A halfhearted effort to stop the bill won’t protect millions of Americans from losing their insurance and, ultimately, from being denied medical care.
The Republican health-care bill now sneaking its way through the Senate has a good chance of becoming law, even though it would do miserable damage. And it has a good chance partly because some of the bill’s most influential opponents have not had the courage of their convictions.
I realize that sounds harsh. These opponents generally have good intentions. But they haven’t been very effective so far, and they don’t have much time to summon the courage to become more effective.
The opponents I’m talking about include almost every major health-care interest group: the lobbying groups for doctors, nurses and hospitals as well as advocates for patients with cancer, diabetes, lung disease, heart disease or birth defects. Each understands that the bill would deprive millions of Americans of insurance. Each has criticized the bill, and some, including AARP, have done more, like organizing phone calls.
But they have not come close to the sort of public campaign that would put intense pressure on senators. History shows what such a campaign would look like:
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In the 1940s, the American Medical Association (which represents doctors) conducted what was then “the most expensive lobbying effort in American history,” according to Paul Starr, author of a Pulitzer-winning history of health care. The campaign changed public opinion about Harry Truman’s plan for national insurance, helping doom it.
In the 1960s, the same association hired a movie star by the name of Ronald Reagan to barnstorm the country denouncing the proposal for Medicare. It would be the start of socialism, Reagan warned, and “invade every area of freedom as we have known it.” He lost that battle, but it set in motion his political career and modern conservatism.
In the 1990s, the lobbying group for insurance companies ran an ad campaign featuring a fictional couple named Harry and Louise. Sitting at their kitchen table “sometime in the future,” they lamented how much worse their coverage had become. The ads helped defeat Bill Clinton’s plan.
Today, however, “there isn’t much of a campaign,” as Starr told me. “And it contrasts very dramatically with some of the earlier conflicts.”
If anything, the case for an aggressive campaign is stronger now. Virtually every big health-care group views the Republican plan as a disaster, one that would harm many Americans largely in the service of cutting taxes for the wealthy.
But much of the groups’ criticism — like “a drastic step backward” — has come via news release. There has been no Harry, no Louise and no Ronald Reagan to capture national attention. “It’s a really big problem,” a Senate Democratic aide said. “It’s important right now that these groups start to mobilize much more than they have.”
The passivity has played into the Republican strategy. House and Senate leaders have taken the radical step of writing a bill largely in secret, without hearings. So health care groups haven’t been able to testify publicly. Without hearings — and without a publicity campaign — Congress has not felt enough political heat. Grass-roots groups have admirably tried to create heat, at town hall meetings and elsewhere, but it hasn’t been enough.
Why haven’t the big lobbying groups done more? I think there are two main answers. First, in past campaigns, groups were largely defending their own financial interests. People fight hard when their own money is at stake. Today’s opposition is at least as much about principle as profit, and lobbying groups haven’t been willing to go all-out for principle.
Second, the groups are wary of attacking the Republican Party, given its current power. “We’re living in a world in which it’s just Republican votes,” one lobbyist told me. Speaking loudly against the bill risks alienating powerful politicians — and risks making the health-care groups look partisan.
I get their reluctance. I feel a pang of discomfort every time I describe the radicalism of today’s Republican Party. I also know that the groups are lobbying behind the scenes for changes that would make the bill marginally less bad.
But that’s not nearly enough.
Doctors, hospital executives and treatment advocates take pride in doing good work that improves people’s lives. Sometimes, good work doesn’t require hard choices. Other times, it does. This is one of those times when it does. A halfhearted effort to stop the bill won’t protect millions of Americans from losing their insurance and, ultimately, from being denied medical care.
Senate leaders are rushing to pass a bill before their July 4 recess, and they seem to be making headway. That leaves opponents only three weeks to live up to their convictions. They can create advertisements that make clear the human damage the bill would do. Or put their well-respected leaders on popular talk shows. Or hold a mock hearing, featuring every group that has been denied the ability to testify.
Above all, they can take a risk for a cause.