Health Reform, the Dog Days of Summer & T.S. Eliot, or: “I do not think they will sing to me”

As summer wears on to an inauspicious health reform end, and we await pronouncements and more posturing from the gang of six (who, through the compromise which is our legislative system, represent less than 3% of the nation’s populace yet seem to have been left holding the relative financial and physical health of the other 97% as well), we are left with the vagaries of legislation inchoate to ponder. Many versions, nothing firm. The debate wandering to and fro and fueled by hyperbole, the desire for “victory” (whatever that may mean), and lobbyist dollars descending upon the corridors of Washington until they have become, in the words of T.S. Eliot,  ”Streets that follow like a tedious argument / of insidious intent.”

And at this juncture, as the debate seems increasingly beyond “the swell of a progress” and into the hands of the true powers within this country, Eliot somehow seems appropriate; if you haven’t read The Love Song of J. Alfred Prufrock in awhile, now might be a good time. If you’ve never read it–you have something to look forward to.

Or perhaps The Waste Land is more appropriate–more particularly, considering the demagoguery which has removed end of life counseling from consideration in the Senate’s bill, the poem’s Latin and Greek epigraph:

“Nam Sibyllam quidem Cumis ego ipse oculis meis vidi in ampulla pendere, et cum illi pueri dicerent: Σιβυλλα τι θελεις; respondebat illa: αποθανειν θελω.”

Which according to the folks from Norton is

A quotation from Petronius’s Satyricon (first century A.D.) about the Sibyl (prophetess) of Cumae, blessed with eternal life by Apollo but doomed to perpetual old age, who guided Aeneas through Hades in Virgil’s The Aeneid: “For once I myself saw with my own eyes the Sibyl at Cumae hanging in a cage, and when the boys said to her ‘Sibyl, what do you want?’ she replied, ‘I want to die.’”

Top 20 Lobby Expenditures Equals Over 1 Billion Dollars in the Last 2 1/2 Years

The Wall St Journal’s Health Blog recently ran a piece on health reform lobbying using data from the Center for Responsive Politics. This link will give you Lobby’s top 20 spenders, many of which have major interests in the outcome of the health reform debate.

The U.S. Chamber of Commerce (which opposes a Public Option) led the field with $26.2 million this year. PhRMA spent $13.1 million, Pfizer $11.7, BC/BS $9.5, AARP $9.4, the AMA $8.5, American Hospital Association $8.5, the Business Roundtable $7.4, Eli Lilly $7.

Remember, those are all just half-year numbers. The numbers over the last few years for the 9 companies and organizations listed above are worth taking a look at.

The numbers below are rounded, you can access exacts (and a nifty graph of money spent since 1998) by clicking on each company or organization.

Interestingly enough, the U.S. Chamber of Commerce, at $26.2 million for the half year thus far is actually on pace this year to spend less than last year (2008: $91.7 million) and about even with the year before (2007: $53 million plus change).

PhRMA, with $13.1 million thus far, spent $20.2 million last year, and $22.7 million the year before.

Pfizer, $11.7 million thus far, spent nearly $12.2 million in the whole of last year, and $13.8 million the year before. But perhaps the additional spending this year may be, at least in part, attributable to antitrust concerns regarding the acquisition of Wyeth.

Blue Cross & Blue Shield has spent $9.5 million thus far this year, spent $15.5 million last year, and a little more than $10 million in 2007.

AARP has spent $9.4 million this year, $27.9 million in 2008, and $19.5 million in 2007.

The AMA has spent $8.5 thus far in 2009, $20.7 million in 2008, and $22.1 million in 2007.

The American Hospital Association has also spent $8.5 million this year, but spent $20.1 million last year, and close to $20 million the year before.

The Business Roundtable has spent $7.4 million this year, $13.3 million last, and $10.2 million in 2007.

Finally, Eli Lilly has spent $7 million thus far this year, $12.5 million in 2008, and $4.3 million in 2007.

