There was a nice article in the Wall Street Journal Health Blog yesterday taking a look at just how many of the top 20 biggest spenders on lobbying are health care related organizations. For those who follow this kind of stuff, there wasn’t much to surprise. PhRMA, the AMA, the AHA, and Blue Cross/Blue Shield are all there as you’d expect. It got me to thinking, though, about the trend in health care lobbying over time.
It’s often said that you can tell a lot about a person by examining just two pieces of information about them: their appointment book and their checkbook. How we spend our time and our money gives us a very strong indication of where our values lie. In fact, time is considered synonymous with money by most of us. Why should organizations be any different?
To answer my question, I headed over the Center for Responsive Politics to start playing around with data. (As an aside, they’ve made all of their data publicly available and downloadable, so look for me to do some more fun things with their stuff in the future.) Rather than focusing on spending by specific entities, I chose to look at health care lobbying in the aggregate. I justified this by reasoning that–due to the inextricably intertwined nature of the health care system– rarely is there going to be a substantial piece of legislation in Congress that affects one player in the system without having at least a sizable indirect effect on the other players.
To get around issues of inflation and changes in absolute spending from year to year, I calculated the percentage of total lobbying dollars attributed to the health care sector. This makes for nice, neat comparisons over time. I graphed the results from 1998 to 2009 (although this is a partial year, things work out as long as we assume spending in the remainder of the year is in keeping with spending to date) and then, did a couple of other things in my search for meaning behind the numbers. The first was to identify time periods during which major health care legislation was being considered in Congress. The second was to identify the political makeup of the Presidency and Congress during the period in question.
What I found was this: Since 1998, the proportion of funds spent on lobbying for health care has decreased only three times. Two of those times, Congress and the Presidency were controlled by opposing parties. The third time, Republicans had control of it all, but they got their “big win” with Medicare Part D and health reform dropped off the agenda for a while.
It’s easy to see–but not that interesting–that peaks in spending occur in conjunction with the introduction of major legislation. That’s intuitive. The real thing that jumped out at me is that the proportion of spending on health care lobbying has generally been on an onward and upward trend. On the one hand, that’s not surprising either: it just parallels the same growth in national health care expenditures. On the other hand, however, it is cause for concern: as the very thing we are attempting to reform grows larger and more unwieldy, the forces aligned to maintain the status quo are working harder than ever before.*
*To be fair, my analysis provides no indication of the amount spent in support of an agenda versus that spent in opposition to the same, but it does signal the relative significance of the issue on the national stage.