MEDICARE’S PROBLEMATIC PRIVATE OPTION

Medicare was created in 1965 when people over 65 found it virtually impossible to get private health insurance coverage. Medicare made access to health care a universal right for Americans 65 and over. It improved the health and longevity of older Americans, as well as their financial security. Initially, Medicare consisted solely of a public insurance program that included all seniors.

Today, a mixed public-private health insurance market exists under Medicare. An examination of it is very instructive in terms of how a mixed public-private system would be likely to work if extended to people under age 65. The Medicare-eligible population has been able to enroll in private health insurance plans since the 1980s. The private health insurance industry lobbied heavily for access to the large, Medicare market.

Private health insurers argued for a private option under Medicare, stating that they could deliver better quality services at lower cost due to their efficiencies, thereby saving Medicare money. Initially they were paid 95% of what a Medicare enrollee cost based on promised efficiencies. However, once they had their foot in the door, the private insurers successfully lobbied for their payment rate to be increased. In 2009, it was as high as 120% of what a senior enrolled in the traditional, public Medicare program cost.

Not only have private health insurers been getting paid more per enrollee than it costs the government to serve seniors in the traditional, public Medicare insurance pool, but they have healthier enrollees who cost less to serve! Clearly, these private Medicare plans, referred to as Medicare Advantage plans, have not been saving Medicare any money, but rather costing it more than it would have to serve these seniors directly. [1] [2] And there’s no evidence that they are providing better quality services that would justify such a high rate of reimbursement. The Affordable Care Act is now working to lower this over-payment to private insurers.

Since shortly after they began, the private Medicare Advantage plans have been getting over paid, and this is exactly what is likely to happen if private insurers are allowed to participate in a universal health insurance program for people other than seniors.

There are four main strategies the Medicare Advantage plans have used to get paid more than they should. Private insurers in a mixed market for non-seniors would be expected to do the same things: [3]

Cherry-picking: The private Medicare Advantage insurers have worked to enroll healthier seniors who are less expensive to serve. Through targeted advertising, special benefits (e.g., subsidized health club memberships), and specialized outreach they have successfully attracted a healthier than average clientele. In the market for non-seniors, the private insurers can be expected to successfully work to attract younger, healthier, and therefore less expensive enrollees, leaving sicker and more expensive people for the public plan.
Lemon-dropping: The Medicare Advantage insurers have implemented strategies to get sick and expensive enrollees to drop out of their plans, even though this is ostensibly illegal under Medicare. For example, they limit access to providers of expensive specialty services, require high co-pays for expensive drugs, and put a complex approval process and other barriers in front of patients trying to access expensive care. The data from Medicare Advantage plans are clear, when patients need expensive services like dialysis or nursing home care they switch back to the public, traditional Medicare in large numbers because the private insurers make it difficult to access these services and get them paid for. In the market for non-seniors, the private insurers can be expected to drop or force out the sicker, more expensive patients, dumping this burden onto the public plan.
Over-reporting the seriousness of diagnoses: Medicare Advantage insurers report more and more serious diagnoses than they should. This makes their enrollees appear to be sicker than they are and therefore eligible for more or higher reimbursements from Medicare. For example, knee pain can be reported as arthritis and an episode of distress can be reported as major depression. Medicare’s occasional audits of Medicare Advantage insurers indicate that they are getting paid $10 billion annually for fabricated diagnoses and much more for what appear to be overly serious diagnoses. Private insurers in a non-seniors’ market can be expected to game the payment system this way too.
Lobbying Congress for generous payments: Over the 35 years of Medicare Advantage plans, the private insurers have cost Medicare more than it would have cost for Medicare to serve their enrollees directly because Congress has directed Medicare to pay the insurers higher premiums than are warranted. These higher premiums support Medicare Advantage plans’ 14% overhead (e.g., profits, advertising, and executive salaries), which is seven times more than Medicare’s overhead of only 2%. The over-payment of Medicare Advantage plans peaked in 2009 at around 120% of the per patient costs of traditional, public Medicare. Since then, the over-payments have been reduced by provisions of the Affordable Care Act (aka Obama Care). The private health care industry has lots of lobbying clout with Congress and can be expected to strongly and successfully lobby for favorable treatment under any expansion of health care coverage to non-seniors, as they did when the Affordable Care Act was being passed. At that time, for example, they were able to eliminate a public option plan from being offered because they were scared (perhaps even knew) that a public option like Medicare for All might well out-perform them.

