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K Street

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Jeffrey Birnbaum
Washington Post Staff Writer
Tuesday, November 20, 2007; 1:00 PM

K Street columnist Jeffrey Birnbaum was online to discuss the intersection of business, politics and government on Tuesday, Nov. 20, at 1 p.m. ET.

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A list of Birnbaum's columns can be found here.

A transcript follows.

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Jeffrey Birnbaum: Hello all,

Congress is out of session at the moment, and Thanksgiving is soon upon us, but it's too early to go completely on vacation! Please send in some questions about the intersection between business and government--that's the topic I write about. And I'm eager to comment. Today, in my column, I looked at the issue of charities lobbying. That's right, good-guy groups can and do lobby, but they don't like to. Does that make sense? Should 501(c)3 groups stay away from the "dirty" business of lobbying? That's what charity group executives said they would prefer to do for the most part, according to a recent survey. Is lobbying really so bad? Maybe it is. Maybe it isn't. Write in and let me know. I bet we can have a very vigorous debate. In any case welcome, and let's get started.

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Yonkers, N.Y.: Has your recent article on the Cassidy group & the Abramoff scandal done anything to slow down the flow of money to lobby firms? It seems as though everyone who leaves government joins or forms a lobbying firm. It must be lucrative.

Jeffrey Birnbaum: I think you may have me confused with Robert Kaiser. He is the fellow who wrote that excellent series about Cassidy & Associates. In any case, the amount of money going into lobbying and into campaign giving have continued to be large and, in some cases, to grow. The amount to registered lobbyists over the first six months of this year is down slightly from the previous period, but that may not be a long-term indicator. Everything I hear is that lobbying is still very much on the increase. In addition, campaign cash is flowing into the coffers of candidates for federal office at a very fast pace, more than 40 percent higher overall than four years ago, according to the nonpartisan Campaign Finance Institute.

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Washington: You implied in last week's column that there is no reason to worry about Pakistan. Sure there is, if for no other reason than that we're pumping a whole lotta taxpayer money into propping up the dictatorship.

washingtonpost.com: Musharraf Makeover Proves Too Much for One Lobby Firm (Nov. 13, 2007)

Jeffrey Birnbaum: I had a snide comment in the column that the readers of the column are probably not all that worried about Pakistan. I did not mean to suggest that they should not worry. The government clearly is not all that sympathetic these days, what with the military crackdown and all. But you are correct. There are lots of reasons for the U.S. government to worry. Pakistan is a nuclear power. If the government falls apart, those weapons might be in danger of falling into very unfriendly hands. In addition, Pakistan has cooperated with us against al Qaeda in a way that would worth maintaining. And you are right. The U.S. has been pumping a lot of money into the country in recent years. That would be a lot of wasted dough if we really, all of a sudden, decided no longer to care.

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Princeton, N.J.: I am concerned with the influence of money on the health care debate. It seems people can't understand that a single payer health care system is simply much more efficient than what we now have. Forget the immorality of the uninsured. Forget the competitive disadvantage of our business community. Other countries get much better health care as measured by all the basic public health statistics at much lower cost. The evidence is overwhelming. (See www.pnhp.org)

Is this a failure of our political system?

Jeffrey Birnbaum: First, the health care debate is likely to be the hottest topic in the nation in 2009, especially if Hillary Clinton is our new president. Certainly, the health care problem is the biggest, or maybe, one of the biggest problems we face. As to your point, it is disputable, I think, whether single payer systems, also generally known as government run health systems, provide better care. They certainly provide more widespread coverage. I will leave that one to experts to sort out. But the real answer to your deeper question is that powerful interests, private interests in this case, have long been arrayed to prevent a government takeover of the health care system. And so far, those interests have won out. Doctors, hospitals, drug companies and health insurance companies are all extremely influential in Washington and know how to work the system here. Their activities represent an enormous barrier to a wholesale remaking of the health care system in the U.S. One of the great stories of 2009 will probably be the monumental battle between those interests and Democrats (and maybe some Republicans too) over how to change the broken U.S. healthcare system.

