6.22.2009
Special Interest Money Means Longer Odds for Public Option
by Nate Silver @ 5:45 AM
As I lamented yesterday, health care is one of those areas where both popular opinionand sound public policy seem to take a backseat to protecting those stakeholders who benefit from the status quo. But can we actually see -- statistically -- the impact of lobbying by the insurance industry on the prospects for health care reform? I believe that the answer is yes.
Some 37 senators are listed by Howard Dean's website as supporting the public option so far: 36 Democrats plus Olympia Snowe. To Dean's list I add Arlen Specter as a 'yes' vote, based on a recent public statement.
I decided to build a model to explain and predict whether a particular senator supports the public option. The variables in the model are as follows:
-- The senator's ideology, as measured by his DW-NOMINATE score;Below the jump, I explain each of these in a bit more detail.
-- Per capita health care spending in the senator's home state;
-- Lobbying contributions received by the senator from health insurance PACs since 2004.
Ideology. DW-NOMINATE scores measure a senator's ideology on a scale that generally runs from -1 (extremely liberal) to +1 (extremely conservative), although scores slightly less than -1 or slightly greater than +1 are possible under unusual circumstances. These days, the average Democratic senator has a score of -.44, and the average Republican senator a score of +.48.
DW-NOMINATE data has not yet been published for the 111th (current) Congress, so I use data from the 110th Congress instead. For freshman senators, I extrapolate DW-NOMINATE scores by translating (via regression analysis) Progressive Punch scores. Extrapolated scores for freshmen members of the Senate are as follows:
Merkley -.495
Burris -.494
Kaufman -.494
Gillibrand -.483
Udall, T -.472
Udall, M -.420
Warner -.398
Begich -.390
Bennet -.384
Hagan -.353
Johanns +.532
Risch +.534In addition, a special score is required for Arlen Specter, who recently switched parties. Specter's score is extrapolated based on a recent analysis we did of his voting behavior since becoming a Democrat. Specter's score according to this analysis is -.255. This makes Specter the fifth most conservative Democrat, slightly to the left of Evan Bayh and slightly to the right of Tom Carper.Per Capita Health Care Spending. As estimated by the Department of Health and Human Services. We use data from 2004, which is the most recent available. Health care spending varied in 2004 from $3,972 per head in Utah to $6,683 per head in Massachusetts.
PAC Contributions. Based on data downloaded from OpenSecrets.org, a.k.a. the Center for Responsive Politics. Contributions were tallied from two industry codes: F3200 (Accident & Health Insurance) and H3700 (HMO's). Data covers the 2004, 2006 and 2008 and 2010 campaign cycles. The fundraising data is adjusted based on the number of cycles that the senator has participated in as a Congressman (including time spent in the House of Representatives) or as a candidate, where 2010 is treated as 1/8th of a cycle since one quarterly report has so far been filed from the two-year period. So, for example, a senator that ran for and won office in 2006 is treated as participating in 2 1/8th out of a possible 3 1/8th cycles: 2006 as a candidate, and then 2008 and the fractional cycle in 2010 as a senator.
Top recipients of PAC money from these industries since 2004 are as follows:
Senator Cycles PAC $
Baucus (D-MT) 3.125 $141,250
McConnell (R-KY) 3.125 $110,750
Nelson (D-NE) 3.125 $106,123
Kyl (R-AZ) 3.125 $106,000
Gregg (R-NH) 3.125 $103,500
Grassley (R-IA) 3.125 $95,000
Lincoln (D-AR) 3.125 $91,000
Enzi (R-WY) 3.125 $87,000
Chambliss (R-GA) 3.125 $86,750
Ensign (R-NV) 3.125 $85,750
======================================
AVERAGE SENATOR $37,267The model employed is a standard logistic regression with these three variables: ideology, lobbying and health care costs. Ideology is statistically significant at the 99th percent level, PAC contributions at the 95th percent level, and health care costs -- senators in states with more health care spending are more likely to support the public option -- at the 90th percent level. The R-squared for the model is .61, which means that these three variables alone give us 61 percent of the information that we need to predict a senator's position on the public option. The model guessed the senator's position correctly in 87 out of 99 instances.There are several neat things we can do with this. One is to evaluate the impact of insurance industry money on a senator's likelihood of supporting the public option, holding ideology and health care spending in the senator's home state constant. The chart below presents these estimates for a liberal (DW-NOMINATE score of -.6), mainline (-.4) and centrist (-.2) Democrat, as well as for a centrist (+.2) Republican:
Lobbying contributions appear to have the largest marginal impact on middle-of-the-road Democrats. Liberal Democrats are likely to hold firm to the public option unless they receive a lot of remuneration from health care PACs. Conservative Democrats may not support the public option in the first place for ideological reasons, although money can certainly push them more firmly against it. But the impact on mainline Democrats appears to be quite large: if a mainline Democrat has received $60,000 from insurance PACs over the past six years, his likelihood of supporting the public option is cut roughly in half from 80 percent to 40 percent.
(One caution: It's possible that we're confusing cause and effect: perhaps senators receive a lot of money from the insurance industry because they hold conservative positions on health care, rather than the other way around. Although I believe that accounting for ideology should correct for most of this, I'm open to suggestions on an alternative model design that would better be able to disentangle these effects.)
Note that PAC money spent on Republicans is completely wasted insofar as the public option goes. Someone like Jim DeMint is almost certainly not going to support the public option to begin with; you don't need to give him any further incentive to oppose it! Of course, the insurance industry may get its money's worth in other ways, such as by generating more vigorous opposition from these Republicans to more "bipartisan" versions of health care reform.
What happens if we set the lobbying variable to zero for all senators? That is, suppose that the health care insurance industry were prohibited from making political contributions? In that case, the model predicts, 47 senators would currently support the public option, as opposed to the 38 who actually do. In other words, the insurance industry's influence appears to swing about 9 votes against the public option.Whatever number of senators wind up supporting the public option, add 9 to it, and you'll have a decent ballpark estimate for what the level of support might be if not for insurance industry contributions. Note, however, that we haven't attempted to model the impact of contributions from other interest groups, including both pro-health reform organizations such as labor unions or other stakeholders like pharmaceutical companies.
We can also estimate which particular senators are most likely to have been influenced by lobbying money. The following chart presents the model's estimates of the net decrease in a senator's probability of supporting the public option based on the quantity of insurance PAC money that he has received:
The single senator who's position on the public option is most likely to have been changed by lobbying money is Mark Warner of Virginia, who has already raised $69,000 from insurance industry PACs in spite of having been in the Senate for less than six months. Absent industry money, the model estimates about a two-thirds likelihood that Warner would support the public option; with it, the model thinks the chances are very low. Indeed Warner has been mum on the public option to date.