As the debate about changing the U.S. health care system to a universal single-payer system, e.g., Medicare for All, has been unfolding, some opponents of a single-payer system have proposed a mixed system with both private health insurers and a public health insurance option, often referred to simply as a “public option.”

Unfortunately, a mixed public-private health insurance market for non-seniors won’t achieve the efficiencies and quality of a single-payer system as is evident in the Medicare Advantage experience. A single-payer system is the only way to both improve quality and control costs. (See this previous post for more details.)

I urge you to contact your U.S. Representative and Senators, as well as candidates in the 2020 election, and ask them where they stand on moving toward a single-payer health insurance system, e.g., Medicare for All. The health care and related industries will lobby strenuously against this, but in the end a single-payer health care system will provide better health care and health outcomes for Americans and will save us all a lot of money.

You can find contact information for your US Representative at http://www.house.gov/representatives/find/ and for your US Senators at http://www.senate.gov/general/contact_information/senators_cfm.cfm.

[1] Patel, Y.M., & Guterman, S., 12/8/17, “The evolution of private plans in Medicare,” The Commonwealth Fund (https://www.commonwealthfund.org/publications/issue-briefs/2017/dec/evolution-private-plans-medicare)

[2] McGuire, T.G., Newhouse, J.P., & Sinaiko, A.D., 2011, “An economic history of Medicare Part C,” The Milbank Quarterly (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117270/pdf/milq0089-0289.pdf)

[3] Himmelstein, D.U., & Woolhandler, S., 10/7/19, “The ‘public option’ is a poison pill,” The Nation (https://www.thenation.com/article/insurance-health-care-medicare/

A MIXED PUBLIC-PRIVATE HEALTH INSURANCE MARKET DOESN’T WORK

A serious debate about changing the U.S. health care system to a universal single-payer system, e.g., Medicare for All, is occurring. Some opponents of a single-payer system, who do want to expand access to health insurance, support a mixed system with both private health insurers and a public health insurance option, often referred to simply as a “public option.”

Unfortunately, the mixed public-private health insurance market some are proposing won’t achieve the efficiencies and quality of a single-payer system. It also won’t achieve universal coverage without substantial public expenditures. If universal coverage were achieved under such a mixed market, the government’s costs would be similar to or greater than those of a single-payer system but without its benefits of efficiency and quality.

There are three core problems with including private health insurers in our health care system (see this previous post for more details):

The private insurers will fragment the pool of insured people undermining the basic theory and efficiency of insurance – having a large pool of insurees with mixed risk profiles. Furthermore, the private insurers will work to enroll healthier people who are cheaper to serve, therefore maximizing profits, and leaving or dumping the higher cost, less healthy people in the public health plan. This and the ability of some, usually healthier people, to opt out if insurance isn’t mandated, further undermines the basis of an efficient insurance system with a large pool of people with mixed risks.
Private insurers have no financial incentive to maintain the long-term health of their enrollees because people change insurers frequently, for example when they change jobs. Therefore, private insurers do not have a long-term relationship with enrollees. Furthermore, profit not quality of care is the driving force for private insurers, so if denying coverage for services or providing low quality services produces more profit, that is what will happen.
Private health insurers spend a large portion of premiums (roughly 25%) on overhead, i.e., non-care expenses. This costs an estimated $570 billion a year and represents money that won’t be used to pay for health care services.

