Political Booknotes Reviews
Baker, Jeffrey H. Birnbaum and Ross K.
Political Booknotes The Serpent on the Staff Howard Wolinsky and Tom Brune Jeremy P. Tarcher/Putnam, $24.95 By Jeffrey H. Blrnbaum President Clinton has been pretty tough on lobbyists. In 1992,...
...At the rally, 10 doctors' organizations, representing more physicians than the AMA's membership, expressed their support for the Clinton plan...
...And Bill Clinton is stirring the pot hard and fast in a way that is especially profitable for the lobbying industry...
...Every survey of public attitudes on the prestige of public officials rates federal judges well above cabinet members...
...But mid-size insurers don't, and they are funding the famous "Harry and Louise" commercials that have caused the Clintons such grief...
...Where it does continue, it relies too heavily on campaign contributions as its basis...
...Carter's concern, however, is not so much with ambassadors or even cabinet nominees so much as it is with Supreme Court justices...
...As a result, health care is likely to be the most lobbied bill in history...
...Clinton is an activist president who believes in an activist government...
...In a wider context, the story of the Clinton White House and the AMA is typical of contemporary interest-group politics...
...When a book receives a president's public endorsement, however, it tends to be taken fairly seriously because there is an assumption that it might influence his policies...
...Had he stuck with those alone and not gotten into the Lani Guinier affair, the book would have had a more consistent point to make...
...Ross K. Baker is a professor of political science at Rutgers University...
...The title is a reference to the AMA logo, the ancient symbol for medicine: a snake twined around a knotty staff...
...The phrase also conveys the authors' sense that all is not well with the politics of the AMA...
...In December 1993, it notes, Clinton held an event at the White House to counter the AMA...
...While it has become tiresome-ly routine to blame journalists for every infirmity in American society, we should not overlook the vested interest that they have in presenting people in the most provocative, even extreme, manner...
...Conceptually, it is as populist a proposal as has been floated in years...
...Carter's appeal to our common sense and good grace may strike some as impractical...
...From their point of view, the association does not lobby for the interests of patients or medicine in general but for the personal interests of doctors...
...That, they point out, is a big-money business indeed...
...Some—the five largest ones—actually like the bulk of the Clinton plan...
...It is doing so by trying to divide the medical establishment against itself in order to defeat it...
...But I found one bit of rationalizing he does on behalf of his fellow law professors unpersua-sive...
...One of this department's chief targets this year, as in almost any other year, is the nearly 300,000-member American Medical Association (AMA...
...Yet Carter advises that we turn this presumption of confirmation on its head and instead force nominees to tell us why they are qualified...
...But back at the White House War Room, it is well understood that there are good insurance companies and bad insurance companies...
...Unlike the reformist tinkerers, Carter sensibly rejects these quick fixes in favor of a more radical and vastly more difficult solution given our thirst for judicial blood: Stop using confirmations to encode the Supreme Court for all time with our ideological genetics...
...In the old days, this hostility was enough to kill almost every attempt at health reform...
...Indeed, while the president is likely to complain about lobbyists and "special interests" from time to time, behind the scenes he is careful to work closely with them...
...He argues that the writings of academics nominated to high office should not be taken too seriously...
...At first, the Clintons courted the AMA...
...The Serpent on the Staff is a helpful addition to this quest, and nowhere more so than with this fact: "Not only does the AMA have one of the biggest-spending PACs in the country, but it also owns the building that houses the only federal agency charged with monitoring PACs and campaign contributions"—the Federal Election Commission...
...And like previous presidents, Clinton has an entire division of his White House devoted entirely to keeping lobbyists, and the interests they represent, in line...
...Prominent in Carter's catalog of flaws in a nomination/confirmation system that has produced debacles such as the Robert Bork and Clarence Thomas hearings and the serial executions of the nominations of Zoe Baird, Kimba Wood, and Lani Guinier is the system's current presumption that a presidential nominee should, by and large, be guaranteed Senate confirmation...
...Despite Carter's underlying argument that a single seat on the Supreme Court is not so all-fired important that the lobbies of the right and left need to put out a fatwa on nominees they don't like, an associate justiceship still counts for a good deal more than, let us say, the job of secretary of Labor...
...The AMA is the subject of an informative new book called The Serpent on the Staff, by Chicago Sun-Times reporters Howard Wolinsky and Tom Brune...
...In the course of the conversation, it became quite clear to the author that Carter either had not read the book or (perhaps worse) that the president had read it but totally missed the point...
...Take the president's health care legislation...
...But it is quite a different thing, as Carter says, to depict the nominee as the devil incarnate, as happened with Robert Bork and, at the sub-cabinet level, with Guinier...
...Hillary Rodham Clinton even addressed one of its meetings...
...One official, Rosi Sweeney of the American Academy of Family Physicians, noted, "The AMA doesn't speak for the entire medical community...
...The one exception was Medicare in the 1960s...
...The authors start off with a promising—and interesting— depiction of the way the AMA got and holds onto its influence in Washington...
...Lobbying is a permanent and pervasive force and, in many ways, is key to the outcome of any piece of legislation, especially one as big and important as an overhaul of the entire health care system...
...But what he is not doing is ending the influence of influence peddlers...
...This is a thoroughly modern strategy that takes advantage of the increasingly diverse lobbying world of Washington...
...One of the Clintons' biggest problems in selling their health plan has been that groups like the Health Insurance Association of America and the AMA have done a better job than the White House in defining what Americans think of the proposal...
...Still, The Serpent on the Staff opens another window on the way interest groups work in Washington, and that always brings a welcome breeze...
