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On the Third Hand: Your Democrats

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Once upon a long golden time ago, when the world was young and health insurance agents had no idea that their activities were interesting to anyone other than themselves, the National Association of Health Underwriters (NAHU) used to let me attend some of its political action committee (PAC) meetings without anyone at NAHU thinking to mention that the meetings might be off the record.

The meetings were held in brightly lit hotel conference rooms, not smoke-filled rooms, and it could well be that there were smoke-filled rooms occupied by cackling lobbyists, Jimmy Hoffa and demonic space aliens, but it seems as if just getting into the brightly lit PAC conference rooms would have been a health care finance conspiracy theorist’s dream come true.

What hit me at the time was that the PAC meetings were pretty much like any other fundraising meeting.

The PACs that represent nurses or consumers might think of themselves as being broke, and maybe they are, but it seemed as if the NAHU PAC also thought of itself as being broke. About 95 percent of the time at the PAC meeting was taken up with pleas for producers to please give more money to the PAC, ideally by signing up for a regular contribution plan. Maybe 5 percent of the time was taken up with talk about strategy, and the main devious idea presented was that lobbyists ought to try to build relationships with everyone willing to talk to them and that PACs ought to try, when possible, to build relationships with as broad a range of congressional candidates as possible.

The PAC meetings really seemed to be about as wholesome as a Girl Scout meeting, and, really, maybe health insurance industry PACs and PAC meetings are actually a force for good for the country as a whole.

I can’t imagine that there are any health insurance company executives who really want to stick it to sick policyholders. They might be a lot more skeptical about sob stories than I am, and they may have a different idea about what constitutes a valid claim, but it seems to me that they sincerely want their enrollees to stay healthy, and for the enrollees to get good care when they do fall ill.

It seems to me that the health insurance agents and brokers at NAHU and other producer groups are about as committed to fighting for individual customers and employer client plan enrollees to get good, cost-effective care as those enrollees’ own parents would be. 

Those folks, doctors, nurses, think tank analysts, government officials and others might have different ideas about how to run the health finance system, and they, of course, want to protect their own role in the system and maximize their own income. 

I think producers, insurance company executives and their lobbyists play an especially important role because just about everyone on Capitol Hill and in state capital cities knows what it’s like to be a patient, and most have seen enough doctor shows on television to have a vague idea about what it’s like to be a doctor or to run a hospital. But few people outside public and private insurance programs knows what it’s like to come up with the money to pay all of the claims, to evaluate the claims carefully, and to pay the claims quickly, without running out of money. If members of the health insurance industry community and their PACs don’t talk about the cold, hard economics of paying for health care, who will?

Those thoughts came up today as I was looking at the wonderful database of Federal Election Commission (FEC) federal campaign contribution data that MapLight has created using FEC data from

Under “accident & health insurance,” for example, the database lists the top 10 Senate recipients funded from July 1, 2005, through June 30, 2011, and the top 10 House recipients funded over that same period.

The top recipients in both chambers are Republicans.

Over in the Senate, Sen. John McCain, R-Ariz., tops the list with $207,401 in accident & Health sector contributions.

In the House, Rep. Dave Camp, R-Mich., the chairman of the Ways and Means Committee, has received $49,800 in contributions.

But the second-ranking recipients are Democrats – Sen. Debbie Stabenow of Michigan and Rep. Jason Altmire of Pennsylvania. Other Democrats that rank near the top in terms of accident & health sector contributions include Sen. Max Baucus, D-Mont.; Sen. Ben Nelson, D-Neb.; Rep. John Barrow, D-Ga.; and Rep. Charles Rangel, D-N.Y.

The contribution rankings for health maintenance organizations (HMOs) are a little different, but not that much different.

On the one hand: The idea that we make our politicians devote so much time and energy to fundraising seems silly. Consumer groups and members of the Tea Party tend to frame discussions about this in terms of the idea that the PAC and super-PAC donations will corrupt members of Congress.

To me, the more important question is we’ll eventually end up with a Congress made up of people who may be great fundraisers but aren’t great policymakers. Even assuming that the lawmakers are incorruptible, why should they have to be champion fundraisers to represent me in the House or the Senate? Why can’t my members just be smart, tough, patriotic people who have great ideas about what where the country should be going?

On the other hand: I think one strength of the PAC system is that it forces members of Congress and their staffs to learn about how big, boring parts of the world work in an unsentimental, warts-and-all way.

Messing with a sector of economy that’s important enough and energetic enough to generate large amounts of PAC money might be necessary, in some cases, but it’s not a low-risk endeavor. If you’re a member of Congress, and you propose changes that cause giant rivers of molten PAC money anger to start flowing your way, maybe you ought to think hard about the implications if you change rules that have allowed a sector of the economy to generate that much PAC money.

Will you just be forcing a few rich people to give up their fancy cars, or will you also be killing off many jobs? If so, which jobs? What will the people who hold those jobs now do next?

Maybe whatever it is you want to accomplish justifies those shifts, but have you made a serious effort to weigh the pros and cons of that shift?

On the third hand: Even if the PAC managers are obeying the letter and spirit of the law, and the candidates receiving the PAC money try their best to do what they think is right, maybe, in some cases, the system could lead to rigged systems and uneven playing fields.

Example: When the states and the federal government get done writing the health insurance exchange rules, will all of the rules be designed to maximize competition and lower prices, or will some actually be designed by politically favored players to shove out their rivals?

My solution: Keep the PACs, and the super-PACs, but have them give the money they raise to an Election Sponsor Committee that would dole out money roughly the way the International Olympic Committee doles out money. Maybe, instead of struggling money to raise money from PACs, the Election Sponsor Committee could simply negotiate sponsorship deals with a few big advertisers.

Maybe we’d end up with the “Google Democratic Convention” and the “Aetna Third Party Free-for-All.”

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