Prescription for Friction

When you're getting a flu shot or a checkup at your doctor's office, your state representatives and senators might not be on your mind. But perhaps they should be. Health care is inseparable from politics in America, and your government leaders have a real say in how you get your medical care.

President Bush's health-care agenda has focused on health savings accounts, expanded community health centers, and a prescription drug benefit under Medicare. He is currently pushing medical malpractice reform and making HSAs available to more Americans.

When Bush signed the Medicare prescription drug bill into law, many Republicans thought the legislative move would take health care "off the table" in the next round of elections, but its actual effect has been mixed.

Its high cost has left true-blue conservatives feeling that the GOP has abandoned its identity as the party of limited government. Meanwhile, Democrats are savoring the thought of seniors hitting the program's "donut hole" coverage gap some time between now and November.

Democrats are also planning to make the GOP's decision to bar Medicare from negotiating for lower drug prices part of its "Six in '06" legislative agenda. Republicans answer these charges by saying that the GOP has pursued a "market-based" approach; Republicans also accuse Democratic members of Congress of discouraging their constituents from signing up for the drug benefit for political motivations.

Liberal interest groups have supplemented Democratic efforts. MoveOn has made the negotiation issue part of its "caught red handed" series of ads which is aimed at four House Republican incumbents, including Rep. Nancy Johnson, R-Conn., who played a key role in drafting the drug law. Two liberal advocacy groups -- Campaign for America's Future and Americans United -- plan to hold events around the country to influence '06 races on this issue.

Charging that some large employers like Wal-Mart are "shirking their responsibilities" by not providing health insurance, the AFL-CIO backed "fair share" health care legislation in 31 states earlier this year.

"Fair share" legislation was dealt a setback in July when a federal judge overturned Maryland's "fair share" legislation on the basis that it violates the federal ERISA law. The Maryland law which was struck down would have required companies with 10,000 or more employees that pay less than eight percent of payroll expenses on health care to pay the state the difference. That money is put into a fund that expands Medicaid eligibility.

The "fair share" decision is currently on appeal.

Beyond these debates, there is no evidence at this point that health care will be a major part of the election dialogue this year. Democrats are wary of advocating expensive programs at a time when they are criticizing Republicans for deficit spending, and when they are trying to avoid the label of being a tax-and-spend party.

We have no reason to believe that health issues will be a major part of paid media for either party.

Looking at Health Care Ahead: 2008 Presidential Candidates:

Hillary Clinton: Tempered by the experience of having spearheaded her husband's failed effort to overhaul the nation's health care system, Sen. Hillary Clinton, D-N.Y., has not pushed a comprehensive-coverage plan in the Senate. Instead, she has focused on reducing paperwork and extending health care benefits to members of the Guard and Reserve.

As she heads into her re-election campaign, Clinton's first major goal appears to be universal health coverage for children, which she hopes to advance by expanding the State Health Insurance Program, an existing federal program up for review in 2007. She has hired as her domestic policy adviser Laurie Rubiner, a health policy expert who for many years worked for the late Sen. John Chafee, R-R.I.

John McCain: To appeal to fiscal conservatives, Sen. John McCain, R-Ariz., touts his vote against the Medicare drug law. He is a longtime champion of an HMO "patients' bill of rights," although that issue has been dormant in Congress since negotiations fell apart early in Bush's first term.

Mitt Romney: Gov. Mitt Romney, R-Mass., has won national notice for signing into law a state health-care plan that combines an individual mandate with insurance market reforms and subsidies for the poor and near-poor, to buy coverage. Over his line-item veto, the legislature approved a fee -- up to $295 per worker -- on employers with 11 or more workers, who don't provide insurance.

Even though the Massachusetts plan passed with the support of the state's Democratic legislature and Sen. Ted Kennedy, D-Mass., the AFL-CIO is vigorously opposed to it, believing that it asks too little of employers and too much of working families who are too rich to qualify for subsidized health care but too poor to afford it on their own.