Ranking next on the list is Harry Reid, who has taken some $78,800 from insurance industry PACs and who has also yet to articulate a position on the public option in spite of his status as Majority Leader. If the model is right, Reid's noncommittal stance on the issue might be better conceived of as tacit, if somewhat soft, opposition. Following Reid is Kent Conrad of North Dakota, who has floated a compromise bill that would replace the public option with a co-op system, a version of which the Senate Finance Committee appears likely to adopt.
Some traditional progressive villains, on the other hand, do not rank as highly on the list as you might think. Ben Nelson of Nebraska, for instance, has taken a lot of money from insurance industry PACs, but as a very moderate Democrat from a state with low health care costs, he was not terribly likely to support the public option to begin with. Max Baucus, who leads all current senators in money accepted from the insurance industry, was also somewhat unlikely to support the public option in the first place, but he almost certainly won't be an advocate for it given the money he's received. Taken in this context, one wonders whether Baucus was ever a sincere supporter of the public option, or rather, whether he used the poor CBO score that the Senate Finance Committee's draft bill received (a draft that did not include a public option!) as an excuse not to have to bother with it.
There are 21 senators, all Democrats, who are currently on the fence on the public option; Mary Landrieu, according to Dr. Dean's website, is the only Democrat who has come out more or less officially against it. (Dean's website also lists many Republicans as "undecided", but since all Republicans except Olympia Snowe sent a letter to President Obama stating their opposition to the public option, it is safe to assume they are against it). We can rank these senators according to their modeled likelihood of supporting the public option, in order to give us some sense for who the most likely converts might be.
If the Democrats are operating in a 50-vote environment on health care (which is debatable) then they need to find 12 additional votes for the public option. The easiest pickup, not listed here, is Al Franken, who will almost certainly support the public option and who will probably be seated by the time the Senate votes on health care. The next 11 easiest converts are, in order, Senators Begich, Byrd, Cantwell, Dorgan, Tester, Wyden, (Bill) Nelson, Hagan, Lieberman, (Mark) Udall, and Carper. One also imagines that if a bill with a public option wins the race to the floor, Senator Reid will at some point have grit his teeth and signed off on it.
The other senators on the bottom half of this list are liable to be tough gets. Keep in mind, however, that these probabilities reflect the chances of a senator having come out for the public option already and not necessarily the probability that he will do so in the future. There are a couple of potential game-changers that could shift the momentum on the issue, one of which would be successful intervention by the President and the other of which would be a favorable CBO score on the House's version of the health care bill, which does include a public option.
To repeat myself slightly, given the following three contingencies...
1. A good CBO score for the House (public option) bill;
2. Successful intervention on behalf of the public option by Obama;
3. The willingness and/or ability to proceed in a 50-vote environment, a.k.a. reconciliation
...I believe Democrats need at least two of these three things to occur to make the public option a realistic possibility, and perhaps all three to make it a likelihood.
If none or one of these things occur, progressives are probably better off devoting their energies to deciding whether they prefer Wyden-Bennett or some other "outside-the-box" alternative to the sausage that the Finance Committee winds up making.
To be clear, not all of the opposition to the public option is the result of special interest money. Most Republicans probably oppose it on general principle, and there are a couple of Democrats, like Maria Cantwell of Washington, who have yet to come around to it even though they've taken almost nothing (in Cantwell's case, literally nothing) from the insurance industry. But the money is why, even with 59-60 votes in the Senate and a President with high approval ratings, Democrats are facing an uphill battle on the issue.
...see also fundraising, health care, ideology, interest groups, lobbying, senate, senate democrats
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76 comments
Nice analysis. We need a public option badly.
In other news, a great twitterer for Mousavi tweets:
oxfordgirl - Can any one good a statistics calculate how many fake votes all of Iran if 10% ballots show 3m fake votes? #iranelection #iranelections
Nate, sounds like Iran needs you.
You may think about changing it to the % of their total money they raised from the medical industry, instead of the raw number.
Also I expect a good CBO number shortly. The House Dem/Rockefeller public option would have made the HELP committee bill about $250 billion.
The "co-op" seems to be gaining steam - if they did that on a national level it might be close enough to the public option to work. If they do it state-by-state I think it will be a disaster.
@Bradford,
The insurance companies can bribe over 1/6 of united states senators, I'd be pretty sure they could get their hand in the coop pot. How many interlocking boards of directors do you think would exist between coops and insurance companies and for-profit hospitals? Probably as many as there are boards of directors for coops.
Of course, you could have the causality reversed: it might be the case that insurance companies support candidates who are, regardless of their position on other issues, supportive of the interests of their industry. Thus opposition to public plan -> donations rather than donations -> opposition to public plan. But either way the net needs to expose these "centrists" for the craven political hacks that they are. Nothing is going to work like humiliating the senators who take insurance dollars and then kill this central plank of the Democratic party platform.
Hey, anybody in Baucus' office reading this? Your candidate is increasingly being identified as an enemy of progressive politics.
Dear Lord, Is this really how a democracy is supposed to work?
In the good old days they just called it "bribery." In the late 19th Century it was the railroads that owned Senators, now it is the insurance companies (and banks). It sure is good to see all that "Change" we have in Washington, DC.
You would have to imagine that if Reid let the public option onto the floor it would get his support, and you would imagine a fair amount of Democrats would fall in behind him. It also seems that the netroots community would hammer any Democrat that didn't support a public option, especially if the public option got beaten.
I worry that Obama will not back a public option unless he knows it will pass and the public option will not pass unless Obama backs it and the leadership gets itself into a mess over that conundrum. Other than that I remain convinced that some kind of public option will be in whatever health care bill Obama signs.
Oh footstep, I have worked on bills on the Hill - it is much uglier than you know.
Separating Cause and Effect
We can never be certain; but primarily we separate cause and effect by including timing in the model, under the presumption that cause must precede effect. Thus, in this case, we would presume that PAC contributions would occur after an issue becomes hot and before the vote.
The way to determine influence is on past votes; where all the PAC contributions are by now declared and the final senatorial votes are known. I would say, perhaps we want to see contributions within the three months prior to the vote.
just wondering: how do you get a r-squared from a logistic regression? do you mean pseudo-r^2? if that's the case, you cannot interpret it as the share of the variance explained by the model.
http://www.ats.ucla.edu/stat/mult_pkg/faq/general/Psuedo_RSquareds.htm
If only it only worked in that manner. Often there is a tit-fortat where the Senator is lobbied by a deep pocketed group and the money only arrives the vote.
