Published on Sunday, July 23, 2000 in the Los Angeles Times
Health Care Firms Spend Big to Head Off Reforms
by Jeff Leeds
With billions of dollars in profits on
the line, the health care industry is waging the largest
national advertising campaign ever conducted
by a political special interest, with a price tag
for the election cycle that could approach
$90 million--more than either of the major
presidential candidates is expected
to spend.
Already, leading pharmaceutical makers
have spent about $34 million on television, radio
and print ads since last July, making
them the biggest exploiter of a just-closed loophole
that allowed donors to remain anonymous
while funding political ad campaigns.
But only part of the staggering sums
are being paid by drug makers, who are fighting a plan
to expand Medicare by adding prescription
drug coverage. Managed care companies
opposed to proposed regulations such
as a right for patients to sue are also pouring cash
into commercials.
"You're going to have the biggest ad
blitz on health care America has ever seen," said Mark
Merritt, a strategist for the American
Assn. of Health Plans, which is broadcasting some of
the ads. By November, he said, the waves
of ads will mean "the most educated electorate
on health care in modern history."
The commercials make no specific reference
to the candidates seeking the White House.
But they attack some White House policies
that are supported by Vice President Al Gore,
the presumptive Democratic nominee,
and opposed by Texas Gov. George W. Bush, his
Republican rival.
One series of ads critical of White House
plans to add prescription drug coverage to
Medicare features "Flo," a senior citizen
in a women's bowling group who rejects the
intrusion of "bureaucrats" in her medicine
cabinet.
Another commercial in March seeking to
block legislation that would allow patients to sue
their health maintenance organization
for medical malpractice includes scenes of doctors
working with a text that reads: "Washington
prefers more lawsuits. But lawsuits don't save
lives. Doctors do. Get patients the
care they need instead of getting lawyers the clients
they want."
Key Congressional Races Targeted
The commercials are being funded largely
by companies that learned the political ropes
when they organized against President
Clinton's highly touted health care overhaul, which
was scuttled in 1994.
Although the ads do not refer specifically
to the presidential campaign, the pharmaceutical
industry has focused on key congressional
races, airing commercials in the districts of at
least four House Democrats who backed
a bill containing the Medicare drug coverage plan.
The ads accuse them of "playing politics"
with the issue.
Gore campaign officials said they are
also concerned about commercials that are critical of
the vice president's health care positions,
even if they do not refer to him by name.
"They're going to win some votes on this
thing," a Gore advisor said, referring to the
prescription drug commercials. "When
you put $50 million on the air, it's going to have its
desired effect."
Although some independent experts agree
the spots will help Bush, others suggest the
industry blitz could backfire by raising
the profile of an issue on which public opinion is on
Gore's side.
"The more the [ad] campaign focuses on
this issue, the more Al Gore wins support," said
Ron Pollack, executive director of Families
USA, a nonpartisan consumer group in
Washington.
Gore recently singled out this year's
biggest health care advertiser, Citizens for Better
Medicare, a pharmaceutical industry-funded
group responsible for about two-thirds of this
year's health-related advertising. Gore
called it a "phony coalition" sponsored by the drug
companies who fear Medicare-backed prescription
drug coverage would erode their profits.
The vice president complained that CBM
was hiding its donors under a controversial
provision in the tax code, Section 527,
which was recently closed in the only campaign
finance reform bill to pass Congress
this year. The provision let groups raise unlimited sums
without identifying their donors.
Most Donors Come From the Industry
Dan Zielinski, a spokesman for the organization,
noted that it has listed its membership,
which includes many of its donors, "from
day one" online. He also said "almost all" of the
donors are from the pharmaceutical industry.
But he declined to reveal CBM's complete list
of donors, how much they contributed
or how much cash the organization has for the
campaign.
Zielinski said critics who attack the
group's lack of disclosure are "vilifying the messenger
instead of discussing the policy" questions
involved. He also insisted the group is not trying
to influence political races.
"Our sole concern is to educate the public
[and] counter misinformation," he said. "We are
not interested in the political and
electoral races."
