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Checking the players: newspapers trail National Journal and Legal Times in reports on influence peddling on health care.

Presidents have unsuccessfully attempted to enact national health care insurance throughout this century. For decades immensely powerful, entrenched forces have been reaping billions of dollars annually from our seriously flawed system. Given all this, you would think that Washington journalists would be swarming all over the influence-peddling power dimension of the Clinton health care reform story.

Think again.

Most of the coverage has been largely stenographic, focusing on the latest presidential pronouncements and the ping-ponging Capitol Hill reaction by Republicans and Democrats alike. And column feet have been devoted to attempts to explain the exceedingly complicated plan and its ramifications to readers -admittedly a daunting task in this instance. Nonetheless, when the long-awaited Clinton plan was finally put forward in September, there seemed to be an unabashed journalistic competition for the most adulatory article possible about Hillary Rodham Clinton.

In the hundreds of stories published by major newspapers in recent months, of course there has been some impressive although infrequent coverage of the internecine lobbying warfare which is being waged over the Clinton reform proposal. The Wall Street journal, for example, has touched on aspects of health care lobbying, but the two publications that have done the most in-depth reporting on the health care influence game are the National journal, The Times-Mirror-owned weekly on Washington politics and government, and Legal Times, another Washington weekly which most closely tracks inside lobbying issues. Unfortunately, these two publications are principally read inside the beltway, which means that most of America has no idea that yesterday's government officials are today reaping huge profits from their prior experience and connections as public servants. The revolving door assures that their special interest clients get a piece of the health care reform pie.

The news coverage of health care reform lobbying has operated on the unstated but implicit assumption that the efforts to tailor and shape the Clinton plan are just now beginning. However, from the insurance companies to the health maintenance organizations, from the doctors to the trial lawyers, from consumer groups to small business trade associations, the jockeying for influence and impact in Washington has been a mostly hidden, behind-the-scenes whirlwind at least since the weeks prior to Bill Clinton's inauguration.

Which brings us to a larger curiosity about the entire health care reform plan: the President himself. How and precisely when did Bill Clinton's thinking on the health care reform issue crystallize? No journalist has written the definitive story to date, and it is crucial to understanding the current legislation and the real underlying intentions. During the 1992 presidential campaign, the Democratic candidates with the most carefully developed health care reform positions were Paul Tsongas and Bob Kerrey - not Bill Clinton. Sometime from the primaries to the fall campaign, the Arkansas governor metamorphosed from a pay-or-play approach to the current concept of "managed competition. " How? Why? Who "educated" him in that direction?

We've all been taught to follow the money, and over the years, long before Bill Clinton emerged in 1992, many journalists - namely Morton Mintz of The Washington Post and Viveca Novak and Vicki Kemper of Common Cause Magazine - exposed the huge sums of money being dumped in the Congress to thwart any attempts at serious health care reform. And when, sometime after his election as President, it became clear that health care reform would be one of the four most important agenda items during the Clinton presidency, reporters began to revisit the Federal Election Commission and the National Library on Money and Politics, for the latest financial data on the health care industry. The resulting stories, most extensively by U.S. News and World Report (May 24, 1993), have been useful and illuminating, but like most campaign finance data-driven stories, limited in scope and linear in nature.

There has been little attention paid to individual health care industry contributions and connections to the Clinton campaign and to the Democratic National Committee, including the Democratic National Convention and the inaugural gala events. Beyond the straight numbers, there doesn't seem to have been an in-the-trenches attempt by journalists to study the direct personal interactions between health care industry officials and their paid lobbyists with the Clinton powers-that-be, beginning during the campaign itself.

One of the most interesting elements in the White House lobbying strategy is the way in which the Clinton forces have attempted to fashion the coming debate as a dramatic David-and-Goliath struggle between a progressive, well-intentioned new President fresh from the heartland, Mr. Clinton Goes to Washington, pitted against multibillion dollar vested interests, led by the insurance industry. At his acceptance speech before the Democratic National Convention in New York, Bill Clinton said. "Your government has the courage, finally, to take on the health care profiteers and make health care affordable for every family." Clinton also castigated then-President George Bush, "He won't take on the big insurance companies to lower costs and provide health care to all Americans. I will."

Actually, the largest insurance companies are generally supportive of the emerging Clinton health care reform plan. Indeed, they have formed a multimillion dollar lobbying effort on their behalf in Washington called, "The Alliance for Managed Competition." Some of Bill and Hillary Clinton's advice on health care reform has come from a private organization known as the Jackson Hole Group, substantially funded by such insurance companies as Prudential, Cigna, Aetna and Kaiser. It is likely that this "brain trust" group also receives funding from pharmaceutical companies and other health interests, but the donor list has been. to date, proprietary.

