In December 2009, a few days before the Senate was scheduled to vote on its version of the health-care reform bill, Senator Claire McCaskill of Missouri was asked on MSNBC’s “Morning Joe” why the Democrats had to settle for a bill that progressives were lamenting no longer contained a provision to create a public option. President Obama had frequently vowed that a public alternative to private health insurance was an essential part of reform, in part because competition from a government-run plan would keep insurers from charging unfair rates for comparable coverage.
McCaskill’s response was the most honest acknowledgement of what had happened to the reform legislation during the seven weeks between the House and Senate votes on their respective bills: “We lost a messaging battle.”
If she had been even more forthright, she would have noted that the main reason that battle was lost was the enormous amount of money the health-insurance industry and its allies spent, much of it in ways nearly impossible to trace, to shape the reform bill to its liking.
One of the reasons I left my job as a health-insurance executive a year earlier was that I knew an avalanche of money was about to be unleashed by my industry either to kill the legislation or, failing that, to ensure that whatever passed would not hinder profits.
In the 1990s, I helped draft and implement the industry’s well-financed campaigns to make sure the health-reform plan proposed by President Clinton and a subsequent effort to enact a patients’ bill of rights would go nowhere. My involvement was always behind the scenes. My peers and I did not want anyone to know our companies were responsible for these campaigns, so we hired public-relations firms to set up and operate front groups with names like the “Health Benefits Coalition,” and we recruited executives of organizations like the National Federation of Independent Business to serve as spokespeople.
I didn’t have the stomach to do that kind of stealth work again. The higher up the corporate ladder I climbed, the more I could see what health-insurance companies do to meet Wall Street’s profit expectations—like dumping policy-holders when they get sick and refusing to pay for doctor-ordered care. And I knew from personal experience how insurers used policy-holders’ premiums to finance misleading and deceptive campaigns to influence public policy.
We will never know how much the insurance industry spent overall during the reform debate because much of it is simply untraceable, but it undoubtedly ran into the hundreds of millions of dollars. That kind of money buys a lot of messaging, much of it false, in the high-stakes battle for hearts and minds—and for votes at the ballot box as well as on Capitol Hill.
Even if President Obama’s Affordable Care Act is eventually fully implemented, the law will still fall far short of assuring every American access to affordable quality health care, and it will not do nearly enough to control costs. Are the philanthropic organizations, unions, and advocacy groups that fought to win passage of the law working to reduce the influence of virtually unlimited money on politics and public policy? Do they see the value of devoting some of their giving and spending to help do that? For the most part, the answer to these questions appears to be no.
I start with health care because it’s my field, and because it’s an obvious case study in how Big Money corrupts. But of course it isn’t just health care. The corruption of our politics and policy affects every aspect of our lives, from the air we breathe, the water we drink, and the food we eat, to the bank fees we pay, the value of our homes, and the cost of sending our kids to college. Take the Dodd-Frank Wall Street Reform and Consumer Protection Act as an example. According to the Center for Public Integrity, the financial services industry spent $1.3 billion in lobbying expenses as the bill was taking shape in Congress in 2009 and early 2010. It is spending millions more to influence how the regulations are written and to try to delay or thwart implementation of important provisions to protect consumers.
I also mention health care because of the array of forces lined up against the insurers. Some groups were expressly political, like unions. But others were nonpolitical, like AARP, Consumers Union, the American Cancer Society, and the American Lung Association. These latter groups all advocated for consumer- and patient-focused health-care reform, and many of them devote considerable resources to trying to secure good health-care outcomes. But their real enemy is Big Money. Their goals will always remain elusive as long as the special interests that profit from making or doing things that harm us can spend unlimited amounts of money to keep things as they are. So why isn’t fighting Big Money part of their agenda?
Afraid to Engage?
While preparing to write this essay, I talked to executives from a broad range of organizations, including AARP and several of the national disease-related organizations as well as foundations that provide funding to nonpolitical interest groups.
When asked if giving even a small amount of money to fight Big Money was either planned or under consideration, almost all of them said that not only was it not a priority, it was rarely if ever discussed.
“The answer is no, no, no, and no,” said an executive at a nonprofit organization in perpetual battle with the big-spending tobacco industry and other well-funded adversaries. He said that his board and executive team would not go near the issue partly because of the belief that it would violate the organization’s bylaws, which prohibit engaging in any kind of political activity, and partly because of the concern that supporting campaign and lobbying reform might alienate some donors.
“Like every nonprofit, we are experiencing real financial difficulty,” he said. “Nobody is rolling in dough. So we clearly keep an arm’s-length distance.”