...These correctives range from the unlikely (requiring a supermajority vote in the Senate for confirmation that would force presidents to nominate only those around whom a consensus could form) to the impossible (a return to the pre-1925 system of having nominees not testify at their own confirmation hearings...
...This combination means big-paying corporate clients have a lot more to fight for—and to protect themselves against—and that translates into more work for lobbyists...
...One of the great truths of life in the capital is that change in any form creates more business for lobbyists...
...It is an intriguing thought, but would make it difficult for presidents to pay off their big contributors with ambassadorships to Barbados, Costa Rica, Ireland, and the Court of Saint James...
...Now Clinton is pressing for campaign finance and lobbying disclosure reforms that have a decent chance of passing...
...My own advice to a law professor who is thinking about pulling his punches in a law review article because a senator might one day brandish it in front of him at a confirmation hearing is that you can't have it both ways...
...The Clinton administration struggled mightily to work with—or around—this major league lobby...
...This school of thought holds that presidents deserve "their own team...
...One of its chief aims is to provide health coverage for the 37 million Americans who aren't covered now...
...Another example of this is Clinton's fight with the insurance industry...
...It strikes me as the very midsummer of wisdom...
...In the manner of good-government advocates from time immemorial, Carter discusses a number of possible remedies to correct a process that has degenerated into an ideological food fight...
...You cannot simultaneously relish the exhilaration of intellectual playfulness and enjoy the sober respectability that makes for a credible case for confirmation...
...The country's most prominent Protestant layman, Bill Clinton, bought Carter's book in Martha's Vineyard last summer, kept it near his desk in the Oval Office, and mentioned it on several occasions...
...I remember a story that James MacGregor Burns told about meeting with Jimmy Carter after the president had publicly praised Burns' book on leadership...
...And besides, cabinet members are now little more than sublimated errand-boys for the interest groups...
...And Carter reserves even more severe criticism for the way the Senate confirms or rejects those nominees...
...This lobbyist-savvy White House is now trying to make a second exception out of the Clinton health care plan...
...But to do so, some of the nation's richest and most powerful interests, such as drug companies and physicians, will have to change...
...Unfortunately, this line of analysis dissipates as the book moves along...
...Another reason that the White House must keep track of what interest groups and their lobbyists are doing is communication...
...senators who shamelessly rag on appointees in order to score points with interest groups—Carter is, in my view, a little too charitable...
...Stephen Carter's newest book, The Confirmation Mess, will probably not be the subject of any public praise by Clinton since it is highly critical of the way presidents choose and package their nominees for high posts...
...A single justice can become a swing vote in the manner of a Lewis F. Powell, so it is the most natural thing in the world for those with a stake in public policy to pick holes in a nominee's robe...
...Jeffrey H. Birnbaum covers the White House for The Wall Street Journal and is the author of The Lobbyists: How Influence Peddlers Work Their Way in Washington...
...Instead, trust that the decisions of nine Americans of more than ordinary integrity will probably not be too wide of the mark for too long...
...To the contrary, in many important ways, Washington is even more lobbyist-friendly now than it was when Clinton came to town...
...In any case, learning more about what lobbies do, and how the White House reacts to them, is an important part of understanding how laws are made and implemented...
...He put three former lobbyists in his cabinet...
...The First Couple has railed against insurance company greed and blustered about its bloated bureaucracy...
...This is an enduring problem, for to be known as a reader of writers such as Reinhold Neibuhr, John Rawls, or Robert Nozick seems to make politicians feel that they are men of many parts...
...He concentrates on perfecting a process that is not intrinsically flawed but which has fallen into the wrong hands...
...The Confirmation Mess Stephen L. Carter Basic Books, $20 By Ross K. Baker Stephen L. Carter has received much favorable attention lately for his book The Culture of Disbelief, a lament over the disappearance of religion from American political discourse...
...I once worked for a senator who was asked what his favorite novel was...
...It would have spelled doom for Harry Truman's nomination of Perle Mesta to Luxembourg and thus deprived us of the basis for a great musical comedy, Irving Berlin's Call Me Madam...
...In 1992, he promised to break their "stranglehold" on Washington, and one of his first acts as president was to ban his appointees from lobbying their agencies for five years after they leave government...
...By all outward appearances, Bill and Hillary Clinton could not dislike any industry more...
...Both Bork and Guinier had written extensively, and in both cases, their scholarly works came back to haunt them...
...Carter's even-handedness in casting the conservative Bork and the liberal Guinier as victims of the same lynch mob psychology makes his argument especially appealing since it appears that he has no axe of his own to grind...
...The Serpent on the Staff makes a brief but telling mention of this effort...
...there is much more to the doctors' lobby than that...
...But in the end, the AMA became just another special-interest road block, repeating its long established pattern of opposition to reform which began when Theodore Roosevelt first proposed national health care only to find America's doctors furiously opposed...
...The author devotes little time to the one element in today's confirmation process that seems to me to be intimately connected with the savagery that nominees must confront: the media and the controversies— often contrived—on which they thrive...
...Even the anti-lobbying president knows this and, despite his rhetoric, is including lobbyists in his plans...
...The Best and the Brightest, he replied...
...It's called the Office of Public Liaison...
...As to the other villains in the confirmation mess—presidents who make cavalier choices and then suffer their hapless nominees to hang in the wind...
...But it is always difficult to find out whether presidents actually read the books they conspicuously talk about...
...Taking provocative academic writings into account in the nomination process, he tells us, deters intellectual risk-taking on the part of professors who might some day aspire to government service...
Vol. 26 • January 1994 • No. 5