Importantly, these are not per se political contributions, as those are listed separately and by party (the recent, but very significant rise in contributions to Democrats is in itself rather revealing of the power= money equation) by clicking on the links to the organizations above and then clicking “Major Political Contributor.”

As we’ve posted before, in the first quarter of this year, $1.4 million per day was said to have been spent on healthcare lobbying.

The 9 companies and organizations above account for:

2009: $101.3 million

2008: $234.1 million

2007: $175.6 million

————————–
Total= $511 million, 2 ½ years.

And in case you were wondering,

the total spent by the entire Top Twenty on Lobbying was:

2009: $205 million

2008: $451.7 million

2007: $351.5 million
—————————
Total: $1,000,800,000

Or, over a Billion Dollars in 2 and a half years.

That’s simply a lot of money. And the phrase “Return on Investment” immediately comes to mind. Presumably there is one, or why would they persist? One of the finer things that one can say about someone is that they “Speak Truth to Power.” Speaking money, however,  seems the preferred means of communication.

Will Conflicts of Interest Sabotage Health Reform?

With health care reform in full gear, one crucial question is that of prioritization. Where should we focus our efforts? Who needs greater treatment, and what type of care is missing from the everyday lives of everyday Americans? Unfortunately, the politicians crafting the legislation may be swayed–not surprisingly–by stakeholders and lobbyists who are concerned with how reform will affect their bottom line. Interestingly, it is not just private insurance companies and pharmaceutical companies that are influencing the legislation.

A recent New York Times piece underscores how the emerging landscape of physician-owned hospitals is helping to shape congressional legislation.

The Times article states that one of the largest sources of campaign contributions for the Senate Democrats Campaign Committee is from the Doctors Hospital at Renaissance for a not-so-paltry sum of $500,000. Ironically, the event that raised the sum was at the home of Alonzo Cantu, a real estate developer in–you guessed it–McAllen Texas. Another event at Cantu’s house “brought in at least $800,000 for the committee’s House counterpart, the Democratic Congressional Campaign Committee.”

McAllen became (in)famous as the town depicted by Atul Gawande in his now oft-cited piece exposing the framework of incentives available to providers and hospitals to perform a greater number of tests and procedures in order to increase their bottom line, even when the greater volume of tests and procedures does not necessarily correspond to an increase in quality of care. Health Reform Watch has discussed the “cost conundrum” before.  Nevertheless, the incessant media and blog coverage of our inefficient system does not seem to have dissuaded those with a stake in that inefficient system from advocating for the status quo. As the Times points out that:

…like others here, he [Mr. Cantu] is not pleased about the president’s depiction of health care in McAllen.

“What’s so upsetting,” he said, “is that to make his case he threw McAllen under the bus.”

One might ask–given Gawande’s seemingly accurate portrayal of the overly-entrepreneurial nature of McAllen’s health care system–why we shouldn’t throw McAllen under the bus, especially when we can put a face on a problem undermining our system? Mr. Cantu and other Doctors Hospital officials are said to have offered the following argument for why Doctors Hospital and other physician-owned hospitals were beneficial and shouldn’t be singled out:

They have argued they are being unfairly grouped with boutique specialty hospitals that do not have emergency departments and that cater to privately insured patients. Eighty-eight percent of Doctors Hospital patients are either on public insurance or uninsured, 750 babies are delivered there a month, and no one is turned away because of inability to pay, they said.

Physician ownership, they added, has meant major investments in the latest equipment and good staffing ratios for nurses. Appealing to local pride, the hospital markets itself as the first in the area to offer services like PET scans, robotic surgery and breast imaging, which once required trips to Houston or San Antonio.

It is perhaps important to remember, as the McAllen boys attempt to mitigate the damages of the Gawande article, just what Gawande found. As we wrote prior:

Gawande writes that McAllen “is one of the most expensive health-care markets in the country. Only Miami-which has much higher labor and living costs-spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.”

El Paso, Texas, similarly situated, spends significantly less– half as much.

