How do they do it? How do private health insurers keep getting things going their way?
They do it the old fashioned way - lobbying. They buy influence. Sometimes it's in the open, sometimes it's hidden. Either way, the Center for Responsive Politics (aka OpenSecrets.org) reports that nearly $7 billion was spent on lobbying during 2009 and 2010 and more than $500 million per year was spent on lobbying health care issues.
No doubt the various health care stakeholders held sway over ACA. The final watered down bill functions, but it could have been so much more. Big Pharma may have conceded on closing the Medicare Part D donut hole, but they prevented the bigger more expensive problems of drug reimportation from Canada and the having to deal with HHS negotiating for better pricing for Medicare recipients. Pharma spent $18 million on lobbying and got billions in unhindered revenues in return. Not a bad ROI.
You'd think patient advocacy groups like AARP would have our best interests in mind, but AARP has an inherent conflict of interest. Democrats may be concerned that the recent investigations are muzzling AARP on the Ryan budget, but think about it; who is the most likely insurer seniors will turn to if Medicare is sacked in favor of a voucher (food stamp like) program? This is a case where AARP can't lose.
The people who oversee our care, physicians and hospitals should be on the patient's side. They are for the most part, but even a hospital and doctor can have political axes to grind. Both doctors and hospitals spent a lot of money trying to shape health care reform in 2010. Were they scoundrels or good guys? That's hard to figure as it depends upon the issue)", but what can't be disputed is the amount of money they spent trying to get laws to go their way. The AMA has a primer on physician lobbying (pdf). What are doctors and hospitals worried about? Financing, money, fraud/recovery audits and Physician-owned hospital restrictions.
AHIP spent a boodle too, over $86 million, and got the Public Option deep sixed. They didn't get everything they wanted, but eliminating the Public Option was number one on their list. That Mission, unfortunately, was Accomplished. It was so successful, AHIP is hoping for a reduex in Connecticut (pdf). As a side benefit in their 2010 lobbying efforts the insurance industry also got a delay in implementing a $70 billion tax on their profitous ways. AHIP skillfully played both sides of health care reform. That $86 million went to the U.S. Chambers of Commerce to do the deed (act on their behalf) so they could make public statement "supporting" ACA. Ever wonder why the Blue Dogs seemed to be on the wrong side of ACA? The other shoe dropped a couple months ago when AHIP hired the ex-policy director for the Blue Dog Coalition, Erik Komendant to be their
VP for Preserving Wasteful, Private Insurance VP for Federal Affairs.
AHIP isn't content with the successes of 2010. They are pushing for more in 2011. People may think Paul Ryan and his Republican cronies are taking a big risk in the attempt to dismantle Medicare and Medicaid; but is there any doubt that AHIP et al gave Ryan their assurances that they would be there monetarily for his 2012 election funding? Pharma has their irons in the fire too. There's still a lot of health policy to shape. MLR's to either keep on track or derail. Health care stakeholders had good success in 2010 and the want a repeat in 2011. In fact, the health lobby is a growth industry in 2011. Plenty of jobs there, only those adept at double dealing need apply.