Nonpolitical? No Such Thing Today

In December 2009, a few days before the Senate was scheduled to vote on its version of the health-care reform bill, Senator Claire McCaskill of Missouri was asked on MSNBC’s “Morning Joe” why the Democrats had to settle for a bill that progressives were lamenting no longer contained a provision to create a public option. President Obama had frequently vowed that a public alternative to private health insurance was an essential part of reform, in part because competition from a government-run plan would keep insurers from charging unfair rates for comparable coverage.

McCaskill’s response was the most honest acknowledgement of what had happened to the reform legislation during the seven weeks between the House and Senate votes on their respective bills: “We lost a messaging battle.”

If she had been even more forthright, she would have noted that the main reason that battle was lost was the enormous amount of money the health-insurance industry and its allies spent, much of it in ways nearly impossible to trace, to shape the reform bill to its liking.

One of the reasons I left my job as a health-insurance executive a year earlier was that I knew an avalanche of money was about to be unleashed by my industry either to kill the legislation or, failing that, to ensure that whatever passed would not hinder profits.

In the 1990s, I helped draft and implement the industry’s well-financed campaigns to make sure the health-reform plan proposed by President Clinton and a subsequent effort to enact a patients’ bill of rights would go nowhere. My involvement was always behind the scenes. My peers and I did not want anyone to know our companies were responsible for these campaigns, so we hired public-relations firms to set up and operate front groups with names like the “Health Benefits Coalition,” and we recruited executives of organizations like the National Federation of Independent Business to serve as spokespeople.

I didn’t have the stomach to do that kind of stealth work again. The higher up the corporate ladder I climbed, the more I could see what health-insurance companies do to meet Wall Street’s profit expectations—like dumping policy-holders when they get sick and refusing to pay for doctor-ordered care. And I knew from personal experience how insurers used policy-holders’ premiums to finance misleading and deceptive campaigns to influence public policy.

We will never know how much the insurance industry spent overall during the reform debate because much of it is simply untraceable, but it undoubtedly ran into the hundreds of millions of dollars. That kind of money buys a lot of messaging, much of it false, in the high-stakes battle for hearts and minds—and for votes at the ballot box as well as on Capitol Hill.

Even if President Obama’s Affordable Care Act is eventually fully implemented, the law will still fall far short of assuring every American access to affordable quality health care, and it will not do nearly enough to control costs. Are the philanthropic organizations, unions, and advocacy groups that fought to win passage of the law working to reduce the influence of virtually unlimited money on politics and public policy? Do they see the value of devoting some of their giving and spending to help do that? For the most part, the answer to these questions appears to be no.

I start with health care because it’s my field, and because it’s an obvious case study in how Big Money corrupts. But of course it isn’t just health care. The corruption of our politics and policy affects every aspect of our lives, from the air we breathe, the water we drink, and the food we eat, to the bank fees we pay, the value of our homes, and the cost of sending our kids to college. Take the Dodd-Frank Wall Street Reform and Consumer Protection Act as an example. According to the Center for Public Integrity, the financial services industry spent $1.3 billion in lobbying expenses as the bill was taking shape in Congress in 2009 and early 2010. It is spending millions more to influence how the regulations are written and to try to delay or thwart implementation of important provisions to protect consumers.

I also mention health care because of the array of forces lined up against the insurers. Some groups were expressly political, like unions. But others were nonpolitical, like AARP, Consumers Union, the American Cancer Society, and the American Lung Association. These latter groups all advocated for consumer- and patient-focused health-care reform, and many of them devote considerable resources to trying to secure good health-care outcomes. But their real enemy is Big Money. Their goals will always remain elusive as long as the special interests that profit from making or doing things that harm us can spend unlimited amounts of money to keep things as they are. So why isn’t fighting Big Money part of their agenda?

Afraid to Engage?

While preparing to write this essay, I talked to executives from a broad range of organizations, including AARP and several of the national disease-related organizations as well as foundations that provide funding to nonpolitical interest groups. When asked if giving even a small amount of money to fight Big Money was either planned or under consideration, almost all of them said that not only was it not a priority, it was rarely if ever discussed.

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