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Patients are being cut off from medications they need, doctors are afraid to prescribe, and the reason traces back to political donations most Americans never see. Richard A. Lawhern, health care educator and patient advocate, joins us to explain how lobbying money shapes health care legislation and what patients can do about it. This episode is based on his article “Health care lobbying is destroying the U.S. system,” published on KevinMD. You will hear why $4.5 billion was spent influencing the 2024 election, how undisclosed donors block reforms like single payer, and why nearly a quarter of every health care dollar goes to administrative costs that do nothing for patients. Richard explains how the National Campaign to Protect People in Pain trains advocates to reach committee staffers and shift the political calculus. Press play to hear how the system actually works and where ordinary advocates can apply pressure.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Richard A. Lawhern. He’s a health care educator and patient advocate. Today’s KevinMD article is “Health care lobbying is destroying the U.S. system.” Richard, welcome back to the show.

Richard A. Lawhern: Thank you very much. I appreciate being invited.

Kevin Pho: All right. Tell us what your latest article is about.

Richard A. Lawhern: Well, I am working with a group of people who intend to do some lobbying in Washington, DC with regard to legislation that’s desperately needed to essentially change the public narrative with regard to the provision of safe and effective opioid analgesic medications to patients who are increasingly being cut off from those medications.

And one of the things that we discover when we start probing at this, and it’s something that’s represented in several of my articles on KevinMD, is that there is a tremendous amount of money sloshing around in political circles, both from health care organizations and from people who intend to influence legislators to essentially pursue policies in law that are in the interests of political donors.

So a couple of my articles on that subject have addressed the whole question of what is health care lobbying doing to the U.S. medical system? We currently and very frequently in public life encounter messes, and it’s particularly true of American health care, and very certainly true of our politics.

But very few of us, very few citizens, ever put these two issues together enough to effectively demand change. And the article that I have in mind, which is as you titled earlier, according to nonprofit interest groups, and particularly to a group called Open Secrets, individuals and political action committees spent $4.5 billion in 2024 to influence United States House and Senate elections.

More than half of that funding came from spending from groups that don’t fully disclose the sources of their funding. For just the top 15 candidates, including presidential candidates, the visible total contribution, that’s to say the contribution that we can trace, which is not all of it, was $1.8 billion in just that year.

Several factors contribute to this. And anyone who intends to influence Congress is going to have to come to terms with the fact that those factors speak very loudly, they speak very secretly, and they speak from a position of money. And when we really want to trace an issue, trace a mess, we can do the classic rule, which is follow the money.

And that’s exactly what I’ve tried to do in several of the pieces you’ve been kind enough to host on KevinMD. One particular decision that, among a few others, has contributed to this was Americans for Prosperity Foundation v. Bonta in 2021. That decision struck down California’s requirement for nonprofits, including those in political activities, to disclose major donors’ identities to state officials.

And that decision has since been generalized to just about all of the other states.

Kevin Pho: Why do you think a lot of patients and citizens here in the United States do not connect lobbying with the health care that they actually receive? The fact that this isn’t common knowledge speaks to the fact that a lot of patients just are unaware about the impact lobbying has on their health care. Why do you think that is?

Richard A. Lawhern: A couple things. For one thing, and I do not mean this sarcastically, I mean this as an observer over many years of the political scene, most Americans don’t understand how legislation gets made. They’ve heard a lot of truisms, and the truisms to some degree, as all of these things are, there’s a degree of truth in them, but they disguise the truth as well.

It’s been said, and this is many years back, “A million dollars here, a million dollars there, and pretty soon you’re talking about serious money.” Now, that sounds sarcastic, but it’s very real in an environment where the contributions are as great as they are. Americans classically do not understand their own political system, and they don’t understand how money influences it, and the money has a vested interest in making it continue that way.

In a world where misinformation is very common, there are actors in this business, either as intermediaries for the big contributors or in some cases quite probably funded by the big contributors. They’re out there and they’re pushing all sorts of mythologies. One of my least favorite is, “Oh, no, no, no. We couldn’t go to single payer. That would be socialized medicine.”

Now, you’ve heard that term. We’ve all heard that term, anyone who works in health care has. The bottom line is a huge amount of money has been spent in the last 25 years to ensure that legislators are very well aware that the insurance companies will send them home in disgrace if they ever actually enact single payer.

But the reality is, and this is again represented in my articles for KevinMD, about 25 percent of every health care dollar we spend is spent on administrative costs that contribute nothing to health care and nothing to patient health, but very few patients realize that. The statistics are there, and we can find them quite easily if we simply go looking, and I’m one of those who has gone looking.

Kevin Pho: Now, in terms of changing the system, of course the legislators, it’s very expensive to win elections, and they’re of course dependent on these lobbyists and special interests to help get them elected and stay in power. So it is a little bit of a never-ending cycle that’s so ingrained in our health care system, our political system. Now, how can we even hope to break that cycle?

Richard A. Lawhern: Well, there is a process that we can use, and I’m part of an organization that teaches that process to individuals who want to advocate either at local level or at state level or at federal level. That process comprises getting on the agenda of key health care staffers that are associated with members of key committees.

There are four in particular that I have made mention of in the work I do. I took a look at four key committee members, chairman and ranking members, that’s to say the ranking opposite party members.

