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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 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.

Originally posted to JDWolverton on Fri Apr 22, 2011 at 07:52 AM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Tips for Contending with health care Lobbyists (16+ / 0-)

    They are still out there pushing their wares. We need the exchanges opened up early. Well, more than that really, but the exchanges would be a start.

    If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

    by JDWolverton on Fri Apr 22, 2011 at 07:52:33 AM PDT

  •  Everything you say is true, of course, (7+ / 0-)

    and I have nothing to add except contrast.

    In 1975, I went to work at a Catholic medical school. The personnel department was one woman. (Note employees were persons, not assets.) There was a free clinic on the main floor where medical students and residents were supervised by faculty physicians.  Though the hospital had 350 beds, the only cafeteria sold cold sandwiches and drinks. Faculty offices were modest, as was the hospital and its rooms. We also traded heart surgery  for nuclear medicine via a sharing-agreement with the VA. I can't remember if it was the feds or the state that required approval of any new beds before they were built.

    In 1995, when I left, there were at least 30 in the "human resources" department, the free clinic was long-gone, the huge cafeteria served mid-range restaurant food. Faculty offices and the hospital were decorated with original art, we had our own nuclear medicine department, and a shiny new hospital was built to attract patients from the suburbs into the oh-so-scary inner-city.

    It start in the '80s the MBAs took over. Though we were allegedly not-for-profit, we charged extra money so we could "grow" (i.e., expand our market). There were remote physicians hired by the hospital to feed in patients from a couple of hours away. Departments fought among themselves for permission to do procedures, because they are so lucrative. About 100 nurses were fired because they could hire temp nurses as needed. They were escorted out of the building by the security department! After I left that happened to several people at the medical school.

    It had caused so many problems for the parent university, they sold the hospital to a big chain. It was a good idea, imho, to protect themselves from the un-Catholic shenanigans at the med school. After all, having a hospital director sexually harass a woman who sold medical equipment cost $1 million. That put the hospital on right up top on the first page of the WSJ.

    BTW, the reason it's called "healthcare" now instead of "medicine" is that it gives a more positive connotation (no lie!) and broadened the market. Oh, and why are you supposed to get a colonoscopy at 50 and ever-after? Because the American College of Gastroenterology recommended it (their members are well-paid for procedures).

    Is anyone else old enough to wonder whatever happened to that little thing you took home and brought back containing a stool sample? That was a test for cancer. Oh, wait ... "to get a baseline" and monitor polyps, my excellent internist says. (The last I knew, providers were only required to keep records for seven years. If that's still true, it pretty much kills the "baseline" argument.)

    Thank you, JD, for the excellent diary chockful of links. Glad I didn't miss it!

  •  This of course is nothing short of bribery and (5+ / 0-)

    corruption.  It's ironic because these corporations doing all the bribing would instantly fire an employee if they had a conflict of interest.  When I worked in a company that needed to buy chemicals to make their products and we technical people met with various suppliers to recommend which one we should purchase from, you would be fired if you were caught taking any money or gifts from any supplier or vendor.  So these corporations do the very thing they forbid in their own house.  Of course this is not at all surprising because corporations have no conscience or any reason to be ethical.  They are concerned about the legality of what they do which of course is very different from ethics.  How in the hell did people in government allow this corruption to take hold ?  And how in hell do those conservative creeps on the Supreme Court rationalize allowing corporations even more leeway in this area.  And why do we allow it ?  It would be so easy and simple to prevent.  So why don't they do anything about it.
    Should I imagine that maybe many of these politicians are profiting personally from these corporations aside from campaign funds??   This whole problem also reflects very poorly on the ethical substance of politicians.  No surprise there and no surprise that Congress has such a poor rating among the general public.  It is sad that they don't even care what the public thinks except if they can exploit it politically in a partisan way.  It is a situation which has and continues to damage the democratic principles this country was founded on.  It is a shameful disgrace.  What has Barack Obama, our transformative president, done about this very important issue ????????????????????????????????????

    •  About Obama, (3+ / 0-)
      Recommended by:
      JDWolverton, bronte17, Ray Radlein

      you might enjoy this diary by Pluto about his executive order to deal with money in politics.

      But don't be too sure about the law any more. In the past I worked at a school where they were careful to obey the law. But things have changed:

      James K. Galbraith wrote in 2006:

          In a predatory economy, the rules imagined by the law and economics crowd don’t apply. There’s no market discipline. Predators compete not by following the rules but by breaking them. They take the business-school view of law: Rules are not designed to guide behavior but laid down to define the limits of unpunished conduct. Once one gets close to the line, stepping over it is easy. A predatory economy is criminogenic: It fosters and rewards criminal behavior.

      •  Well, what I meant about corporations being most (2+ / 0-)
        Recommended by:
        cotterperson, JDWolverton

        cognizant of legal risks and not very concerned about ethics was not meant to indicate that corporations don't break the law or even that corporations are never concerned about ethics.  It's true that they will do whatever they can get away with and when you have regulatory agencies captured by the industry they are supposed to regulate then the criminals know they can get away with breaking the rules and you have predatory industries like the big banks and Wall Street getting away with all kinds of stuff.  I agree with you that we have a predatory economy and that some players break the law. I would like to see those bastards prosecuted just like you or I would be if we broke the law.  Government sponsored injustice is a terrible thing.

  •  We have the best health insurance that money can b (1+ / 0-)
    Recommended by:

    Who are we kidding?  We haved the best health insurance that money can buy.

    If one has credible health insurance, then one may secure adequate health care.  If one does not, then good luck.

    What we will see in the future of private health insurance is an increasingly difficult ability for the sick to access health services.

    One must understand that health insurance companies are in it for the money.  Good luck if you have an expensive debility.

    After all, for progressives, taking one for the team is desirable, but all too often at present, we are taking one from the team.

    by El Tomaso on Fri Apr 22, 2011 at 05:32:19 PM PDT

  •  There we were (3+ / 0-)
    Recommended by:
    phonegery, JDWolverton, cotterperson

    Trying to figure out a way to create a massive public push to get big donor money from buying elections and get a public funding system that would actually work. To get rid of the corrupting influence of special interest money on the creation and enforcement of laws at the federal level.

    Because it was bad.
    Really bad.
    Dysfunctional government bad.
    Votes to the highest bidder bad.

    Then along came Samuel Alito and John Roberts and Citizen's United.

    Everyone and anyone who voted for George W. Bush can kiss my ass. Hope they enjoy the clusterfuck nation that they had a hand in creating.

    An imbalance between rich and poor is the oldest and most fatal ailment of all republics - Plutarch

    by Anthony Page aka SecondComing on Fri Apr 22, 2011 at 05:42:48 PM PDT

  •  sneaky scoundrels (1+ / 0-)
    Recommended by:

    Fret not, comrade.  The single payor system is on its way!  Free healthcare for all!!!!

    •  If only that were true ... (0+ / 0-)

      Well, maybe it is true, it's just going to take longer than we planned.

      If a nation expects to be ignorant and free, in a state of civilization, it expects what never has and never will be. Thomas Jefferson

      by JDWolverton on Fri Apr 22, 2011 at 08:26:14 PM PDT

      [ Parent ]

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