The Revolving Door - Healthcare Edition

Northwestern University's Medill News Service in partnership with the Tribune Newspapers Washington Bureau and the Center for Responsive Politics have released their analysis of the revolving door in the healthcare debate. OpenSecrets' Revolving Door database tracks anyone whose résumé includes positions of influence in both the private and public sectors and tracks the shuffle of individuals who were former federal employees and then take jobs as lobbyists, corporate consultants and legislative strategists as well as hired guns who then return to work in government helping to craft legislation.

The fact is that a stint on Capitol Hill as a legislative aide often leads to a more lucrative perch in the land of tasseled loafers known as K Street. For example, House Majority Leader Steny Hoyer has 14 of his former employees now working for the US Chamber of Commerce, Pharmaceutical Research and the National Association of Manufacturers, and Verizon while Senate Majority Leader Harry Reid has 13 former staffers who now lobby for clients including the US Chamber of Commerce and Pharmaceutical Research. In the healthcare debate, at least 14 former aides to House Majority Leader Steny Hoyer and at least 13 former aides to Montana Democratic Senator Max Baucus, the chairman of the Senate Finance Committee served as registered lobbyists lobbying their former bosses and their colleagues.

At least 166 former aides from the nine congressional leadership offices and five committees involved in shaping health overhaul legislation -- along with at least 13 former lawmakers -- registered to represent at least 338 health care clients since the beginning of last year, according to the analysis.

Their health care clients spent $635 million on lobbying over the past two years, the study shows.

The total of insider lobbyists jumps to 278 when non-health-care firms that reported lobbying on health issues are added in, the analysis found.

Part of the lobbying pressure on current members of Congress and staffers comes from the powerful lure of post-congressional job possibilities.

"There's always a worry they may be thinking about their future employment opportunities when dealing with these issues, particularly with health care, because the stakes are so high and the breadth of the issues -- pharmacies, hospitals, doctors," said Emory University political scientist Alan Abramowitz.

Lobbyists' earnings can dwarf congressional salaries, which currently top out at $174,000 annually for lawmakers and $156,000 for aides, though committee staff members can earn slightly more.

In the health care showdown, insider lobbying influence has magnified the clout of corporate interests and helped steer the debate away from a public insurance option, despite many polls indicating majority support from Americans, according to Rutgers University political scientist Ross Baker.

"It imposes a kind of conservative bias on the discussion," said Baker, himself a former Senate staffer.

Breaking it down by Senate or House Committee, the numbers are eye-opening. Forty-five former staffers of the members of the Senate Committee on Health Education, Labor and Pensions (HELP) are now lobbying. Their clients include the Chamber of Commerce, Exxon Mobil, AARP, Pharmaceutical Research and Manufacturers, General Electric, Blue Cross/Blue Shield, Verizon, AT&T, Lockheed Martin, and Northrop Grumman. Thirty-six current lobbyists are veterans of the Senate Finance Committee. They now represent the Chamber of Commerce, the Pharmaceutical Research and Manufacturesrs, General Electric, and Blue Cross/Blue Shield.

Over in the House of Representatives, the House Energy and Commerce Committee has 45 former staffers now working as lobbyists, the Ways and Means Committee 23, and House Education and Labor trails with just 18.

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A Broken United States Senate

While Paul Krugman writing in the New York Times believes that the healthcare reform legislation now on the verge of passage in the Senate is "an awesome achievement," I do not share those sentiments. Though there is certainly much of merit in the bill, overall it is a Frankenstein monster of bill whose sum of parts more reflects the narrow and profane interests that are overrepresented in the United States Senate. I do agree with Paul Krugman that the Senate has become "ominously dysfunctional." It is an institution that no longer works for the American people, one that produces flawed legislation no matter which party is in control and an institution that does not serve the national interest but instead caters to those who have access.

First let me state unequivocally that you can replace all one hundred of the Senators currently serving in the Senate and you would still have more or less the same inferior legislative product being delivered serving the same narrow interests. The problem is quite simply a mix of its composition that favors rural, more conservative sectors of the country over the more populous, urban and more progressive sectors of the country and the arcane rules that govern the body plus the insidious role that corporate lobbying and other monied interests now play in the nation's politics.

I have noted in previous posts that the 26 least populous states in the country who form a majority in the Senate represent just 17.8 percent of the nation's population according to the 2000 US Census. While these 26 include states like Vermont, Delaware and Rhode Island, of the 26 states 15 voted for McCain and 11 for Obama in 2008 but if we go back to 2004 then 19 of these 26 states voted for Bush versus just eight for Kerry (OR, CT, RI, ME, VT, HA, NH, DE). The most populous of these 26 states is Colorado and the least is Wyoming with the bulk of the states being a mixture of Southern, Prairie, Mountain West/Far West or New England states. Of these four regions, three are overwhelmingly rural and conservative and account for 20 of the 26 states. The United States is not the only country with a legislative body that overrepresents rural interests. Thailand and Japan have the same problem and not surprisingly suffer from many of the same problems that we do. The question of whether Thailand is a failed state or not is one that many Thai now discuss.

As the Republican Party is favored by rural and conservative interests, it too is overrepresented in the Senate though not to the extreme shown above. The GOP has 40 Senators at the moment but those seats represent just a fraction above 35 percent of the US population. Still that's an over-representation of 5 Senate seats, not an insignificant number in a 100 member body.