In fact, vote with them alot and you can be called a "friend" of an industry which will greatly increase your intake in furure cycle.
The Bribery Model
Bradford is correct, the bribery model for the technology-aware politician is more payoff based.
It works like this: Make a legal donation to my campaign, $2500 or $5000 or whatever. That proves you are a serious buyer; and I will sit with you and hear you out.
Never ever bring up your donation, or money, or any conditions on money, or anything even suggestive of a quid pro quo. It is my job to listen to your ideas and complaints, but you will just have to trust that I am intelligent enough to see how to help you.
So consider that initial contribution an earnest money payment, and when I do help you out, pay your bills by making more serious contributions, or my door will not be opened again.
Political influence is based on trust, people. You need to have some faith that the politician's greed and corruptibility will drive him to please you, and he needs to trust that you know how this game is played and will never do anything that impugns his facade of integrity. Even if you always assume at all times that your conversations are being recorded and videotaped and every note or email that passes between you is being read by a judge and jury, you can still accomplish what you want, 100% legally.
The movie scenes of corruption are explicit for the benefit of movie viewers. In real life, the buyers are rich and can afford to blow a few thousand without a second thought. Payoffs are incremental; and if the votes are generally going your way you don't really care if it is ideology or bribery, either way you want that person re-elected.
But to be prudent, it is best to assume it is bribery and keep the payoffs coming!
Nate…
Speaking of Al Franken, what’s the holdup with the MNSC ruling on Coleman’s suit? They’ve had the arguments and everything from June, so today makes 3 weeks they’ve been sitting on their hands.
Surely you have some grapevine tendrils that reach as far as Minnesota—?
I’d be glad to write the opinion for them, if that’s what’s gumming up the works…
The biggest battle right now is on the "meme" front - that is, defining the term "public option". It is crucially important that this term not be identified with left fringe politics. Rather it needs to be continually hammered home that it is a tool for controlling the cost of health care by creating a COMPETITIVE PLAN, an animal which doesn't presently exist in this country, and whose absence permits spiraling costs to continue.
In response to:
"(One caution: It's possible that we're confusing cause and effect: perhaps senators receive a lot of money from the insurance industry because they hold conservative positions on health care, rather than the other way around.)"
Even if that's true, it means that since elections are expensive we'll see that successful politicians are those who can appeal to moneyed interests, or what Lessig would observe as an "improper dependence of money."
They should just say health care reform with a public option a WAR, and that it only has the support of 40% of the American people. It would easily get 70 votes.
Honestly, these people are moronic. When the public are telling you to quit faffing about and pass real health care reform, regardless of your personal views and political contibutions, you get behind it 100%.
Nate mused on Sunday:
"I'm generally not one to carp about special interest money -- seeing politics through that lens is often an overly reductive formulation that serves as a catch-all excuse any time Congress does something you don't like. But on something like the public option, which has broad public support and which would probably reduce -- not increase -- the long-run bill to the taxpayers, it is just about the only way to explain what's going on in Washington."
I put forth the same idea in an earlier comment thread, however I think that congress generally is in the pocket of special interests in many cases. The degree to which that influence diverges from public opinion seems to be directly proportional to the size of the special interest (ie: the health care industry, big oil, etc.). I don't think members of congress are completely prepared to commit to the public's will at the expense of political expediency.
For example: I doubt we'll see real, substantial environmental changes until big oil is forced to get on board. Despite all the fluffy rhetoric and soaring, anthemic greenwashing commercials with narrators who speak in soft, serious tones of a PBS documentary, big oil has no compelling reason to change as long as Americans keep hitting the pumps. Neither does congress.
Conversely, I think this is why Americans have such a low opinion of congress even if they have a high opinion of president. They know the game is rigged.
Even with the Iraq war. Anyone remember or participate in one of the thousands of rallies involving millions of people across the world to protest going into that war? Yet our congress authorized it anyway (and possibly propelled our current president into office as a result).
It must be a fine line to dance upon balancing the desires of one's local constituency with those of your corporate backers.
Nate, I think you're confusing, or not making clear, the correlation and causation in your analysis. As far as I can tell, there's no way to distinguish between democrats voting based on their contributions and democrats getting contributions based on their expected voting. If the latter is the case, then this analysis is not terribly surprising or interesting.
For all of you who question the cause/effect, chicken/egg relationship of these donations, I have some land in the Everglades I'd love to sell you.
why don't you instead try to dummy out the members who are on the finance cmte
Wait, what was your dependent variable? Was it 1-Has come out in favor of public option, 0-Has come out against -or- no comment?
Seems self-evident, but you do have to wonder how much the health industry is buying the silence on single-payer or "Medicare for all" options. Even the polls are representing "public option" as the left-most position, when a single-payer system would still be more moderate than the nationalized health care systems in some countries.
http://news.yahoo.com/s/huffpost/20090622/cm_huffpost/218688
Medicare for all is by the best option.
Interesting post and comments. One caveat: The 2010 data is incomplete: About 1/2 of the 30 or so PACs included here are quarterly filers and as such will not file their first 2009 reports with the FEC until July 31. This includes big guns like Blue Cross Blue Shield, Aetna, UnitedHealth, etc.
Zee: As far as I can tell, there's no way to distinguish between democrats voting based on their contributions and democrats getting contributions based on their expected voting. If the latter is the case, then this analysis is not terribly surprising or interesting.
But as Professor Lawrence Lessing points out, even if it is in fact the latter, it's still possible to infer the former. And that's what destroys the public trust in government.
There is simply no good reason to have special interests contributing such large sums to our political system when we could do it ourselves for a trivial amount ($8.78 per eligible voter per year, by my calculations, which covered all the presidential candidate, congressional candidate, national party committee, and 527 organization spending for the 2008 election).
And while I do think it's not easy to buy results, there are some outcomes that are hard to explain any other way: the recent bankruptcy revision, copyright extension, Medicare prohibited from bargaining for drugs, the ability of people who can afford $1 million homes to write off the mortgage interest. Finding the "public interest" in these items is pretty difficult.
Most Republicans probably oppose it on general principle
If you include in the category of "principle" opposing it primarily to deny Democrats credit for another popular program, I could agree with that statement.
(Note that this was explicitly stated by Republican strategists as the reason it was essential to kill the healthcare effort in 1994.)
I wouldn't have used the "on principle" wording. I'd say that almost all of the GOP opposes the public option based on party dogma and party discipline.
