Insularity & Impenetrability: What Happens to Health Funding and Policy When Voters Can’t Reach Lawmakers
In the United States, Congress wields enormous power over health care policy and funding. With health care committees and floor votes on budgets controlling national health spending of nearly three trillion dollars annually (Department of Health and Human Services 2015), and the U.S. estimated to spend 50% more on health care per capita than any other nation (Commonwealth Fund 2015), the impact of members of Congress on our health policy is impossible to overstate. In late 2014 and 2015, the first two authors of this column conducted an outreach experiment to gauge the accessibility and approachability of all 535 members of Congress and their staff representatives, in relation to an important public health issue. We contacted the offices of all Senators and Representatives to advise them of a recent article (by the first and third authors) on the long-term health effects of war on civilians in affected areas — namely, interactions between malnutrition and infectious disease that result from sanctions, embargoes, and other intentional tactics. We offered to send a full version of the published article, and then tracked responses. Not one member of Congress requested a copy, and the only direct response we received was a request not to be contacted again (for a full description, see the resulting Anthropology Newscolumn).
What this brief summary belies, however, is how difficult it actually was to attempt to share such public health information with elected officials. To even identify email addresses to which to address our messages proved extremely challenging, taking countless hours of digging through official legislative websites, calls to district and D.C. offices to verify ‘official’ email address formulas that resulted many times only in bounce-back messages, and ultimately, in two of us systematically writing to each member of Congress through online contact forms on their websites (which preclude uploading attachments), over several months. Still, this did not yield actual communication with those who ostensibly represent average Americans, and who we expect to advocate for our health needs.
The challenges we encountered in contacting elected officials for a simple public health information mission have serious and troubling implications for voters who need to contact their members of Congress about more urgent and personal health issues like difficulty getting V.A. benefits, help with processing Social Security disability claims, appealing Medicaid or Medicare coverage denials, or efforts by those who wish to lobby for state block grants for homecare funding — to name just a few reasons voters might wish to contact their elected representatives at the federal level.
Congress members’ local district and D.C. offices may ostensibly be reached by phone, but in many cases people could have scanned versions of benefits denial documents they need to submit as part of a request for advocacy, or other documents they hope to show their Congressperson — in our outreach experiment, simply sending a PDF of an article proved impossible. Applied medical anthropologists, or those to whom we return our findings, may find it equally difficult to engage elected officials in policy change efforts related to health coverage or funding efforts, if simply reaching a Senator or Representative is so difficult in routine matters.
With the damaging effects of neoliberalism on democracy (Collins et al. 2008) and increasing corporatization of the political process in the U.S., signified by the more than $2.5 billion spent on corporate lobbying (Drutman 2015), Congress has evolved into an insular institution in which, rather than lawmakers being protected from well-funded special interests like the paid lobbyists of multibillion dollar corporations, elected representatives are secluded from the citizenry and, hence, from accountability to voters who put them in power (Ostrach, Houston, & Singer 2015; Schoenbrod 2008). The result is unhealthy health-related laws that are harmful to the broad public interest (Castro & Singer 2004).
While the current presidential election campaign continues to feature politically motivated discussions of building a 1,954-mile wall across the southwest sealing the country off from a workforce it actually needs, a real wall has been built sealing off the elected from the electorate (Schoenbrod 2008), while opening the door to corporate and special interest lobbyists (Brodbeck, Harrigan & Smith 2013). So long as those making funding and policy decisions with our tax dollars and those of our participants can avoid communicating with and being responsive to those whose health is most affected by their decisions, this insularity and impenetrability at the highest levels of the U.S. government should be of grave concern to medical anthropologists.
References Cited
Josh Brodbeck, Matthew T. Harrigan, and Daniel A. Smith. 2013. “Citizen and Lobbyist Access to Members of Congress: Who gets and who gives?” Interest Groups and Advocacy 2:323-342.
Castro, Arachu and Merrill Singer. 2004. Unhealthy Health Policy: A Critical Anthropological Examination. Walnut Creek, CA: AltaMira Press.
Commonwealth Fund. 2015. “US Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse Health.” Commonwealth Fund press release, October 8th, 2015.http://www.commonwealthfund.org/publications/press-releases/2015/oct/us-spends-more-on-health-care-than-other-nations
Collins, Jane, Micaela Di Leonardo, and Brett Williams, eds. 2008. New Landscapes of Inequality — Neoliberalism and the Erosion of Democracy in America. Santa Fe: School for Advanced Research Press.
U.S. Department of Health and Human Services. 2015. “Health, United States, 2014.” Report prepared jointly with the Centers for Disease Control and the Center for Health Statistics.http://www.cdc.gov/nchs/data/hus/hus14.pdf#102
Drutman, Lee. 2015. The Business of America is Lobbying: How Corporations Became Politicized and Politics Became More Corporate. Oxford: Oxford University Press.
Ostrach, Bayla with Ashley Houston & Merrill Singer. 2015. “Syndemics & Legislative Outreach: An Experiment in Educating Congress about the Health Effects of War.” Anthropology News 56(6): e1-e12.
Schoenbrod, David. 2008. Power Without Responsibility: How Congress Abuses the People Through Delegation. New Haven: Yale University Press.