Tommy Boggs and the death of health care reform.

• Author: Franklin, Daniel
• Position: Lobbyist

Bill Clinton should have known his health reform plan was in trouble the day he introduced it in September 1992 at the New Jersey headquarters of the Merck pharmaceutical company. As the candidate made his trademark post-speech plunge into the crowd, a mother handed her infant son to him. The baby vomited on Clinton's lapel. "That's what babies do," Clinton said.

Clinton's speech was one of the most important moments of his campaign. Health care reform had become a vital issue for voters, second only to the economy. Bush had already drafted a health reform plan, and although Clinton had alluded to his own package, he had never before laid out in detail what it might look like. Now, the line in the sand was drawn. After Clinton's speech, two things seemed clear regardless of who won the election: The nation's trillion-dollar health care industry was in for drastic changes, and the Capitol would see its most profound legislative battle since the tax reform fight of the mid-eighties.

It's hard to remember the hope and optimism with which the Clinton health care plan was greeted. Democrat and Republican alike agreed that the nation's health care system was in crisis and needed some kind of reform. Clinton's victory gave the sense that the moment for health reform had finally arrived. Only four days after his inauguration, Clinton appointed his wife and Ira Magaziner to lead the task force charged with designing the President's health care plan. The details would be left to the task force, but the broad principles had been known since Clinton's Merck speech: All Americans would be insured by large, regional purchasing cooperatives run by insurance companies. The costs would be picked up by the nation's employers. Also, the nation's malpractice system would be reformed to limit the possibility of frivolous lawsuits. In the end, the plan would achieve universal coverage and help stem the persistent growth of health care costs. In the first few months of the Clinton presidency, his health program enjoyed the support of over 60 percent of the country.

But then Washington's lobbyists began doing what they do, to much the same effect as that prophetic little boy in New Jersey. Along Washington's K Street, which is to lobbying what Times Square is to prostitution, the capital's biggest law firms geared up for the coming fight. Health-care experts were wooed and staffs were bolstered, all in hopes of landing the industry's major players who, seeing their very existence at stake, promised to devote as many resources as possible to ensure that the debate fell their way.

By any estimation, it was a seller's market. At the time, there were more than 800 different registered associations in the field of medicine, and nearly 300 representing businesses, each needing its own lobbyist to guide it through the jungle of Washington. Everyone had a stake in health care reform, and no one wanted to take chances.

Few firms were better positioned than Patton, Boggs & Blow, home to Thomas Hale "Tommy" Boggs, Jr. Over the years, no other Washington firm had linked itself so closely to the Democratic party. The biggest Democratic policy initiative since the days of Roosevelt was sure to be a windfall for the city's most prestigious Democratic firm. Shortly after the election, Boggs was pictured on the cover of the National Journal above the headline: "Ready to Cash in on Clinton."

It couldn't have been more correct. Patton Boggs did very well in the grab for clients. In addition to its longtime client the Association of Trial Lawyers of America, the firm landed some of the biggest players in the health reform debate, including the National Association of Life Underwriters (NALU) and the National Association of Health Underwriters (NAHU).

Patton Boggs found itself in the middle of two crucial aspects of the health reform debate. NALU and NAHU loathed the idea of mandatory alliances. "Underwriter" is actually a misnomer - the organizations represent agents and brokers who recruit clients and find an insurance company's policy that meets their clients' needs. Under Clinton's plan, consumers would negotiate directly with the purchasing alliances, removing the need for the go-between function the agents serve and, as a result, eliminating many of their jobs. For the Association of Trial Lawyers of America, the health care debate meant renewing its 20-year fight against any and all attempts to reform the malpractice system by putting limits on the amount a victim could collect from a lawsuit.

Malpractice reform had been a long time coming, but now die pressure for change seemed irresistible. A 1991 Harvard study estimated that malpractice insurance added about $9 billion to health care costs each year. Worse still, the study found, was the ever-present threat of lawsuits, which prompted doctors to protect themselves by prescribing unnecessary tests, or referring to a specialist patients whom they could just as well treat themselves. The cost of defensive medicine, though difficult to pinpoint, is estimated at approximately $25 billion per year. Reforms such as capping the size of awards for pain and suffering" have proven effective. In California, which passed reforms 20 years ago, malpractice premiums are 33 percent less than those of other large states. With polls showing Americans squarely in favor of reform, it came as no surprise when Clinton said he would include malpractice in his health package.

But the Trial Lawyers had traveled this road before with unblemished success, in no small part thanks to Boggs. In his 20-year association with the Trial Lawyers, not one attempt at malpractice reform has succeeded. Boggs, says Fred Graefe, a lobbyist for malpractice reform, "has singlehandedly stopped malpractice reform for 20 years."

Son of former House Majority Leader Hale Boggs and Congresswoman Lindy Boggs - and brother to ABC political correspondent Cokie Roberts - the 54-year-old Boggs is widely considered to be the most effective lobbyist in Washington. His network of powerful friends and his stable of influential clients have elevated him in some eyes beyond the status of a mere lobbyist. William Fay...