As the White House begins a push for healthcare reform, it starts at a significant disadvantage, perhaps as large as $1.38 billion. According to the Center for Responsive Politics

, a nonpartisan group that tracks campaign contributions and lobbying expenditures, that’s the sum that five industries–pharmaceuticals/ health products, insurance, health services/HMOs, hospitals/nursing homes and health professionals–spent lobbying lawmakers from 2007, the first full year Democrats controlled Congress, to the most recent first-quarter filings for 2009.

In fact, starting in 2006 healthcare interests have spent even more than the financial services industry to sway lawmakers. Since 1998, three of the top ten lobbying spenders have sought to influence healthcare policy; the American Medical Association’s $204 million in the past decade was second only to the perennial top lobbyist, the US Chamber of Commerce. Beyond lobbying, hundreds of millions have been spent by healthcare interests in campaign contributions in the past two election cycles alone.

So what does all this money buy? According to Nate Silver

, renowned number-cruncher and blogger at FiveThirtyEight.com

, a whole lot. Silver crafted a method to measure how lobbying might be shaping Democratic senators’ votes on a healthcare bill with a public option–which 76 percent of Americans support, according to a recent NBC/Wall Street Journal poll–and concluded that the low sum of $60,000 in campaign contributions over the past six years would cut in half the odds of a centrist Democrat supporting the plan.   SEBASTIAN JONES

LEADING NOW: Kim Gandy

never figured out how to pull a punch. In eight years as president of the National Organization for Women

(NOW), Gandy staked out positions that defined American feminism as forceful and unlimited in its reach. After the slaying of George Tiller

, the Kansas physician whose work made real the promise of reproductive rights, Gandy declared, “Bringing the killers to justice is not enough–the Justice Department and the Department of Homeland Security must root out and prosecute as domestic terrorists and violent racketeers the criminal enterprise that has organized and funded criminal acts for decades.” NOW badges shouted, Murder Is Not Pro-Life.

When Barack Obama’s Justice Department filed a brief describing the Defense of Marriage Act as “a cautious policy of federal neutrality,” Gandy shot back, “Neutrality is not what DOMA is about. This law flat- out favors one form of legal marriage over another. The Obama administration has no business treating a discriminatory law as neutral and should instead be working with Congress to develop legislation repealing this harmful law. The Bush years are over– we expect much better from our new president.”

It was during those years that Gandy led NOW as an opposition force on virtually every issue. In her view, there were no limits on “women’s issues.” NOW’s logo was temporarily updated to insert a peace symbol in the “O.” Economic justice, media reform, immigration and healthcare moved to the top of NOW’s agenda–alongside commitments to equality, diversity and abortion rights. Gandy’s successor, former NOW vice president Terry O’Neill

(backed by former NOW president Patricia Ireland

), won a spirited contest with current NOW veep Latifa Lyles

(backed by Gandy) with promises to make the organization even more activist and progressive–an exciting prospect, as Gandy was no slouch on those fronts.   JOHN NICHOLS

DISPLACED IN PAKISTAN:

While the mainstream press is lately blanketed with worrying headlines about Pakistan’s internal struggle, one in which many Western nations claim to have a vested interest, relatively little is being reported on the escalating humanitarian crisis of internally displaced persons (IDPs) in the Swat Valley. Estimates from the United Nations

put the IDP population, mostly Pashtun and living in camps or with relatives (some eighty to a house), at more than 2 million–a figure that far exceeds the number of IDPs in Rwanda.

As of June 22, however, the UN had re- ceived less than 35 percent of the $543 mil- lion it has requested from donor nations to aid Pakistan’s IDPs. With the sole exception of the United States, which has given $110 million and promised $200 mil- lion more, wealthy Western nations and, more conspicuously, the Arab world, have contributed very little. Without further donations, the UN, as well as several other aid agencies including Oxfam

and Save the Children

, could run out of money very soon. With the monsoon season on its way, the situation for Swat Valley IDPs is about to become even more dire, with a projected rise in malaria and potentially lethal stomach ailments. John Holmes

, the UN humanitarian chief, has also warned that an army incursion into South Waziristan could produce another half-million IDPs.

Saddled with $7.6 billion in IMF debt, Pakistan’s tenuous democracy is simply not equipped to tackle the IDP problem without aid. Given the battle taking place between Pakistan’s military and a resilient cadre of extremists, it seems imperative, from a strategic perspective, that the Pakistani people understand that resisting the Taliban will not lead to such disastrous outcomes.   NISA QAZI

FLAMED:

On page 39 of this issue, readers will find an ad from the organization Facts and Logic About the Middle East

(FLAME), which warns of “the deadly threat of a nuclear-armed Iran” and claims that the only solution is to threaten to destroy Iran’s nuclear facilities. This magazine has long held the opposing view; as we editorialized three years ago (“Saber Rattling Over Iran,” May 22, 2006), the “continued use of coercive diplomacy to curtail Iran’s nuclear program will only strengthen its hard-line regime and solidify Iranian public opinion behind a national goal of obtaining nuclear weapons…. Threatening Iran with sanctions and military attacks strengthens Iranian hard-liners’ case for nuclear weapons.” Our ad policy starts with the strong presumption against banning advertisers because we disapprove of, or even abhor, their views. We reserve the right, however, to attack them in our editorial pages–a right we exercise here in brief.