Might I suggest that there is little consolation in the fact that the largesse found in McAllen is largely funded through “public insurance,” or that there are “boutique hospitals” which charge even more?

In addition, “Local pride” aside, the real question is whether McAllen needs a PET scan facility or robotic surgery. Importantly, Texas is not a Certificate of Need (C.O.N.) law state. Therefore “local pride” (i.e. desire of a local, often private, facility) may often trump the actual “need” of the community. This idea is reinforced when taking into account that a PET scanner may have an annual operational cost of over $1 million, in addition to the upfront construction costs that can also venture into the millions. Altruism aside for the moment (or perhaps, it seems, longer), the investors in those machines will seek to recoup their cost plus profit. To do so, they simply must use that machine.

Thus, as it stands, the allocation of expensive high-tech machinery in physician-owned hospitals is based upon the government subsidized decision of private investors regarding the liklihood of turning a profit (for the subsidies, think “depreciation” and “expensing” for business equipment; think “public insurance” for billables). Perhaps we should not be quite so surprised when they then comport themselves in a way which ensures such a profit. But, it certainly may be argued that with our health care system in its precarious state, without a showing of actual need, the trip to Houston or San Antonio for very advanced high-tech procedures is a price we must be willing to pay and that the allocation of medical resources (and government subsidies for such) should be based on public need and not private profit.

In addition, given the overlap between physician-owned hospitals and single specialty hospitals, as Professor Frank Pasquale points out, these single specialty hospitals may siphon scarce health resources and undercut the care that community hospitals provide.

In a previous post, I discussed comparing a health care system to a pyramid, the foundation of the pyramid requiring a solid base of primary, preventive, and wellness care, that tapers to the top of the pyramid where we find the specialists utilizing, for example, advanced equipment and procedures like robotic surgery. However, a stable foundation for the pyramid is necessary, and the favoritism described above may stymie actual reform–reform that will provide Americans with the basics that they need at an affordable price.

Democrats are surely not the only ones to blame, and money has flowed to Republicans as well. As we discussed in an earlier post, a Common Cause report finds that $1.4 million dollars per day is being spent by healthcare interests lobbying Congress this year. From the perspective of the physician-owned hospitals and private health insurance companies, donating to both sides of the aisle makes sense; it ensures that both political parties have a financial stake in preventing legislation that would limit physician-owned hospitals from being subject to greater restrictions (like CON laws), or tightly regulating insurer practices. Though there are some restrictions governing physician-owned facilities in the House bill, these have been watered down, and will now allow facilities like Doctors Hospital to maintain their current structure, and even expand in certain future circumstances. As the Times reports:

The Senate Finance Committee has yet to release its final draft, but bills passed by two House committees would prevent the opening of new physician-owned hospitals by disqualifying them from receiving Medicare reimbursements. Existing facilities like Doctors Hospital would be grandfathered in.

One key provision would limit a hospital’s ownership by doctors to the level in place at the time of enactment. That is a change from previous language in House bills to restrict physician ownership to 40 percent. It would have forced Doctors Hospital, where physicians have an 82-percent stake, to be sold or required some of its owners to divest.

The future disallowance by Congress of Medicare funding for procedures performed at physician-owned hospitals is a tacit acknowledgment that the structure is one in which conflicts of interest abound; that he who owns a machine and will profit from its use is apt to refer patients for its use–regardless of actual need. It is the acknowledgment that the foxes are essentially guarding the henhouse–and that hens cost money. The exception made for Doctors Hospital and others of its ilk, however, considering the large campaign contributions, gives rise to other questions about conflicts of interest.

The problem is not simply the amount of money that is being funneled to Congress by the health care industry. The more pertinent issue at this point is: Read more

Do You Want Rats in YOUR Baby’s Crib? The RNC Poses Some Questions

Accompanied by images of a sprawling mass of big black rats, and then a close-up (separate) of a baby asleep in its crib, that’s what the ad for the local TV news said: “Do You Want Rats in YOUR Baby’s Crib? News at 11.”

