Special Interests: The Lobby

Another huge obstacle is the incredibly powerful medical industry and insurance lobbies. If history is any suggestion, Obama will have serious problems navigating this astonishingly influential collection of lobbies.

In the late '40s President Truman prioritized reforming health care. In his State of the Union speech in 1948, he asserted health care in the United States needed “A comprehensive insurance system to protect all our people equally against insecurity and ill health.” Universal health care became a national issue for the first time.

Enter the American Medical Association. Understanding the universal coverage system as a step towards complete government control and a direct threat to doctors’ well being, the AMA launched a comprehensive lobby and ad campaign denouncing Truman’s plan as “communist.” This campaign pioneered the phrase “socialized medicine.”

Over a four-year period, the AMA spent $5 million—roughly $44 million today—on its “national education campaign” aimed at defeating the proposed legislation to reform health care coverage. The Committee for the Nation’s Health, a group supporting the legislation, spent $36,000 during the same timeframe—or about $318,000 today.

“The AMA clearly played an activist role in shutting down health care reform,” said Stephen Parente, an associate professor at the University of Minnesota who specializes in health economics. “They were one of the first to mount a multi-million dollar pack advertising campaign to shut down any attempts at universal coverage—and that legacy is what drives resistance today.”

Almost 60 percent of the U.S. population sided with Truman’s plan as of 1948. By 1950, thanks largely to the AMA’s aggressive advertising campaign only 36 percent supported the plan. The concept of single payer health care legislation was dead for the next 15 years.

Former Senator Durenberger witnessed the power of special interests in during President Clinton’s attempt at reform in the early '90s. Now heading the National Institute for Health Policy at the University of St. Thomas, he sits at a crucial interchange between government and private interest groups that have a great deal invested in any health care reform.

Special interests need to be in the discussion, but as far away from actual decision-making power as possible Durenberger said.

“Bring them in, remind them what’s at stake and ask them what they are going to put on the table. As long as they are aware that things need to change and they need to be willing to change, Obama might have a chance to pass some kind of reform,” Sen. Durenberger said.

“But if Obama allows special interests to have as much influence on the process as in the past, problems are going to arise. He needs to distance them from the process.”

Parente agrees special interest groups pose a serious barrier to comprehensive reform. Both Parente and Durenberger point to President Clinton’s attempt at reform in the early ‘90s as a clear example of the influence and reach these organizations have.

Similar to Truman’s attempt in the late '40s, President Clinton’s attempt to lead health care reform started in September 1993 with an address to a joint session of congress. Rarely do presidents push legislation so aggressively. Clinton explained the problems with the U.S. health care system in explicit detail:

“Millions of Americans are just a pink slip away from losing their health insurance, and one serious illness away from losing all their savings…[On] any given day, over 37 million Americans…have no health insurance at all. And in spite of all this, our medical bills are growing at over twice the rate of inflation, and the United States spends over a third more of its income on health care than any other nation on Earth.”

The Health Insurance Association of America led the charge against Clinton’s plan, which aimed to create an insurance marketplace heavily regulated by the government to keep costs down. Scared this system would drive small insurance companies out of business and slash into profits, the HIAA launched multi-million dollar ad campaigns in 1994, including the infamous “Harry and Louise” commercials.

Depicting a white, middle-class couple arguing over the limited options and high cost of their new mandated health care plan, the “Harry and Louise” ad campaign galvanized resistance to Clinton’s plan and stoked public fears of “Big Government” medicine. Along with fierce partisan resistance from Republicans led by Newt Gingrich, the reform measure suffered a long and painstaking death.

The famous couple reemerged in the 2008 Democratic and Republican National Conventions to push for the return of health care dialogue in campaign agendas. This reemergence was due in large part to five major special interest groups: The American Cancer Society Cancer Action Network (ACS CAN), the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).

All eyes are now on Obama. How he reacts to the lobby will play a huge part in passing any bills through congress. The history is clear—interest groups have the capacity to sink legislation. For Obama, pharmaceutical companies have the greatest chance of being his main adversary.

According to the Center for Public Integrity, the pharmaceutical lobby has spent $189 million on lobbying efforts in 2007, the most recent figures available. A 32 percent increase over 2006, the lobby is the biggest in Washington. It's this lobby that spent $1 billion—over $273,000 a day—the last decade on efforts to forward pharmaceutical interests, in a era of extremely limited health care legislation.

If Obama’s reform attempts to restructure Medicare or Medicaid, influence insurance company structure or create comparative testing agencies, he can expect one of the most powerful lobbies in history to be the knocking on his front door.

But not everyone is so sure Obama’s reform attempts are a lost cause.

Sen. Durenberger is confident Obama has the political capital and environment necessary to make comprehensive changes while neutralizing the special interests.

“He’s sat down with the special interests and told them what needs to be done. When it comes to having an instinct or knowing what the people are thinking or where the people are likely to head, he’s the only one who has it figured out. He has people willing to deal with the politics. He has unique social and economic circumstances wanting this change. He can do it.”

There was once piece of advice for Obama that both Parente and Sen. Durenberger agreed on—this reform needs to come incrementally. “There is no way this passes as one, two or even a collection of bills,” Parente said. “It needs to take time; there are too many players involved.”