$150,000 a year for each doctor trained and pays premiums to hospitals that serve a large number of poor and uninsured patients, often the same hospitals. The proposed cuts amounted to $8.6 billion for teaching hospitals and $7.1 billion for treating the poor ( Fein 1995).
The hospital industry as a whole was concerned about cuts in Medicare and Medicaid. In July 1995 they called for a commission to devise a plan to revamp Medicare. Earlier they had opposed the cuts, eventually adopted in the budget resolution in June 1995, and put ads in newspapers attacking the proposals ( Serafini 1995e; Toner 1995).
One last aspect related to interest groups needs to be told. In chapters 3 and 4, we discussed a policy proposal known as medical savings accounts ( MSAs). We saw that MSAs were mentioned in some proposals in 1994, that they were included in some of the Republican plans for Medicare in 1995, and that they showed up again in 1996 in regards to insurance reform (the Kennedy-Kassebaum bill). The major interest lobbying for MSAs was Golden Rule Insurance Company. Golden Rule gave almost $1 million in campaign contributions to Republicans in 1993-94 and worked closely with Gingrich and other key Republicans. Golden Rule also contributed to political action campaigns, such as Gingrich's GOPAC, and funded groups such as the National Center for Policy Analysis and the Council For Affordable Health Insurance ( Common Cause 1995; Dreyfus and Stone 1996). The company's efforts paid off when the Kennedy-Kassebaum bill included money for a trial run of medical savings accounts.
From the early days of the American Republic, the issue of interest groups in the political system has been a concern. Madison, as we have seen, sought ways to curb the "mischiefs" of faction. Some political scientists going back to early years of the twentieth century have seen in the clash of interest groups the very stuff of politics. Others have seen certain groups, primarily business, as having a dominating presence over public policy. Based on the theoretical discussion of interest groups in the first section of this chapter and the examination of interest groups in the two health care periods, what can we conclude about interest groups and the outcome of policy making in the health care area and, more generally, about interest groups in the political system?
Both periods under study were marked by intense interest-group activity. As Wilson's ( 1980) discussion of the importance of concentrated costs and