The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

The CMA, California’s 5th Assembly District and the Future of Health Care Reform

Posted by Alan on March 20, 2010


[Full Disclosure: This post is about the 5th Assembly District. The leading Democrat in the race, Larry Miles, is a Trustee on the San Juan School Board, an attorney, mediator and my close friend for over 35 years. I’m actively supporting his campaign.]

Regardless of whether health care reform passes the House of Representatives this weekend, a great deal of how health care reform takes shape going forward will be determined by the states. If national reform fails, state legislators, who for the most part have been holding back to see what emerges from Washington, will attack the problems inherent in the status quo with a vengeance. If Congress enacts President Barack Obama’s health care reform package, the terms of the new law creates substantial responsibilities on the states to implement many of its provisions.

In short, the health care reform debate won’t be over any time soon. It’s center of gravity will, however, shift somewhat toward the states. Special interests have recognized this coming reality and some are doing something about it.

Take physician groups, specifically, the California Medical Association. Even the most ardent supporters of the health care reform bill before Congress will concede it deals more with health insurance reform rather than medical cost containment. True, the legislation being considered by Congress has some cost reducing provisions and lays the groundwork for still more, but it also contains many elements likely to increase the cost of medical insurance. Having addressed the easy part of reform (changing how carriers do business) lawmakers will eventually have to tackle the hard, complex and politically charged work of constraining medical costs.

For now, however, President Obama’s health care reform package asks little sacrifice of doctors. And that’s just the way the American Medical Association and its affiliates like it. The Medical Associations exist, after all, to look after the financial interests of doctors as their focus on medical liability reform, medical physician payment reform, balance billing issues and the like makes clear. They are a political organization looking out for the best and specific interests of its membership. Nothing wrong with that. In fact, that’s what special interests groups are supposed to do.

What’s happening in the 5th Assembly District here in California illustrates just how serious the California Medical Association takes this role. There the CMA has recruited a candidate and is now seeking to buy the seat on his behalf. Thus the candidacy of Dr. Richard Pan in the 5th AD. (The 5th AD stretches from east Sacramento to Folsom).

Dr. Pan is by all accounts an outstanding pediatrician and a fine, decent person. Whether he had any political ambitions before the CMA came calling is unknown. He certainly cannot claim to be a community-generated candidate nor boast of much grass roots support in the district. In the financing period that ended December 31, 2009 (the last reporting period available) over 95 percent of Dr. Pan’s campaign contributions came from outside the 5th Assembly District. Even more revealing: over 95 percent of those campaign dollars came from the California Medical Association, other medical PACs, doctors, dentists and other members of the medical industrial complex. Calling Dr. Pan’s support from within the district “thin” would be an understatement.

But the CMA doesn’t care. They are not concerned with the interests of the residents of the 5th Assembly District. They want one of their own in the state legislature – one of their own who can look out for the interests of the California Medical Association.

In addition to pouring money into the campaign, the CMA has provided Dr. Pan with a campaign manager enamored with the Karl Rove school of politics, Josh Pulliam. Mr. Pulliam is well known for hardball tactics of the devious kind. He’s a brawler both in the political arena and beyond (Mr. Pulliam, is the alleged instigator of a melee at a Cubs-Dodgers baseball game involving players and fans when he reached into the Dodger bullpen and grabbed catcher Chad Kreuter’s cap). In fact, Dr. Pan has already had to apologize for Mr. Pulliam’s Liz Cheney-esque campaign attack on Larry Miles, the front runner in the Democratic primary. (Mr. Pulliam, like Ms. Cheney, fails to understand the role lawyers play in America’s system of justice).

The CMA’s concerns are not limited to the 5th Assembly District of course. In 2009 the California Medical Association Small Contributor Committee contributed over $925,000 to lawmakers and candidates. And this is just from one of their PACs. Nor does this total include contributions from their allies in the medical-industrial complex including contributions made by individual doctors, county medical associations and the like at the CMA’s request.

