If a frog had a back pocket …

It’s time for a political reality check

By Tom Banning
TAFP Chief Executive Officer/Executive Vice President

This issue of Texas Family Physician features a series of political tutorials emphasizing the importance of grassroots activism and political action in order to build the kinds of relationships with elected officials that get the interest, attention, and oftentimes support of well-reasoned policy positions. Put another way, if you want to affect health care policy, you must get involved in the political process. It is that simple and that important.

The unwritten laws of politics are as immutable as the laws of nature. As Voltaire put it perhaps more eloquently, “hawks have always eaten pigeons when they have found them.” Understanding these three, albeit cynical, rules will help you break the code to why some bills survive the legislative process and some die before ever being filed.

Politics drives process that sets policy.

You’ve heard us preach this before, but this is the holy trinity of how things really work. Who we help elect and how strong our relationship is with them determines the rules of the legislative process—whether or not a bill will get filed, set for hearing, debated on the floor, signed by the Governor, etc. In turn, this means our policy options are limited by political and legislative opportunity. In other words, policy objectives—no matter how well-meaning—may only see the light of day if our politics are in proper order.

Legislative reforms are reactive, not proactive.

Legislative policy changes occur after the proverbial train wreck, plane crash, biblical plague, financial meltdown, oil rig explosion—you get the picture.

A politician’s first duty is to get re-elected.

Every legislative idea and every vote that is cast passes through a political filter that measures the potential electoral consequences of supporting or opposing one set of constituents while antagonizing another. A legislator may not always be influenced by the politics, but they will invariably weigh the political consequences (a potential career-ending vote) against the policy implications (passing a tax bill to fund indigent health care).

Most physicians are understandably frustrated by the legislative process and think it is a fixed, insider game. I’ve heard it expressed many times from many different physicians: “If only they listened to me and supported my idea on how to fix health care, all would be right with the world.”

In a perfect world, our elected officials would make decisions based solely in the best interests of patients, but we don’t live in a perfect world and you can’t pass wishes. Politics and other considerations ultimately come into play. That’s how it works in the real world of practical politics and health care policy.

A veteran legislator, who to this day is still handing out one-liners and hard-earned wisdom to his less experienced colleagues on the House floor, is fond of reminding them that “if a frog had a back pocket he’d carry a pistol and shoot snakes.”

What he means, in my words, not his, is that good ideas will be devoured by the reptiles in the legislative swamp every time unless you can defend those ideas with more than mere words and good intentions. Or as Al Capone famously said, “you get more with kind words and a gun than kind words alone.”

Consider this: If all 5,000 members of TAFP gave $100 per year, a little more than a quarter a day, to our political action committee, the PAC would match and even exceed the political muscle of other influential professions and businesses. If only one-tenth of our members developed personal relationships with their elected officials, our grassroots presence would be transcendent. A legislator couldn’t swing a dead cat without hitting an involved family physician in his or her district armed and ready to work.

In the synergistic combination of activism and money, political action puts the pistol in the frog’s back pocket.