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Alford, Mass.: With the amount of money being given to both parties is it reasonable to think that the needs of the country and its citizens will take a distant second place to the wishes of the groups that congress is in debt to?

Jeffrey Birnbaum: On some issues, yes. My view here is that the big movements in legislation are not dictated by campaign donations. Those things, like health care reform, as I discussed in the previous answer, are directed by mass movements that touch large groups of people. Where there's a real problem, and people know it, Congress and Washington tend to act. But on the margin of those big changes, lobbyists get a lot accomplished. Sometimes they are even able to delay major changes advocated by big blocs of people--take the Patients Bill of Rights, dealing with HMOs, which never became law. But if health care reform or, later, Social Security reform, are seen as a must by a consensus of folks, those things will happen. The lobbyists, and the monied people behind those lobbyists, could well shape the details in ways that would help them, or, at least, not hurt them as much as the popular movement would have otherwise. Does that make sense?

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Washington, D.C.: Do you think Hillary will change the way lobbyists work if she becomes President?

Jeffrey Birnbaum: I think she will favor a different set of lobbyists than have been favored so far. She will pick some real enemies. Those would probably include health insurance companies and drug manufacturers. And she will favor labor unions, plaintiffs' lawyers, environmental groups and women's groups. That is not a big surprise, I guess. Almost any Democratic president would do the same. But do not be fooled. It is a mistake to think that a new president will sweep clean the lobbying establishment in Washington. They were here before the new president arrives and they will be here after he (or she) leaves office. The capital has gotten too large and complicated for lobbyists not to have found a permanent niche. Interests need expert guides to get around and lobbyists are those people.

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Re: Answer to Alford: The trouble is that powerful monied interests can prevent the facts from getting to the public so it may not be possible to have a general movement.

Jeffrey Birnbaum: Maybe, but with so many outlets for information these days, no group or cluster of groups has that much power. Or am I being naive?

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Princeton, N.J.: Well, you sort of asked for this. Here is my usual screed.

Let's forget the immorality of the uninsured that lets poor people die. Forget the burden on businesses that make them less competitive. Just consider health care financing as a business decision. Develop statistics for measuring how we are doing. Look at the competitors (other countries). Look at their cost. If you are honest, you will become an advocate of a single payer system. Here are some facts. They can be checked at www.pnhp.org.

If you look at the 13 wealthiest countries and rank them according to the 16 basic public health statistics, the US ranks 12th or 13th in each one. Yet, yet we spend 2.5 TIMES as much per person as the average of these countries. Other countries get much better health care at much lower cost. (As a sanity check, WHO ranked the US 37th in the world in health care, above Bolivia , but below Slovenia.) All of these other countries use some form of single payer system. Of course, they have some problems, but most of these are because they are not spending enough. We would not have those problems. In spite of all these so-called problems, they get better care. Also Medicare is a single payer system, and it is one of the most popular programs in the history of our country. The plan I like simply gives Medicare (without limitations, co-pays or deductions and with complete drug coverage) to everyone. We could do this without spending any more than we are now.

The reason for this is that we waste at least $200 Billion a year on excess paperwork by physicians and at least $100 Billion a year on high overhead (15% vs. 1.3% for Canadians) of private insurance. Look here is a simplified example of what we are doing.

Suppose you have 100 dollars to give to 10 people. You could give $10 to each person. Alternatively, you could develop criteria that determine who is deserving, and then investigate each person. You might find that according to your criteria, only 5 people deserve the money. You spent, however $75, on your investigations, so now you can only give $5 to the 5 deserving ones. We spend much too much money denying people health care.

The basic problem is that the rules are made by private insurance companies whose only goal is to make money, not efficiency or good health care. If they can save a buck by having a physician fill out a 40 page form, they will do so.