They haven't articulated much of a principle beyond that of supporting a free market -- despite the fact that this free market has been a failure at holding down costs and assuring coverage.
As far as I can tell, there's a missing step in tying these results to the influence of lobbying on votes.
Right now, all we have is a model of influence (causality aside) of lobbying dollars on statements of support vs. withholding comment. The results are really striking of course. The fact that lobbying dollars can be shown empirically to influence legislators' actions of some kind is immediately a condemnation of the practice.
However, to make the connection between lobbying dollars and votes, you need to either quantify the correlation between withholding comment before a vote, and the senator's direction on that vote, or look directly at voting data on bills which also had large impacts on special interests.
The healthcare debate is not occurring in the court of public opinion and there has been far from robust debate about it.
The great mass of citizens who will have to face the consequences are clueless about what may be in store for them.
As Nate discussed yesterday I think it was, people are polling and analyzing longevity statistics to see if they reveal anything about the efficacy of socialized medicine against our own present hybrid.
I think not knowing the answers to a whole lot of questions is to call in question as to how fast we should proceed.
We should proceed with a great deal of caution especially at this time when we are nearly broke and our credit rating as a nation is under assault and the number of unemployed is climbing and looking to remain steadily so as we collectively march into the Obama era of slow but “correct” growth economics. Who can say where his “command and control” will lead us? What are lists scientific underpinnings?
Some debate is in order here.
Obama’s promise of slow, measured safe growth will grow stale and sound discordant to a working class populace that is insecure about its work.
The Promise of Slow Growth” There's an election slogan, but I digress.
Mr. Big Ideas Obama is not content with trying to fix the existing broken entitlement programs, be wants to create a few more. Adding trillions to the budget like it were no big deal.
Medicaid and Medicare are seriously underfunded and while cited (esp MCare) as successful socialized medicine, they depend on private sector subsidization and not just from extensive tax revenues but from market dislocations that shift costs on the non-government patient, which is most of us.
There's populism for you!
The real scandal of course is that Medicare reimbursement is so low that the private system is called upon to subsidized it and the even worse funded Medicaid. The problem with the cost of healthcare today is not the uninsured, but the cost of the Federally insured. Eventually the private systems will collapse as unable to compete against the poor paying government plans (who will also losing many willing providers, those who practices cannot afford them to take the loss on the federal patients).
Fewer and fewer patients will be able to find providers will to accept their business.
The private insurance companies will be forced into the business of offering supplementary coverage (for that which the government will not pay). It will be a booming business!
The outcome it seems is that we wind up on some sort of Medicaid style universal coverage where there is theoretical coverage for all conditions/disease states, but the range of choice and the availability of providers is limited.
For the 2/3rds of Americans who are satisfied with their coverage today (including many of the uninsured) along with the tens of millions who work or invest in the medical industry, we have a lot at stake and hope the government gets it right.
Please report, so we can decide.
petekent01 (on twitter)
One thing left out of this analysis (though I leave it up to you guys to determine if it's germane) is the amount of grass-roots money that flowed to members of this senate Democratic caucus.
I've just written a post on Kay Hagan (NC), and in researching it, I discovered that:
a) she's received about $12k in donations from the health care sector since she got on the HELP committee
b) she got about $140k from the health care sector last year
c) but she got about 10 times as much money via ActBlue and a substantial amount from MoveOn.
I wonder if the netroots fundraising apparatuses are having any influence on the thinking on Capitol Hill.
Good point Doug. It's time for MoveOn and all of the other major progressive fund raisers to flat out say: No public option, no more money for you. EVER. It's time to get tough.
Josh,
You are a Fascist. Money should not dominate this debate. The public option will kill healthcare in America and insure a slow devolution to a Cuban system.
I actually hope the progressives bullies show themselves on this one.
Obama's popularity is plumetting as the people begin to wake up to waht he and is supporters are. This overreaching will destroy you all politically.
petekent01 (on twitter)
Nobody likes liberals or progressives or whatever the hell you all are!
You have to pretend to be something else in order to be elected!
petekent01 (on twitter -- and a proud conservative and with the people!)
To resolve the correlation/causation problem, you'd need to look at senators who have changed their opinion after changes in donations. Of course, this data is probably harder to come by.
JUST TO TAUNT YOU:
President Obama's poll numbers start to wilt
Now there’s a cheery headline!
Surveys released last week by Gallup, Rassmussen, Pew, NBC News/Wall Street Journal and The New York Times/CBS News, show a similar pattern. The Pew survey, for example, registered an eight-point drop in public approval for Obama’s handling of the economy — falling from 60 percent to 52 percent between mid-April and June. The percentage of Americans who disapprove jumped by 7 points during the same period.
Could it be that the people are waking up from the dream to the nightmare of the reality?
Read more: http://tinyurl.com/n8q5vt
You all are much more unpopular than you think!
Nobody likes you!
petekent01 (on twitter)
The polling I've seen posted on this site seems to measure popularity of a Public Option (either directly menationing govt or not) as the ONLY alternative to the status quo.
So, it's likely what we're seeing is not necessarily wide support for a govt-sponsored plan, as so much a change from status quo. As such, I'd like to learn more about other proposals, like a co-op or even non-profit options. They seem politically doable, and potentially the best alternative.
How about trying to separate the cause-effect issue by creating two other variables to use in addition too, or to replace, the ideology term in the logisitic model. One variable would look at 10-12 non-health care related votes over the last couple of years, while the second variable would focus on a smaller number of health care related votes, that perhaps covered a longer time span. These could be modeled as the percent holding the more progressive opinion on each vote. Just a thought.
Lieberman is opposing the public option.
PeteKent: The real scandal of course is that Medicare reimbursement is so low that the private system is called upon to subsidized it and the even worse funded Medicaid. The problem with the cost of healthcare today is not the uninsured, but the cost of the Federally insured. Eventually the private systems will collapse as unable to compete against the poor paying government plans (who will also losing many willing providers, those who practices cannot afford them to take the loss on the federal patients).
There are so many contradictions here it's hard to know where to start....
Government programs take many of the most sick out of the private system entirely. Thus, the private sector's costs are relieved of the most expensive patients. If the private system is expensive now, what would premiums be like if they could not turn away the elderly, most of whom would probably not be deemed insurable by private industry?
I also don't see how the private system will "collapse" if the public option pays so low that it can't get doctors to provide services. If the public plan doesn't have enough doctors in it, who would choose it? Can't have it both ways.
