Aside from the war in Iraq, health care has been the most importantissue for the U.S. public in the early phase of the 2008 presidentialcampaign, ranking higher than both immigration and the economy.1,2Indeed, a majority of the U.S. population thinks that the federalgovernment "should guarantee health insurance for all Americans,"particularly children.2 Americans would be willing to pay highertaxes to make changes possible, although, like politicians,they disagree about whether participation in a national healthcare plan should be required and whether the government or privateinsurers would do a better job of providing coverage.2
What the next president of the United States does or does notadvocate with regard to expanding coverage for the uninsuredand reducing the costs of care may affect the health care systemfor years. Between January and June 2007 — the latterbeing about 16 months before the election — the presidentialcandidates raised more than $265 million. This represents thefastest start to presidential fund-raising ever, according tothe Center for Responsive Politics (www.opensecrets.org), anonpartisan group that researches money in politics. The eventualDemocratic and Republican nominees could each ultimately raise$500 million or more — record amounts. So far, however,only a small percentage of the contributions — albeitmillions of dollars — has come from people who are affiliatedwith the health sector or from political action committees (PACs)associated with the health sector.
Under the Bipartisan Campaign Reform Act, the contribution limitfor an individual is $2,300 per candidate per election; primaryand general elections are considered separate elections. TheCenter for Responsive Politics analyzes campaign finance datareported to the Federal Election Commission and classifies contributionsof $200 or more from individual donors or PACs into 13 sectors;the health sector includes doctors, drug companies, and hospitals,among other groups. For the first half of 2007, Democratic candidateHillary Clinton, senator from New York and the leading fund-raiser,collected $63.1 million, of which $1.7 million, or 2.7%, wasfrom the health sector (see table). Senator Barack Obama ofIllinois, the second-leading fund-raiser among the Democraticcandidates, collected $58.9 million; $1.2 million, or 2.1%,was from the health sector. Republican candidate Mitt Romney,the former governor of Massachusetts and the leading Republicanfund-raiser, collected $44.4 million, including $1.4 million,or 3.1%, from the health sector. Rudolph Giuliani, the second-leadingfund-raiser among the Republican candidates and the former mayorof New York City, raised $35.6 million, including nearly $900,000,or 2.5%, from the health sector. Republican candidate TommyThompson of Wisconsin, who was the secretary of health and humanservices from 2001 to 2005, received the highest percentageof funds from the health sector — 6.1% — but heraised less than $900,000 overall.
Fund-Raising by Presidential Candidates, January–June 2007.
In total, Democratic presidential candidates raised a reported$60 million more than Republican candidates in the first 6 monthsof the 2-year 2008 election cycle. The actual difference maybe smaller, however: campaign contributions to Fred Thompson,the former Tennessee senator, were not reported because he hadnot officially entered the race. Democrats raised a total of$3.9 million from the health sector, and Republicans $3.1 million,figures that are consistent with the Democrats' overall leadin the race for money.3
In the health care domain, Clinton and Romney are the best-knownpresidential candidates. As first lady in the 1990s, Clintontried and failed to expand the federal role in health care,alienating drug companies, health insurers, and others in thehealth care industry with her proposals for universal healthcare and cost control. Subsequently, however, she has moderatedmany of her positions. Since she has been serving in the Senate,pharmaceutical companies and insurers have come to view hermore favorably, and she has received more contributions fromthem.4 In her 2006 Senate reelection campaign, Clinton raised$51.6 million — more than any other Senate candidate —including $1.6 million from the health sector. Among Senatecandidates, she ranked first in terms of contributions fromdoctors and other health care professionals, second in contributionsfrom hospitals and nursing homes, fourth in contributions fromthe insurance industry, and 20th in contributions from the drugindustry. Former Governor Romney, for his part, last year signedfar-reaching legislation for Massachusetts health care reform,which is considered a major accomplishment.
Traditionally, the financial sector — banks, insurancecompanies, and the real estate industry — has been thelargest source of funds for presidential and congressional races,followed by lawyers and lobbyists and then ideological and single-issuegroups, according to the Center for Responsive Politics. Thefinancial sector contributed $338.9 million to federal candidatesin the 2004 election cycle (which included the presidentialelection) and $251.8 million in the 2006 cycle (which was justcongressional). In both cycles, the health sector ranked sixthamong the 13 sectors. Health sector contributions — $123.9million in the 2004 cycle and $98.6 million in the 2006 cycle— accounted for about 7% of all donations. The majorityof health sector contributions were from individuals (see Figure 1);doctors and other health care professionals contributed themost. In the 2004 and 2006 cycles, more than three fifths ofthe health sector funds went to Republicans. This contrastswith the beginning of the 2008 cycle, during which the fund-raisingadvantage went to the Democrats.
Figure 1. Contributions from the Health Sector to Federal Elections, 1990–2006.
"Soft-money" contributions to the national parties were first publicly disclosed in the 1992 election cycle. After the 2002 election, the Bipartisan Campaign Reform Act banned such contributions. Donations to state and local party committees are not included. In the 2004 election cycle, health care professionals contributed $74.1 million to presidential and congressional candidates; pharmaceutical and health care product companies, $18.0 million; hospitals and nursing homes, $16.6 million; and health services and health maintenance organizations, $7.9 million. In the 2006 cycle, health care professionals contributed $53.9 million to congressional candidates; pharmaceutical and health care product companies, $19.3 million; hospitals and nursing homes, $13.7 million; and health services and health maintenance organizations, $7.6 million. Data are from the Center for Responsive Politics.
Like some other businesses, the health care industry spendssubstantially more money lobbying Congress and federal agenciesthan it does on elections (see Figure 2). In 2006, the healthsector spent $351.1 million to lobby the federal government— an amount that accounted for 13.8% of all spending onlobbying and nearly equaled similar spending by the financialsector, which ranked first. Within the health sector, manufacturersof drugs, medical devices, and other health care products spentthe most; Pharmaceutical Research and Manufacturers of America(PhRMA) spent $18.1 million, Pfizer $11.8 million, and Amgen$10.2 million. The drug industry was followed by hospitals andnursing homes and then by organizations of health care professionals,such as the American Medical Association (AMA). Between 1998and 2006, the AMA, the American Hospital Association, AARP (formerlythe American Association of Retired Persons), and PhRMA spent,respectively, the second, fourth, sixth, and seventh most moneyon lobbying.
Figure 2. Top-Spending Sectors and Organizations Lobbying Congress and Federal Agencies in 2006.
Panel A shows the 5 top-spending sectors and a breakdown of most spending in the health sector. Panel B shows the 10 top-spending organizations. The total spent on lobbying of Congress and federal agencies was $2.55 billion. Data are from the Center for Responsive Politics and include all data made available through April 2007. HMO denotes health maintenance organization, and PhRMA denotes Pharmaceutical Research and Manufacturers of America.
By contributing to political campaigns, individuals and PACshope to influence both who gets elected and what they do whenthey are in office. Currently, there is broad support for making"fundamental changes" in or "completely" rebuilding the healthcare system.2 However, the details are complex, and as the discussionbecomes specific, more people may prefer to maintain the statusquo or to make incremental changes rather than start over. Althoughcontributions from the health sector to presidential and otherfederal candidates may increase in the months ahead, they willcontinue to be dwarfed by the amount the sector spends on lobbying.There are no assurances that the election of a new presidentwill lead to major changes, although the potential for reformseems greater than it has for many years.
Source Information
Dr. Steinbrook (rsteinbrook{at}attglobal.net) is a national correspondent for the Journal.
Previous