The composition of the body has subtle effects in perhaps unexpected ways. Since 1961 the Majority leaders in the body have come from Nevada (Reid), Tennessee (Frist), South Dakota (Daschle), Mississippi (Lott), Kansas (Dole), Maine (Mitchell), West Virginia (Byrd), Kansas (Dole), Tennessee (Baker), Montana (Mansfield). All but Tennessee (16th in population thanks to Nashville and Memphis but otherwise culturally similar) form part of these 26 least populated states. And if I include Minority leaders, I'd be adding Kentucky (McConnell) and would have to extend back until 1977 before I could find a Minority leader that came from one of the top 15 populated states, Hugh Scott of Pennsylvania.

There's a reason for this. It's reflective of the fact the Senators from the larger states are more burdened by serving in leadership roles. Senators from the more populated states have to cater to the needs of a much larger, broader and heterogenous constituency that they are effectively prevented from holding leadership positions. As the Senate's own website notes Senators "from small and large states alike all have comparable committee and floor responsibilities, Senators from the more populous states, such as California, face a broader array of representational pressures than do Senators from the smaller states, such as Wyoming. An indirect effect of Senate apportionment is that contemporary floor leaders of either party tend to come from the smaller rather than larger states because they can better accommodate the additional leadership workload."

The repercussions are that it further limits the interests of more diverse urban America from gaining currency. The last majority leader to come from one of the more populous state was Lyndon Johnson when the country was a vastly different place. This is in marked contrast to the House where members serve more or less the same size constituency and where the leadership tends to come from the more populated states. Speaker Pelosi hails from San Francisco and her predecessor was Dennis Hastert who represented Chicago. The last Speaker of the House who came from one of the least populated states was Carl Albert of Oklahoma in the 1970s.

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The Myth of Health Care Rationing

There has been a lot of talk the past few weeks about the false possibility of health care rationing in the current storm of discussions surrounding President Obama's health care reform plan, as well as options put forth by Congressional Democrats such as Senator Max Baucus.  

While rationing may be a popular topic - particularly among the conservative and right leaning blogosphere, it is, at its core, a health care myth. Unlike the health care debate in 1994, where Harry and Louise were lamenting government rationing on behalf of the insurance companies, rationing has no place in current health care reform bills.

According to the American Medical Association, "The health reform plans being debated in Congress ensure that health care decisions will be made by you and your doctor - no one else."

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A One-Two Punch of Contribution Clusters

An article published in the UK Guardian provides an overview of the lobbying effort conducted by insurance companies, pharmaceutical firms and hospitals dedicated to ensuring that healthcare reform proposals don't threaten their profits. All told, these industry and interest groups have spent $380 million trying to influence healthcare legislation through lobbying, advertising and in direct political contributions to members of Congress.

The Sunlight Foundation and the Center for Responsive Politics have teamed up on a collaborative investigative project that has uncovered never-before-seen webs of campaign contributions from outside lobbyists and their clients, who are all important players in the health care reform, to key members of Congress.

Their investigation identified outside lobbyists who donated to the same members of Congress as their clients. Their findings strongly suggest that special interest giving is enhanced by the K Street contributors they hire. Call it a one-two punch aimed at TKOing a public option.

Senator Max Baucus, the chairman of the Senate Finance Committee and the author of one of the  health care reform bills now being debated in the Senate, was the biggest beneficiaries of this one-two punch from the lobbyists and their clients. From January 2007 through June 2009, Senator Baucus collected contributions from 37 outside lobbyists representing PhRMA, the pharmaceutical industry's chief trade association, and 36 lobbyists who listed drug maker Amgen Inc. as their client. Overall Senator Baucus has received $1.5 million from the health sector towards his re-election coffers.

In all, 11 major health and insurance firms had their contributions to Senator Baucus boosted through extra donations from 10 or more of their outside lobbyists. You can see all these curious clusters of cash at Open Secrets.

Beyond the noxious effect of all that cash, the health industry has permeated the process in other ways. At Senator Baucus's side, helping to draft the wording of the Baucuscare, was Liz Fowler, a Senate committee counsel whose previous position was  as Vice President of Public Policy and External Affairs of the country's largest health insurer in terms of membership, WellPoint. Ms. Fowler worked at WellPoint from May 2006 through February 2008, according to the company. She previously worked for Senator Baucus from 2001 to 2005. Something about a revolving door comes to mind.

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Following the Money

Curious that the Democrats on the Senate Finance Committee that receive the most money from the healthcare and insurance industries are also the ones that voted no on the Rockefeller and Schumer amendments. From Politicus USA:

The two largest industries in terms of contributions to Finance Committee are the Health, and Insurance industries. According to Open Secrets, the healthcare industry gave $7 million in PAC contributions to committee members. Not to be outdone, the finance, insurance, and real estate industries also gave $7 million to the committee.

Committee chairman Max Baucus has taken $1.1 million each from the health and insurance industries. The two largest contributors to Tom Carper of Delaware for 2010 have been the health and insurance sectors. The same holds true for Kent Conrad. The top donor for 2010 to Blanche Lincoln was the healthcare industry. The insurance industry has given $1.5 million to Bill Nelson for the 2010 cycle.

The Open Secrets data is current as of August 29, 2009.

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