How To Lobby Effectively

[Ace844]

Hello Everyone,

At various times on this board we have had proposals to chnage the state of EMS and an oft asked question is how. While doing some reading I stumbled upon this article which we ALL should read and I think it could give us each a basic idea and frame work for which to perform some organized EMS lobbying from, then begin to effect soem much needed changes.

Hope this Helps,

ACE844

http://www.imedicine.com/DisplayTopic.asp?...3&topic=689 ; How to Lobby Effectively

Emergency Medicine - Legal Aspects Of Emergency Medicine ; Author: Dan K Morhaim, MD , Member, Maryland House of Delegates 1994-2006; Consulting Staff, Department of Emergency Medicine, Sinai Hospital of Baltimore; Faculty, Johns Hopkins School of Public Health

Editor(s): Richard Lavely, MD, JD, MS, MPH , Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine; Francisco Talavera, PharmD, PhD , Senior Pharmacy Editor, eMedicine; Matthew M Rice, MD, JD , Vice President, Chief Medical Officer, Northwest Emergency Physicians, Assistant Clinical Professor of Medicine, University of Washington at Seattle; Assistant Clinical Professor, Uniformed Services University of Health Sciences; John Halamka, MD , Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Craig Feied, MD, FACEP, FAAEM, FACPh , Director, National Institute for Medical Informatics, Director, Federal Project ER One, Director of Informatics, Washington National Medical Center, Director, National Center for Emergency Medicine Informatics"]

Politics is important to medicine because of the myriad ways it influences medical practice. Malpractice, graduate medical education, Medicaid reform, managed care rules, Consolidated Omnibus Budget Reconciliation Act (COBRA), "prudent lay person" bills, hospital financing, and occupational safety are just a few of the ways government directly influences emergency medicine. In today's highly charged political and medical climate, emergency physicians must participate in governmental process.

Nearly every important government action influences emergency medicine indirectly because many patient visits to the emergency department (ED) are precipitated by social problems that may be caused or alleviated by government action.

Government is not an abstraction; governments are made of people. The legislators who comprise government are usually responsive to their constituents. The closer the legislator is to voters, the more responsive the legislator. Therefore, state legislators are easier to reach than are federal representatives. However, most issues key to emergency medicine are decided at the state level.

Physicians in general are regarded as a knowledgeable and influential group, and ED physicians have a special ability to influence the political process because most legislators know that ED physicians see and treat patients regardless of the patients' ability to pay. Although most legislators are now aware that EDs provide a vital social and health safety net, many legislators still need to be educated about the basics of the medical profession.

The political process is, by nature, a responsive one. The problem is that the political process responds only to input that is received, and very rarely do legislators actively seek alternative views. Many citizens are predisposed to the cynical notion that politicians are bought and sold, and many citizens believe that the average citizen has little or no influence. In reality, the ability for an individual citizen to influence politics is substantial, but like all other tasks, it requires patience, practice, and persistence.

Several simple guidelines make any physician a more effective lobbyist at the local, state, or federal level.

Do not give up

"If at first you don't succeed, try, try again." Many bills take years to pass. Legislators are bombarded by competing views, and sorting out the issues takes time. Even seasoned legislators become frustrated. However, physicians squander education opportunities if they prematurely abandon efforts to influence legislators after insufficient or no response to queries. When the effort is abandoned, victory is conceded to the opposition.

Do not burn bridges. Do legislators change their minds? The answer is an emphatic "yes." Most legislators are remarkably open-minded. With the exceptions of certain controversial emotional issues (eg, abortion, death penalty, gun control), those who persist often persuade legislators to take other viewpoints. Remember that most legislators are in office for years. Educating them can take time, but it is worth the effort.

Register to vote and exercise this right

Registered voters are the most influential citizens. The 2000 presidential election, which hung on the ballots of a handful of voters in Florida, testifies to the potential importance of even a small number of voters. Even under ordinary circumstances, the number of votes needed to swing an election can be small.

The author (a Democrat) serves as legislator in a district of Maryland that has 90,000 eligible voters out of an overall population of 120,000. Of these 90,000, approximately 50,000 are registered. Of these, 28,000 are Democrats and 22,000 are Republicans. In a primary election, voter turnout is typically less than 50%, often much less. Thus, 14,000 Democrats and 11,000 Republicans may go to the polls in a primary election. Lists that indicate which citizens voted in the last 3 primary elections are available; such citizens are considered prime voters. These prime voters typically show up to vote regardless of circumstances (eg, blizzard, broken leg). Approximately 8000 prime Democratic voters reside in the author's relatively affluent middle-class district.

