Tag Archives: lobbyists

America: Democracy or Dollarocracy?

A mere 15 years after buying it, I am finally getting around to reading Reinhold Niebuhr’s Moral Man and Immoral Society. Thoughtbasket readers will probably see numerous posts inspired by this book, likely spanning months, since that is how long it will take me to finish it based on my current reading pace.

The basic premise of the book is that while people, as individuals, are generally pretty moral, once they group together – as tribes, countries, companies, trade organizations – they often act in immoral ways. How Niebuhr bridges this dichotomy will require me reading beyond page 25, which is where I am now.

But in setting up the dichotomy Niebuhr discussed the forces that push man into society and ways that society enforces mores and rules. Writing in 1932, he says this:

“With the increased centralization of economic power in the period of modern industrialism, this development merely means that society as such does not control economic power as much as social well-being requires; and that the economic, rather than the political and military, power has become the significant coercive force of modern society.”

I don’t know whether to be relieved or disturbed that the economic elite have controlled our society for at least 75 years.

As the government throws trillions of dollars at Wall Street, with Goldman alumni seemingly running the Treasury department, and bankers using taxpayer dollars to pay themselves multimillion dollar bonuses (why isn’t that bonii?), it really seems like Simon Johnson is right and the financiers have taken over government via a quiet coup. But according to Niebuhr they took over government long ago, and while they have certainly managed to pillage the common man in the intervening years, the reality is that standards of living have increased since the 1930’s, so perhaps economic coercion isn’t that bad. That’s the relieved side of my brain.

US Income Distribution

The disturbed side of my brain, on the other hand, focuses on the pillaging. Note that in the above graph, standards of living have improved dramatically at the top end, but not so much at the bottom end. Not surprisingly, those who hold economic power ensure that society is set up such that most of the proceeds of growth accrue to them. Or, as Niebuhr puts it, “the dominant class….always paying itself inordinate rewards for its labors.” I wonder when and how we went from being a democracy deriving its “just powers from the consent of the governed,” to a society in which economic entities are dominant.

Should we blame greedy businessmen and craven politicians? Of course. But we need to look in a mirror too. Gary Cross discussed at length in An All-Consuming Century the trade-offs that labor organizations consciously made to ensure steady employment at a stable wage. Many of these trade-offs transferred power from unionized masses to the corporate elite. And as I’ve noted before, we all need to be more active and informed voters; when our representatives are more beholden to corporations than to people, we need to vote them out.

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Even Sadder History of Lobbyists

I recently posted about how corporate lobbyists stymied consumer protection reform in the 1960’s and 1970’s. Now here is a quote from Baron Arthur Salter’s book Recovery, from 1932:

“Government is failing above all because it has become enmeshed in the task of giving discretionary, particular preferential, privileges to competitive industry.”

Ugh. Will the system ever be as responsive to individuals as it is to corporate interests?

The Sad History of Lobbyists

I recently finished reading a great book called An All-Consuming Century by Gary Cross, a professor of history at Penn State. In this book Professor Cross traces the history of American consumerism in the 20th century, exploring the various roles of consumers, marketers, politicians and temperance movements, and teasing out theories of why America is so much more consumery (my word, not his) than other countries.

There is too much in his book to summarize, and I’d prefer that you buy it anyway, because it’s a great book. It’s currently number 330,562 on Amazon and I’m sure that we can get it up in the two hundred thousands. Suffice it to say that in a society founded on egalitarianism, consumption can be a method of both differentiation and assimilation.

One of the side themes that emerges from Cross’ book, and the one this blog entry is actually about, is the role that corporate lobbying has historically played in keeping consumption up. At a time when the role and power of Wall Street and insurance company lobbying are being much discussed, it seems appropriate to note that it’s nothing new for big business to use its money and lobbying clout to push around the little guy.

In particular, Cross discusses how after a rush of consumer rights legislation in the 1960’s (Hazardous Substance Labeling Act, Child Protection Act, Clean Air Act, etc.), corporations figured out how to lobby in order to limit the scope of those laws. “By 1976, they had begun to learn how to lobby a more decentralized Congress and to use Public Action Committee funds and grassroots pressure groups to regain dominance.” (p. 158)  Moreover, as Cross makes clear, the deregulation that marked the Reagan era was the nexus of laissez faire ideologues and corporate lobbying, and it encouraged consumption by limiting constraints on corporate marketing and product safety as well as environmental impact. Cross: “…deregulators were not friends of the average consumer, for they allowed higher bank fees, cable TV rates, insurance premiums, and child care and health costs.” (p. 205)

The fact that corporate lobbyists have been harming our hypothetical little guy for decades doesn’t make it right. I’m sure that the moneyed and powerful have been pushing their interests for longer than that. But in a US congressional system that has become so driven by the need to raise vast sums of money, the power of lobbyists is greater than ever. Solutions? Campaign finance reform and term limits are both possible answers. But the strongest answer is for voters to be aware of what their representatives are doing and act accordingly. Hey Montanans: if you don’t like that Senator Baucus took millions from the insurance industry while writing the health care reform law, then vote him out. We the people have a fair amount of power, but we have to work to exercise it.