It was maybe ten years ago, but I remember then just sitting before the TV astonished. I had babies, but I had never been asked that question before. I hadn’t even realized that that particular group of words could amount to a question. After much consideration of what seemed to be a rather limited set of options, I decided to go with “No,” but watched the news anyways just in case I had missed something.

I had not.

It was with similar feeling recently that I pored over the latest health care reform survey from the Republican National Committee. The survey was sent to the RNC faithful and is destined, I’m sure, to be spun into the latest “facts and figures” about the “pulse of the nation.” The introduction to the survey promised the putative survey taker that through the magic of Republican survey math:

Your answers represent the views of thousands of other Republicans living in your area. And your active membership in the new RNC will help us fight the Obama Democrats and recruit and train new Republican candidates nationwide. (emphasis added).

The survey itself is well worth taking the moment or two to read through, if only to get a better idea of how the spin works.  But there are a few questions that simply need to be highlighted.  As follows:

3. Do you believe that your health care decisions should be made by you and your doctor, and not government bureaucrats in Washington, D.C.?

Yes

No

Undecided

7. Rationing of health care in countries with socialized medicine has led to patients dying because they were forced to wait too long to receive treatment. How concerned are you that this would be inevitable in the U.S. under the Democrats’ plan?

Extremely Concerned

Mildly Concerned

Not Concerned

Don’t Care

11. Does it concern you that the Democrats are trying to ram health care legislation through Congress THIS MONTH to limit the American people’s opportunity to evaluate it?

Extremely Concerned

Mildly Concerned

Not Concerned

Don’t Care

12. Does it concern you that the liberal media has gone to unprecedented levels to only give Obama’s views on health care reform and no one else’s?

Extremely Concerned

Mildly Concerned

Not Concerned

Don’t Care

Though I’m told the study is one of subtle difference, I make no claims of expertise regarding the art or science of survey and polling. But in the Law there is an old adage about courtroom practice that one is taught very early on: “Never ask a question that you do not know the answer to.” It is a cardinal rule. No one could accuse the RNC of having broken it.

As we laugh at the crude and unabashed manipulations in the survey above, it may however behoove us to consider this: as the RNC mounts its attack on the Health Reform bills emerging from the House & Senate, Chairman Michael Steele accuses President Obama, Speaker Nancy Pelosi and key congressional committee chairmen of being part of a “cabal,” and then further states that “Republicans will stop at nothing,” perhaps we should believe him.

And when question #7 gets spun into an ad that starts:

“A Majority of Americans polled are ‘extremely concerned’ that the Democrats’ health care plan will ‘inevitably’ kill them. Shouldn’t you be too?”

Some people will listen. Just like I listened to the rats in the baby’s crib story (rat only seen somewhere in apartment building, woman in building had baby). But not everyone who listens will laugh.

Why the Health Reform Rush?

If you’ve been ignoring health care legislation for months, waiting for the moment of truth to arrive — well, now may be a good time to start paying attention. Ted Marmor and Jonathan Oberlander have helpfully encapsulated the current state of play in an NYRB essay. The media have started highlighting voices critical of current proposals, ranging from alarmists to prudentialists to beleaguered governors. They are curiously uninterested in the views of those representing the sizable number of Americans who want more thoroughgoing reform than is currently on the table. That bias is a major reason for a big push on reform now, rather than later this fall or winter.

If the media were up to a real health reform debate, they’d complement every story relating skepticism about reform efforts with a careful investigation of where things are headed given the status quo. For example, on Sunday’s Meet the Press, David Gregory aggressively pressed HHS Secretary Kathleen Sebelius about the possibility that reform would lead employers to drop private coverage because they could shift workers to a public plan. Gregory ignored the fact that employer-based coverage is eroding now. Similarly, media outlets persistently pair as sparring partners incrementalist academic experts with soi disant conservatives who in reality envision radical changes for tax treatment, risk pooling, and coverage determinations in health care. It’s not a fair fight, and the longer it goes on, the more misinformation is likely to be spread about reform.