In a mixed market system, the presence of multiple payers (i.e., insurers) in the market means that the complexities of billing and administrative paperwork will not be eliminated as they would be with a single-payer system. Potential administrative and overhead cost savings will not be realized; they are estimated at $220 billion per year for insurers’ overhead expenses and $350 billion per year for the administrative costs of providers who have to deal with multiple sets of rules, regulations, co-pays, and forms. [1]

A single-payer system is the only way to both improve quality and control costs, as Dr. Donald Berwick (the former head of the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees those public health insurance programs) has stated. An example he cites to illustrate this point is an action he took when he was the head of CMS in 2010-2011. Data were showing that senior care facilities were using drugs to sedate patients whose behavior was challenging at times, rather than taking the time and energy to handle their behavior more appropriately. Given that Medicare and Medicaid pay for much of the care these facilities provide, he had the leverage to tell the facilities’ managers that they should address this problem or that he would develop regulations to deal with it. The result was that the facility managers reduced drug use and costs, while providing better care to their patients. Berwick could do this because he had the leverage as the primary payer (although not quite the only or single payer) for these services. [2]

The bottom line is that a mixed public-private health care system with multiple private insurers won’t work efficiently because:

Administrative and overhead costs will remain high,
The pool of people being insured will be fragmented and the private insurers will game the system to serve healthier people and maximize their profits, and
Improvements in quality will not occur because private insurers have no long-term incentive to keep enrollees healthy.

I urge you to study the policy proposals for our health care system; pay attention to the facts and ignore the scare tactics. If you do this and reflect on your experiences with our current health care system, I will be surprised if you don’t end up supporting a single-payer system. The transition to a single-payer system will not be easy and there will be bumps in the road.

The health care and related industries will lobby strenuously against it, but in the end a single-payer health care system will provide better health care and health outcomes for Americans and will save us all a lot of money. Remember that every other wealthy country in the world has a single-payer health care system and for half the per person cost of the U.S. system, they get better health outcomes, including everything from longevity to birth outcomes.

A mixed public-private health insurance market exists today under Medicare. An examination of it is very instructive in terms of how a mixed system would be likely to work if extended to those under Medicare’s eligibility age of 65, so I will summarize it in my next post.

[1] Himmelstein, D.U., & Woolhandler, S., 10/7/19, “The ‘public option’ is a poison pill,” The Nation (https://www.thenation.com/article/insurance-health-care-medicare/)

[2] Ready, T., 9/20/16, “Donald Berwick calls for ‘moral’ approach to healthcare,” Health Leaders Media (http://www.healthleadersmedia.com/quality/qa-donald-berwick-calls-moral-approach-healthcare) See in particular page 3 of the article.

MEDICARE FOR ALL: ONE WAY TO PAY FOR IT

The main critique of Medicare for All has been that it’s too expensive and that we can’t afford it. Or that the only way to pay for it would be a big tax increase on the middle class. My previous post discussed the big picture in the health care debate – should comprehensive health care be available and affordable for everyone or should it be left to the private market where people buy whatever they can afford. It also documented the consensus that Medicare for All would provide significant savings and reviewed the typically ignored costs of not having universal, comprehensive health care.

To counter criticism that Medicare for All is unaffordable, Senator Warren recently released a detailed proposal for how she would pay for Medicare for All and its estimated cost of $59 trillion over ten years. She identifies $7.5 trillion in savings to offset part of the cost and then identifies $52 trillion in revenue to pay for the remaining costs. The revenue would come from the following: [1] [2]

$31 trillion that is already being paid by the federal, state, and local governments for health care.
$9 trillion from a fee that employers would pay per employee instead of paying for a portion of employees’ health insurance. This is projected to SAVE employers $200 billion over ten years.
$3 trillion from a 3% annual tax on individuals’ wealth of over $1 billion and the annual collection of a tax on the increase in the value of investments (i.e., a capital gains tax).
$2.9 trillion from closing corporate tax loopholes on the earnings of multinational corporations and from reducing accelerated write-offs of equipment purchases.
$2.3 trillion from improved enforcement of existing tax laws by enhancing the IRS’s enforcement capacity and effectiveness.
$1.4 trillion from increased income taxes paid on the roughly $4 trillion increase in workers’ take-home pay because they would no longer have money deducted from their paychecks for the health insurance premiums of their employers’ health plan or for health savings accounts.
$900 billion from a financial transaction tax of 0.1% on sales of stocks, bonds, and other financial instruments (that’s a sales tax of $1 on every $1,000) and a fee on too-big-too-fail banks to reflect the risk they present to our economy.
$800 billion from eliminating the Defense Department’s Overseas Contingency Operations fund, which is basically a slush fund for military spending that was originally meant to be short-term funding for unanticipated expenses of wars in the Middle East.
$400 billion from immigration reform that allows undocumented workers to work legally and therefore pay taxes on their earnings.