I looked at, for instance, Senator Bill Cassidy, who heads up the key so-called HELP committee in the Senate, and Senator Bernie Sanders, who is the ranking member on that committee. In the House, Senator Ron Wyden from Oregon has been working with this issue for over 20 years.

But when you look at those individuals, they’ve been specifically targeted by big money.

If we’re going to be heard, we have to target their key staffers, and we have to target their staffers with a basic message. You have been lied to. Your boss has been lied to, and you’ve been lied to by big money interests that intend to manipulate you into killing patients by legislative fiat in order to preserve their profits.

Now, that’s really hard over and I am somewhat hard over on this issue. I’ve been dealing with it for three decades. But beneath that discussion, and this is where the organization I’m part of is very, very active these days. We are the National Campaign to Protect People in Pain, and our tagline is, “We are a nation in pain, and we will not be silent.”

Which means I’m out here in public, several others of my colleagues are out here in public. Some of us are working with you, others are working in other venues. We’re coming to Congress in a process of telephoning. Telephoning congressional offices, asking to speak with health care staffs, asking to give them basic truth on what is going on in these issues, which interestingly enough, the staff themselves don’t always know.

Many of the staff have the feeling that, oh, pain is just all in your head. If you concentrated well enough, you wouldn’t be in the jam that you think you’re in. But the message that’s beneath all of this is, we have trained, focused advocates in every U.S. state. We can act in your behalf. Several of us are associated with 501(4) organizations that can organize fundraising for you or for your competitors. We can either hire or ourselves do door-to-door canvassing.

We can do contacts with major media that won’t cost you a dime. But if you don’t get with our program, we’ll send you home in disgrace because we will get with anyone who does do those things and who does realize that not only is health care cost in America too expensive, it is too politically and financially influenced by people who have a financial self-interest.

Now let me give you an example. Something like a year ago, a health care executive was assassinated on the streets of New York. I won’t name him. I think we can all find that pretty easily, a number of places, and KevinMD, among others. A year later, a journalist or journalistic group got interested in the question would a jury convict that assassin, assuming that he is the assassin.

Now that’s obviously not proven in court yet. I’m not making that assertion. But the question, the narrowly defined question was would a jury, or if you sat on a jury of your peers, would you convict this defendant of this crime? Now what was interesting is that when the question was elaborated, among younger voters 40 percent of them indicated that they believed the assassination was entirely justified.

Now that captures something really basic in this dynamic. Large numbers of people, and they’re not only young people, old people like me, and well, to a lesser degree like you, old people and young people are realizing that we’ve been had. We’ve been had by major health care insurance companies who spend a tremendous amount of money trying to keep themselves in business by fair means or foul, and obviously as lobbyists they have a right to do that.

They have a right to protect their interests. They don’t have a right to lie, which they often do. But they do have a right to protect their interests, but the bottom line is the result of this political influence and the money being spent is that patients are dying of suicide across this entire nation in every U.S. state because the health care laws don’t protect their doctors.

Now in 2018 there was a very fundamental statement made by six major professional clinical groups with a total membership of just over 620,000 clinicians and medical students. The American Psychiatric Association was one of those. The American College of Surgeons, I believe, was another.

And it was headed up by the American Academy of Family Physicians. They did, in a detailed way, they said, “It is time to remove political influence from the practice of evidence-based medicine.”

Kevin Pho: So let’s kind of bring this back and bring it full circle to the points you would like to make.

Richard A. Lawhern: Big money talks loud. The only thing that talks louder is the fear of being unelected. To be credible, lots of people are going to have to speak up in their own behalf, and on behalf of others that are in the same situation.

That means a lot of people who commonly wouldn’t speak because they don’t feel confident to, or they don’t feel they have enough information. I am one of many advocates that are increasingly becoming very publicly visible. I’m not unique in this. There are many voices in pain communities.

When I publish in venues such as yours and in others, I publicize what I publish in social media groups that have a registered readership of over two million health care professionals, particularly in the organization called LinkedIn. They’re very good for that sort of thing. Others are doing the same, and we are working to create a sea change in the perceptions of legislators from, “Oh, I’ll ignore it and it will go away,” to, “Maybe I ought to pay attention. Maybe I should really seriously look at some proposed legislation that these people can offer me.”

Kevin Pho: We’re talking to Richard A. Lawhern, patient advocate. Today’s KevinMD article is “Health care lobbying is destroying the U.S. system.” Richard, let’s end with some of your brief take-home messages that you want to leave with the KevinMD audience.

Richard A. Lawhern: Me be brief? Yeah, right. Take-home message. One, you’re not alone. If you’re a chronic pain patient or a clinician who treats them, you’re not alone.

There’s an organization that we strongly recommend that you come visit. The website is NCP3.org, which stands for the National Campaign to Protect People in Pain. We provide resources there for doctors, for patients, for caregivers, and for lawyers, and for journalists. We have already published two continuing medical education courses that are fully accredited by the Postgraduate Institute for Medicine.

We have a draft continuing legal education course that is called Defending Doctors in Adversarial Proceedings. We need a lawyer to help us go through that material and be sure that we got it right before we try to make it public, and we’re going to have to do that state by state. Basically, we are out here conveying the message on your behalf, and we urge you to join us in conveying that message on your own behalf and on behalf of others, that we are a nation in pain, and we will not be silenced.

Kevin Pho: Richard, thank you so much for sharing your perspective and insight. Thanks for coming back on the show.

Richard A. Lawhern: More than happy to.