Legislators, lobbyists, and health care reform

December 6, 2010

"Almost every month a new book comes out that impugns the integrity of lobbyists and legislators," says professor of public policy and political science Rick Hall, "that they're in bed together, that there's a corrupt conspiracy, that members are beholden to special interests, that they sell their votes for campaign contributions..." The reality—in health care legislation and other policy areas—isn't quite as racy.


Rick Hall

Rick Hall

In almost 200 interviews conducted over several years, Hall has surveyed lobbyists and legislators around substantive policies—about half of these in the health arena. Through these interviews, he can quantify their contacts and characterize their relationships. His discovery: lobbyists don't spend much time talking to the legislators who are undecided or who disagree with them; they invest their time in supporting friends. For these likeminded legislators, lobbyists offer data and anecdotal evidence, they gather information for speeches, they craft legislative language, they provide political intelligence. They become, in the words of Lester Milbrath, a scholar who published on the topic five decades ago, adjunct staffers.

Hall disagrees with Milbrath, however, on the consequences of this behavior. "Milbrath described the same patterns but came to the wrong conclusion. He thought that because they mainly lobby their congressional allies, lobbyists are ineffective, they are singing to the choir. I find that lobbyists are effective because they lobby their allies." In the main, lobbyists don't buy votes or quietly bribe legislators with fancy meals or long weekends in the Hamptons (although there will always be a few corrupt ones who do). Lobbyists gain influence because legislators don't have time to take action on every issue they care about and are more likely to propose legislation or amendments if they have a reliable source of support. "To influence legislation, a legislator has to work at it," Hall summarizes. "Lobbyists help them do that work, but only on issues that also serve the lobbyist's interests."

In one sense, Hall explains, "this strengthens the democratic process by allowing legislators to become involved in more issues, support more constituency interests, give voice to more problems." In another, more important sense, he says, it creates problems. Because interest groups don't have equal resources, some are, in the proverbial words of George Orwell, "more equal than others." They have more staff to support their proposals, thereby enabling more legislators to work on their common interests. But that also takes time and attention away from other constituent matters. Resource-rich interest groups may not influence legislators' positions, but they do influence their priorities, says Hall. As a result, resource-poor interests are pushed down, perhaps off, the legislator's "to do" list.

This summer, Hall did the research for his last case study—interviewing health care reform lobbyists from health provider groups, the insurance industry, public interest groups, business groups, and others involved in the 2010 Patient Protection and Affordable Care Act. Those interviews, and others he's conducted around the Medicare prescription drug act, the Patients' Bill of Rights bill, and other health legislation, continue to support his theory.

"I do not think it's a very complicated story," says Hall, "but as far as I can tell, nobody has told it, nobody looks at it this way."

Below is a formatted version of this article from State & Hill, the magazine of the Ford School. View the entire Fall 2010 State & Hill here.

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