In a district primary race in the Maryland State Legislature, the number of votes required to win election also depends on the number of candidates. In the preceding example, roughly 6000 votes would win the primary election. Thus, what started as a daunting task (to become elected in the state of Maryland) simply became a challenge to find 6000 voters to support the candidate. Of course, after the primary, one has to win the general election, but winning the primary is obviously an essential first step.

The smaller the number of votes that can affect the outcome of an election, the more each single vote counts. Elected officials have immediate access to voter rolls, and staff members know if someone contacting the office is registered. Certainly, legislators respond to those who are not registered, but politicians pay closer attention to registered voters, who have direct influence over their political futures. If citizens are not registered voters, they are not players in the game.

Identify up-and-comers

No elected official begins as an incumbent. Almost all had to work hard to win an election, and most started at lower offices. Most governors and senators—with the notable exceptions of those with notoriety in other fields—began serving the public on city councils, state legislatures, or other lower offices.

Developing influence with elected officials in higher offices and establishing and maintaining relationships with politicians who are getting started in politics and who appear likely to be successful, especially if views agree, is important. Newly elected officials are usually highly accessible and truly appreciate input from their constituents. As elected officials climb the political ladder, the influence of long-time supporters grows.

Contribute money and help campaign

This must be stated plainly: Running a campaign costs money. Citizens who contribute to a campaign are well regarded. This does not mean that politicians are owned or that a timely contribution buys a vote; most politicians are honest and ethical. Nonetheless, politicians appreciate citizens who understand the importance of financial donations to a successful campaign.

Appropriate, timely, and legal campaign contributions are part of the real-world price that must be paid to participate fully in the political process. Until campaigns are financed differently, any group that wishes to increase its ability to influence legislation must have a budget for political donations.

Candidates appreciate and remember those who help with other parts of the campaign, such as placing lawn signs, joining the candidate door-to-door or in parades, arranging neighborhood meetings, or working the polls on election day.

Share ideas

Politicians are not omniscient. A surprising number of pieces of important legislation originate with a constituent's letter or phone call.

If the legislator likes a submitted idea, the constituent need not be concerned about drafting the bill. The constituent physician can help by providing an outline of the key points, but each legislature provides lawyers who specialize in bill drafting so that bills are in proper legislative form.

The ED physician has a unique insight into almost every major social problem society faces, from environmental degradation to adolescent pregnancy to street violence to cardiac disease. Emergency physicians are on the front lines and provide care for all kinds of people. The thoughts and insights of emergency physicians will be taken seriously if seriously communicated to elected officials.

Although politicians expect input from citizens regarding personal economic issues, be sure to balance this by providing input regarding issues that are purely for social good (eg, toughening drunk-driving laws, promoting seat-belt use).

When lobbying on issues that affect personal financial well-being, remember that legislators earn less than physicians. The author once observed a prominent surgeon complain to a legislative committee that fee cutbacks would jeopardize his second home. Although committee legislators did not demonstrate emotion during the hearing, the comments in the back room afterward were devastating.

Build relationships

During the legislative session, most legislators are swamped from dawn to dusk. Their ability to hear new ideas and to process new concepts during this time is limited. The time to get to know an elected official is when the legislature is out of session.

Try to learn what the legislator likes to do. Do not be afraid to offer a low-key social invitation or to invite the legislator to address a community group, professional club, or just some friends gathered in the living room. Most politicians love an audience and the chance to meet new people.

If possible, invite a legislator to join you for an ED shift. Seeing what emergency physicians really do from their perspective is often a real eye-opener and a valuable experience for legislators.

Partnerships of interest groups especially carry weight when they come together on an issue. Building coalitions with other professionals (eg, nurses, paramedics, physician assistants, organizations, public interest groups) can establish key relationships.

Communicate effectively and appropriately

As 1 of 188 legislators in a state with a population of fewer than 6 million people, this author still receives as many as 40 pieces of mail daily when the legislature is out of session and as many as 150 communications daily when the legislature is in session. Write a single-page letter whenever possible. State your problem clearly and simply, preferably with a personal angle, and include ideas for solutions. If comprehensive in-depth material is required, include an executive summary.

Real letters from real people are always read. Mass mailings are noted but are less effective. Sending a newspaper article and adding a brief comment is sometimes a useful technique. Persistence pays: Continue making contact with short but frequent communications. Most politicians return calls from registered voters in their district. Do not assume legislators know medical jargon and abbreviations. To legislators in Maryland, for example, "DNR" means Department of Natural Resources rather than "do not resuscitate."

