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Exploring the Big Money Behind Health Care Reform

December 22, 2009 at 12:00 AM EST
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With Senate Democrats inching towards passage of landmark health care reform legislation, Gwen Ifill examines the massive lobbying effort behind the bill.
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JEFFREY BROWN: And still to come on the “NewsHour”: making tough decisions in the Washington, D.C., schools; shoring up computer networks and fighting cyber crime; and sending holiday photos to U.S. troops overseas.

That follows a conversation about the big money behind the health care reform legislation.

Gwen Ifill has our look.

GWEN IFILL: When the Senate votes out its version of health care reform Thursday morning, hundreds of millions of dollars will have been spent lobbying for and against it.

The Center for Responsive Politics finds the health care sector spent nearly $400 million on the effort during the first nine months of this year. That includes lobbying Congress, federal agencies and the White House, high-priced persuasion practiced by hospitals, doctor groups, nursing homes and other players — not included in that figure, another $122 million spent by the insurance industry during the same period.

For more on how the money was spent and what results it did or didn’t produce, we turn to Dave Levinthal of the Center for Responsive Politics, a not-for-profit group that tracks money in politics.

Nice to have you, Dave.

DAVE LEVINTHAL, Center for Responsive Politics: Good to be here.

GWEN IFILL: You know, some people say that, unless you’re at the table, you’re on the menu, and that is what drives lobbyists to do what they do. So, how much money was really spent, and on what?

DAVE LEVINTHAL: Well, overall, you have had $2.5 billion spent on lobbying in general. And a good portion of that has been spent on health care reform legislation.

It’s just taken so long for this to develop, months and months and months. And you have had so many different entities that have had an interest in it. You talked about health care, but that industry alone is just only one of the several industries that have actually spent money to lobby the federal government.

The U.S. Chamber of Commerce, for example, has spent a ton of money, potentially tens of millions of dollars, on health care reform. And when you add it all up, it could potentially be one of the most, if not the most, biggest lobbying efforts ever on a single piece of legislation that the United States has ever seen.

GWEN IFILL: So, how does it compare? There has been big, big lobbying efforts in Washington on trade and on deficit reduction, even, and on all kinds of issues. Why is health care so much more expensive?

DAVE LEVINTHAL: I mean, you could go defense, and tort reform, and even the health care lobby of 1994.

What’s happened this time, though, is you have had a piece of legislation that literally since Barack Obama has come in office has been in play. The issue certainly has been. And when you have so many different entities that are vying for a piece of this pie, are trying to control the trajectory of this legislation, are trying to insert this or take out this, and the process lasts literally a year, that’s when you have these dollar figures that are really unprecedented.

GWEN IFILL: What do you get for that money? If there’s this much money floating around in Washington, presumably being spent on varying things, what are they buying with it?

DAVE LEVINTHAL: First and foremost, they buy access. And access is critical in this, because if you come to the door of the Capitol, and you knock on it, and you don’t have some money in your hands, oftentimes, you’re not going to get allowed in.

If you do come in and you have, for example, working on your behalf former members of Congress or former high-ranking congressional staffers, that’s certainly going to help your case. And so many clients who employ lobbyists are hiring people who have worked in Congress before, because they know the system. They know the players. And they are intimately familiar with the issues.

So, all three of those things put together are very expensive, but they also can definitely pay dividends for the people who are hiring the lobbyists.

GWEN IFILL: What is inherently wrong with that? Isn’t that what we’re supposed to have, people who represent us, people who speak for us in Washington and places where power is practiced?

DAVE LEVINTHAL: Well, if you pull out your copy of the Constitution or go online and look it up, it says in the First Amendment of the Constitution that you have the ability to petition your government for redress of grievances.

Well, what does that mean? That means that you have the right to lobby. And, by that, of course, most people would argue that, at least at its face value, that there is nothing wrong with lobbying.

But what the founding fathers probably didn’t anticipate when they were writing the Constitution is $3.3 billion spent on lobbying, as was the case in 2008. So, you have a situation where a lot of people feel like lobbyists and the people who hire lobbyists have really have taken over the process.