Warren’s plan projects that over ten years about $11 trillion would go back into people’s pockets because they would no longer be paying the $20,000 per year the average family pays for private insurance premiums, co-pays, and deductibles. If insurance premiums are viewed as a mandatory expense that is essentially a tax, this would represent the largest tax cut in American history for low and middle-income households. [3]

The Warren plan projects savings of $7.5 trillion over ten years from:

Reducing payments to service providers to save $2.9 trillion.
Cutting administrative spending by $1.8 trillion, reducing it from the current 12% of private insurers’ premiums to 2.3%, which is what Medicare spends on administrative costs.
Saving $1.7 trillion on drug prices by negotiating prices and setting a price ceiling for each drug that is 110% of an international index. If a drug company won’t negotiate a price under that ceiling, the plan calls for revoking the drug’s patent and licensing other manufacturers to make the drug or having the government manufacture it directly.
Restraining the growth in health care costs to the rate of growth of the economy to save $1.1 trillion, setting an overall health care budget cap, if necessary.

These projected savings do not include likely savings from the benefits of broad implementation of preventive care or stronger enforcement of antitrust laws. Virtually every part of our health care system has become highly concentrated, which increases costs due to monopolistic power. For example, hospitals in 90% of metropolitan markets are highly concentrated due to the 1,667 hospital mergers that have occurred over the past 20 years.

Now that Sen. Warren has put out a detail proposal for paying for Medicare for All, opponents of Medicare for All will quibble over the specific estimates and whether these revenue sources are the best way to pay for Medicare for All. They may also shift their criticism to other aspects of the transition to Medicare for All. The transition will be complex because Medicare for All is a major restructuring of our health insurance system.

Warren proposes a four-year transition period in two steps. First, soon after she becomes President, everyone would be allowed to buy into Medicare and it would be free for anyone under 18 or with an income below twice the poverty line (about $51,000 for a family of four). Second, three years later, Warren would push legislation that would complete the transition to Medicare for All and eliminate private insurance except for very special situations. [4]

The bottom line is clear: Medicare for All can be paid for, it will lead to significant savings in health care, and most Americans will be better off both health care-wise and financially. Everyone who’s honestly analyzed Medicare for All acknowledges that there will be significant savings from reduced administrative and non-care overhead costs, as well as from cost controls and long-term health benefits due to increased preventive care and reduced barriers to accessing care when needed. As Dr. Donald Berwick, the former administrator of Medicare and Medicaid has said, based on his extensive experience, only a single-payer system can both improve quality and control costs.

Therefore, Medicare for All is a realistic policy option. After all, all the other developed countries in the world have some version of a national health care system that covers everyone, controls costs, and enhances quality. We can do this too!

Medicare for All will improve access to care for many Americans, reduce costs for almost all Americans, and increase people’s choices of doctors, hospitals, and other providers for everyone who now faces restrictions from their private insurers.

My next post will summarize the reasons why a single payer system is necessary for efficiency and quality, and why having a private insurer option undermines the overall health care system.

[1] Warren, E., 11/1/19, “Ending the stranglehold of health care costs on American families,” Team Warren (https://medium.com/@teamwarren/ending-the-stranglehold-of-health-care-costs-on-american-families-bf8286b13086)

[2] Dayen, D., 11/1/19, “Warren’s Medicare for All plan includes no new taxes on the middle class,” The American Prospect (https://prospect.org/health/warrens-medicare-for-all-plan-includes-no-new-taxes-on-the-middle-class/)

[3] Dayen, D., 10/22/19, “The Medicare for All cost debate is extremely dishonest,” The American Prospect (https://prospect.org/politics/medicare-for-all-cost-debate-is-extremely-dishonest/)

[4] Bidgood, J., 11/16/19, “Warren outlines phased path to Medicare goal,” The Boston Globe

THE REAL HEALTH CARE ISSUES FOR THE PRESIDENTIAL RACE

The mainstream media and their moderators of the Democratic debates have been focused on creating conflict and controversy among the Democratic candidates over their health care proposals. They, and some of the candidates, continually pit Medicare for All against alternative vehicles to provide health insurance to more Americans. They focus on Medicare for All’s costs and who will pay them as opposed to its benefits and savings. They typically ignore the issues of quality and efficiency.

