US healthcare lobbyists outspend other pressure groups
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《英国医生杂志》
Healthcare lobbyists spent $237m (￡130m; �195m), more than any other industry, to influence US senators and representatives, the White House, and federal agencies in 2000, says an article in the American Journal of Medicine (2004;116:474-7).
Drug companies and medical supply companies together spent $96m. Physicians and other health professionals, such as nurses, spent $46m, hospitals and nursing homes $40m, health insurance and managed care companies $31m, and disease advocacy and public health organisations spent $12m. During the study period, 1997-2000, spending on lobbying by health professionals grew by only 10% compared with 26% by other organisations.
An editorial in the same issue (p 496-7) by Dr Margot Kushel and Andrew Bindman of the University of California, San Francisco, says: "Health policy is at risk of being unduly influenced by special interest groups that can bring the most financial resources to the table" and suggests that this is "alarming for physicians."
The editorial says that pharmaceutical lobbying intensified at a time when dramatic increases in spending for drugs were a worry for elderly people, who "not only have the greatest burden of disease but who also are predominantly insured by Medicare, a health insurance program that did not cover outpatient pharmaceutical costs." Recent changes in Medicare "suggest that pharmaceutical lobbyists were unified and narrowly focused on securing an expansion of pharmacy benefits without associated cost controls."
Doctors should combine their interests with those of patients and with the need to improve the health of the population, the editorial says.
Lobbyists usually meet with legislative assistants, who collect and summarise information on a topic for their senator or representative. American doctors are respected and listened to, but they抮e talking about the wrong things, said Dr Ashwini Sehgal, one of the authors of the paper and associate professor at Case Western Reserve University in Cleveland, Ohio. He and Dr Steven Landers previously reported legislative assistants?reactions to lobbying by doctors (Archives of Internal Medicine 2000;160:3248-51).
Dr Sehgal told the BMJ: "There are about 29 000 meetings a year between physicians and legislative assistants, but the issues discussed almost exclusively relate to physician reimbursement and funding for research. Legislative assistants really would like more input on patient access to care, tobacco control, abortion rights, and public health issues, for example."
The number of lobbying organisations grew by 50% between 1997 and 2000, when 1192 organisations filed about 40 000 reports.
Since 1995, lobbyists have had to report the organisation for which they work and the amount spent. However, they need not mention the legislation for which they lobbied or their organisation抯 position—or how much was allocated to salaries, printing, transport, entertainment, or other costs. Organisations within a lobbying category may lobby for or against proposed legislation.
The reports do not cover campaign contributions, state and local lobbying, or campaigns urging people to write to their legislators.
In future, Dr Sehgal said, it would be helpful to know how the lobbying money was spent—entertainment versus printing, for example—and its impact on legislation (by recording the votes of the legislators who were lobbied.(New York Janice Hopkins T)
Drug companies and medical supply companies together spent $96m. Physicians and other health professionals, such as nurses, spent $46m, hospitals and nursing homes $40m, health insurance and managed care companies $31m, and disease advocacy and public health organisations spent $12m. During the study period, 1997-2000, spending on lobbying by health professionals grew by only 10% compared with 26% by other organisations.
An editorial in the same issue (p 496-7) by Dr Margot Kushel and Andrew Bindman of the University of California, San Francisco, says: "Health policy is at risk of being unduly influenced by special interest groups that can bring the most financial resources to the table" and suggests that this is "alarming for physicians."
The editorial says that pharmaceutical lobbying intensified at a time when dramatic increases in spending for drugs were a worry for elderly people, who "not only have the greatest burden of disease but who also are predominantly insured by Medicare, a health insurance program that did not cover outpatient pharmaceutical costs." Recent changes in Medicare "suggest that pharmaceutical lobbyists were unified and narrowly focused on securing an expansion of pharmacy benefits without associated cost controls."
Doctors should combine their interests with those of patients and with the need to improve the health of the population, the editorial says.
Lobbyists usually meet with legislative assistants, who collect and summarise information on a topic for their senator or representative. American doctors are respected and listened to, but they抮e talking about the wrong things, said Dr Ashwini Sehgal, one of the authors of the paper and associate professor at Case Western Reserve University in Cleveland, Ohio. He and Dr Steven Landers previously reported legislative assistants?reactions to lobbying by doctors (Archives of Internal Medicine 2000;160:3248-51).
Dr Sehgal told the BMJ: "There are about 29 000 meetings a year between physicians and legislative assistants, but the issues discussed almost exclusively relate to physician reimbursement and funding for research. Legislative assistants really would like more input on patient access to care, tobacco control, abortion rights, and public health issues, for example."
The number of lobbying organisations grew by 50% between 1997 and 2000, when 1192 organisations filed about 40 000 reports.
Since 1995, lobbyists have had to report the organisation for which they work and the amount spent. However, they need not mention the legislation for which they lobbied or their organisation抯 position—or how much was allocated to salaries, printing, transport, entertainment, or other costs. Organisations within a lobbying category may lobby for or against proposed legislation.
The reports do not cover campaign contributions, state and local lobbying, or campaigns urging people to write to their legislators.
In future, Dr Sehgal said, it would be helpful to know how the lobbying money was spent—entertainment versus printing, for example—and its impact on legislation (by recording the votes of the legislators who were lobbied.(New York Janice Hopkins T)