CAPE ELIZABETH — In general, people and organizations base advocacy on national issues based on the benefits to themselves personally and/or to the country as a whole. Of course, motivation can never be known for sure, and wouldn’t determine the validity of arguments anyway, but it’s hard to deny that likelihood of personal gain may affect at least the selection of, and spin put on, the arguments presented.

Case in point: Partnership for America’s Health Care Future. Formed last year in response to rising interest in public health care proposals (“Medicare for All” and its variants), the group states that its mission is “to improve what’s working in health care and fix what’s not.” Its members “support building on the strength of employer-provided health coverage and preserving Medicare, Medicaid, and other programs that so many Americans depend on.”

However, as one reads through the partnership’s material, promoted through Facebook and Twitter, the efforts of the political consulting firm FP1 Strategies and email blasts, one wonders what they mean by “what’s not (working)” in health care. Is it what the public plans attempt to address – the waste, the uninsured and inadequately insured, the cost shifting, the prohibitive cost-sharing, the job lock, the business burden, the physician burnout, the patient confusion, the medical bankruptcies and the medical classism?

A look at some of the partnership’s 30 members – which collectively spent $143 million lobbying Congress last year, according to the Center for Responsive Politics – offers some perspective.

The Pharmaceutical Research and Manufacturers of America, the drug industry’s main lobbying group, is one such member. Last year, PhRMA lobbied against Medicare Part D drug price negotiation and the importation of cheaper drugs; the year before, it resisted Nevada’s efforts to control the surging price of insulin. Another partnership member, the Association for Accessible Medicines, represents generic-drug manufacturers; in 2018, it argued successfully against a Maryland law restraining massive generic-drug price hikes. Maine and 43 other states recently filed a lawsuit alleging that drugmakers conspired to inflate prices of over 100 generic drugs by up to 1,000 percent. Both PhRMA and the Association for Accessible Medicines have good reason to resist reform that could entail drug price regulation or negotiation.

Another trade group, America’s Health Insurance Plans, spent over $6 million lobbying Congress last year, during which the inflation rate for health insurance was over 10 percent, as opposed to 2.3 percent for medical care services themselves. The prime goal of the Council of Insurance Agents and Brokers, another partnership member, is to “advance our members’ businesses and grow their bottom lines.” Any public health care plan would, of course, greatly reduce for-profit insurers’ bottom line.


Representing hospital interests are the American Hospital Association, which supported the creation of the Affordable Care Act and its government-subsidized insurance; and the Federation of American Hospitals (investor-owned). Other hospital management members include the Fortune 500 companies LifePoint Health (owned by affiliates of equity firm Apollo Global Management), and Universal Health Services (“an inspired choice for value investors,” according to investment adviser Zacks). Hospital Corp. of America, Community Health Systems and Tenet Healthcare, also Fortune 500 companies, have been fined for overcharging and upcoding claims; they, too, might well like to keep government oversight to a minimum.

Hospitals in general, including nonprofit ones, acutely aware of Medicare and Medicaid’s lower reimbursement rates, are understandably concerned about greater government control. What they don’t seem to acknowledge, though, is the considerable savings they should enjoy with many of the public plans (billing simplification, drug and device price negotiation, etc.).

Interestingly, the only partnership members representing physicians are the American Medical Association (originally an opponent of Medicare, and now representing a quarter of U.S. physicians), the North Dakota Medical Association and the American College of Radiology.

What must strike anyone reviewing the partnership’s membership is that the partnership’s goal of sustaining private, for-profit, employment-based insurance while keeping government responsible for the poor and elderly (“what’s working”) would benefit all of them personally.

What is less clear is whether it would benefit the country as a whole, and whether fixing “what’s not (working)” would, either, if that doesn’t include the issues that the public plans try to address.

By all means, consider Partnership for America’s Health Care Future’s arguments, but do so in light of just whose interests they serve.

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