Also, I don't know what the reference to "socialized" medicine means. There is no proposal to make doctors government employees, or have government manage hospitals. "Socialized medicine" is a scare term that inhibits looking at different ways of providing and paying for services.
The outcome it seems is that we wind up on some sort of Medicaid style universal coverage where there is theoretical coverage for all conditions/disease states, but the range of choice and the availability of providers is limited.
Why is that the outcome? Of course a government plan won't cover everything. Guess what: neither do private plans. (And of course people who have no plan get nothing, or get treated in emergency rooms which we pay for.)
To my knowledge, it's pretty undisputed that Europeans get just about the same health outcomes as we do, while we spend almost twice as much per capita as they do. I think that shows that the 2/3rds of the public who are happy with their plans really don't have much to fear from reform, since other nations have shown we can maintain our present standards for a lot less money.
dsimon:
I think you make my point when you say, "I think that shows that the 2/3rds of the public who are happy with their plans really don't have much to fear from reform" If two-thrids are happy leave us alone and just fix the broken public system. I suspect also that the data on satisfaction with socialized plans has been manipulated just as climate data has been manipulate to facilitate the greater government involvement in our lives.
If things were so great in Canada why do they export their patients to the US and why do women with breast cancer in the UK die because drug therapies that are commonly avaialbe here are considered too expensive?
People want to make their own choices, not be dictated to by bureaucrats. It's called freedom.
The problem here is that the government expects the private sytem to supoport its underfunding of Medicaid and Medicare. The government will not fund these plans adequately because it lacks the will. What will it do when it has millions of more lives to support? Tax us all to death? print the money and debase the currency?
Obama has no answers! he creates problems and calls them "solutions".
The private insurance companies will be priced out of the market as their costs are driven up by niggardly government payments within the federal system.
The government plans must first learn to pay their own freight and get on a solid keel before we start tackling the "problem" of the uninsured. Most of whom are quite content to be without insurance in the first place!
petekent01 (on twitter)
PK,
Firstly, have a look at Republican approval ratings before taunting anyone with Obama's approval ratings!
On the healthcare debate, my personal sense is that actually most people are quite happy with real proper healthcare overhaul. They understand that Bush's tinkering did little but swing the pendulum in the insurance companies favor, and that at the moment the healthcare system in the US is not based on need, as in most other places in the world, rather on ability to pay. Seriously. You quoted a figure of 2/3 of people happy with there own health coverage. Well that is one figure, but what it doesn't descrbe is how many people are happy with the system as a whole. And in a wider context, IMHO its not about how many people are happy in this debate. Its how many people are being denied treatment or being forced into bankruptcy or worse in the current system. In other words this isn't an issue that is about being popular in my view, its a policy that is about doing the right thing.
PK said
If things were so great in Canada why do they export their patients to the US and why do women with breast cancer in the UK die because drug therapies that are commonly avaialbe here are considered too expensive?
-----------------------------
Have you any evidence of that actually happening PK, because I live in the UK, and have never heard of that happening at all. I rather think there would be a national scandal if it was happening.
I don't think anyone is satisfied with the current system.
Its an ideological point. Part of the country thinks that government usually makes things worse. Part of the country thinks that government can do no wrong. The majority is somewhere in the middle.
I will say trying to rush through a healthcare plan without proper analysis and debate isn't a smart thing to do. Recent history has shown congress often acts without entirely thinking about the longterm ramifications of policy.
Everyone needs to calm down and relax. I am pleaseed that it looks like there will be several competing proposals which is a very good thing in my view.
to check Krugman's hypothesis, it would be interesting to add a variable for the amount of market concentration in each senator's state.
http://krugman.blogs.nytimes.com
/2009/06/22/competition-redefined/
PeteKent:
You really didn't address any of my points. If you claim that a public plan's reimbursement rates will be so low that doctors won't participate, then the 2/3rds of the people who don't want to switch will just keep what they have. You don't explain why that wouldn't be the case.
You say you "suspect also that the data on satisfaction with socialized plans has been manipulated just as climate data has been manipulate to facilitate the greater government involvement in our lives." Putting aside the undefined use of the scare-word "socialized," I'm not referring to "satisfaction" data; it's based on five-year survival rates. It's hard numbers. Instead of "suspecting," how about looking them up before writing? (For starters, here's a chart for the US, England, New Zeland, and Australia http://www.nytimes.com/imagepages/2009/06/17/business/17leonhardt.graf01.ready.html. The US does somewhat better on breast cancer, but remember that we're paying tons more overall. And we do only as about well or even worse on many other diseases, such as kidney transplants and colorectal cancer, despite our far higher costs.)
You say "People want to make their own choices, not be dictated to by bureaucrats. It's called freedom." Which bureaucrats are you referring to--the insurance company bureaucrats who try to tell doctors what they can and can't do? Private or public, you're not going to get away from bureaucrats. Private bureaucrats have a profit motive to say "no." And they do.
You again bring up the underfunding of Medicare and Medicaid, which is fair enough, while utterly ignoring my prior point that these programs are precisely the ones taking the most expensive people out of the private system and keeping their cots from being even higher than they are, essentially subsidizing them. How many of the 2/3rds that are satisfied today would be able to afford their programs if their companies couldn't turn down these otherwise uninsurable clients?
And as Paul Krugman points out in today's New York Times, the Bush tax cuts cost more than what it would take to fund health care reform. The Clinton tax rates were hardly an impediment to robust growth, so it would hardly require taxing us "to death" to pay for it.
You also say that "most" people who are uninsured are content to be that way. Got any data on that? Nor do you include those who consider themselves underinsured.
You need some more facts before making so many unwarranted assumptions. As Senator Moynahan said, everone has a right to his own opinion, but no one has a right to his own facts. You should see the facts on health outcomes in other countries and what they pay to get them. You should look up facts as to how revenues might be raised to provide universal coverage without "taxing us to death" instead of assuming that it will. You need to look up numbers as to how many people choose to be uninsured or underinsured instead of assuming that most people want to be in that state.
Perhaps you might want to consider addressing specific counterarguments, instead of just repeating what was written before. If those arguments aren't addressed, minds won't be changed.
marky mark,
In terms of GOP approval ratings I'll take my chances with the generic copngressional ballot where we are near parity with the DemocRATs.
A few more million unemployed and we just might move over the top!
Sux to fail, don't it?
petekent01 (on twitter)
The problem, marky mark, is that the DemocRATs are not willing to allow debate. Indeed they wanted to pass this using reconciliation. They would rather the people not a have a clue as to what is going on because they know full well the truth of this overhaul would terrify them.
