—who oppose a public plan just as fiercely—were getting a free pass.
There has been no media scorn for the doctors or the hospitals or the drug companies that are considered good guys because they make sick people well. The press has not picked up on their opposition, and lobbyists have begun calling in their Capitol Hill chits. Friday, The American Prospect co-editor Robert Kuttner gave his thoughts about a public plan on the magazine’s blog, unsurprisingly referring to the “immense power of the private insurance industry.” No mention that the AMA, the drug companies, and hospitals don’t want a public plan either. Their reason: A public plan might pay them lower prices for their services, or set other regulations they don’t like, or force private insurers to pay them less, too. That’s why some compromisers like New York Sen. Charles Schumer have proposed a plan that would pay these groups higher rates than Medicare, and would follow the same rules, such as maintaining reserves against future claims.
Former Clinton administration labor secretary Robert Reich, now a professor at the University of California-Berkeley, reveals that drug makers and insurers have teamed up to kill the public option, and that many moderate Dems and Republicans seem to be embracing softer versions of a public plan. Count the AMA on the insurer-drug team as well.
Most journalists, let alone the public, haven’t read the lengthy comments the AMA submitted to the Senate Finance Committee, laying out what the AMA really wants. But Kuttner, Reich, and other influential bloggers and MSM reporters should take a good look, and offer a more informed discussion of the AMA’s actions.
The group, which represents the hard-liners of organized medicine, has been as instrumental as insurers in blocking serious health reform over the decades—not only with their campaign contributions (the AMA ranks second only to the U.S. Chamber of Commerce over the last ten years in the amount it has spent to influence Congress) but also with other forms of public pressure. Like insurers, they started out by being oh-so-agreeable. Early this year, the AMA even tried to position itself as the “Voice for the Uninsured.” But look what it stands for now. Some of its proposals look like they were cloned from those of AHIP, the insurers’ trade group.
According to the AMA, the magic of the market will bring insurance to all. To that end, it supports letting markets create the most attractive combinations of plan benefits and premiums. It wants to tax some insurance benefits provided by employers and shift some of the newly created tax revenue to tax credits or vouchers for the uninsured, and it supports the individual mandate, which would require people to buy insurance in the private market if they coud afford it. The individual mandate is the sine qua non of the insurers’ reform agenda.
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Thanks to Trudy Lieberman for a perceptive article. The record will show that I’ve written many pieces over the years criticizing the drug industry, AMA, and hospital lobby, as well as the insurance companies, for resisting systemic health reform that might reduce industry profits. But Trudy is right that critics like me, in short columns, tend to default to characterizing the insurance companies as leaders of this pack (or PAC). I do think that the insurance lobby is first among evils, as it were, but in future critiques I will be sure to pay more attention to the precise roles of the whole unsavory team and not just the quarterback.
#1 Posted by Robert Kuttner, CJR on Tue 9 Jun 2009 at 11:04 AM
The information you've revealed, and the intricacies of the hospital, AMA, insurance, and drug company interests brings most of us to the brink of despair. Added to this is the lack of leadership by our elected representatives, especially in the Senate. Each vested interest group is asking for concessions from the others that they know are unacceptable, and on we go.
#2 Posted by dpjbro, CJR on Tue 9 Jun 2009 at 12:07 PM
Ms. Lieberman and Mr. Kuttner
Speaking as a physician, yes The AMA is as you say it is but keep in mind it no longer speaks for the whole "doctor' public. Indeed only 13 % of the physicians in the country belong to the AMA.
You would find more pay dirt if your were to sub divide the physicians into Generalists, lower reimbursement specialities ( they support single payer Universal plans in a majority, PNHP is amongst these) and then specialists, surgeons etc. Then, add to the fray specialist owned hospitals, non-profit hospitals acting like for-profit hospitals and doctor owned insurance companies. These are the true players you are looking for.
Finally, the biggest players will still remain the insurance compnaies, Big PHRmA, device manufacturers and physicians who are in bed with them.
Hope this helps.
#3 Posted by wilbur larch, CJR on Tue 9 Jun 2009 at 02:44 PM
We've got a "top-down" problem. Nobody can be happy with any solution imposed on everybody by the Senate, Obama, the "government", the AMA, etc ...
There's too much lumping of diverse entities with special needs and priorities into phony categories.
If the people want a public option, enough people, they have the right to expect their elected officials to allow them to provide it to themselves, through the instrument of their government, notwithstanding the bribes and "leg-breaking" by special interests (who are often not human entities but legal fictions.)
#4 Posted by public takeover, CJR on Tue 9 Jun 2009 at 04:52 PM
Several people have noted that the AMA no longer represents the opinions of a majority of doctors. It is helpful to remember that the AMA still has enormous lobbying clout in Congress as my post pointed out.
#5 Posted by Trudy Lieberman, CJR on Wed 10 Jun 2009 at 08:19 AM
the ama opposed medicare too
#6 Posted by jamzo, CJR on Wed 10 Jun 2009 at 03:08 PM
AMA and some other medical associations must be in deep fear of losing funds from pharmas, insurance and instrument companies that they depend on to run their organizations, foundations, grants, annual meetings, CME programs, fellowships, patient literacy programs, clinical trials, lobbying efforts and publications. In essence, their organizations could be reduced to small non-profits with a staff of six, or however many can be supported through membership dues. But health care shouldn't be about job retention or society maintenance.
BTW, watch for a flurry of emails this week from Dodd et al inviting you to "Take part in health care reform!" They want our thoughts(now that deals have been struck) but only by email, an afterthought.
Never mind that doctors and nurses have been arrested for attempting to have the majority of we "mighty citizens'" voices heard in Baucus's committee meetings.
As Rep. Louise Slaughter (D-NY) reflected in a 2006 editorial published in the New England Journal of Medicine: “The current problems with Medicare Part D are largely the direct result of the undemocratic way in which the plan was authored and passed. The final legislation, heavily influenced by drug-company and health insurance lobbyists, focused mainly on the needs of those industries instead of those of the seniors it should serve.”
If anything, the process is even more undemocratic now in 2009.
#7 Posted by Kathlyn Stone, CJR on Fri 12 Jun 2009 at 10:10 AM
I think it is important to identify what the problems are but only insofar as this information will be used for stratigic organizing. There is little time left to get the bill that we need.
All of us need to be relentless in our grassroots efforts: call your representatives, your senators, and the president. We need to go door to door. We need to discuss this with friends, family, and neighbors. We need to write letters to the editor in our local districts and to the papers of record. And we need to write to the major broadcasting networks to give this issue it's proper exposure. Money does talk and we have the numbers and are relentless in our pursuit.
This will require a herculean effort but 2 years ago, I didn't think that a community organzier from Chicago had a chance to be president.
We are in the battle of and for our lives. It is good to analyze but better to organize.
#8 Posted by Sarrar, CJR on Fri 12 Jun 2009 at 10:39 AM
The Leaders in the U.S.Senate and their Spouses are in the Pocket of the Insurance Company's and Mega. Medical establishments as per an article in the AP yesterday By LARRY MARGASAK and SHARON THEIMER, Associated Press Writers Larry Margasak And Sharon Theimer, Associated Press Writers . I incourage you to look it up, because you won't find it in any of your News Papers or TY news outlets. It names names and quotes the amounts of money recieved by these Senators and their Wives.
#9 Posted by Curtis Mulkey, CJR on Sat 13 Jun 2009 at 10:16 AM