I've been in and out of government;
I spent 16 years in the government
and 16 years out of the government.
Do I prefer being in the government,
you know, making policy that I believe in?
Yeah. My wife doesn't like it very much.
So I would probably have been in the government longer
if it weren't for the fact that
I wouldn't still be in my first marriage.
My name is Tom Scully.
I'm the senior counsel at Alston and Bird,
which is a big Atlanta-based law firm,
probably 750 lawyers based in Atlanta.
And we have about 150 in Washington,
and I run the health care practice in Washington,
which is about 15, 16 people.
And I do that half-time,
and I'm a partner
in an investment firm in New York
the other half of my time,
where we invest in mainly health care companies.
So I've been doing health care policy
for probably 30 years.
So almost everything I do
basically is trying to figure out
hospitals' health care policy
compared to services,
nursing homes, hospitals, dialysis clinics,
doctor practices, things like that.
And in the Washington role,
we represent a ton of different
health care companies:
again, a ton of hospitals, insurance companies,
dialysis centers, imaging facilities --
anything you can think of in health care,
we represent one of them someplace.
Well, there are two types of lobbyists
in Washington.
When I first started out, out of law school --
I hate to admit, 28 years ago --
I was at Akin Gump,
which is one of the bigger law firms in town.
The two biggest lobbying law firms
in Washington are probably
Akin Gump and Patton Boggs.
So I started my career out of law school
at Akin Gump,
and later on I was a partner at Patton Boggs.
They are probably --
and they're great law firms,
but they tend to be more of the traditional
door-opening access lobbying.
But I think there are door-openers
that basically are relationship people
that raise a lot of money
and just kind of make sure
if you're a company from Cleveland
and you need access
to explain your issue
to your congressman
or your senator,
which I think is a legitimate function
and a lot of people do that.
Long ago I decided
I liked the substantive side better,
so I spent a lot more time on details.
So people generally don't hire me or us
to do door-opening
for their senators
or to get to know their congressman;
they generally hire us
because we know the policy really well.
You know, hopefully we know it,
and most of the people that work here
have worked either in the Senate or the House
or in one of the agencies,
and so they understand the process.
But they're much more likely to
get into the weeds of how
kidney dialysis works
or how a hospital gets reimbursed
in North Carolina for --
you know, why a hospital in Charlotte
has a problem with payment
and how it gets fixed,
that kind of thing.
You know, people need advocates.
And whether you're an advocate in a courtroom
because you're getting sued
or you're an advocate because
you're trying to get a radio station
licensed with the FCC,
whether you need an advocate
because you're a hospital
and you're trying to make the argument
because you're in Memphis
that your hospital is taking care of all these
indigent care people
and it needs more subsidies,
people have a right to
petition the government.
Sometimes they do it through a courthouse
and sometimes they do it through
the Federal Communications Commission
and sometimes they do it through Congress.
And you can't expect some guy from Memphis --
I did a lot of work
with the poorest hospital in Memphis, the Med,
which is a low-income hospital,
when I was in the government.
You can't expect somebody from Memphis
to show up and understand
how to deal with their congressmen
and their senators and the agencies.
And so just like you'd hire somebody
if you got sued in the courthouse in Atlanta, Georgia,
you hire somebody in Washington
who lives this stuff every day and knows --
you know, if you've got a problem with
health care,
you go to certain committees and certain people,
and you generally would
probably hire people
that have worked with those people
over the years,
which is no different from advocacy anywhere else.
I have a company I represent
that makes diabetes pumps,
very unique diabetes pumps.
Technically -- if you know what an insulin pump is,
it's a mechanical pump
that's a piece of metal that sits on your belt.
Well, this company invented a new diabetes pump
that basically has a handheld little device,
and it's a disposable pump
that you throw away every three days.
Okay, so you have a little thing
you can move around on your belt;
it's taken over the juvenile diabetes market
because kids can swim with it,
they don't have to have a pump on their belt,
they can move it around on their body,
they have a patch.
Well, these guys can't get Medicare
to pay for it,
and the reason is, under the law,
technically Medicare doesn't pay for disposables.
