It's too early to say how the messy, protracted health care debate will end. But one thing is already clear: It's generated record lobbying expenditures. And like health care itself, the lobbying battle over health reform just keeps costing more.
Health-care-related lobbying and TV advertising have easily cleared the half-billion mark, topping $700 million in 2009, according to political money and ad tracking experts. Much of that went to pay for an army of lobbyists that numbered 4,525 last year, reports the Center for Public Integrity -- eight for every member of Congress.
The health care lobbying bonanza has raised uncomfortable questions, both for lawmakers and for industry players and activists.
The issue remains as complex as it was during the Clinton years. And many lobbyists who bickered over the specifics now fret that they may end up with no bill at all.
For President Obama and congressional Democrats, close dealings and ties with health industry operatives turned into bad PR. Having promised to banish special interests and negotiate in the open, Obama has struggled to live down his administration's quiet deals with pharmaceutical executives. (These reportedly capped the plan's cost to drug manufacturers, in exchange for the industry's support.)
Key lawmakers went along with those deals, even as they sat on millions in campaign contributions from doctors, medical professionals, hospital and nursing home executives, and drugmakers. Since 2005, the House and Senate leaders and committee chairs with jurisdiction over health care have pocketed at least $28 million in campaign donations from health care interests, according to Citizens for Responsibility and Ethics in Washington.
For health industry players and liberal activists, it's unclear whether all that lobbying, advertising and check-writing yielded much. At bottom, partisan rifts and fickle political winds have done more to derail proposed health care changes than any lobbying campaign. That stands in contrast to President Clinton's failed health reform plan 16 years ago, which ran aground in part because of deft insurance industry lobbying.
"I think the larger political narrative, and what's going on in the grassroots around the country, is much more important than any traditional lobbying," said Richard Kirsch, national campaign manager for Health Care for America NOW, a liberal coalition that's spent millions on a push for comprehensive insurance coverage.
"In the end, it's not about the lobbyists," concurred Peter Jacobson, a professor of health law and policy at the University of Michigan. "It's about the Democrats, and it's about the failure of advocates for health reform to coalesce around a solution that can be enacted."
Not that anyone's ignoring the hundreds of millions dumped into health care lobbying. Health care industry lobbying costs came in around $544 million in 2009, according to the Center for Responsive Politics. That doesn't even include TV ad spending to influence the health care debate. The Campaign Media Analysis Group tallied more than $200 million in health care TV ads by January.
But some of the biggest spenders were progressive advocates such as organizers at Health Care for America NOW, who found themselves playing defense by August, when conservative activists crowded town hall meetings to shout down comprehensive reform. Having been surprised and swamped by industry opposition during the Clinton health care debate, such groups lobbied early and aggressively for the Obama plan this time around. But they lost control of the narrative.
"I don't believe we've done a good enough job explaining to the American people how health care reform will help every family," acknowledged Ralph Neas, CEO of the National Coalition on Health Care Action Fund. "Too many people think that health care reform is getting taxed to pay for those who don't have health care insurance."
For all their squabbling, lobbyists on all sides largely agreed this time that the health care system is broken and needs to be fixed. Early last year, some analysts took this as a sign that Obama's health care plan would succeed where Clinton's had failed. But the issue remains as complex as it was during the Clinton years. And many lobbyists who bickered over the specifics now fret that they may end up with no bill at all.
As health care negotiations enter what may be their final phase, procedural and political uncertainties have shuffled the deck for lobbyists. "We are on the reform train, but it's at the station right now," said Charles N. Kahn III, president and CEO of the Federation of American Hospitals. "So we've got to see what the next step is the White House and the Democratic leadership are going to take."
With no specific pending bill or action to fight over, many stakeholders are concentrating less on high-dollar ads than on activism. Progressives, in particular, are mounting rallies, marches and demonstrations to push for comprehensive health care. And with the midterms fast approaching, health care lobbying expenses are already starting to morph into campaign messages. That means political health care spending will only keep escalating.
"The way the bill is drafted, health care is certain to be the number one or two domestic political issue for the next five to six years," said health care expert Henry J. Aaron, a senior fellow at the Brookings Institution. "It just won't go away."