Healthcare, I suspect is a bit like the weather - -everyone likes to complain about it, but no one really wants to do a thing to change it.
The damned Dems are using the same misinformation techniques regarding healthcare reform as they did with Global Warming. Their shrill attacks to the contrary, the whole GW thing is unraveling as a hoax and they now must find a new means to get into our shorts!
You, yourself, are a purveyor, of this same misinformation. You wrote:
"Its how many people are being denied treatment or being forced into bankruptcy or worse in the current system."
Who is being denied treatment? If it's anybody, its Medicaid patients who cannot get a doctor to treat them and nor can they get a medical facility to open anywhere near them. Why? because the government does not pay. And now they want to drag millions of people who neither need nor want insurance into the system to subsidize their own folly.
You are also far behind the curve. The notion of all these people going bankrupt because of their medical bills has been dismissed as an urban legend. People go bankrupt because they spend too much at Best Buy!
Obama does not know what he is doing and he wants to spend trillions doing it. It is a recipe for electoral disaster. Tee hee!
petekent01 (on twitter)
markymark,
Glad to hear you are far away in the UK.
Also, get yer head outta yer azz its all over the news how your public health was denying breast cancer pateints therapy that was widely avaiable in the US because of cost reasons. They got shamed into finally paying for it. The breast cancer mafia saw to that!
Imagine how many of your citizens suffer neglect and die because of bureacratic choices. The frail elderly, those who live in indigency in nursing homes are one such population that has virtually no one advocating for them.
"No set of iron bars a stronger prison makes than old age and want of money!"
Have some compassion.
We know Europe has passed its Zenith, but please do not try and infect us with your cynical malaise and acceptance of the scarcity.
This is Amerrica -- we are not the victims of history, we make history!
petekent01 (on twitter)
Great analysis, Nate. Pretty powerful causation between industry money and voting.
My my, the Pathetic Kurmudgeon of self-righteous Dudgeon just can't get enough of baiting us with his foaming inanities. To paraphrase Sartre, if SaltPeter Kent did not exist as the resident unrepentant and uninformed troll (wrong so often and laughably so on every prediction he made about the election [remember how many times Obama was finished, done, McCain was on his way to a resounding triumph?], he brazenly and pathetically continues to offer wrong predictions which are not worth the tweets they are thumbed on.) Well, I guess we feed and care for this troll, as he shows what he so appropriately now is, a nitTWIT.
PeteKent: The problem, marky mark, is that the DemocRATs are not willing to allow debate. Indeed they wanted to pass this using reconciliation.
Pete, please get your facts straight. Reconciliation does not mean no debate. It means at least 50 votes are needed instead of 60. Do you have something against majority rule?
The notion of all these people going bankrupt because of their medical bills has been dismissed as an urban legend. People go bankrupt because they spend too much at Best Buy!
Data? Facts? Citation?
Yes, some people spend too much at Best Buy and then don't have enough to cover their medical bills. But there are obviously many people who do everything right but still can't afford insurance (or adequate insurance) and are still overwhelmed with catastrophic health care costs, and that number does account for a significant amount of bankruptcies. You might want to look at this article from Politifact on the topic: http://www.politifact.com/truth-o-meter/statements/2009/jun/11/chris-dodd/medical-bankruptcy-study-not-clear-cut/.
And I can tell you that according to medical professionals interviewed in the Frontline piece "Sick Around The World," the number of people in several European countries who are bankrupted by medical care is--zero.
They would rather the people not a have a clue as to what is going on because they know full well the truth of this overhaul would terrify them.
Again, where's the data? Where's your survey showing that most people would be "terrified" if the knew "the truth"? And it makes little sense to talk of "the truth" of "this overhaul" when we don't even know yet what this overhaul is; as you must know, there are several competing options on the table.
If you're going to substitute speculation, innuendo, and unwarranted inferences for facts, data, and logic, then it doesn't make any sense to engage in a discussion--for either of us. The data has to come first, not the ideology.
Everyone...
Any attempt at “discussion” with PeteKent is only poking a tarbaby. He isn’t interested in reasoned analysis—he’s got nothing in his mental arsenal but GOP talking points.
To those unfamiliar with PK, his post at 2:34 presents a semblance of a rational approach, but it’s never long before the real PK steps out from behind the curtain, as he did half an hour later, saying “Josh you are a Fascist! Nobody likes liberals or progressives or whatever the hell you all are!”
So arguing with that is like arguing with a toilet bowl.
dsimon, you wrote
"You really didn't address any of my points. If you claim that a public plan's reimbursement rates will be so low that doctors won't participate, then the 2/3rds of the people who don't want to switch will just keep what they have. You don't explain why that wouldn't be the case."
They won’t want to keep what they have because practitioners will demand so much higher reimbursement from them that the cost of insurance will become uncompetitive.
This is only an acceleration of a trend that has been going on since the 1960s where the private patient subsidizes the federal.
Eventually, we will all become federal patients because the cost of basic coverage will get to be too great.
Once the private subsidy is gone, then the practitioners will leave the field as well, finding more lucrative occupations. All that will be left are doctors from Syria to treat you.
Your point about the federal system taking the most expensive patients out of the system might hold water if the Feds actually paid their freight, but they don’t.
Don’t you think we should fix what we got instead of creating a new set of entitlements?
Krugman's voice is like a dog whistle. I cannot hear him!
Why do you think all socialized medicine countries have a VAT tax? They need to tax everything in order to pay for their welfare states! And why do you think these nations are not the economic engines of the world they way the US used to be before Obama started monkeying with the gears?
Don’t pat Bill Clinton's tax hike on the back for anything! The prospect of higher taxes will only retard recovery and assure the misery of millions upon millions of underemployed Americans. In case you had not noticed it we have 9.4% unemployment today, the highest in over 30 years. Let’s get folks some jobs before we screw with entitlements. Many of these folks will never find work if their employers are taxed or are forced to give them healthcare benefits that they do not want or need.
The true number of folks who are uninsured because of circumstances is about 8 million. The rest of the 45 million or so uninsured are uninsured b/c they either don't want to pay for it or don't need it (young and hale!). This is common knowledge.
If you think Europe or New Zealand is so swell, please move there.
We have a much more diverse population than any of those countries and hence comparatives are hardly instructive.
If you need a liver transplant would you really be indifferent to having it here or in Spain?
As far as Obama's liver goes -- I hope it fails!
petekent01 (on twitter)
And the effect of a potential primary challenge?
Look at Specter and Gillibrand drifting leftward.
That's another way to persuade those on the fence. And use the money they take from insurance companies against them in a campaign.
