Dr. Zwelling prescribes: 5 cures for congressional health policy paralysis

You may want to change how Congress handles Medicare, health care for people under age 65, or long-term care (LTC) finance.

Whatever you want to do to influence the people on Capitol Hill, Dr. Leonard Zwelling has some highly personal unfiltered ideas about how you, as an outsider, may look to the people working on the inside.

See also: House panel considers public catastrophic LTCI proposal

Zwelling, an independent who believes in the need for a single-payer health care system, had been a cancer research and research administrator at MD Anderson Cancer Center in Houston.

The Robert Wood Johnson Foundation fellowship program gave him a chance to spend a sabbatical year jammed into the Republican staff of the Senate Health, Education, Labor and Pensions (HELP) Committee. Starting in late 2008, he got a chance to watch the committee work on some of the proposals that eventually served as the basis for the Patient Protection and Affordable Care Act of 2010 (PPACA).

In a book about the experience, Red Kool-Aid, Blue Kool-Aid, Zwelling tries to analyze the chronic legislative blockage in the bowels of Congress and develop a treatment plan. One reason Congress works so slowly is that the founding fathers meant for it to work slowly, to keep bad bills from ever getting through, Zwelling writes.

But Zwelling says another reason health policy efforts work so slowly is that health policy advocates often have a weak understanding of how Congress really works.

The Robert Wood Johnson Foundation fellows program director taught the incoming fellows that there are four critical P’s in Washington: Policy, Process, Politics and Personality.

Personality is the most important, according to Zwelling.

“Nothing is more critical to getting something done in Washington,” he writes. Elsewhere, he gives a chapter the title, “If you’re right, but you’re rude, you’re wrong.”

See also: Alexander Hamilton: What did he really say about health policy?

The insurance industry often organizes “fly-ins,” to get members involved in a little citizen lobbying in Washington. 

Zwelling talks about what it’s like to be the target of the fly-in. In too many cases, he says, when professional organizations send members to Capitol Hill, “These professional groups target the policy issues and are largely unaware of the process, politics or personalities involved.”

Zwelling recalls the time the head of a major university visited the HELP Committee to “explain” the issues to the committee staff. ”When he was gone,” Zwelling writes, “one of the young staffers who met with the chancellor and me turned and asked, ‘Why do the academics come to the office to tell us what we already know?’”

Meanwhile, Zwelling says, the staffers often had only a vague understanding what life was really like for the visitors from outside Washington.

For a look at some of Zwelling’s ideas for suturing the gap, read on.

1. Decrease the size of congressional staffs.

More than 10 thousand people work on Capitol Hill, either for Congress itself or for the agencies or vendors that support it.

Zwelling says the sheer number of aides on lawmakers’ staffs adds to the legislative paralysis.

In Congress,”535 people get elected,” he writes. “What are the rest of the thousands of staff doing up there?”

See also: FIA Fly-In: More Than 150 Offices Visited

2. Get real subject matter experts a higher level of importance among the staffers who are still employed in the Capitol.

Zwelling says that, even though members of Congress and their committees employed thousands of aides, the percentage with relevant professional experience often seemed low.