Most troublingly, journalists routinely let critics of reform take opportunistically partial potshots at legislation. First the critics complain about costs. Then, if a reformer proposes a public plan designed to contain costs, the complaint morphs into worries about “socialized medicine.” When it’s explained that the public plan will be just one of many options, a “slippery slope” appears: if it’s really so cheap, won’t everyone sign up for it? Reformers then point to consumers’ risk aversion and the presumed capacity of private insurers to innovate and attract customers. Unwilling to further investigate the many countries that vindicate that claim, most journalists just balance such arguments with assertions about the “road to tyranny” that any further government intervention entails.

If the media (or the “go-slow caucus”) showed a genuine interest in the health policy issues raised by reform, I’d welcome a months-long Congressional debate on policy minutiae. Instead, we get page after page and hour after hour of political gamesmanship, relating perceptions of perceptions of who’s up and who’s down in the polls. It’s no wonder the MSM is in crisis — it “splits the difference” among viewpoints well to the right of the average American’s views.

The longer the health care debate goes on, the more we can expect “dumbo journalism” about the hard issues at stake. We can rely on the elite media to translate their own frustration at trying to understand multiple, complex bills into reportage on an imaginary public’s anger and skepticism about the same. In short, we can expect more Rush–and that’s why there’s a rush.

AMA About Face on Public Plan?

CNN reports that Dr. J. James Rohack, the “new president of the American Medical Association, which represents the interests of the nation’s doctors, said Wednesday the group is open to a government-funded health insurance option for people without coverage.”

And that

“Dr. J. James Rohack told CNN the AMA supports an ‘American model’ that includes both ‘a private system and a public system, working together.’”

As we posted back on June 11, 2009 the AMA had announced the day prior that it would “lobby against the inclusion of a Public Plan in health care reform legislation.”

At that time, many people made note of the AMA’s long history of opposition to “public” health measures such as Medicare and Medicaid, and as we noted in our post, “AMA to Oppose Public Plan–Again,” “at least one physician, Dr. Chris McCoy, Policy Chair for the National Physicians Alliance…publicly quit the AMA in response.”

But that was way back on June 11^th , a full twenty days ago. Apparently something has changed since then? Although Dr. Rohack became president of the AMA on June 16^th, under the circumstances that alone seems insufficient to account for the purported change.

Insurance & Financial Advisor Webnews describes the situation thus:

The new president of the American Medical Association appears to have confused or complicated the organization’s position on a public health insurance option during a CNN interview.

Dr. J. James Rohack, a physician in Texas who became president of the largest doctors’ group in the nation June 16, said in a live interview Wednesday (July 1) with CNN’s Tony Harris and Medical Correspondent Elizabeth Cohen that the group wants people who lack health insurance to be put into the Federal Employee Health Benefits Plan, the insurance program for federal employees and members of Congress.

“If it’s good enough for Congress, why shouldn’t it be good enough for individuals who don’t have health insurance provided by their employers,” Rohack said in the nine-minute interview.

A call for comment from the AMA was not returned.

One of the more interesting things about this apparent change of heart is that Dr. Rohack’s ascendancy to the post was preordained , so to speak . The AMA chooses it’s “president-elects” a full year in advance (the present AMA president-elect is Dr. Cecil B. Wilson, named on June 15, 2009, will take office in June, 2010 ).

According to this Reuters Press Release from June 17, 2008 announcing Dr. Rohack as the president-elect, Dr. Rohack was certainly no stranger to the inner sanctum of AMA policy decisions prior to becoming president. He did not just jump upon the scene:

“Taking a leadership role with the AMA in 2001 when he was first elected to theAMA Board of Trustees, Dr. Rohack served a one-year term as chair of the AMA Board of Trustees in 2004-2005.  He was reelected to a final four year term in 2005.”