Looks like Petey has been dropping his turds not just on 538 but elsewhere too, or was until they pulled the plug on him last year.
Petey, it seems nobody wants to listen to you. Why is that?
You say you can show the impact of lobbying. You can't. You cannot take into account -- because you cannot tell, statistically -- whether someone is opposing the public option because of money, or because of principle.
And no, your timing model doesn't reliably show cause and effect at all. Were I to go to Congress, even before I ever voted, the lobbyists would know where I stand, because I am a libertarian conservative, and I therefore would oppose a public health insurance program. Many, many of the Republicans in the Senate have shown over the years that they are -- not by money, but by their words and deeds -- generally against such programs.
If Ron Paul were in the Senate, even if he never took a red cent from any health insurance lobbyists, who here thinks for half a second that he might possibly vote in favor of creating a public health insurance program? Of course he wouldn't (and probably even John with his Everglades land knows this). So clearly, any money he DID get wouldn't make him MORE likely to oppose it. (And no, I didn't support him for President, I'm just using him as an obvious example).
Like most statistics, this is meaningless because you aren't taking -- and really can't take -- some of the most important information into account. You really WANT it to be true -- because you are in favor of public health insurance, because you love statistics, and so on -- so you ignore the problems and make obviously unsupportable statements like "we actually [can] see -- statistically -- the impact of lobbying by the insurance industry on the prospects for health care reform."
Great article from Politico
Obama Health Plan Imperiled
By Mike Allen and Jim VandeHei
Politico
June 19, 2009
http://www.politico.com/news/stories/0609/23906.html
Shows you what a bunch of bumblers Odumbo and his crew really are.
Thank goodness they are f**king this up!
petekent01 (on twitter)
Pk said
'Also, get yer head outta yer azz its all over the news how your public health was denying breast cancer pateints therapy that was widely avaiable in the US because of cost reasons. They got shamed into finally paying for it. The breast cancer mafia saw to that!'
--------------------------
You'll be able to post a link then? I didn't hear anything about it over here in the UK. Of course it might be an urban myth the right spread just to show how bad 'socialised medicine' is.
Pk also said
'The true number of folks who are uninsured because of circumstances is about 8 million. The rest of the 45 million or so uninsured are uninsured b/c they either don't want to pay for it or don't need it (young and hale!). This is common knowledge.'
-----------------
Again here, you won't have a problem posting a link.
Just because Limbaugh says it doesn't make it true or 'common knowledge.'
But if it is true, thats precisely why a government mandated system is preferable. Nobody knows when they will need health insurance. You wanna leave a young cancer sufferer uninsured? Are you really happy with that happening in the richest country in the world?
PK then trotted out this cliche
'If you think Europe or New Zealand is so swell, please move there. '
-----------------------
Honestly, if the US had a reasonably priced system of medical insurance, I might be back in a flash. UK healthcare, for all its faults is one reason why I am happy to live away from the USA.
I would suggest two modification to the explanatory variables to allow for differences across states: 1) normalize Per-Capita Health Care Spending per-Capita with some measure of median income for the state (household or per-capita), and 2) normalize the impact of PAC contributions across states.
I live in Montana and a million dollars of campaign contribution in this state goes a whale of a lot further than it does in, say, California. So some contributions may look smaller, but in terms of the necessary campaign cost for the state be actually quite substantial.
Any chance getting the data set you are working from Nate?
Chris
Flush PeteKent down the toilet.
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Removes troll's comments fromfivethirtyeight.com.
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Can Nate get some of that PAC money for this?
The graph is a perfect illustration of what some economists like to call The Bobbi Fleckman Principle.
PeteKent:
This will be my last response to you. Again, you're not explaining or addressing the facts.
You say: "If you think Europe or New Zealand is so swell, please move there." That statement does not address the fact, which you do not deny, that those countries get just about as good results as we do while we spend almost twice as much per capita. I don't have to move there for that to be true. Why not confront the issue?
"We have a much more diverse population than any of those countries and hence comparatives are hardly instructive." Why in the world should the diversity of a population matter? You don't explain it. (Perhaps diversity would help serve as a hedge against a group prone to medical problems. Without facts or data, how can we know?)
"Krugman's voice is like a dog whistle. I cannot hear him!" Again, no refutation of the point that we don't have to tax ourselves "to death" to pay for reform. If you can't hear the question, I suppose there's no point in asking you to actually address it.
You write: "And why do you think these [Europoean] nations are not the economic engines of the world they way the US used to be before Obama started monkeying with the gears?" As I recall, the US was a great economic engine in the 1990s, faltered somewhat in the 2000s, and our economic collapse was well underway before the 2008 election, so it had nothing to do with Obama. Again, facts matter. Ideology comes in a distant second, if that.
As for your scenario about a market left with a public plan but no doctors: "[people] won’t want to keep what they have because practitioners will demand so much higher reimbursement from them that the cost of insurance will become uncompetitive." Why that conclusion? Why wouldn't doctors just refuse to take patients on the public option because it would drive away their (better paying) private patients? After all, some doctors already refuse Medicare and Medicaid, so your premise seems to me flawed from the start.
"Your point about the federal system taking the most expensive patients out of the system might hold water if the Feds actually paid their freight, but they don’t." Well, they still pay a good chunk of it, don't they? And doctors still must make some money if they take them (or they're just a great group of people for doing so). What do you think would happen to private insurance rates if these people were dumped into the private system with no right of refusal?
"The true number of folks who are uninsured because of circumstances is about 8 million. The rest of the 45 million or so uninsured are uninsured b/c they either don't want to pay for it or don't need it (young and hale!). This is common knowledge." I'm ready to believe you, but you should provide a cite to show that you know what you're talking about (you haven't provided one yet). Also, many states require car insurance, even for those who are "safe" drivers. Why treat health insurance differently? For someone so concerned about expenses of health care reform, it should be pretty obvious that an individual mandate spreads out both risk and cost.
And sometimes those "young and hale" people get catastrophically sick. They get very expensive treatment in the emergency room and afterwards. And we all pay for it. Or you dispute that too?
"Many of these folks will never find work if their employers are taxed or are forced to give them healthcare benefits that they do not want or need." Actually, many in the business community are in favor of government-sponsored reform precisely because they're getting killed by medical expenses.
PeteKent:
One last point that I forgot to include above: ss I wrote above (which again was not addressed in any response), isn't it just slightly premature to pontificate on the consequences of healthcare reform when we still don't know what version is going to be considered for passage? We don't even know if there is going to be a public plan. If there is, we don't know if it will require physician participation (probably not, in my view). We don't know if it will be subsidized. We don't know what reimbursement rates it will offer. Doesn't that kind of blow a huge hole through any analysis you or I might attempt?