If you’re sitting at home in Nebraska or California or New York or Florida, and you don’t have health insurance, if you don’t have two dimes to run together, then you’re going to be in a much more compromised position. You’re going to be completely unable, when it comes down to it, to lobby at the level that a Pfizer is lobbying at, a Chamber of Commerce is lobbying at, any of these large companies that are spending millions of dollars to lobby.

GWEN IFILL: So, some voices get heard and some voices don’t.

DAVE LEVINTHAL: Well, not only some voices get heard, but the richest voices get heard, the voices that are already powerful, that are already very strong in this debate, and they’re becoming ever more so because of the money that they have to put behind their efforts.

GWEN IFILL: But is there any way to draw a really clear line between the money that is spent and action that happens actually in the bill, something that lives in this bill that wouldn’t otherwise live in it, things that are taken out because lobbying money is spent?

DAVE LEVINTHAL: One issue that’s come up just in recent weeks in earnest is the issue of, for example, prescription drugs from foreign nations.

And this has become a big issue for a lot of people, because they would very much like to be able to buy their drugs from Canada or Israel or Mexico or other countries, the European Union, and get them at a much reduced rate than they would if they were buying them at the drugstore in the United States.

And the pharmaceutical companies came in and said, we have grave concerns about the safety of these drugs. And that may be a very legitimate concern. The White House itself has said that may be a legitimate concern. But a lot of people are thinking, no, this is not what this is about. This is about profit and profit motive.

And if people are able to buy drugs at $20, instead of $200, then your large pharmaceutical companies are going to be losing a lot of money as a result of that.

GWEN IFILL: Let me give you another example. We have been hearing a lot this week about the last-minute deals that were cut on Capitol Hill in backroom dealing to get the 60 votes for this health care reform bill.

How do we know or how do you prove that any of that dealing that went on had anything to do with what lobbyists were — pressure they were exerting, and how much of it was just a senator from Montana representing the small hospitals in his state because they are his constituents? What’s the difference between the small hospital association speaking to him and getting this or him just representing his constituency?

DAVE LEVINTHAL: Well, ultimately, sometimes, you don’t know what the effect has actually been by the lobbying efforts.

And that’s because the laws, as they are on the books right now, as they’re written by Congress itself, doesn’t allow you to find out, for example, who has actually lobbied whom.

So, if you want to find out, for example, if a lobbyist for a large health care firm has gone in and spoken to Max Baucus or Joe Lieberman or this senator or that congressman, you’re not going to be able to find that out, because it’s not federally required for the client of the lobbyist to disclose that. So…

GWEN IFILL: But does that lack of transparency automatically suggest malfeasance or any bad action?

DAVE LEVINTHAL: Not at all. And we wouldn’t suggest anything of the sort. But what lack of transparency does is, it gives people less information to draw conclusions from.

And, unfortunately, we can’t see exactly what the interactions have been in their entirety. And, as far as we’re concerned, if there’s a lack of transparency or there’s not as much transparency as is possible when these very important public processes are taking place and public decisions are being made, then the public has less information to go on.

GWEN IFILL: This is not an Abramoff situation, as far as we know; there’s nothing illegal about anything that we’re seeing that you have been able to chronicle?

DAVE LEVINTHAL: It’s certainly not an Abramoff situation. And Congress, to its credit, in 2007 tightened its rules to make sure that there was more transparency, and, in a lot of people’s opinion, did a great job in making sure that those types of travel and trips that were being taken and lavishing congressmen with this and that would be done.

But, yes, there’s still a long way to go, a lot of people would feel.

GWEN IFILL: Dave Levinthal of the Center for Responsive Politics, thanks for joining us.

DAVE LEVINTHAL: Thank you.

JEFFREY BROWN: For the record, we invited several health care lobbying groups to join our conversation, but they declined.

A spokesman for the pharmaceutical industry told us they opposed re-importation of drugs for a number of reasons, including concerns over counterfeiting and tainted products. He said, “There’s no way for the FDA to guarantee the safety and efficacy of medicines brought into the U.S. outside of its control.” And he added, “The industry’s profits are necessary to fuel research and development of future medicines.”