Professor Lawrence Lessig of Harvard Law School has written a seminal new book entitled, Republic, Lost: How Money Corrupts Congress–and a Plan to Stop It, recently published by Hachette Book Group. In it he argues that the root of most of our perceived economic and political problems in the U.S. today is the dependence that politicians have come to have on big money donors to political campaigns.
The mere 11% approval rating that currently disgraces Congress (the lowest approval rating in its history), shows growing public consensus in recognizing the problem, he suggests. In his book, Professor Lessig proposes a way to begin to address the root of the problem.
Lessig characterizes the problem not as overt bribery of politicians by monied or special interests, but rather as a perhaps unwitting “dependence” on campaign cash that well-meaning members of Congress have come to have. When money flows freely into their campaign coffers, politicians become dependent on that cash for their re-election, as an alcoholic becomes dependent on liquor (Lessig’s comparison). In order to secure the continued flow of that cash their way, they then look for opportunities to favor the interests of those contributing the money, without there being any overt quid pro quo or illegal bribe involved.
Professor Lessig’s thesis has strong implications both for our health and for health care reform.
Money Politics and Health Care Reform
In a lecture (see video below) about the subject matter of his book, Republic, Lost, Professor Lessig takes issue with those liberals who characterized the Affordable Care Act as a complete victory in which the Obama Administration succeeded in “neutralizing every single industry,” and who proclaimed the law a harbinger of the “twilight of the interest groups.”
Instead, Professor Lessig quotes the views expressed by columnist Glenn Greenwald in his piece, “Industry interests are not in their twilight.” Mr Greenwald wrote that if “neutralizing” industry interest groups means “bribing and accommodating them to such an extreme degree that they ended up affirmatively supporting a bill that lavishes them with massive benefits,” then that is a correct characterization of what happened.
As Marcia Angell, Professor at Harvard Medical School and the former editor of The New England Journal of Medicine, famously pointed out on a Bill Moyers panel on health care reform on March 5, 2010, “They [the private health insurance industry] really haven’t fought it [the health care reform legislation] very hard. What they’re fighting for is the individual mandate. And if they get that mandate, if everyone does have to buy their commercial products, then they’re going to be extremely happy with it.” Professor Angell argued for a single-payer federal insurance system in the best interests of the American people, which the private insurance industry did indeed vehemently oppose.
“Being able to force the Government to bribe and accommodate you is not a reflection of your powerlessness; quite the opposite,” Greenwald wrote. “The way this bill has been shaped is the ultimate expression — and bolstering — of how Washington has long worked. One can find reasonable excuses for why it had to be done that way, but one cannot reasonably deny that it was. And one can truthfully say many things about the political power of industry interests in Washington after this is all done; that they were “neutralized” and are in their “twilight” is most assuredly not among them.”
This is not to say that Lessig or Greenwald opposes the Affordable Care Act. In fact, Greenwald expressly says, “Again, none of this is proof that the health care bill is a bad idea — it’s possible that a bill which pleases these industries also produces, on balance, more good than harm (by expanding coverage and restricting some industry abuses).”
Professor Lessig’s point is simply that as long as we have a system in which the dependence of politicians on campaign cash from industry interests induces the politicians to bow to the interests of those contributing industries — or find it necessary to “bribe” the industry interests with compromises in policy to procure their support of legislation — then the reform that comes out of that process will not completely reflect the will or needs of the American people. Instead, it will more perfectly reflect industry interests, or a compromise among those industry interests.
Examples of the Influence of Money Harming Our Health
Professor Lessig cites several examples in his book, a few of which are also included in his lecture (video below), illustrating the effects money appears to have on health-related outcomes.
For example, he finds that among scientific studies of the health effects of the chemical BPA found in many soft plastics products sold for use by children, 100% of the studies funded by the BPA industry found no harm to health from BPA, while fully 86% of the independently funded studies found that BPA is harmful to the health of those exposed to it. Yet, BPA continues to be included in plastic products for children.
Similarly, among studies whether microwaves emitted by cell phones are harmful to health, 72% of studies funded by the industry find no harm, while 67% of independently funded studies have found harmful effects to health from microwaves emitted by cell phones. And, we continue addicted to our microwave-emitting cell phones.
In addition, he makes the case that an important contributing cause to the well documented obesity epidemic and related diabetes pandemic plaguing the health of our nation and contributing to rising health care costs, is that fructose corn syrup is found in fully 40% of the products in any supermarket. In his video lecture (below), Professor Lessig explains how the increase of cheap fructose corn syrup in processed foods can be traced to policies and subsidies passed by Congress in response to heavy lobbying efforts by the agribusiness industry and the sugar industry.
The CLASS Act: Another Example of Industry Interests Getting in the Way of Needed Reform?
