Doctors and Dark Money: A Bad Prescription for Health Reform

Augie W. Lindmark, MD; Micah A. Johnson; Alec M. Feuerbach


March 06, 2020

As Democratic presidential candidates continue to debate health reform, a multi-million-dollar advertising campaign aims to sway voters against any expansion of Medicare. Behind that campaign is a coalition of 115 healthcare industry groups, including insurers, hospitals, drug companies—and physicians.

The ads that have run during Democratic debates are paid for by the Partnership for America's Health Care Future, a group formed in 2018 with a seemingly benign goal: "improve what's working in health care and fix what's not." Leaked documents, however, reveal that the Partnership is focused on the more specific goal of blocking Medicare for All, Medicare Buy-In, and public option plans..

The American Medical Association (AMA) was a notable founding member of the Partnership, and as physicians and medical students, we were troubled that medicine's largest professional body would join a dark-money lobbying group. Others in the profession shared our concern, organizing protests at the AMA annual meeting last summer in Chicago. After mounting pressure—and just 2 months after the summer protests—the AMA did the right thing: It quit the Partnership. Doctors, we hoped, would play an honest and constructive role in the next wave of health reform debates.

Unfortunately, the AMA was not the only physician group in the Partnership. Other members listed on the group's website include the American College of Radiology (ACR), the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, and the Virginia Orthopaedic Society. We believe that these organizations should follow the AMA and exit the Partnership, and all doctors' groups should avoid such deceptive efforts in the future.

It is inevitable that physicians will hold diverse views about healthcare reform, but doctors should adhere to professional standards such as disclosing financial conflicts of interest and presenting evidence truthfully. Simply put, we believe that the tactics of the Partnership for America's Health Care Future are incompatible with these standards.

To understand the problem of the Partnership, it helps to examine both their interests and actions. To block Medicare expansion, the group has launched a multiyear strategy (containing at least 17 initiatives) aimed at influencing the national health reform debate, including their deep-pocketed advertising campaign.

One ad aired during the South Carolina Democratic debate shows a mother at her child's basketball practice who warns about "new government-controlled health insurance." Another ad warns that a "one-size-fits-all" government health insurance program could force 55% of rural hospitals to close.

When the public hears a message denouncing the expansion of public health insurance, they deserve to know that a private insurance trade group sponsors that message. But from Facebook ads to YouTube videos to television ads, the Partnership relies on its nondescript name and does not disclose the identity of its member groups. This provides a convenient avenue for industry groups to simultaneously influence public opinion and obscure their own financial interests.

This was evident when the group spent nearly $300,000 in South Carolina in advance of that primary, and more than $900,000 in Virginia leading up to Super Tuesday on March 3. Last summer, the Partnership bought half of all political advertising in Iowa—re-upping its investment to $1.2 million before that state's caucus. As a dark-money organization, the Partnership does not disclose its funding sources, but its member groups are clearly big spenders: They spent $143 million lobbying Congress in 2018.

And it's not just advertisements. In December, the Washington Post reported a series of email exchanges that suggest lobbyists affiliated with the Partnership had drafted significant portions of op-eds published by state lawmakers attacking proposals to expand Medicare. Upon publication, there was no mention of the Partnership, leaving readers unaware of the industry role in crafting these messages.

The Partnership also actively promotes misinformation. For instance, one advertisement states that "Medicare for All, Medicare Buy-In, and a public option all mean the same thing: you'd pay more to wait longer for worse care."

This message is misleading in numerous ways. First, a public option is vastly different from Medicare for All: One proposal could add a public plan to the Affordable Care Act Marketplace while leaving the rest of the insurance system intact, and the other would transition all Americans into a version of Medicare.

Furthermore, the Partnership's claim that Americans would "pay more" under these reforms is contradicted by Congressional Budget Office (CBO) findings that a public option would have lower premiums than private insurance. Similarly, when asked about Medicare for All during a Congressional hearing, the deputy director of the CBO indicated that many people in the middle- and low-income groups could pay less for Medicare for All than they currently pay for their employer-sponsored insurance, largely because a public insurance system can be financed progressively.

Instead of pouring money into such campaigns of misinformation, doctors should present evidence truthfully. But the ACR "has committed extensive resources to the Partnership's goal," including a $300,000 grant to the Partnership around the time of its inception. Supporting misinformation campaigns seems to violate not only an established norm of the medical profession, but also the ACR's own bylaws which state: "Members should not publicize themselves through any medium or forum of public communication in an untruthful, misleading, or deceptive manner."

Physicians should play an honest and constructive role in the health reform debate, and uphold the values of the medical profession when entering the public arena. Physician groups should not participate in a dark-money lobbying organization that promotes misleading information and obscures significant conflicts of interest. The Partnership for America's Health Care Future is a bad prescription for health reform, and doctors should stay away.

Augie Lindmark, MD, is a resident physician at Yale New Haven Hospital in Connecticut and a former board member of Physicians for a National Health Program. Micah Johnson is an MD candidate at Harvard Medical School, Cambridge, Massachusetts. He provided unpaid technical assistance to the campaign of Sen. Elizabeth Warren (D-MA). Alec Feuerbach is an MD candidate at the Mount Sinai School of Medicine in New York City and a board member of the New York Metro chapter of Physicians for a National Health Program.

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