Health Care Industry Lobbying Statistics (1998-2005)

*Since 1998, drug companies have spent $758 million on lobbying -- more than any other industry (according to government records analyzed by the Center for Public Integrity -- a watchdog group)

*The Health Care industry has 1,274 lobbyists in Washington, D.C. (there a more than two lobbyists for every member of Congress)

*$266 million was spent on lobbying throughout the entire health care industry in 2005 (i.e. pharmaceuticals/health products, insurance, and hospitals/nursing homes)

Pharmaceutical Industry Lobbying Statistics (1998-2005)

*Amount spent on lobbying: $675 million

*Lobbyists: 3,009

*Former officials who registered to lobby: 1,014

*Former members of Congress who lobbied: 75

*Bills lobbied: More than 1,600

Special Interest Groups Involved in Health Care

*Big Business

*National Federation of Independent Businesses (small businesses)

*Labor Unions

*American Federation of Labor & Congress of Industrial Organizations (AFL -- CIO)

*Change to Win (coalition of American labor unions formed as an alternative to AFL -- CIO)

*Families USA (consumers)

*American Association of Retired Persons (AARP)

*Health Insurance Association of America (insurance companies)

*American Medical Association (AMA - doctors)

*American Trial Lawyers Association (ATLA)

*Pharmaceutical Research and Manufacturers Association (PhRMA)

*American Hospital Association

Brief history of failed health care reform efforts

Harry Truman: made health care a major issue in his 1948 presidential campaign. But immediately after the election, the AMA launched a four and a half million dollar "national education" campaign, warning that "national health insurance would lead to federal control of health care." Joining the doctors in opposition were the U.S. Chamber of Commerce, the American Farm Bureau Federation, and even the social welfare arm of the American Catholic Church.

Medicare and Medicaid: were enacted in 1965. The key to the 1965 success was Lyndon Johnson's landslide triumph over Barry Goldwater the year before.

Richard Nixon: proposed two measures: the expansion of health maintenance organizations (HMOs) and a companion measure to require all employers to provide a basic minimum package of benefits to all their employees.

The HMO bill passed; the benefits bill, opposed by the AMA and the insurance industry, did not.

Jimmy Carter: promised during his 1976 campaign to offer a "comprehensive national health insurance system with universal and mandatory coverage." But because of his narrow victory, he postponed any attempt to fulfill his campaign promise until he faced a re-nomination challenge from Sen. Ted Kennedy.

*Kennedy favored a government-run, tax-financed system; Carter, one that preferred a role for private insurance.

*Neither had the votes to pass.

Medicare: was expanded in 1988 to insure recipients against the cost of catastrophic illness. Despite the fanfare that greeted its adoption, seventeen months after it became law, and before any of its major benefits took effect, the catastrophic-insurance provision was repealed by Congress.

** Source: "The System" by David Broder and Haynes Johnson **

Failure of Health Care Reform under the Clinton Administration After winning the 1992 presidential election, Bill Clinton announced that the leader of his task force on health care reform would be the first lady, Hillary Rodham Clinton. The task force which she and Ira Magaziner headed met secretly and without input from members of Congress.

*A complicated plan was finally produced after a couple of deadlines were not met. Clinton eventually did testify before Congress.

*Hillary Clinton was unable to persuade Congress to adopt her plan.

*It never came to the floor in either house, and was abandoned in September 1994.

Cover the Uninsured Week: Since 2003, an eclectic coalition of organizations, led by the Robert Wood Johnson Foundation, and including the US Chamber of Commerce and the AFL-CIO, have joined together to promote "Cover the Uninsured Week." The coalition, which includes representatives from the business, insurance, and labor sectors, holds events across the country to draw attention to the plight of the uninsured. It does not, however, endorse solutions. The 2006 effort was held from May 1-7 and included more than 3,000 events.