The Community Living Assistance Services and Supports Act (“CLASS Act”), is a piece of legislation that was originally introduced by Senator Edward M. Kennedy. The bill was intended to address the urgent need for help with long-term care costs that we face as our population ages. The need is acute because few people can afford to self-finance the up to $10,000 per month cost of a nursing home or the premium costs of obtaining private long-term care insurance to cover those costs. Yet, Medicare does not cover long-term care costs of home health care, assisted living or nursing home care, except to a very limited extent after certain hospitalizations.
After some battles in Congress, the CLASS Act, which would establish a government-run insurance program to provide limited long-term care insurance benefits to seniors and disabled people, eventually found its way – in a watered-down version – into the Affordable Care Act.
As originally proposed by Senator Kennedy and promoted by others supporting the CLASS Act, the program should automatically enroll employees as participants and charge them premiums averaging around $65 a month. Assuring sufficient participation in the program by young people while they are in good health, seems to have been a key to making the program actuarially sound.
During the debates in Congress over the health care bill in 2009, it was widely reported that the private insurance industry opposed the CLASS Act. They wanted the ability to write (and profit from) long-term care insurance left to them in private industry.
Somehow, the CLASS Act, as finally included in the Affordable Care Act, made participation in the long-term care insurance program purely voluntary – for both employees and employers. The CLASS Act did include a required five-year period of paying premiums before one could collect benefits, however it failed to include provisions to induce people to sign up while young and well.
Nevertheless, the law charged the U.S. Department of Health & Human Services (HHS) with finding a way to implement the CLASS Act so that it would be completely self-sustaining based on beneficiary premiums, without government subsidies. And, as reported by Bloomberg News, the health care law further provided that “[HHS Secretary] Sebelius wasn’t allowed to begin [the CLASS Act long-term care insurance program] unless actuarial analysis showed it would be financially stable for 75 years.”
Even at the time of the 2009 debates over the CLASS Act, insurance industry groups, like the American Association for Long Term Care Insurance, in opposing the CLASS Act, issued reports saying that as a voluntary program, the CLASS Act would lead to people in poor health being more likely to sign up for the program than young people or those in good health, which the industry said would make the program unable to deliver without charging premiums far in excess of the $65 per month being sought by sponsors of the legislation. In other words, the insurance industry that opposed the CLASS Act understood and openly stated at the time that the CLASS Act legislation as being proposed was flawed, virtually setting the program up for failure.
Just this week, as reported by Bloomberg News and others, HHS Secretary Kathleen Sebelius announced to Congress that after 19 months of study, trying to find a way to implement the long-term care insurance program within the terms required by Congress in the CLASS Act, HHS was forced to conclude that under the terms of the Act as passed by Congress, there was no way to structure the program which could satisfy the Act’s requirement to demonstrate actuarially that the program would be self-sustaining based only on premiums collected for a period of 75 years.
The CLASS Act requires HHS Secretary Sebelius to certify that the program would be fiscally solvent for 75 years, before the program could be implemented. “She could not meet that threshold,” Assistant Secretary for Aging Kathy Greenlee said on a conference call with reporters, Politico reported.
Paul Van de Water, a Medicare and budget specialist at the Center on Budget and Policy Priorities, a nonprofit research group, commented to Bloomberg News, “The aim here was a good one. But the program as written in law was over-constrained.”
Was the combination of terms that ended up in the CLASS Act a result of compromises that members of Congress made with lobbyists for the monied private insurance industry which opposed the CLASS Act?
In order to quiet opposition to the CLASS Act from their campaign contributors in the private insurance industry, did members of Congress accept a combination of terms dictated by that industry? Did industry leaders and their lobbyists extract a set of terms which they knew would make the Act impossible to implement? Namely: (A) make the program completely voluntary — for both employees and employers, (B) omit any provisions to avoid people waiting to sign up until they actually become sick, and then (C) prohibit HHS from implementing the CLASS Act program unless HHS could demonstrate actuarially and certify that the program would be self-sustaining and financially stable for 75 years?
Was the failure of this reform to benefit seniors and the disabled actually written into the law by terms extracted by lobbyists for the insurance industry — an industry upon which many members of Congress are dependent for their re-election?
Further investigative reporting will no doubt be required to uncover the truth behind all of this.
Professor Lessig’s Lecture: Republic, Lost
Watch this Video in which Professor Lawrence Lessig explains his thesis in Republic, Lost — that under our current system of unlimited spending by corporate interests to influence policy and elections, money has come to have a pernicious influence on U.S. policy, standing in the way of meaningful legislative reforms that would reflect the will and interests of the American people. In this lecture, Professor Lessig also provides a glimpse of the potential solution to the problem that he proposes in Republic, Lost »
The book, Republic, Lost, is available for purchase from Amazon.com: Republic, Lost: How Money Corrupts Congress–and a Plan to Stop It
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