The Congressional struggle over healthcare has been like a heavyweight championship that has gone the distance, with both fighters still standing but bloodied. As of this writing, it is not clear which side has prevailed or even whether both have been knocked silly. Whatever the outcome, however, the battle will not end because the state capitals will join Washington, D.C. as a place where legislation will determine the shape of the healthcare system in the future.
Wherever there is legislation, there are lobbyists, and where there are lobbyists, there is money. Lobbying about healthcare is big business. The spigots of money turned on during the past year will continue to gush as a network of pipelines channel money into capitals from Dover to Des Moines. In view of the myriad issues to resolve by votes, the floodwaters of lobbying money are far from cresting.
I have no problems with lobbyists. Indeed, I think that lobbying is an essential part of democracy. The United States is a diverse, rambunctious, and contentious society and disagreements abound. Fortunately, litigation or legislation can usually settle these disagreements. Within this framework, in Washington, the real representatives of the people are often advocacy organizations (a.k.a. lobbyists) that keep their fingers on the legislative pulse, help prepare position statements, arrange meetings with members of Congress, and otherwise promote the agenda of constituents.
Advocacy is only one part of this process. Financial contributions to political campaigns are another. Elections in the United States are unbelievably expensive, with direct financial contributions from political action committees bolstering advocacy efforts. For physicians and other healthcare providers, politics is a murky place and many of us feel uncomfortable there. Nevertheless, efforts like RheumPAC are critical to advancing rheumatology in this country. 2010 is here now and 2012 is not far away.
The Cost of Political Speech
While I am great supporter of democracy, with its attendant competition for ideas and dollars, I worry about the future because it turns out that free political speech is not free. In fact, free speech is very, very expensive. The great likelihood is that the price is going to increase. If each state witnesses a legislative struggle of the kind that occurred in Washington, D.C., in 2009, the amount of money expended will total in the tens or even hundreds of millions of dollars. In California, for example, $80 million was recently spent in industry lobbying on an initiative on drug pricing.