When Hillary Rodham Clinton blasted the insurance companies, namely the Health Insurance Association of America (HIAA), over their TV commercials, most Americans assume the Clintons are taking on the entire giant industry. Most Americans, from the avalanche of attendant articles when the Clinton health plan was announced, do not know that the White House has directed the Democratic Party to mount a multimillion dollar National Health Care Campaign, funded by many of those same vested health care industry interests, including the largest insurance corporations. Dana Priest of The Washington Post first broke this story, but there has been little followup on the general subject of Clinton's use of the national political party apparatus.

The press has reported that one of the big "winners" of the Clinton proposal are the HMO's. But most Americans probably don't realize that in recent years, the seven largest insurance companies have been making serious acquisitions. In fact, they own about 45 percent of the nation's HMO's.

The point here is that there seems to be little rigorous analysis beyond consumer journalism replete with charts and graphs, all striving to be reader-friendly and responsive to the central question, "Here's how it will affect you." But in many ways, the most compelling broad issue surrounding the 1992 candidate of change and his historic proposal still remains largely unanswered: just who and what is being "reformed?

As regards the political process in Washington, it is generally unreported that the entire health care proposal has caused an extraordinary bonanza in which scores of legislative and executive branch officials leave in droves for the private sector, doubling, tripling, and even quadrupling their salaries. How many Americans know that a sitting United States Congressman quit his job on Sunday, January 31, and went to work the very next day for health insurance interests? Willis Gradison resigned from the House of Representatives to lead the Health insurance Association of America.

Which begs the question, who else has left, and what exactly are they doing? This is relatively virgin territory in terms of reporting and the examples are resplendent and metaphoric. They range from former Capitol Hill staffers like Randy Cooper, who was a long-time administrative assistant to Senator Edward Kennedy and is presently representing the Pharmaceutical Manufacturers Association and Pfizer Inc., to former Representative Anthony Toby Moffett who has been hired by U.S. Healthcare. And let's not forget the Arkansas clan of lawyers who are cashing in on their state and their familiarity with the Clintons to peddle for health care, such as W. Jackson Williams, Jr., Bill Clinton's former law partner and close friend who now works for the Federation of American Health Systems. Or former Representative Beryl Anthony who now represents the American Hospital Association for Winston and Strawn.

Again, the fundamental issue is that this has been evolving now for two fun years - the conceptualization and the planning, the tinkering and especially, the lobbying. Hundreds of specific changes in the Clinton plan were made in the first six months of the new Administration, away from public view and scrutiny. Why is there an innocent assumption by reporters that all of this was purely and pristinely intellectual in those early task force months? Most coverage emphasized how the vested interests were shut out, not included in the elaborate "tollgate" process implemented by White House adviser Ira Magaziner. The fact is, White House staffers met with scores of lobbyists or their clients, and specific changes did occur in the plan following those meetings.

The most formidable obstacle to journalists attempting to write insightful, incisive articles about this extraordinary Washington power story is the sorry state of available public records. Lobbying disclosure laws are notoriously weak and unenforced, especially when it comes to domestic lobbying by U.S. entities. Thus, the thousands of health care-related meetings around Washington between the lobbyists and the lobbied are virtually all nondisclosable. Getting to the bottom of what is really happening is necessarily an interview-driven exercise, in which the interviewees are not required to reveal much of anything.

It is a frightful notion to then imagine how John Q. Journalist is going to really get a bead on the machinations of a $900 billion industry and its convergence with the well-heeled Washington lobbying community. Beyond that, we are talking about a policy plan so complicated its own authors and administration spokespeople don't seem to completely understand it - and that's without a copy deadline staring them in the face.

No one said it would be easy. Through persistence, perseverance, creativity and luck, a clearer picture of the health care plan, from its evolution to its real beneficiaries, can emerge. In Washington, most of the reporters working this story have had to put on heavy boots to wade through the mesmerizing muck so endemic to our nation's capital.

For example, just to satisfy our curiosity and perhaps our need for entertainment, we sent a tongue-in-cheek letter to 30 or so health care interests who most recently contributed money to the Democratic Party. We wrote "Because contributions play such an important role in political campaigns, we are interested in learning the reasons behind such a generous donation."

We received just two responses. As John Carson, director of government affairs for the American Podiatric Medical Association political action committee, wrote: "The record will show that, in addition to [ the $ 15,000 contribution to the DNC, a comparable amount was donated to the Republicans. We strongly believe and support the political party process."

Maybe in Washington the color of money is red, white and blue.

Charles Lewis, a former producer for the CBS News program "60 Minutes," is founder, chairman and executive director of the Center for Public Integrity, a nonprofit research organization based in Washington. He was the author of the center's study "America's Frontline Trade Officials," which led to a General Accounting Office investigation and Justice Department ruling. He begun his journalism career at age 17 working nights in the sports department of the Wilmington News Journal. Robert Tsai, Margaret Ebrahim, D'Arcy Morgan and Jeffrey Cook of the Center contributed to this article.
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Title Annotation:Covering Health Issues
Author:Lewis, Charles
Publication:Nieman Reports
Date:Dec 22, 1993
Words:1931
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