Moreover, the mainstream media, their debate moderators, and some of the candidates miss the big point:

Democrats are talking about health care policies that would:

Expand coverage to more Americans,
Ensure coverage of a broad set of services, and
Reduce out-of-pocket costs for consumers such as co-pays and deductibles.

Meanwhile, Republicans in Congress and the White House are trying to:

Reduce the number of Americans who have health insurance by limiting access under the Affordable Care Act (aka Obama Care) and limiting the number of low-income people covered by Medicaid,
Limit the range of services that are covered,
Increase the number of people in insurance plans with high out-of-pocket costs, such as co-pays and deductibles,
Cut $845 billion from Medicare over the next ten years, and
Expand the privatization of Medicare by increasing the number of people in private Medicare Advantage plans, even though these plans cost the government more than traditional Medicare, have more restrictions on access to doctors and hospitals, and make it harder to access care, particularly expensive care, when one gets sick. [1]

Despite these major differences between the parties, the media and the debates have been deep in the weeds of policy details, focused on the cost of Medicare for All and how to pay for it. Because Medicare for All is a major restructuring of our health insurance system, there will be major differences between how health care is paid for today and how it would be paid for under Medicare for All. And there would be significant transition issues.

The alternatives to Medicare for All that some of the Democratic candidates support would also be expensive government programs, but no one seems to discuss that. If these alternatives were to cover anywhere near the number of people Medicare for All would cover, their costs would be similar to those for Medicare for All, if not higher, due to the inevitable inefficiencies in a system of multiple, competing, for-profit health insurers. Senator Warren has put forth the most detailed proposal on health care of any of the candidates. I will summarize it in my next post.

Medicare for All will generate significant cost savings. The overall and per patient costs in the U.S. are very high by international standards – almost 18% of our overall economy and more than $10,000 per person per year compared to 7% to 8% of the overall economy in other countries. Even a study by a right-wing think tank estimated that Medicare for All would save $2 trillion over ten years. The Congressional Budget Office recently estimated that a proposal in Congress to have Medicare negotiate prices for just 25 drugs would save $345 billion over ten years. This estimate implies that the savings from the bargaining power of Medicare for All on all health care spending would save far more than $2 trillion over ten years. [2]

Medicare for All would also improve health outcomes, an issue that has been largely ignored by the media and in the debates. From an international perspective, not only are our health care costs very high, but our outcomes are poor.

Also largely ignored by the media and in the debates are the costs of NOT having universal, affordable health insurance:

5 million people without health insurance for all of 2018 and another 63 million who are under-insured (i.e., have plans with high out-of-pocket costs that are likely to cause financial hardship if a covered individual gets seriously ill or injured).
Medical costs lead 530,000 people to file for bankruptcy each year. Between 2013 and 2016, the most frequent reason families filed for bankruptcy was health care costs, even though over 90% of Americans had health insurance.
57 million people had trouble paying their medical bills in 2018.
Tens of thousands of people die unnecessarily each year due to lack of access to health care.
44% of people didn’t go to the doctor when they were sick or injured due to cost.
37 million adults didn’t fill a prescription in 2018 because of cost.
36 million people skipped a recommended treatment, test, or follow-up because of cost.
34% of cancer patients had to borrow money from family or friends to pay for care.