While he understands the importance of reform, he knows his board believes that it’s somebody else’s fight and that the organization needs to stick to its knitting: “With Citizens United the game changed. But groups like ours don’t really think about that. We don’t sit down and talk about what it means. There is a bit of a head-in-the-sand mentality. Advocacy groups in general are very slow to react. We don’t step back and ask, ‘Do we need to look at things differently?’ ”
AARP has steered clear of the issue for similar reasons. “It’s important, but I don’t recall ever seeing the organization taking a stance on campaign-finance reform,” said AARP President Robert G. Romasco.
“We are nonpartisan. We don’t have a PAC. We do advocate and lobby for legislative initiatives that are important to our members, and we have gotten involved on a selective basis in ballot-access issues, like protecting our members’ right to vote, but we haven’t gotten into campaign-finance reform.”
The California Endowment, a private health foundation that provides grants to community-based groups, was the only organization I spoke with that devotes attention and provides at least some money to political reform. Senior Program Manager Mary Lou Fulton said she has made grants to the National Institute on Money in State Politics because of the wealth of data the group collects that the endowment’s media, service, and advocacy grantees in California can put to good use in their communities.
“At the community level, accountability and transparency are important to policy change,” she said. “Community leaders are becoming more aware of that, and they need the kind of data that the National Institute on Money in State Politics can provide to help them achieve their objectives.”
Lauren LeRoy, who recently stepped down as president and CEO of Grantmakers in Health, an umbrella group that serves as a resource to health-focused philanthropies, said she has found that mainstream foundations in general are so risk averse that about the most they are willing to do when it comes to reform is have an occasional boardroom discussion. While there might be some talk, “my sense is that they don’t do a whole lot about it.”
LeRoy suggested that the reluctance by most foundations to consider giving money to lobbying and campaign-finance reform groups can be explained at least in part by what Andrew Rich, former president and CEO of the Roosevelt Institute, called a “preoccupation with neutrality” in a 2005 article in the Stanford Social Innovation Review. In his article, Rich wrote that the reason many Americans have been persuaded to think government has become too big and intrusive, and that we should support deregulation and privatization is that conservative foundations have succeeded by aggressively promoting their ideas. Non-conservative foundations have found such promotion unseemly.
In his article, Rich quoted a think-tank leader as saying, “Liberal foundations are liberal not just in their belief in social and economic justice, but also in their belief in the possibility of neutrality, which makes them uncomfortable with making grants that seem too ‘political.’ ” Conservative foundations demonstrate no such reticence. “It’s frustrating,” the think-tank leader continued, “because, by contrast, if you’re on the right, the foundations will only fund you if you toe the ideological line, if you want to do battle for the conservative cause.”
A Bipartisan Issue
What is even more frustrating is that reform of lobbying and campaign finance is not a liberal or conservative issue. All of us, regardless of our ideology or political affiliation, are affected by the corruption caused by Big Money. And reforms enacted throughout our history have been supported by both Democrats and Republicans. In fact, the earliest champions of reform were Republican Presidents Theodore Roosevelt and William H. Taft. And, lest we forget, the official name of the McCain-Feingold law, sponsored by Republican Senator John McCain of Arizona and former Democratic Senator Russ Feingold of Wisconsin (author of one of the essays in this symposium, on page 45), is the Bipartisan Campaign Finance Reform Act of 2002.
But mainstream foundations nevertheless have largely decided that the issue is too political and too partisan to touch, much less take on as a cause. And advocacy groups, fearful of being shunned by foundations and individual donors if they spend a dime of their scarce resources on reform, won’t touch it either.
It is time—long past time—for such groups not only to touch the issue but to grab hold of it and own it, and educate their constituencies on how vital it is. Not just to enable them to achieve their missions—which is easier to do when the playing field is more level—but also to safeguard the future of our democracy and way of life.
Having bylaws that prohibit contributions to nonprofits fighting Big Money need not prevent foundations from working to purge our democracy of such insidious corruption. In fact, I’ve looked at a number of organizations’ bylaws and have not seen specific language that bans giving to nonpartisan, nonprofit groups that advocate for campaign and lobbying reform. For those that might include such language, I urge their boards and leaders to amend those bylaws.
As long as our country’s foundations avoid tackling this critical and urgent issue, they will continue to lose messaging battles and the war of ideas (like those mentioned by Senator McCaskill and Andrew Rich) to adversaries who care far more about preserving profits than preserving democracy and protecting the common welfare. As someone who spent many years working for some of those adversaries and helping to allot some of their big money, I know they feel in control, and for good reason.