Presumably, as one in “a leadership role” this year as both a Board of Trustees Member and as president-elect, Dr. Rohack was privy to, and part of, the AMA’s announcement (five days before he assumed the presidency) that they would “lobby against the inclusion of a Public Plan in health care reform legislation.” Therefore, his ascendancy seems insufficient to account for the change .

The question then is what could have changed in those twenty days between proclamations besides the ascendancy of Dr. Rohack? New research? A close reading of Profs Cortez, Greaney, Jost, Jacobi and Pasquale? I think not. Although reluctant to criticize for a reasoned and responsive change in direction (to reconsider carefully in the face of conflicting data is a good thing), this sudden (and unexplained) shift of direction smacks of politics and P.R. from an organization which is no stranger to either. I can’t help but find myself thinking of Tess of the d’Urbervilles when faced with her “converted” malefactor Alec:

“Don’t go on with it!” she cried passionately, as she turned away from him to a stile by the wayside, on which she bent herself. “I can’t believe in such sudden things! I feel indignant with you for talking to me like this when you know–when you know what harm you’ve done me!

I’m not sure what harm the AMA has actually done, but their repeated opposition to public options such as Medicare, Medicaid, early forms of HMO’s which sprung up in the Great Depression era, and the present Public Plan have not helped.

Keep your eyes on the spin.

Having said all that, a final note. CNN reported on

“the American Medical Association, which represents the interests of the nation’s doctors…”

Whether or not the AMA can be said to actually “represent the interests of the nation’s doctors,” is, perhaps, subject for debate. A quick google search on the AMA brings up some interesting figures: “the percentage of doctors who belonged to the organization declined from the mid-1960s on. At the height of the group’s campaign against Medicare, the AMA claimed at least 70 percent of American doctors as members. By the mid-1990s, the AMA represented only about 40 percent of American doctors.”

The 40% number of the mid-1990’s is a fond memory for the AMA. The present number for American doctor membership is closer to 22 ½ % — and that’s counting students and interns (who pay reduced yearly dues of only $20 and $45 respectively).

On June 14, 2009, Emily P. Walker, Washington Correspondent, MedPage Today reported on the present status of the AMA:

Although the group boasts close to 240,000 members, 29% are students or residents, who pay sharply discounted dues. Still more of the members are retirees, whose dues are also cut.

The AMA’s Council on Long Range Planning and Development had more specificity. It reported that there are 1,060,333 physicians and medical students in the United States and 238,977 of them AMA members.

Of those members, 20.5% are medical students, 9% are residents, and 36.5% are 56 or older. As one delegate put it, “we have a lot of students and a lot of old docs, but not a lot of practicing physicians.”

WaPo, Say it Ain’t So: Publisher Katharine Weymouth said to have offered lobbyists paid access to the Washington Post’s “Health Care Reporting and Editorial Staff”

It doesn’t happen often, but I am bereft of the power of speech. Fortunately, POLITICO is not– and as for what they have written? Res Ipsa Loquitur

POLITICO reports that:

Washington Post publisher Katharine Weymouth said today she was canceling plans for an exclusive “salon” at her home where for as much as $250,000, the Post offered lobbyists and association executives off-the-record access to “those powerful few” – Obama administration officials, members of Congress, and even the paper’s own reporters and editors.

The astonishing offer was detailed in a flier circulated Wednesday to a health care lobbyist, who provided it to a reporter because the lobbyist said he felt it was a conflict for the paper to charge for access to, as the flier says, its “health care reporting and editorial staff.”

With the Post newsroom in an uproar after POLITICO reported the solicitation, Weymouth and Executive Editor Marcus Brauchli both said today that they were not aware of the flier or the specifics of what it offered.

“This should never have happened,” Weymouth told Post media reporter Howard Kurtz. “The fliers got out and weren’t vetted. They didn’t represent at all what we were attempting to do. We’re not going to do any dinners that would impugn the integrity of the newsroom.”

“You cannot buy access to a Washington Post journalist,” Brauchli told POLITICO. Brauchli was named on the flier as one of the salon’s “Hosts and Discussion Leaders.”