Nor is the substantial political spending by the CMA anything new. A recent report published by California’s Fair Political Practice Commission shows that, between January 1, 2000 and December 31, 2009, the CMA has spent over $9 million to influence elections (including ballot measures and giving money to political parties) and spent another nearly $14 million on lobbying activity to help shape legislation.

There’s nothing immoral with the CMA and like-minded attempting to foist Dr. Pan on the residents of the 5th Assembly District. They’re playing by the rules of the game. Nor is there anything wrong with the CMA spending large amounts on campaigns. It’s their money and again, they’re playing by the rules. While obnoxious, there’s nothing illegal with Mr. Pulliam’s hardball election tactics either. Politics is, after all, a contact sport. That the CMA and Mr. Pulliam are running Dr. Pan against a good friend of mine is just one of those things. May the best candidate win.

Nor is the CMA alone among interest groups concerned about how health care reform plays out. Others are spending tremendous amounts of money to influence elections and legislation, too.

What’s significant about the CMA’s efforts (and the efforts of other special interest groups) is what it says about the important role state legislatures will play in determining how national health care reform (assuming there is national reform) is implemented and how future health care reform efforts play out. Washington will still matter. Regulations will be developed there. Follow-on legislation will be voted upon there. But the role played by state lawmakers and regulators will be increasing The California Medical Association and their allies recognizes this. That’s why they want Dr. Pan in the State Assembly. They know one vote, one voice in the legislature, can make a difference.

Whether the CMA-led medical-industrial complex can purchase the 5th Assembly District for Dr. Pan is far from certain. The frontrunner for the Democratic nomination, Larry Mile, has built his campaign with a strong and broad foundation of local support. Significantly, Mr. Miles has won two elections in a school district that covers some 75 percent of the Assembly District. Then there’s the general election. Democrats only recently have come to outnumber Republicans in the District (and roughly 20 percent of registered voters are in neither party). But what’s significant is not whether the CMA wins. What’s significant is the money, resources and political capital they are spending to try.

[Note: As I mentioned at the beginning of this post, Larry is a long-time friend. I’ve contributed to his campaign (as has the California Association of Health Underwriters PAC).  Those readers of this blog wishing to join me in supporting Larry can do so at his web site or through ActBlue.]

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3 Responses to “The CMA, California’s 5th Assembly District and the Future of Health Care Reform”

  1. Rxvette said

    applaud President Obama for his effort to get healthcare reform passed. This legislation has many much needed fixes for our current system. However, being the independent voter and healthcare professional I am I do believe that we still fall far short of addressing the core of this nation’s healthcare crisis. And this would be – an unhealthy America.

    Michelle Obama is the one fighting the bigger more important fight with her campaign to reduce obesity in children. This needs to be expanded to everyone in America. Because if you still have 2/3 of Americans who are overweight and sick you still have a healthcare crisis regardless of the legislative fixes you put in place. To learn more and to find specific resources we can all use to make an even bigger impact on our nation’s healthcare system please read my article on healthcare reform below. It turns out that we all individually have much more control over what happens about this issue than we think.

    A healthcare professional’s view on health care reform – http://bit.ly/9QLV8

  2. Nosedoc said

    It sounds like the CMA has decided to fight a battle it thinks it can win. Physician voices in state legislatures are a rarity, especially compared with the numbers of trial attorneys serving in these governing bodies. Additionally, the insurance industry, at least in my state of New Jersey, is well known for spreading its campaign contributions liberally on both sides of the political aisle, best insuring bipartisan support for the industry. I imagine things aren’t too different in other states, especially those with very little competition in the health insurance marketplace.

  3. Alan,

    My response to your commentary may be considered to be “extraneous”.

    That said, while I have little experience with CA politics, versus National or WA State politics, I find your commentary to be again, filled with reasoned information and education.

    Thank you.

    Spence

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