Again, we need to get over the scare tactics, innuendo, and ideology, and focus on the facts first.
PorridgeGun: Honestly, these people are moronic. When the public are telling you to quit faffing about and pass real health care reform, regardless of your personal views and political contibutions, you get behind it 100%.
Except issue polling such as this oftentimes fails to capture how soft support for certain policies really is. Sure, most people support a "public option" when asked by a pollster, but how many people care enough to really make it an issue? I'd wager the members of Congress received far more mail, email, and telephone calls about the bailouts than about this. This is all beside the fact that I don't believe support for a public option is really as strong as these polls imply.
Additionally, saying no to a public option might be far less harmful to a member of Congress's reelection prospectives than saying yes and then having to vote for the measures necessary to pay for whatever policy is passed...even among those who supposedly support a public option.
Davy: Conversely, I think this is why Americans have such a low opinion of congress even if they have a high opinion of president. They know the game is rigged.
Does this imply that Americans believe the 'game' isn't rigged when it comes to the president's policies? And also, why do individual members of Congress typically receive high marks from their constituents? Is it simply that they prefer their corrupt representative to everyone else's?
Juris: They haven't articulated much of a principle beyond that of supporting a free market -- despite the fact that this free market has been a failure at holding down costs and assuring coverage.
The logical response to such a critique would be that a public option would be an even worse failure. I don't buy that argument, but simply showing that our system has flaws doesn't necessarily mean there is a better option, much less that the options being proposed are better.
pudge: Like most statistics, this is meaningless because you aren't taking -- and really can't take -- some of the most important information into account
I feel like this is a rather standard argument from those who really don't understand statistics. Although it is true that statistics can be done poorly such that important information is left out and that statistics are often abused for whatever purpose, a properly done statstical analysis can provide plenty of useful information. Perhaps if you understand the enormity of the odds against seeing something considered highly stastically significant occur by mere chance, you wouldn't be so quick to judge.
Fox News Interpretation: The top graph shows that Republicans are actually least likely to be influenced by lobbysists.
I don't think this has been mentioned before, but, to put it briefly, this analysis is interesting - but only that. The potential statistical issues mentioned in a number of the comments are secondary to the real issue: that the data given here, except under pretty unreasonable assumptions, cannot give any information about causality. The results given are what could be called 'summary statistics' - indicators that something interesting is probably going on, and that further analysis is warranted.
To actually draw some causality out of this data, one has to be able to claim that the independent variable is just that: independent. If, for example, PAC money were randomly given to certain senators and not to others, and we were to observe their voting afterwards, or if senators voted randomly, and then PAC contributions were made after the vote, then we could make claims about causality.
This is essentially the core focus of modern applied statistics in fields such as economics and political science - such conclusions are simply very difficult to make with any real certainty.
- Tiro
The Maxwell Evans Report
@Marcus et al., who wrote "I don't think this has been mentioned before," if you'd read earlier comments you'd realize that it has actually been mentioned before.
The issue of causality when it comes to lobbying has always been there. But whether the money moves votes or votes move money or the anticipation of votes moves money, the correlation between lobbyist spending and votes is hardly coincidental and is a terrible mark against the democratic process.
And this has been known, like forever. The classic book on this subject by E. E. Schattschneider, The Semisovereign People, was written 50 years ago. Classic and discredited counterarguments about "plural" and counter-balancing interest group have been around just as long. But on something like health care, except for an occasional breakthrough such as Medicare in 1965 (after a huge Democratic electoral landslide), the moneyed interests have won and the people's interest has lost.
The lobbyists spend their money the way they do for a reason, and not because they are just good citizens. The "people," whose views on this subject are fairly well crystallized by now, typically get outspent and outorganized by the interest groups. Nate's analysis is intended to show the unseemly correlation between Congressional votes and lobbyist spending. For that purpose, it's right on target.
Nice shout-out for this article by Nate in Krugman's NYT blog:
"The medical-industrial complex and the public option
Fascinating statistical work by Nate Silver. It doesn’t support the crude view that it’s all about special interest money, but suggests that the money is making the odds substantially longer."
The Insurance Industry only wants to insure strong,young, and genetically 'superior' people- so they can keep their costs down- if you are older, have health problems etc- either they reject you or charge you $700 or more a month.
I hear someone here calling the progressive ideas for change in health care as Fascist? Actually the Fascists in Italy, Nazi Germany, and Spain had universal coverage- but in Nazi Germany you only received health care if you where an Aryan- or non Jew. Actually universal health care in Germany goes back to the time of Bismarck in the 1870s
Soviet Russia and present day Russia have universal health care, - as does France and most of the rest of Europe. The countries of Europe as a whole have a lower infant mortality rate then the USA, lower rates of heart disease and cancer. They have far better preventive care- and have a higher quality of life and longer lifespan. And there is a balance for most citizens on health care availability- something increasingly lacking here.
If it where not for the Government we would have no FDA, no VA- No National Park system- talk about 'waste in Government?' LOL
Teddy Roosevelt who was a republican and very progressive busted the big business trusts and heavily regulated them, started the FDA to protect our health- and wanted to preserve our environment.
It makes me laugh when I hear someone ignorant enough to call progressives 'fascists' the only fascists around are the conservatives and far right- which make up the Republican party- who have used 'Plantation style Laissez Faire economics' the last 40 year through racism, cultural warfare and fear.
I think the model proves something unintended - that less information is better. The model assumes the recipients of lobbyist largesse know the amount and source of the largesse. Most lobbyists and representatives say the money given has no effect on anything the representative does since he or she votes his or her "conscience." So - instead of more extensive reporting and analysis, provide that all contributions have to be anonymous. There can be absolutely no way a recipient can trace the source of the gift.
In addition to the issue of reverse causality that others have noted (Medical PACs support senators they think are on their side), and countervailing lobbying (which you acknowledge), you are also failing to account for senatorial influence.
Your two big outliers - Baucus and Reid - should have a big fat dummy variable in the model for being the individuals with the most influence over pending medical reform legislation. (Baucus chairs the finance committee, Reid is majority leader)
If the goal is influencing decisions, then Strategic lobbyists would allocate funds to senators based on a combination of "likelihood to influence" and "position of power". If the goal is rewarding closely aligned senators, then strategic lobbyists ought to allocate funds to senators with clearly articulated positions in their favor.
The model could really use an instrument...
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