Brauchli said in an interview that he understood the business side of the Post planned on holding dinners on policy and was scheduled to attend the July 21 dinner at Weymouth’s Washington home, but he said he had not seen the material promoting it until today. “The flier, and the description of these things, was not at all consistent with the preliminary conversations the newsroom had,” Brauchli said, adding that it was “absolutely impossible” the newsroom would participate in the kind of event described in the solicitation for the event.

“Underwriting Opportunity: An evening with the right people can alter the debate,” says the one-page flier. “Underwrite and participate in this intimate and exclusive Washington Post Salon, an off-the-record dinner and discussion at the home of CEO and Publisher Katharine Weymouth. … Bring your organization’s CEO or executive director literally to the table. Interact with key Obama administration and congressional leaders.”

The flier promised the dinner would be held in an intimate setting with no unseemly conflict between participants. “Spirited? Yes. Confrontational? No,” it said. “The relaxed setting in the home of Katharine Weymouth assures it. What is guaranteed is a collegial evening, with Obama administration officials, Congress members, business leaders, advocacy leaders and other select minds typically on the guest list of 20 or less. …

Brauchli emphasized that the newsroom had given specific parameters to the paper’s business staff that he said were apparently not followed. He said that for newsroom staffers to participate, they would have to be able to ask questions and that he would “reserve the right to allow any information or ideas that emerge from an event to shape or inform our coverage.” That directly contradicts the solicitation to potential sponsors, which billed the dinner as “off-the-record.”

Baucus: Not So Fast with that Swift Boat, Attack Ads = Lose Your Seat at the Table. Some Hold Fire.

Yesterday, we ran a post (Health Care Reform in 60 seconds or Less, or “Was That a Swift Boat I Just Saw Carrying Away Meaningful Reform?”) in preparation for what we perceived to be the onset of a deluge in Health Care Reform advertising as we approach the 4^th of July recess. And although Roll Call reports that for the recess

A long list of industry and interest groups have taken out advertising spots, are activating grass-roots networks and are planning Member meetings outside the Beltway.

Roll Call also reports that

Several major industry stakeholders, however, will be noticeably absent from the advertising airwaves over the July Fourth recess….AARP, the American Medical Association, America’s Health Insurance Plans, the Federation of American Hospitals and AdvaMed all say they are sitting out this recess when it comes to advertising campaigns.

The Pharmaceutical Research and Manufacturers of America will be running positive ads touting health care reform.

The groups have been holding their fire in response to threats from the staff of Senate Finance Chairman Max Baucus (D-Mont.) and White House aides, who have warned that any groups that run ads attacking reform efforts before the bills have been crafted would lose their seats at the bargaining table.

Presumably, the Republican Senators on the Finance Committee are exempt from the decree, and will not lose their seats at the table despite a recent offering from the Republican National Committee which, as we posted yesterday, seeks to explain the complexity of health care finance through the following: “President Obama talks about a quote, ‘public option.’ When he says public option, that means putting government bureaucrats in charge instead of patients and their doctors. It’s a bad idea.”

But maybe, in a real sense, the Republicans lost the table a little more than 6 months ago–which is why the tag line in this ad is: “Republicans want bipartisan health care reform.” I’m sure they do.

Health Care Reform in 60 Seconds or Less, or “Was That a Swift Boat I Just Saw Carrying Away Meaningful Reform?”

USA Today has run an interesting article about recent advertising efforts regarding Health Care Reform. USA Today reports that

Business groups opposed to health care bills floated by House and Senate Democrats launched print ads this week. The Republican National Committee ran its own TV ad as well.

Until now, ads for and against President Obama’s proposed health care overhaul have been run by lesser-known groups. Interested groups are stepping up their efforts during Congress’ July Fourth recess.

“It’s probably the starting gun,” says Evan Tracey of Campaign Media Analysis Group, which tracks political advertising.

