Lobbying in US Health Care—Lessons From the Field of Oncology
Authors: Olivier J. Wouters
Journal: Journal of the National Comprehensive Cancer Network (2024)

hen asked to explain the woes of the US health care system, many commen- tators point to the role lobbying plays in influencing health policy. 1 It's not hard to see why: in 2023, the health care sector spent $745 million lobbying Congress and federal agencies in the United States, more than any other sector in the US economy. 2For comparison, the next biggest spender was the finance, insurance, and real estate sector, with $597 million in spending. 2 Despite the high stakes, empirical research on lobbying expenditures and campaign contributions by health care organizations is lacking.In this issue of JNCCN , Choradia and colleagues 3 analyzed lobbying expenditures by US health care organizations from 2014 to 2022, with a focus on oncology-related groups.The authors categorized oncology-related organizations according to function: physician professional organizations (eg, ASCO), cancer hospitals that are exempt from the Medicare prospective payment system (eg, Dana-Farber Cancer Institute), patient advocacy organizations (eg, American Cancer Society), and provider networks (eg, US Oncology Network).The authors focused on hospitals that are exempt from the Medicare prospective payment system because most of them disclosed spending on oncologyrelated lobbying, unlike other hospitals that only reported aggregated amounts. 3mong cancer-related groups, Choradia and colleagues 3 reported an uptick in lobbying expenditures by both physician professional organizations ($0.8 million in 2014 vs $2.3 million in 2022) and cancer hospitals that are exempt from the Medicare prospective payment system ($2.4 million in 2014 vs $3.9 million in 2022).Spending by patient advocacy organizations ($8.3 million in 2014 vs $8.4 million in 2022) remained fairly constant over time.(All sums reported in their study were inflation-adjusted to 2023 dollars.)The authors also reviewed lobbying trends across the broader health care sector.Spending rose among pharmaceutical and health-product companies ($294 million in 2014 vs $377 million in 2022), health services and health maintenance organizations ($107 million in 2014 vs $123 million in 2022), and hospitals and nursing homes ($118 million in 2014 vs $126 million in 2022). 3Spending flatlined among organizations representing health professionals ($96 million in 2014 vs $96 million in 2022). 3hese observations are troubling, and if anything, the authors underestimated the amount spent by organizations with an interest in shaping cancer care in the United States.Choradia and colleagues 3 adopted a narrow definition of cancer-related organizations, which excluded any group with an indirect interest in oncology.For instance, the American Medical Association, one of the largest lobbying groups in the United States, 2 was not counted because it represents the interests of the wider medical profession, and not only oncologists.The American Medical Association spent $21 million on lobbying in 2023, the sixth highest of any organization in the United States. 2 The study by Choradia and colleagues 3 is a useful new entry in the literature around lobbying in the health sector.5][6] One study found that, from 1999 to 2018, drug companies targeted key legislators with their campaign contributions