Roughly a third of the $3.6 trillion spent annually on health care in the U.S. (i.e., $1.2 trillion) goes for expenses other than actual, direct health care services. These include costs such as administrative paper shuffling, advertising, profits, executive compensation, and nice office space for insurance companies, as well as more than $500 million a year spent on 2,500 lobbyists. In Canada, these administrative overhead costs are about a third of what they are here. The U.S. system with multiple payers, multiple forms, multiple sets of rules, and complicated billing spends 12% of overall costs on billing-related administrative expenses, while Medicare spends only 2% on these costs. [3]

A study recently published in the Journal of the American Medical Association (JAMA) finds that 20% – 25% of our current health care system spending, about $760 billion per year, is waste, which it analyzes in detail. The largest category of waste is the $266 billion per year in administrative costs. Changing to a single-payer system, such as Medicare for All, would largely eliminate the great and wasteful complexity of the multiple payment and reporting requirements of the various private payers. [4] [5]

The second largest category of waste, over $230 billion per year, is prices that are higher than they would be with more competitive markets or the price controls that are common in other countries, particularly on drug prices. A single-payer, Medicare for All-type system maximizes the ability to negotiate prices with providers for services, drugs, and medical equipment.

If identified strategies for reducing waste were implemented, the savings of $200 – $300 billion per year would pay for health insurance for the 27.5 million people (8.5% of the population) who lacked health insurance for all of 2018 [6] – even if our current high costs remain unchanged.

In my next post, I will summarize Senator Elizabeth Warren’s proposal for Medicare for All, including how the federal government would pay for it and the savings for middle and low-income households, for employers, and in the health care system as a whole.

[1] Johnson, J., 10/3/19, “Warnings of ‘stealth privatization’ effort as Trump signs Executive Order expanding Medicare Advantage plans,” Common Dreams (https://www.commondreams.org/news/2019/10/03/warnings-stealth-privatization-effort-trump-signs-executive-order-expanding-medicare)

[2] Dayen, D., 10/22/19, “The Medicare for All cost debate is extremely dishonest,” The American Prospect (https://prospect.org/politics/medicare-for-all-cost-debate-is-extremely-dishonest/)

[3] Hightower, J., July 2019, “Here’s the straight skinny on Medicare for All,” The Hightower Lowdown (https://hightowerlowdown.org/article/heres-the-straight-skinny-on-medicare-for-all/)

[4] Shrank, W.H., Rogstad, T.L., & Parekh, N., 10/7/19, “Waste in the US health care system,” Journal of the American Medical Association, (https://jamanetwork.com/journals/jama/article-abstract/2752664)

[5] Frakt, A., 10/7/19, “The huge waste in the U.S. health system,” The New York Times

[6] Census Bureau, Nov. 2019, “Health Insurance Coverage in the United States: 2018,” https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-267.pdf)

LOBBYING: HOW TO WEAKEN ITS INORDINATE INFLUENCE

Big companies and their wealthy executives and owners have inordinate influence on our supposedly democratic policy making. They wield their power through the cumulative impact of lobbying, campaign spending, and the revolving door of personnel going back and forth between the private and public sectors. This post presents some steps that can be taken to reduce the ability of lobbying to skew our public policies to the benefit of big business and the wealthy. (See my previous posts for background on lobbying and examples of how it works to thwart policies that benefit the public.)

Multiple proposals have been made for reining in lobbying. Senator Elizabeth Warren has probably made the most extensive and detailed proposal. [1] [2] It would:

Require everyone who is paid to influence government decisions to register as a lobbyist
Impose strict disclosure of whom lobbyists contact and what information is exchanged
Prohibit lobbying on behalf of foreign governments
Ban contributions to federal campaigns by federal lobbyists
Shut the revolving door between government positions and lobbying jobs
Tax any organization that spends more than $500,000 on lobbying in a year (see details below)

Senator Warren proposes a tax on companies spending over $500,000 in a year on lobbying. This would reduce the incentives for what she calls “excessive” lobbying and provide funding to counteract lobbying blitzes when they occur. Any organization that exceeded the $500,000 threshold would pay a 35% tax on lobbying expenditures from $500,000 to $1 million. For spending above $1 million, the tax would be 60% and it would increase to 75% for spending above $5 million.

Experts estimate that under this proposal, over the last ten years, 1,600 corporations and industry groups would have paid $10 billion in excessive lobbying taxes. Fifty-one of these organizations, including the U.S. Chamber of Commerce, fossil fuel-based Koch Industries, drug maker Pfizer, defense contractor Boeing, Microsoft, Walmart, and Exxon, would have paid the 75% rate every year due to lobbying expenditures of over $5 million in each of the last ten years.

