He is also one of those health-care lobbyists the Clintons criticize so often. He despises a proposal Clinton has considered to pay for health care with a new tax on beer, wine and liquor. So Forth has put stickers on the back of his trucks reading 1-800-BEER-TAX, a phone number drivers can call to register opposition to the fee. He’s visited members of Congress and written to the White House as part of a campaign by Beer Drinkers of America-a group partly financed by the beer industry-that generated 90,000 letters.
Forth is but a grunt in what will be the biggest lobbying war the country has ever seen. “You have a $900 billion poker game that is about to start,” says lobbyist Dirk Van Dongen, who heads the Health Equity Action League, a coalition of business interests. Even though the plan is now not expected until September, the fight has already begun. In recent weeks Hillary Clinton concentrated on stroking anxious doctors at the American Medical Association meeting in Chicago, governors who had gathered in Woodstock, Vt., and liberal lawmakers who support a Canadian-style government-run system. Hundreds of interest groups have started lobbying as well. But this campaign will entail more than just tasseled-loafered influence peddlers prowling Congress. This time all sides are employing massive, sophisticated grassroots campaigns using-and sometimes manipulating-people like Kevin Forth. No one will escape their reach. Ross Perot-style infomercials and celebrity-studded videos will clutter your cable dial, canvassers will knock at your door and your own doctor may beseech you to help.
Any effort to radically overhaul one seventh of the economy was bound to kick up some dust. Those who don’t work for an industry threatened with reorganization (insurance, doctors, hospitals) might be part of an industry targeted to pay for reform (liquor, tobacco, gunmakers or business owners generally). Others will try to make sure the basic health package includes their favorite benefit. Psychologists want plenty of subsidized therapy sessions and trial lawyers want medical-malpractice laws left alone.
As in a national election campaign, each group will try to prove it can mobilize massive numbers of voters. The National Federation of Independent Business mailed postcards to 600 000 members asking them to call their congressmen last week to oppose new payroll taxes and requirements that employers provide health care. Citizen Action, a group that supports a government-run system, this summer will send 1,500 “canvassers” to 45,000 homes each night; volunteers will reach an additional 20,000 people by telephone. The group already has ginned up 1 million postcards to the White House. The American Association of Retired Persons has specially trained 1,400 members to talk about health care; they’ve already given briefings at 30,000 community meetings. The AFI-CIO has 287,000 activists ready to operate phone banks and generate mail.
The nature of lobbying has changed dramatically since the last major health-care overhaul. When Medicare was created in the 1960s, only a handful of interest groups battled, usually focusing on Washington. In the past decade, scores of industry groups have sprouted and have concentrated on reaching the people to whom members of Congress really listen-the constituents. Rep. Mike Synar of Oklahoma estimates that he has met with more than 1,000 people representing 50 different groups this year-and the plan hasn’t even been announced yet. In a typical week in May, Rep. Rob Andrews of New Jersey heard from not only the Mental Health Association of Southwest New Jersey and a disabled workers’ group but also the Social Concerns Committee of the Grace Baptist Church in Westmont, N.J. “When I look out at my congregation I know who’s struggling to make ends meet and can’t afford health care,” said the Rev. Steven Cates, his brow furrowed with empathy. After Clinton announces his plan, the lobbyists intend to organize community meetings and letterwriting drives.
Business groups opposed to Clinton’s initiative have been laying groundwork for months. The Hospital Corporation of America, a chain of 73 hospitals based in Nashville, Tenn., has circulated a manual-produced by Washington lobbyists-that teaches its 66,000 doctors, nurses and other employees how to hobnob with local business leaders, visit Kiwanis and Rotary Clubs, and write op-eds in the local newspaper. The Pharmaceutical Manufacturers Association has mounted an expensive ad campaign to counter the frontal assault against them by Bill and Hillary Clinton. (The Clintons have used both bellicose stump speeches and photogenic visits to local drugstore owners to bemoan price gouging by the drug companies; the PMA opposes price controls on drugs.)
Alert to the risk of information overload, interest groups will struggle to dramatize their message. Citizen Action in the fall of 1991 led five ambulance caravans through 48 states to foster support for reform. It has let no potential advantage go unexploited. Just 20 minutes after Rep. Tom Barrett gave his election-victory speech at a Milwaukee convention center last November, five of the group’s activists buttonholed him to support their health-care proposals. “It was an odd time to be lobbied,” he says. Health executives who went to Washington in March watched football-coach legend Lou Holtz stalk around a stage giving a locker-room-style motivational talk (for which he earned $20,000) to strengthen their resolve. “If you believe in your cause and are committed to excellence, you can succeed!” he shouted. “That’s true whether it’s football or health care!” Families USA, a liberal group expected to support the White House plan, manages a “misery bank” to help reporters find heart-wrenching stories about the ailing health-care system.
_B_Massive campaign:b Even the Clinton administration intends to use these techniques to create broad-based enthusiasm for its plan. For the first time, the Democratic National Committee has organized a massive national campaign around a single issue instead of a candidate. Its National Health Care Campaign will feature petition-writing drives, celebrity video endorsements, educational pamphlets and town meetings. “In size and scope, the tactics will be similar to what you see in a presidential campaign,” says coordinator Celia Fischer. The White House has met with hundreds of groups, ranging from the YWCA to the International Union of Electronic, Electrical, Salaried, Machine and Furniture Workers. Administration strategists will need the street-level support of labor and the AARP, one reason they’ve tried so hard to include long-term care. If labor likes the plan, AFL-CIO president Lane Kirkland promised Hillary Clinton in March, “we are your troops.”
Most Americans share an enormous personal stake in the health-care battle. But this struggle will also reveal whether the political system can cope with such a gargantuan, complicated problem. Some voters may be confused into championing a particular cause. More likely, though, the debate will help illustrate why the system so often gridlocks. Ordinary citizens may join the debate but, in effect, adopt the mind-set of a Washington lobbyist by focusing on narrow self-interest to the exclusion of broader issues. That would be very democratic, but would also jeopardize the chances for reform.
