Health Care System in Limbo

If the U.S. Supreme Court finds the federal health care reform act unconstitutional later this year, experts say it could unravel more of the nation's health care system than anticipated, including Medicare.

Judy Feder, a former Clinton administration official, tells NPR's Julie Rovner that the push toward more integrated and coordinated health care delivery would be disrupted.

Gail Wilensky, who ran Medicare and Medicaid programs for President H.W. Bush, says voiding federal health care reform would erase the most recent benchmarks for doctor and hospital payment rates. 

"Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid," Wilensky says. "Changes in coverage that have begun to take effect for the elderly, such as closing the donut hole, might not happen." The effects, she adds, would undoubtedly spill over to everyone in the health care system.

Sara Rosenbaum, a professor of health law, likens it a train wreck. "We could find ourselves at a grand stopping point for the entire health care system." One problem she cites is the possibility of thousands of Medicare policies being suddenly null and void.

Jeremy Lazarus, president-elect of the American Medical Association, says, "With countless hours of work already done to implement the law, it is hard to imagine the full impact of it disappearing."

Dan Mendelson, a health care consultant with Clinton administration ties, says the high court's decision could put most of health care in America in a legally murky place. Lazarus calls it "political never-never land."

Repeal or partial repeal of what Republicans like to call Obamacare would make a pretty big policy crater in Congress, which already is staring at big holes in long-term funding for Medicare and Social Security. Trustees for those entitlement programs released reports showing Medicare hits the financial wall in 2024 and Social Security's Waterloo has inched closer by three years to 2033.

More than 56 million American retirees or disabled workers and their spouses and children receive Social Security payments, which average $1,232 per month. It doesn't take a calculator to realize that is a lot of money rippling through the economy because Social Security recipients spend what they receive on food, rent, transportation, utilities and medical bills.

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Hacking the Chamber of Commerce

On the same day a Goldman Sachs economist described the Chinese Communist Party as a "chamber of commerce," a group of Chinese hackers were uncovered eavesdropping on the U.S. Chamber of Commerce.

Fabled magazine publisher Henry Luce famously lamented the loss of China to Communists by noting "Communism is the most monstrous cancer which ever attacked humanity." Now it is just attacking computers.

ABC News reported the hackers, allegedly aided by the Chinese military, have been sneaking peeks of U.S. Chamber of Commerce computers for more than a year. Maybe they are looking for a blueprint of how to act more like a chamber of commerce.

Jim O'Neill, an economist with Goldman Sachs, told NPR that in his 21 years of observing the Chinese, he concluded that while it is a run by a "Communist Party leadership, it's almost more like a chamber of commerce than a political party."

Chinese governmental leaders, O'Neill said, "worry about a lot of major problems that they face, as much as foreign observers and investors." His experience teaches him, O'Neill added, that countries with policymakers who worry about big problems are "usually better places in terms of investing."

Of course, if the Chinese hackers had taken the time to fly to Washington, D.C., they would have noticed the four-letter, three-story word "JOBS" draped in banners on the U.S. Chamber of Commerce building, located just across Lafayette Park from the White House. That could have justified all that spending on big dams, high-speed rail lines and wind farms.

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Shoe Leather and Good Ideas

NPR's Planet Money segment carried a recent piece focusing on how fundraising affects access to Members of Congress. Money is a factor in the political world of Washington, D.C., but don't underestimate the old-fashioned values of shoe leather and a good idea.

Planet Money reporters interviewed former lobbyist Jimmy Williams who recalled an incident where a congressman questioned why he should me with Williams or his principals after they had failed to respond to his campaign contribution solicitation.

Working Capitol Hill may not be that politically raw all the time, but money does talk in the halls of Congress, just as it does anywhere else.

If you don't have lots of loot, your best options are hard work and clear thinking.

Most federal lobbying is conducted with fact sheets and field trips, not briefcases full of cash.

Good lobbyists work with their clients, which can rang from big corporations to local cities and towns, to sharpen their agendas, making sure their asks are reasonable and fit the times.

For example, you can save the plane fare to Washington, D.C. to plead for an appropriations earmark. They are so last Congress.

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Creating Echo Chambers for Issues

Terms such as "lobbying," "advocacy" and "public affairs" are used commonly – and not always flatteringly – when discussing influencing Congress. NPR's Morning Edition ran a piece this week that gave a glimpse of what those terms mean on the ground.

"The art of public affairs," says Anne Womack-Kolton, a vice president of communications for the American Chemistry Council, "is telling your story as many ways as you can to create that echo chamber around whatever target you are trying to reach."

The NPR story centered on the congressional debate over restricting use of bisphenol A (BPA) in manufacturing hard-plastic drinking bottles, including baby bottles. Chemical companies insist BPA is safe, while consumer activists say it interferes with reproductive development in animals and has been linked to heart disease and diabetes in humans.

"I'll get an email or a phone call from either side saying, 'Hey, did you see this new Canadian study that says BPA is safe?' or 'Hey, did you see this Australian study on the health effects of BPA,'" explains Lyndsey Layton of The Washington Post. "So over the transom there's scientific data pouring in from either side and they're trying to use it to their advantage."

That's an example of advocacy – using credible, or at least seemingly credible, third-party sources to hammer home your side's argument.

Keep in mind, public affairs and advocacy campaigns aren't direct lobbying. That's the role of men and women who troop around Capitol Hill in Washington, D.C. to meet with Members of Congress and their staffs to lobby a point of view, usually in the form of asking for a "yes" or "no" vote on a bill.

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