Greedy Doctors Are The Same As Wall Street Bankers

Given the current legislative efforts to reform health care, it’s not surprising that there are plenty of articles being written on the subject. But I was surprised that in just one day last weekend I managed to read three articles that blamed doctors for a decent chunk of our out of control health care costs. More interesting, not one of these articles was talking about defensive medicine or a focus on high tech care; no, they were all basically saying that too many doctors are greedy for money.

First there was this article in the NY Times, which discussed how the AMA has since 1929 (yes, 80 years ago) fought against systems (such as cooperatives) that would potentially limit doctor incomes by creating a salary structure rather than a fee for service structure. Although some cooperatives were formed, it was over the objections of the AMA. Not coincidentally, the two medical groups that are continually held up as paragons of cost-effective and world-class care, the Mayo Clinic and the Cleveland Clinic, are both cooperatives. At a recent conference on cost-effective care, most doctors and hospital executives agreed that the fee for service system is “archaic and fundamentally at odds” with good practice.

Next was this article by Dr. Atul Gawande in The New Yorker, in which he investigates why health care in McAllen, Texas is so much higher than the national average. In fact, he notes, McAllen’s health expenses are twice as high as El Paso, Texas, which has the exact same demographics. Gawande explores a number of reasons – service quality, technology, legal environment – but ultimately concludes that it comes down to massive overuse of medical care. Doctors in McAllen do far more tests and scans and procedures than average.

But Gawande goes even further. He blames this overuse not on a surfeit of caution, or desire to better treat patients, but on doctor greed. Doctors make more money when they do more procedures, and if they have ownership stake or revenue sharing agreements with imaging centers or labs or hospitals (and many of them do), then they have financial incentive to send patients to those facilities. Interviewing doctors in McAllen, Gawande uncovers a culture of greed, where doctors are in it for the money. Or, as a McAllen cardiac surgeon says, “Medicine has become a pig trough here.”

I sent Gawande’s article to a friend of mine, who is a doctor in a family practice, but who also has a Master’s in Public Health and did a fellowship in preventative medicine. My friend agreed with Gawande’s conclusions, noting that “nobody wants to give up that $500k+ salary, and the AMA is a huge lobby.”

Finally, The New Republic had a piece that sort of summed it all up, noting:

“Given how much of the game of reining in costs hinges on doctors–whether they see themselves as profit-maximizing small businessmen (or, for that matter, large businessmen), or as fundamentally involved in healing patients and receiving fair compensation for that service–I think we have to think about the kinds of people who go into the profession.”

And this is where I get to have my say. Because if someone is going into medicine because they want to make a million dollars, I say they should go to Wall Street instead. As this chart shows, it isn’t exactly like doctors are hurting for money. Practicing medicine isn’t a license to print money, and when a doctor orders an extra $1,000 procedure, while he gets to keep that $1,000, we all have to pay for it through higher insurance premiums. At which point he is no better than the greedy mortgage-backed security trader whose huge bonus ended up being subsidized by taxpayers.

This just in: right before posting, I read this article in the Wall Street Journal about how the AMA and the American College of Surgeons both came out against the idea of a commission setting Medicare payments to doctors. These groups continually lobby against reductions in Medicare payments.

Added bonus links:

  • Slate article describing how a Supreme Court anti-trust decision gave rise to doctor-owned hospitals and other greedy doctor abominations.
  • Denver Post article about a woman who died when a doctor-owned specialty hospital that didn’t have the resources necessary to handle her post-surgery complications.
  • Book review by Harvard Medical School professor Arnold Relman, who attacks the “medical-industrial complex” and the whole concept of profit-driven medicine: “in no other country is medical care marketed and advertised so aggressively, as if it were just another commodity in trade.”
  • New York Times article describing how the greediest hospital in Gawande’s article is one of the largest contributors to Democrats this year as it lobbies “to soften measures that could choke its rapid growth.” This lobbying has been successful, as language limiting physician ownership of hospitals has been stripped out of bills. According to Democrat Pete Stark, the physicians “just thought they could buy their way out of it, and it’s a sad commentary on the Congress.”

Food and Politics

I was listening to Micahel Pollan on the radio last night (yes, on NPR; I was drinking chardonnay and eating sushi too) do his usual spiel on food, although this time it involved him promoting his new film “Food, Inc.” And although I know his viewpoint already — the American diet is unhealthy and politicians don’t care because they accept money from food corporations — this time I got  angry.

Maybe it was because this time Pollan told a story I hadn’t heard before: about how in 1977 Senator George McGovern led a committee that called for Americans to eat less red meat, until the meat industry threw a hissy fit and forced the committee to water its position down to “eat less saturated fat.” I just hate the fact that a single industry gets to throw money at politicians and thereby screw the American public.

Or possibly it’s because Pollan was speaking in the middle of the debate over health care reform. Politicians are feuding over the cost of health care and insurance, but they continue to throw subsidy money at the corn farmers and beef ranchers whose products are what make our diet so unhealthy. Hell, even the Wall Street Journal ran a column yesterday in which a doctor said that preventing obesity would save enough money to cover everything and everyone else.

So politicians, I ask you, again, please try to do what is right for the American people, and stop doing what some lobbyist pays you $2,000 to do.