But Democrats are already suspicious
because the company that places the commercials
for Citizens for Better Medicare--National
Media, an Alexandria, Va., firm--also does the
same for the Republican National Committee.
Many of the CBM ads are also being
broadcast in the same markets as GOP
ads, including those in Midwest battleground
states.
When the RNC temporarily suspended its
television ads earlier this month, Democrats say
that CBM increased its advertising buys.
The GOP resumed its television campaign this
week.
The ads featuring "Flo"--broadcast by
CBM--recall the health insurance industry's famed
"Harry and Louise" ads, in which a fictional
middle-class couple sat at the kitchen table
berating Clinton's 1994 health care
overhaul proposals.
At the time, jaws dropped in Washington
over that ad campaign's estimated $14-million
price tag, which was picked up by the
Health Insurance Assn. of America. Now, with far
more money to flood the airwaves, major
corporations are testing the tactic again.
Democrats and industry experts expect
CBM will have spent $65 million by November. An
analysis by the Campaign Media Analysis
Group, a Virginia-based firm that tracks political
advertising for The Times, shows CBM
has spent about $34 million since last summer.
Researchers at the University of Pennsylvania's
Annenberg Public Policy Center say the
airwaves this year also are awash with
ads from at least six other health care groups that
had spent or committed to spending about
$25 million on political commercials.
Health care industry spending could surpass
the ad budgets of either presidential
campaign. Bush has spent about $22.3
million on ads from early 1999 to the end of May of
this year, according to the Campaign
Study Group, a Virginia-based organization that
tracks campaign finances for The Times.
Gore has spent about $10.8 million over the same
period. Each candidate is expected to
spend about $40 million on ads in the general
election.
By commercial advertising standards,
the health care groups' political ad blitz is big, but not
overwhelming. The pharmaceutical group's
spending is roughly comparable to the marketing
budget of a summer blockbuster movie
such as "Mission Impossible 2."
Still, the millions being shelled out
are "small compared to the amount of money that's at
stake" in November, said Princeton health
economist Uwe Reinhardt.
For the HMOs, many of which are barely
profitable, and the pharmaceutical firms, whose
profits are among the highest in American
industry, bombarding the airwaves is good
business, he said.
"The rate of return would be stunning
if you hold off [stricter regulation] for another three to
four years," said Reinhardt. "It would
be a fine investment . . . and of course the TV industry
will laugh all the way to the bank."
Elderly people without prescription drug
coverage make up one of the most profitable
segments of the $100-billion-a-year
U.S. drug market because they pay retail prices for their
medicine with cash up front.
The presidential candidates' competing
plans could have markedly different effects on that
market. The federal government's Medicare
program, which helps pay for health care for 39
million elderly and disabled Americans,
has never covered prescriptions.
Gore, like Clinton, is pushing a plan
to have the government cover 50% of Medicare
recipients' drug costs up to $5,000
and the full cost of drugs for people with very high
out-of-pocket costs. Bush would overhaul
Medicare and have private insurers offer a range of
coverage, some with drug coverage.
State Reforms Already Pending
Major drug firms are already concerned
because bills to mandate drug discounts are
pending in 18 states.
Nerves are also frazzled among HMO executives,
who are seeing accelerating momentum
for expanding patient rights. Both major
party candidates back legislation prohibiting HMOs
from making patients obtain prior permission
to visit an emergency room, for example.
HMOs try to limit access to emergency
and specialist services because they cost the
companies more.
Bush signed a patient protection bill
as governor of Texas and said he would expand its
provisions to cover people in federally
governed health plans. He also said he would support
a limited right for patients to sue
their HMOs in some cases.
Gore supports a more expansive plan that
would guarantee consumers many of the same
rights, including an independent vetting
of HMO-related complaints. His plan is more
expansive, however, covering people
in all health plans.
"We're talking about no less than the
final destruction of managed care," Reinhardt said.
And with pharmaceutical companies wary
of government plans that might lead to price
controls, "they fear the government
like the plague."
Copyright 2000 Los Angeles Times
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