And so it begins. 30 to 60 second assaults on reason designed:  to grab the reins of the angels of our better (or worse) nature (see RNC ad which states:  “President Obama talks about a quote, ‘public option.’ When he says public option, that means putting government bureaucrats in charge instead of patients and their doctors. It’s a bad idea.”); to remind Congressman where their bread is buttered (last week “the U.S. Chamber of Commerce ran a full-page ad in Roll Call, a Capitol Hill newspaper,” and “the National Federation of Independent Business ran an ad in The Hill” –see list of health industry contributions to Health Committee Congressman here, page 16); and, last but not least, to protect the interests of those who have paid for the ads.

In short spots, the key is to evoke emotion (fear and anger work well) under the flag of the “informative” (in the RNC ad listen to the gentle voice and piano meant to convey dispassionate, grandfatherly “reasonableness” while stating the conclusory). The trick, of course, is to make the viewer believe that his or her interests and that of the producer of the ad are coextensive– all in 30 to 60 seconds.

Even a cursory glance through the pages of this blog will show a multifarious complexity sometimes difficult to grasp even with hours if not years of study. Very smart people can, and often do, disagree. There is minutiae to contend with and, as always, the devil is in the details.

In an NPR All Things Considered piece about lobbyists we covered in a post the other day, one of the lobbyists, “Sharon Cohen, head of the health-care practice at the Podesta Group, one of Washington’s biggest lobby firms,” made a point well worth noting regarding the legislative process and the importance of details in the form of amendments. NPR spoke with her after she had attended the initial health care overhaul panel of the Senate Committee on Health, Education, Labor and Pensions:

Cohen later told us that, as she sat in that first health care session, she was listening to the senators position themselves in their opening statements, but “it’s really about the amendments, in terms of how they’re being discussed and the ultimate votes on those amendments.” The committee didn’t get to any amendments that day. The 22 opening statements consumed morning and afternoon sessions.

In the first quarter of this year, the expenditure for health care lobbying reached $1.4 million per day.

Ultimately, the devil is in the details. The Big Print giveth and the small print taketh away. The obscure clauses in the depths of the amendments are as likely as not to make big differences in the reality of reform. The ads we will be seeing most assuredly will not provide details–they will be Big Print–”opening statements”–more likely to obfuscate than educate. They will help provide clatter and cover for the lobbyists to do what they need to do, and help provide justifications for Congressman to vote against their political opponents and in favor of their benefactors (see list of health industry contributions to Health Committee Congressman here, page 16).

The ads may be dumb, but that doesn’t mean they can be ignored. To quote the snake oil ad above: “It is under such conditions that the seeds of disease are sown which bear bitter fruit in the present and future generations. “The danger here is that we will ultimately wind up with “Health Reform” in name only– and it will be another 10 or 20 years until anyone seriously talks about overhaul again. Whether through advertisement or amendment or a combination of both, to be “swift boated” is to lose.

Health & Taxes

Only a few short months ago, Barack Obama was elected President of the United States of America. Supporters rejoiced, “Yes we did!” Shortly after that historic event, then President-elect Obama announced his nomination of former senator Tom Daschle to be his secretary of health and human services. Advocates of universal health care reform were ecstatic.

With the release of Critical: What We Can Do About the Health-Care Crisis and his nomination for U.S. Secretary of Health and Human Services, it seemed that Tom Daschle was the solution to all of our nation’s health care woes: a fragmented and inefficient patchwork of public and private payors, rising costs, too many government ties to the private sector, and a lack of uniformity on the proper spelling of “health care.”

Yet it appears that that dream is over: Daschle announced today that he is withdrawing his nomination for Secretary of Health and Human Services. CNN.com reports that, in announcing his withdrawal, Daschle said:

[I]f 30 years of exposure to the challenges inherent in our system has taught me anything, it has taught me that this work will require a leader who can operate with the full faith of Congress and the American people, and without distraction.

The president said Tuesday he accepts Daschle’s decision “with sadness and regret,” according to CNN.com.

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