Support politicians of your choice

When in agreement with your legislator on an issue, communicate that agreement. When politicians feel that the public is supportive, they are more likely to promote specific positions and to work to influence other politicians. If legislators are unsure of public support, they may vote the citizen's way, but they do not push the issue as enthusiastically.

Letting politicians know when they do something that is appreciated is also important. Being a politician has its rewards, but it is not an easy job. Elected officials are often subject to personal attack from those who disagree with a position. More can be gained by forging a positive relationship than by creating a negative one; when an elected official does something right, send a letter of support. Like everyone, politicians appreciate praise. Just like emergency physicians, they often hear complaints, but hearing positive feedback for the good things is unusual and is highly appreciated.

Visit government in action

Most citizens are surprised to learn the degree to which their government is accessible. In Annapolis, the capital city of Maryland, citizens stroll the halls and pack hearing rooms. Testimony sign-up sheets are outside hearing rooms each day. The citizen does not have to be a lobbyist to participate: anyone can sign up to be heard on any issue.

Virtually every state has access to government on the Web. Familiarize yourself with your state government's Web site.

Most legislators, given reasonable notice, give visitors an insider's tour. An old saying states that "the two things one never should watch being made are sausage and the law," but a day spent in a state capitol actually provides great insight into the political process and into how a citizen can make a difference.

Democracy is a fragile thing, and many have given their lives for its existence. Government suffers when it lacks citizen participation. Most physicians are fortunate to have good jobs, good incomes, and personal stability. Physicians hold a unique place in the life of the community and a unique perspective on the needs of all those for whom they provide care. With that perspective comes an obligation to work to improve society. Active engagement with government is part of the way that obligation can be met. Being political can be seen as a natural extension of being an emergency medicine physician.

[Ace844]

Hello Everyone,

I just found this interesting document and was wondering what you all thought of the points made here. Here's the link:

http://www.nemsma.org/Portals/3/NEMSMA%20P...l%20Support.pdf

OUT HERE,

ACE844

[AZCEP]

Grassroots level involvement? Good plan Ace. Now the lazy, scared, or indifferent among us have to make their voices heard. Letters to Congressmen and Senators people.

For admin:

If we put together a letter to Congress, could you post the links to the senators/representatives so we could do a mass mailing?

One voice type solidarity.

[Ace844]

Grassroots level involvement? Good plan Ace. Now the lazy, scared, or indifferent among us have to make their voices heard. Letters to Congressmen and Senators people.

For admin:

If we put together a letter to Congress, could you post the links to the senators/representatives so we could do a mass mailing?

One voice type solidarity.

Interestingly enough I believe there is already one of those in existance as our distinguished colleagues "PRPG, et. al, and RidRyder911, et.al,DUSTDEVIL et.al.," {There are links ot these efforts post in "GAmedics recent thread; give me some time and I will post them here as well.} tried to do something quite similar, I would definatelty be interested in doing something of this nature, but the real question is will our peers who post here step up to the plate and participate; or will this be a poor showing which is embarrasing like before? LETS HEAR IT PEOPLE, ARE YOU IN??? "GAmedic,&others" heres your chance to back up what you say....

ACE

The most exciting phrase to hear in science, the one that heralds new discoveries, is not 'Eureka!' (I found it!) but 'That's funny ...'

-- Isaac Asimov --

[paramedicmike]

Yep...I'm in.

[Ace844]

"Grassroots..." Who woulda thunk..?

Here are the links::

Formation of a new EMS political action group

Detroit Screws Up Again, Kills Another Person

A Total Restructuring of EMS as a Profession

Letter to Congress in regards to New EMS Adminstration

[AZCEP]

Letters duly sent to my representation.

You would think that with an election coming up, they would be more responsive than normal.

Probably have to send one daily for the next millenia to see an effect, but if that is what it takes form letters are not hard to generate.

[Ace844]

For those who are interested in further reference to what is discussed in the above link here are a few more to look at as well::

http://www.nyu.edu/ccpr/NYUEMSreport.pdf

http://www.gwu.edu/~dhs/reports/HSPI_EMS_t...port_5-2-05.pdf

http://www.flightparamedic.org/docs/IAFP_E...1st_Century.pdf

Now what do you think?

ACE844

[tinman694]

Uh, I'm already in at my state level---

We passed 9 bills the past term and have the legislatures and governor's favorable opinion.

Will support anything to improve the non-system we seem to now have.

As far as congress goes....good luck--you'll need it.

[AZCEP]

Every letter that is sent is one less that is needed.

The links have been provided, the information is there as well. Take a few moments to compose a coherent thought on the subject and send it to your representation.