Three Keys to Successful Legislative Advocacy

Physicians are in many ways poorly suited to be legislative advocates. We function in a world that acknowledges our extensive training and experience and is respectful of scientific analysis. And despite all the difficulties of practicing in the 21st century, we still get what we want in most situations. When we make a diagnosis and propose a treatment plan, our patients usually go along with it. And when we want things to go a particular way in our clinical settings, be it the office or the operating room, they usually do.

However, in the world of legislative advocacy, we are back to square one: Important decisions are not necessarily made by the best trained or the most experienced, statistics and other data are manipulated if not ignored, and the influence we are used to exerting in our clinical settings seems not to exist.
In the legislative arena, it is not uncommon for a group of us to meet with a legislator who has had less than a third of our formal education. In such a meeting, we as a group will typically, and with great patience, explain our sage analysis and thoughtful recommendation regarding a piece of legislation. But not uncommonly we find out later that the legislator ended up voting "the other way."

While in the vast majority of cases it turns out that the legislator's preexisting beliefs would have in fact predicted their "vote," we physicians do not deal well with the frustration of having our advice going unheeded. In fact, we find it so frustrating that, over the years, I have seen it drive dozens of would-be physician advocates to just walk away from the process. And even worse, I have seen this frustration result in behavior that was counterproductive and even detrimental to what we were trying to accomplish.

For those of you who are interested in advocacy and willing to learn, there are three bottom-line points from the experience of those who advocate for you that will serve you well. Success is never guaranteed, but if you follow these three points, be assured that you will never really "fail." And to illustrate what can go wrong, I will relate three scenarios — all of which actually took place in the setting of a group of physicians meeting with a state legislator in his or her office in Sacramento or with a member of Congress in his or her office in Washington, DC. Each of these scenarios illustrates some of the behavior that simply must be avoided if one is to be a successful advocate.

Respect Elected Officials and Their Staff

Nothing you or I will ever do as a physician will put us in the position of constantly living in the crucible of public opinion as much as an elected official. Only an elected official knows what it is like to have their every action scrutinized by not just the public but the media, both of whom often lack all the facts but still have the constitutional freedom to publicly criticize at will. And at election time, every elected official knows that his or her every opinion and vote stands to be distorted by the opposition into something evil, which is then stuffed into every local, high-propensity voter's mailbox and/or displayed on television.

Whether you agree or disagree with an elected official about a given issue, or even about his or her entire political philosophy, you must give these folks their due. They have taken on something that the vast majority of us could never even attempt to do in a credible fashion.

I cannot emphasize this enough. If you are not capable of being respectful to a broad philosophical range of elected officials, stop reading now and instead seek out other physicians to be involved in legislative advocacy.

Finally, staff members are also worthy of our respect. The staff of elected officials are usually underpaid, underappreciated, and over-blamed. And, in many cases — particularly in Washington, DC — they are at times flat-out overworked.

How Not to Be a Successful Legislative Advocate, Example 1: After being told that a legislator was unavailable to meet with us and that we would have to meet with a staff member instead, one of the physicians in the group openly protested, along the lines of, "Doesn't he know that the Doctors are here?" Well, as it turns out, a legislator's first priority when in Sacramento or in DC is to attend his or her committee meetings, which often end up being in conflict with the times when groups wish to meet with them. In addition, an opportunity to educate legislative staff on an issue is usually well worth our time.

How Not to Be a Successful Legislative Advocate, Example 2: After a legislator stated to a group of physicians that he had decided to vote for a CMA-opposed bill, one physician proceeded to pepper the legislator with a series of escalating questions designed to change his mind, the last of which was, "Do you want people to die?" The reality in this case is that it is quite rare for a legislator to actually volunteer to a visiting group that they are voting in opposition to one of their top positions. When that happens, it means that the legislator has already given the issue significant thought and is highly unlikely to change his/her mind. A barrage of interrogative questions in that situation is basically saying that we believe that the legislator is being stupid — not a good idea (even if true).

Respect Your Adversaries

In the vast majority of cases, those who oppose us on issues actually believe what they are saying. They may be lacking in the appropriate background or experience, such as non-physicians seeking a scope-of-practice expansion, or just have an entirely different view of the world, such as attorneys who believe that med-mal lawsuits act to improve medical quality (bizarre but true). It is important that we never allow our disagreements with our adversaries to in any way diminish our fundamental respect for the fact that they, like us, are willing to stand up for what they believe.

To use the same example, I sincerely believe that the trial lawyers who want to weaken or repeal the MICRA law are wrong, wrong, wrong on that issue, but I also believe that most do in fact believe that MICRA infringes on the rights of those few truly harmed by medical malpractice. I have also fought for years with various "business lobbies" over their lockstep devotion to the agenda of health plans, but I have never doubted that most of their advocates truly believe that CMA's legislative successes against health plans have made health insurance less affordable.

To ascribe evil motives to one's opponents in the legislative arena is a losing strategy. Many of our opponents do it to us, and, in fact, it almost always ends up being to their detriment. The legislators know that those who are in their office disparaging others are only a tough vote or two away from disparaging them.

Respect the Truth

This should be an easy one. In the end, all that we really have as advocates for the profession is our credibility. As hard as it is, in a profession where we are always supposed to have all of the answers, many of us need to learn to say, "I don't know, but I can find out," when responding to the questions of an elected official or their staff member.

How Not to Be a Successful Legislative Advocate, Example 3: Some years back, in a burst of enthusiasm when discussing a CMA proposal to increase Medi-Cal fees, a physician in Sacramento for the first time volunteered that, in the past, CMA had never objected to Medi-Cal fee cuts when the state budget was in a bad situation, so it was only fair that we should receive an increase when the state budget was doing better. While enthusiastic and well intentioned, that statement was patently untrue (and that particular veteran legislator knew it) — CMA has always strongly opposed any cuts to the profoundly underfunded Medi-Cal program. But once you make an untrue statement, even with the best of intentions, your credibility with that legislator for anything else you might say drops to zero.