What about choice? I am 69 years old and retired. During my career I had 5 HMO's and 5 indemnity health plans. I have much more freedom of choice under Medicare than I had under any of the private insurance plans. I have no more referrals, no more in plan - out of plan nonsense. As for choice of insurance plan, why would anyone want choice if everyone had a plan that covered everything? In any case, you could still have private insurance for those who can afford it as most European countries still do.

Some opposition to a single payer system is that it is pie-in-the-sky; we will never get it through. Maybe so. That's what they said about Social Security and Medicare. One thing is for sure. We will never get a rational health care system if we do not try.

Jeffrey Birnbaum: Thank you for this, Princeton. Does someone out there disagree?

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Washington, D.C.: Could you list other examples of charities that lobby for good causes?

Jeffrey Birnbaum: Gary Bass, the executive director of OMB Watch and the chief instigator of the effort to get charities to lobby more, cites MADD, the Mothers Against Drunk Driving, and civil rights groups of all sorts, among others, to show that charitable organizations can make a very big difference in the world and in government policy. He has also mentioned environmental groups and groups that push health care changes.Clearly, there are a lot of them. But he argues there should be many more. What do you think about that?

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Chevy Chase, Md.: You probably are asked this all the time, but do you think Hillary has a good chance of becoming president?

Jeffrey Birnbaum: To the extent I know, which I do not, it appears likely that at this moment whoever wins the Democratic nomination for president will win the White House. But the election is not being held at this moment, which makes that kind of prediction hollow. If Sen. Clinton wins Iowa, she is likely to have a much easier time running away with the nomination. If she loses there, and she is slightly behind in the latest Washington Post/ABC News poll in Iowa, that could open up the race a great deal, especially for Sen. Obama. The biggest factor that has not been adequately parsed, I think, is that Iraq as an issue is probably fading as violence in the region declines and so does the number of U.S. soldiers on the ground there. The big issue could well turn out to be the economy. If growth slows and unemployment rises, the anxiety over housing and credit could turn into a real political issue. At the moment, it's hard to guess which candidate steps out furtherest and fastest to capture that issue in the public's mind. But that would be the real race to watch, issue wise, in my view. Whoever wins that one could well have an important leg up when it comes to the answer to your basic question: who will be the next president.

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D.C.: In answer to your question, I think charities should stay out of lobbying. They should just do what they do, which is to do good works. There's nothing good about lobbying. Maybe that's too harsh. But lobbying does not need anyone with all those tax advantages. It sounds to me like a special conflict of interest. Don't you think that's true?

Jeffrey Birnbaum: The tax advantage question is worth noting. People who give money to a 501(c)3 can write off that amount on their tax returns. In exchange for that benefit, the charity has to accept limits on what it can do. One thing that is limited is its ability to advocate, or spend money to advocate, before government. That seems like a reasonable trade off to me. What OMB Watch and others want is to do is push charities to lobby as much as they can and then, maybe, to see if government might make a little extra room for additional lobbying as well. I'm not sure I see a conflict of interest, per se, but I do see the rationale for keeping the amount of lobbying down except for those groups, including nonprofits of a different 501(c) designation, that have the okay to lobby a great deal.

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Re Answer to Alford: Examples of facts never getting out:

1. There never was a marriage tax penalty--in 2000, the group of married people paid the same as they would have if they had been allowed to file as single.

2. Over 80% believe that their heirs will have to pay estate tax. Actually it's under 1%

3. A majority still believes Saddam was behind 9/11.

3. Most people believe that tax cuts increase tax revenue. Never happens. Sometimes revenue increases in spite of tax cuts.

Etc.

Jeffrey Birnbaum: Well, the facts are out now. Thanks for writing in.

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Jeffrey Birnbaum: Thanks for writing in everyone. I'll be back in a couple weeks for another Web discussion. I will try to stir the pot a little bit harder next time and see if I can get a real debate going here online. Until then, Happy Thanksgiving. Enjoy a great meal!

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Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.


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