WHY DON’T YOU WANT TO BRIBE POLITICIANS? IT WORKS.
$744 million vs. $200,000
Healthcare lobbying hit a record in 2024. Almost none of it came from independent physicians. The laws reflect it.
That’s healthcare lobbying in 2024.
The cartel: pharma, hospitals, insurers, PBMs. $744 million.
Independent physicians: $200,000.
The ratio is 3,700 to 1.
You’re not losing because you’re wrong.
You’re losing because you’re not in the room.
IN TODAY’S ARTICLE:
The 3,700-to-1 ratio that explains why independent physicians lose every policy fight
Where the cartel’s $744 million actually went
Why the AMA’s $24.8 million belongs in the cartel column, not yours
The math on what it would actually take to compete
Glossary at the bottom of today’s article. This is Article 2 of the Cash Pay series. Article 1 exposed the math.
THE CARTEL TALKS IN CASH
In September 2025, Pfizer CEO Albert Bourla stood in the Oval Office with President Trump.
The deal: $70 billion in U.S. investment. Most-favored-nation drug pricing. A three-year exemption from pharmaceutical tariffs. Direct sales through a government website at 50% discounts.
Bourla thanked Trump “for your leadership and for your friendship.”
Friendship….
One pharmaceutical company pledged more to the U.S. economy in a single deal than independent physicians have spent on lobbying in the entire history of American healthcare.
That’s how the world works.
You don’t win by being right.
You win by being present.
By writing checks.
By building relationships founded on cash.
Physicians watched the same deal and did nothing.
THE NUMBERS
Here is how The Swamp works.
In 2024, total federal lobbying hit a record $4.4 billion. Healthcare was the largest sector, spending $744 million. That’s more than finance. More than defense. More than energy.
Here’s where the money came from:
Pharma and Health Products: $384 million
PhRMA (trade group): $31.7 million. Individual companies (Pfizer, Lilly, Novo Nordisk, etc.): tens of millions each. AdvaMed (medical devices): $4 million.
Hospital Lobby: $34+ million
American Hospital Association: $29 million. Federation of American Hospitals: $1 million. America’s Essential Hospitals: $5 million.
Insurer Lobby: $50+ million
Blue Cross Blue Shield plans: $43 million. AHIP (trade group): $8 million. UnitedHealth, Cigna, Elevance: millions each.
PBM Lobby: $18 million
PCMA (trade group): $18 million.
AMA: $24.8 million
Add it up. The cartel spent three-quarters of a billion dollars telling Congress what to do. Independent physicians? Physician Led Healthcare for America spent $200,000. That’s not a typo. Two hundred thousand dollars.
The ratio is 3,700 to 1.
THE AMA ISN’T ON YOUR SIDE
Does the American Medical Association (AMA) represent physicians?
It doesn’t.
The AMA spent $24.8 million in 2024.
That’s real money. But look at where it went.
What the AMA lobbied for:
Medicare payment tweaks (to protect employed physician salaries).
Prior authorization reform (to reduce paperwork).
Scope of practice restrictions (to block nurse practitioners).
What the AMA didn’t lobby for:
Lifting the ban on new physician-owned hospitals.
Repealing Certificate of Need laws.
Breaking hospital consolidation.
Site-neutral payment reform.
Any structural change that would restore physician independence.
The AMA’s agenda protects employed physicians.
It does nothing for independent ones.
This isn’t accidental. The AMA has a history.
In the early 2000s, the AMA lobbied to cap federal funding for residencies and restrict physician supply. They got what they wanted. Twenty years later, we have a physician shortage. The AMA then lobbied to remove the caps it had lobbied to create.
The AMA lobbied against universal healthcare in the 1930s. It lobbied against Medicare in the 1960s. It lobbied to restrict physician supply in the 1990s.
The AMA doesn’t fight the cartel. It negotiates the terms of physician surrender.
When you count the AMA’s $24.8 million, you shouldn’t count it on the physician side. It belongs in the cartel column.
The system isn’t broken. It’s working exactly as designed. The question is: designed by whom?
