Who Will Be at the Table? Part V

The hospitals begin to take their seats

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 take a 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 fifth of an occasional series of posts that will analyze their activities and how the media are covering them. The entire series is archived here.

Jeff Hansel of the Post-Bulletin in Rochester, Minnesota, has given us some insights into the lobbying that has begun around health reform, chronicling the visit Rochester’s large employer, the Mayo Clinic, recently made to Washington. Hansel’s piece is especially enlightening in view of the confirmation troubles faced by Health and Human Services secretary-designate Tom Daschle, and the questions surrounding his activities on behalf of health care institutions after he left his post as Senate majority leader in 2004. One of those activities was serving as a director on the board of the Mayo Clinic.

Hansel’s piece began: “Mayo Clinic officials are making headway in their quest to shape the future of U.S. health care.” The story went on to explain that the head of Mayo’s Health Policy Center and other hospital bigwigs traveled to Washington in January to meet with members of Congress and new administration officials, no doubt to make their case for health reform as the hospital and its Policy Center see it. The Center, according to the Post-Bulletin, has developed four “cornerstones” of reform:

• Creating value for patients through better quality at lower cost

• Coordinating care, especially for those with chronic and multiple conditions

• Rewarding value with new payment methods

• Finding basic health insurance coverage for all Americans

Now who can oppose goals like these? Just about every special interest group has similar language on their Web sites. As the Washington cognoscenti know, such boilerplate really doesn’t mean much when it comes to the legislative maneuvering. The devil is always in the details. For example, what exactly are Mayo and other hospitals willing to do in terms of cutting costs? Hospitals account for about one-third of the U.S. health care tab, and, as Maggie Mahar has pointed out in her healthbeat blog posts, they have embarked on building sprees all over the country that can’t help but increase costs down the road.

Hansel’s piece showed that the Mayo delegation had extraordinary access on their trip. They met with “more than 15 key leaders,” according to the Policy Center, including Daschle’s deputy Jeanne Lambrew, House Speaker Nancy Pelosi, Sen. Max Baucus, and Rep. Pete Stark. Key leaders indeed! “They all want to hear more from us as they move forward on reform,” Mayo’s national CEO Dr. Denis Cortese said, in what the paper called the Center’s update. “We must keep the momentum going by sharing our perspective as policy positions are put forth.”

We don’t know whether Daschle had a hand in arranging any of these visits, but we do know that directors of companies—whether engaged in health care or not—and advisers—whether technically lobbyists or not—do open the doors for such meetings. Commenting on the Daschle mess, Sheila Krumholz, executive director of the Center for Responsive Politics, told the San Francisco Examiner that Daschle “is in some sense no different from a registered lobbyist. He has been a strategic adviser serving in that same capacity. While not technically a lobbyist, he can still influence legislation by advising lobbyists on what strategies to pursue.”

No matter who is running the administration’s reform effort, we hope Hansel will continue to give us a peek at what going on behind the closed doors.

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Trudy Lieberman is 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. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.