During the 2008 presidential campaign, both the winner and the loser spent a considerable amount of rhetoric denouncing the activities of lobbyists, scorning (but not always spurning) donations from them, and promising a new attitude in which the role of lobbyists would be drastically restricted. This is a fairly common posture for some politicians, particularly those who are challenging incumbents.
I spent 28 years representing radiology in Washington. The American College of Radiology retained a former member of Congress to represent you with Congress. My mission was to work with him and to represent you with federal agencies, including Medicare, the US Food and Drug Administration, the Nuclear Regulatory Commission, and other US Public Health Service agencies, as well as state governments. A federal law requires people who relate client interests to Congress to register as lobbyists. By far, a greater number of us who worked with federal agencies were not covered by that law.
As this is written, several former lobbyists, including the infamous Jack Abramoff, and several former members of Congress are involuntary residents in federal pokeys after being caught passing and catching bribes. Other lobbyists, within legal bounds, funnel significant contributions to political campaigns. Several of John McCain’s leading advisors were among sophisticated Washington hands with fat-cat clients.
Most of the thousands of people who influence legislation, regulations, and federal expenditures represent benevolent, nonprofit organizations, charity groups, professional societies, veterans’ organizations, state and local governments, foreign nations, retiree groups, victims of various diseases, and farmers, labor unions, and victims of disasters. Some of us are paid well, and others are volunteers with no pay.
The mission of lobbying for radiology was to make the federal government aware of the significance of the specialty, its impact on health care, on the safety of patients, on the advances in medical practice, on spending, and at times on frauds and abuses.
Our first big triumph of effective lobbying was the definition of radiology (and pathology and anesthesiology) as medical disciplines, rather than hospital services, in Medicare. From 1965, when Congress enacted Medicare, we worked with federal agencies to make certain that regulations also regarded radiologists as physicians payable through the Medicare Part B physician benefit section, not as part of hospitals through Part A. When new imaging and cancer treatment technologies came along, it was my task to persuade the Food and Drug Administration to approve the equipment, to persuade the Nuclear Regulatory Commission to license radiologists to use isotopes, and to persuade Medicare to instruct its carriers to pay for new services. This was true with ultrasound, which we got legislatively defined as part of radiology. It was true of computed tomographic scans for heads and bodies and coverage for single photon-emission computed tomography and positron emission tomography. We were involved in preventing airlines from refusing to carry molybdenum cows to hospitals for technetium-99 scanning. I have dozens of other examples. The reality was that these actions would not have been taken without our effective explanations and advocacy.
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