This past summer, I was fortunate enough to be an intern for the government relations arm of a national medical society. I’m grateful for the opportunity not just because I worked on and researched important health care policy, but also because I was able to spend time on Capitol Hill watching how policy stakeholders (a fancy word for people who are affected by bills) influence Congress. Below is an attempt at recreating a “Hill Day” so that you, the reader, can get a better idea of how policy is influenced.
What is a “Hill Day”? The short definition: a day where lobbyists and the stakeholders they represent visit Congress. Let’s start with the players. There’s me, the silent intern who does nothing but watch and yet is still asked to introduce himself. Then there’s the stakeholder, in this case, a physician who is very involved in the medical society and was flown in from the South to join us. The team is rounded out by the society’s in-house lobbyist and senior management, both of whom are well connected and know everyone’s name in whichever room you will find yourself. More players will join us later, but first, breakfast.
Breakfast with stakeholders is a special sort of dance in Washington, D.C. A Congressperson is invited by the host organization (in this case, it was the society for which I worked). A dozen or so lobbyists, all of whom are representing different corporations or interests, join in. These range from corporations like Wal-Mart to obscure firms that make millions advocating on behalf of their clients.
When the inevitably late politician finally arrives, everyone gets breakfast. While eating, they listen to the politician express his or her views on the day’s pressing issues. It’s boilerplate stuff: nothing fancy and not very different from what you see on the news.
What’s unique is that the purpose of breakfast isn’t facetime with the politician. It’s facetime with the politician’s Chief of Staff. The more that person likes you, the more willing he or she will be to have one of his or her aides meet with you in person. If his or her aide really thinks what you have to say conforms with the branding of the politician, you might get a meeting with the boss.
Every Hill Day has its own structure and its own set of meetings. This one happened to involve a meeting with the Center for Medicare & Medicaid Services (CMS) regarding specific issues that the physician (stakeholder) was representing. He had already been briefed by the society on specific talking points to stick to and just how he was supposed to say them. Amusingly, a specific line in the prep materials warned him that everyone he’d meet would be in his or her 20s. It’s true: the federal government is sustained by the hands of 20-year-old serfs toiling away for septuagenarian employers.
We were joined at this point by a consultant, who is paid hefty sums to coordinate these meetings for the medical society. You see, the in-house lobbyist is kind of like the super spy who has his finger on Washington, D.C.’s news and gossip. The consultant, on the other hand, is the living, breathing Rolodex who arranges meetings between his clients and Congress with a snap of his fingers. Together, these two players provide a wealth of information about whom the stakeholders are meeting, their needs, their vices and just how to ply them for the client’s benefit.
The meeting went well, with lots of enthusiasm and support from CMS. All parties shared great ideas and jotted them down in notebooks. No promises were made, but if there’s anything Hill Day has taught me, it’s that influencing policy is a slow, slow game.
Lunch is just as important as any of these other meetings because it rewards the stakeholder, who may have traveled across the country to be in Washington, D.C., with the joys of a company credit card. It also provides everyone a way to reorganize themselves for the next meeting should the first one have gone poorly.
This time, we go to Capitol Hill. Sort of. You see, most Senators and Representatives don’t actually conduct much business in the Capitol building. Most of their work, and most of the work done by their aides is accomplished elsewhere in buildings scattered around the Capitol building. Our building was the Rayburn House Office Building. Another consultant who worked for the same firm as consultant number one greeted our team. Both had close relationships with the aides we were about to meet.
This is where things got political. The physician spoke about specifics of health care policy that directly affected his specialty. Both aides were representing members of the House, one from the Republicans, another from the Democrats. One of the aides was a physician herself who decided to work for Congress instead of practice. While there aren’t statistics on how many physicians forego practicing and work as congressional aides, there are about 15 currently serving members of Congress. Not a small number, considering there were only two in the 1990s.
Given her credentials, we assumed the physician turned congressional aide would have easily been able to understand our stakeholder’s case. To our surprise, however, she stated she wanted another meeting with the society, claiming she needed time to wrap her head around just what the needs of the specialty were. Something fishy was afoot. After the meeting had ended (none of these meetings lasted longer than an hour), she took a consultant aside and admitted that she had only asked for an individual meeting because she didn’t want to share her Congressperson’s position with the opposing side.
We had another meeting that was pretty much the same as Meeting #2. And then, just like that, the day was done.
So what can anyone, let alone a physician or medical student, take away from this experience? The first is that the politician is not the only important person in Washington, D.C. His or her aides are just as, if not more, consequential to policymaking. Without their approval, your policy doesn’t even get to the politician’s desk. Without that relationship, you’re not on the politician’s radar.
Second, keep sending letters and calling Congressional offices. And then, more importantly, get on Twitter and start bombarding them with tweets. Who sees all those letters and receives those emails and screens those phone calls? An intern. Someone who will be gone in a few weeks and will have moved on to something else. Who pays attention to a Senator’s Twitter? Or a Representative’s Instagram? The media relations director.
It genuinely shocked me how important Twitter is to Washington, D.C. One of the biggest reasons why it is so important is that Twitter is the perfect place for public shaming. It’s also a frontier of opportunities for the politician to “connect” with his or her constituency. The number of times social media was brought up in any of these meetings was truly astounding. Do not underestimate the power of a coordinated Twitter campaign; it can get your voice noticed in a way that a stock letter never can.
Finally, the politician doesn’t just care about money. In fact, money is a means to an end. That end is more votes. So whom do we seek out when we want to sway a politician’s vote? The voters. A lot has been written and said about money in politics. But money isn’t going to change a politician’s mind when his or her constituents are cornering him or her into a specific position. It doesn’t matter how much money Planned Parenthood (PP) uses to lobby a Republican Congressman because he knows with certainty that his district will keep him in office so long as he says the right anti-Planned Parenthood things.
So along with — not instead of — railing against money in politics, medical students and physicians need to start thinking more locally. This can’t be emphasized enough: all politics are local. All. Politics. Are. Local. The biggest impact you can have on health policy isn’t by calling or tweeting your Senator. It’s knocking on doors in your neighborhood and making sure that the voters in your district are aware of the benefits of Medicaid expansion and programs like PP. It’s speaking with your patients and reminding them that the benefits they have from seeing you are only possible with sensible, affordable health care.