Each year retailers begin their Christmas sales hype earlier and earlier. Now, as soon as the “back to school” sales end in August, we begin to see the first signs of Christmas. Primary Presidential elections are following suit in this regard. Many states now are considering holding their primary elections only days after we ring in the New Year. In only a few months, the 2008 election will be cruising along at full throttle. Despite the fact that this painfully lengthens the whole election process, in other ways this development should be good news for health care.
Aside from the war in Iraq, health care has been the most important issue for the American public in the early phase of the 2008 presidential campaign, ranking higher than both immigration and the economy. A New York Times/CBS News poll indicates that a majority of the U.S. population thinks that the federal government “should guarantee health insurance for all Americans,” particularly children. The poll confirms that Americans would be willing to pay higher taxes to make changes possible, although, like politicians, they disagree about whether participation in a national health care plan should be required and whether the government or private insurers would do a better job of providing coverage. This means that we in psychology must position ourselves to be key players in these debates to insure that mental health coverage and specifically psychological services are included in whatever health care plan will unfold in the future.
The next president of the United States will have tremendous impact on the health care system for many years and it is critical that he or she be well versed in matters pertaining to mental health. Elsewhere in this edition of Advance, two psychologists discuss their roles in the campaigns of two Presidential candidates.
It is instructive to analyze the fundraising results of the candidates at this point in the election in order to better appreciate the role of political money in the election process. During the first six months of 2007,the presidential candidates raised more than $265 million. This represents the fastest start to presidential fund-raising ever, according to the Center for Responsive Politics. The eventual Democratic and Republican nominees could each ultimately raise $500 million or more — record amounts. So far, however, only a small percentage of the contributions has come from people who are affiliated with the health sector or from political action committees (PACs) associated with the health sector. Of note, AAP does not become directly involved in supporting Presidential candidates, in large part, because the risk jeopardizing psychology’s lobbying activities for at least four years is too great if we found ourselves in the difficult position of having supported a losing candidate for President.
The Center for Responsive Politics analyzes campaign finance data reported to the Federal Election Commission and classifies contributions of $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 candidate Hillary Clinton, the leading fund-raiser, collected $63.1 million, of which 2.7% was from the health sector. Senator Barack Obama collected $58.9 million, 2.1% was from the health sector. Republican candidate Mitt Romney, the leading Republican fund-raiser, collected $44.4 million, including 3.1%, from the health sector. Rudolph Giuliani, raised $35.6 million, including 2.5%, from the health sector.
In total, Democratic presidential candidates raised a reported $60 million more than Republican candidates in the first 6 months of the 2-year 2008 election cycle. 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 lead in the race for money.
Traditionally, the financial sector — banks, insurance companies, and the real estate industry — has been the largest source of funds for presidential and congressional races, followed by lawyers and lobbyists and then ideological and single-issue groups. The financial sector contributed $338.9 million to federal candidates in the 2004 election cycle (which included the presidential election) and $251.8 million in the 2006 cycle (which was just congressional). In both cycles, the health sector ranked sixth among the 13 sectors. Health sector contributions — $123.9 million in the 2004 cycle and $98.6 million in the 2006 cycle — accounted for about 7% of all donations. The majority of health sector contributions were from individuals; doctors and other health care professionals contributed the most. In the 2004 and 2006 cycles, more than 60% of the health sector funds went to Republicans. This contrasts with the beginning of the 2008 cycle, during which the fund-raising advantage went to the Democrats.
Like some other businesses, the health care industry spends substantially more money lobbying Congress and federal agencies than it does on elections. Organized psychology, represented by the APA, maintains an extensive public policy office within APA which vigorously lobbies Congress on issues of concern to the science, education and public interest constituencies within APA. The APA Practice Organization’s Government Relations Department lobbyists fight on Capitol Hill for issues affecting professional psychologists. The APA and the APA Practice Organization invest a substantial amount of financial resources in these lobbying operations which far exceed the amounts available in AAP’s psychology PAC, AAP/PLAN, not unlike the lobbying to campaign ratio of most other interest groups.
In 2006, the health sector spent $351.1 million to lobby the federal government — an amount that accounted for 13.8% of all spending on lobbying and nearly equaled similar spending by the financial sector, which ranked first. Within the health sector, manufacturers of drugs, medical devices, and other health care products spent the 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 and nursing homes and then by organizations of health care professionals, such as the American Medical Association (AMA). Between 1998 and 2006, the AMA, the American Hospital Association, AARP (formerly the American Association of Retired Persons), and PhRMA spent, respectively, the second, fourth, sixth, and seventh most money on lobbying.
By contributing to political campaigns, individuals and PACs hope to influence both who gets elected and what they do when they are in office. Currently, there is broad support for making fundamental changes in or completely rebuilding the health care system. However, the details are complex, and as the discussion becomes specific, more people may prefer to maintain the status quo or to make incremental changes rather than start over. Contributions from the health sector to presidential and other federal candidates will likely increase in the months ahead. There are no assurances that the election of a new president will lead to major changes, although the potential for reform seems greater than it has for many years. Once again, it is incumbent upon psychology to amass the resources we need to insure our place at the table. Please be sure to renew your AAP membership NOW. Just as important, recruit a colleague to become an AAP member. If every psychologist contributed to AAP’s political advocacy program, psychology would be second among all health PACs in Washington. Currently, we are way down on the political giving totem pole. Please resolve to help us change that ranking today.