The U.S. Chamber of Commerce is the biggest spender on lobbying and would have paid an estimated $770 million in taxes on over $1 billion in lobbying expenditures over the last ten years. The National Association of Realtors, Blue Cross Blue Shield, the pharmaceutical industry association, and the American Hospital Association are the next four organizations on the list of the biggest spenders on lobbying, each having spent between $200 million to $425 million on lobbying over the last ten years. The five industries paying the most in lobbying taxes would have been the pharmaceutical, health insurance, oil and gas, financial, and electric utility industries.

Under Warren’s proposal, the funds raised from the excessive lobbying tax would go into a new Lobbying Defense Trust Fund, which would be dedicated to blunting the influence of excessive lobbying and strengthening the voice of the public interest in policy making. The funding would be used to: [3]

Strengthen Congressional expertise so members aren’t relying on lobbyists for information and expertise. For example, the Congressional Office of Technology Assessment (which was eliminated by Speaker Newt Gingrich) would be resurrected and the Congressional Budget Office would be strengthened.
Support federal agencies that are facing an onslaught of lobbying. They would be provided funding, for example, to allow them to hire personnel to complete rule-making more quickly when being inundated by lobbyists’ comments, to which they are required to respond. When an organization goes over the $500,000 expenditure threshold (triggering the lobbying tax) and spends money lobbying against a proposed rule or regulation, the tax on the spending would go to the federal agency doing the rule-making to help it respond.
Establish a new Office of the Public Advocate that would fight for the public interest in the rule-making process.

Senator Sanders also has a plan to reduce the influence of businesses and their lobbying in policy making. It would prohibit political contributions by federal lobbyists. It also calls for a lifetime ban on lobbying by former members of Congress and senior Congressional staff. [4]

The ethics and election reform bill, H.R.1, the first bill introduced after Democrats took control of the House in 2016, would tighten lobbying regulations. It would reduce from 20% to 10% the amount of time an individual could spend on lobbying activities before having to register as a lobbyist. The American Bar Association, among others, has proposed eliminating the 20% threshold and replacing it with a less arbitrary and more enforceable criterion. Numerous calls for a lifetime ban on lobbying by former members of Congress have been put forth, but the effectiveness of such a law is questionable given the amount of shadow lobbying, i.e., lobbying activities by unregistered persons, that currently exists. [5]

Big companies and their wealthy executives and owners work relentlessly through lobbying, campaign spending, and the revolving door to block or weaken policy changes that would benefit workers and the public. They attack legislation as it goes through Congress. They work to get the President to oppose or veto proposed laws. Failing that, they work to block or weaken the implementation of laws, including the issuance of relevant rules and regulations. If they can’t block the issuing of rules or regulations, they sue in court to block their implementation. At best, this delays policy changes that would benefit workers and the public by years; often it succeeds in killing them completely.

I urge you to contact your elected officials at the federal level, and at the state and local levels too, and to ask them to pass laws that require full disclosure of paid lobbying activities. Ask them to ban campaign spending by lobbyists and to close the revolving door between public sector positions and related private sector jobs, including as lobbyists. Finally, ask them to use tax laws and other mechanisms to provide financial disincentives for excessive lobbying spending.

We need to take these steps to reduce the inordinate and undemocratic influence of companies and wealthy individuals in our policy making.

[1] Warren, E., 10/2/19, “Excessive lobbying tax proposal,” Team Warren (https://medium.com/@teamwarren/excessive-lobbying-tax-fca7cc86a7e5)

[2] Tusk, B., 10/14/19, “Lobbyists should embrace Warren’s anti-corruption plan,” The Boston Globe

[3] Warren, E., 10/2/19, see above

[4] Sanders, B., retrieved from the Internet on 10/15/19, “Get corporate money out of politics,” Sanders for President (https://berniesanders.com/issues/money-out-of-politics/)

[5] Evers-Hillstrom, K., & Auble, D., 10/3/19, ‘Shadow lobbying’ in Trump’s Washington,” Open Secrets, Center for Responsive Politics (https://www.opensecrets.org/news/reports/shadow-lobbying-2019#reforms)