So I went into Medicare, made all the arguments,
met with the staff;
they said, you know what, this is a great product.
Seniors would love to have it.
Works great for kids.
We agree with you; it's fabulous.
Only one problem:
the statute says
we don't pay for anything that's disposable.
And the pump,
it's a very unusual, fabulous product.
And if it costs the same or less
than the old mechanical pump
you've got on your belt,
by all accounts it's a better product.
It just so happens
the statute says
Medicare pays for durable medical equipment,
not disposable medical equipment.
So there's a good example.
So what do you do?
You know, the company's in Massachusetts;
I've been talking to Senator Kerry's staff.
The agency staff likes it.
It's going to be a long process;
it may take six months, it may take two years.
I don't know.
But going through the staff
and educating them about this product
and why it should be paid for --
it's not going to cost the government any more.
The company's based in Massachusetts --
talking to the delegation
and getting them to support it.
This kind of stuff happens.
There's no rational reason
why this thing shouldn't be paid for,
except an old statute said
Medicare doesn't pay for anything that's disposable.
So, the first step was to go into CMS,
which is Medicare,
and see if there was some way
they could interpret the statute to cover this,
which I still think there is.
But if you read it by the book,
historically there's no precedent for it.
I think legally they could do this,
and we're still in the process of doing that.
But as a backup,
if Medicare can't find a way
to pay for it
even though they think it's a great product,
we're going to have to go to Congress and say,
look, we need a little technical fix.
Well, passing any health care legislation
is incredibly difficult,
because it becomes a freight train,
so it's very hard to say --
you know, there's usually one bill every couple years,
and this one just passed
and there may not be another one for a while,
so going in and saying,
oops, we need a little fix,
is not easy.
It takes a lot of work.
It's a fact of life
that people follow the incentives they have.
And there are people -- you know,
members of Congress
have to be able to raise money to get reelected.
And the guy that shows up
and raises a lot of money for you,
you're probably going to meet with him.
But I also think, equally if not more so,
people value substance.
And I don't know of any member of Congress
that's worth a damn in either party,
if you come in with a bad argument,
that's going to help you.
So whether it's your hospitals
or your nursing homes,
people help their constituents.
So if you're from North Carolina or California,
you're probably not going to
spend a whole lot of time worrying
about helping somebody from Indiana,
you're going to help the guy from your district.
And if he comes up with a crappy argument,
you're not going to help him anyway.
So, you know, what a lobbyist really is,
is nothing more than a lawyer or a representative
or somebody who comes in
and crafts your argument and helps you
to go get your member of Congress
or your senators to build an argument
and fix whatever your problem is.
I don't think there's any shame
in representing people
and making a good argument.
So the idea that somehow
being a lobbyist is evil...
You know, I don't like it.
I know some lobbyists in town,
I've known them for years,
who basically don't
know the substance around their clients
and their whole practice is
based around fundraising.
There are plenty of people that do that.
That's not my preference.
I've avoided that for a long time.
But that's a small minority.
If you went around and looked at
who the lobbyists are that are specialists,
you know, there are 25 or 30 people
that do health care,
practices of people that do
health-care-specific substance like I do.
Probably another 25 or 30,
if you've got a problem with the FAA
if you were an airline,
you'd go hire them.
You know, pick your issue.
Let's say if you're a farmer
and you got a problem in Nebraska
with your corn stuff
and you've got to go to the Agriculture Committee,
I would have no clue how to do that,
but there's probably 25 people
that could do that for you.
And they know all about the ag programs
and they know who to go see,
and I think that's perfectly legitimate.
I grew up exactly the opposite;
the world wasn't quite as cynical back then.
When I was in college,
I wanted to work in Washington
and be in the government
and maybe be in lobbying
because I thought it was interesting.
And it's all about making policy.
So I think it's gotten a much worse image
over the years.
Do I think it's right or fair?
I think it's uneducated, largely.
I mean, are there some lobbyists out there
that are doing stuff
that I don't think is great?
Maybe, but I think the vast bulk of people
are basically into the
little substantive silos
that they deal with most of the time.