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 The Forces That Set the Agenda
 
 By Jeffrey H. Birnbaum
 
  In the grand scheme of things, Social Security isn't the nation's biggest fiscal problem. That's not my view. That's the assessment of Douglas Holtz-Eakin, a Bush political appointee before he became head of the nonpartisan Congressional Budget Office, who says that looming financial calamities in Medicare and Medicaid are larger and more immediate worries in a strictly budgetary sense.
 
 As economic calamities go, more significant crises confront the states, which are responsible for our kids' education; the nation's hospitals, which bear the brunt of an overburdened health care system; and international institutions, which have to deal with famine, poverty and HIV/AIDS.
 
 With all these pressing woes, how did Social Security, Terri Schiavo's end-of-life fight and judicial nominations make it to the top of the Washington agenda? It's not merely because the White House or the party in power wants them to be there.  It's because deep-rooted, well-heeled organizations have been targeting those issues for years. What seems like serendipity to the public -- why is Congress talking about trial lawyers again? -- is more often the result of an interest group's advance work combining with the right circumstances to send an issue hurtling into the limelight.
 
 Like it or not, we increasingly live in a stage-managed democracy where highly orchestrated interests filter our priorities. These groups don't have absolute power, of course. In the nation's capital, home to 30,000 registered lobbyists, hundreds of politicians, thousands of journalists and untold numbers of entrenched bureaucrats, no one's in charge. But long-established entities like the AARP, the Family Research Council and the U.S. Chamber of Commerce mold our collective thinking and regularly dictate the language and tenor of our civic debates.
 
 This notion runs counter to an abiding myth -- that political leaders actually lead. That's  true sometimes, of course, but more often than not, the ideas and movements that get on the government's to-do list come from the broad middle and not from the top.
 
 A case in point: More than a decade ago, the National Federation of Independent Business, the country's premier small-business lobby, began to methodically contact its half-million members by phone and mail to categorize them by political leanings and their willingness to contact federal lawmakers. The lobby group trained its most eager members at local seminars and sent staffers door-to-door during elections in critical congressional districts. Regular "grass-roots" outpourings from this made-to-order machine vaulted NFIB-championed issues onto center stage -- especially when the Republicans it favored took control of the White House and Congress. In particular, the inheritance tax (which NFIB loyalists redubbed the "death tax" for marketing purposes) was repealed (temporarily so far, but Congress is now considering whether to make the repeal permanent). This was the organization's No. 1 priority.
 
 The process is a lot like surfing. Interest groups float along, waiting for the perfect wave of public sentiment or official fiat to carry their issues to victory. They can't create the wave, but they can be ready for the moment when it comes. The key is to be prepared for that moment: Not every issue has an organization with the wealth and staying power to be in that position. Those that do have a shot at winning.
 
 "Lobbying is subtle and complicated," says John W. Kingdon, a professor emeritus of political science at the University of Michigan who studies interest groups. But the most important attribute of a successful lobbying campaign, he says, is persistence -- something that only entrenched organizations possess.
 
 "It takes a sustained organization, mobilized followers and an immense amount of power to get onto a legislative agenda," agrees Theodore J. Lowi, a professor of government at Cornell University.
 
 In many ways, interest groups have replaced political parties as the real influence brokers. Candidates for office rely on these groups for campaign cash, for campaign workers and, increasingly, for campaign issues -- all of which had once been the domain of the Republican and Democratic national committees.
 
 Republican ground troops come from such diverse groups as the NFIB, the U.S. Chamber of Commerce, the Family Research Council and the National Rifle Association. Democratic soldiers are recruited from places like labor unions, the trial bar and Moveon.org. "The standard distinction between interest groups and parties used to be that parties were committed to winning elections and that pressure groups let elections happen and then tried to influence the people who got elected," Lowi said. "Now interest groups through their PACs and a variety of other methods are very much involved in the pre-policy arena."
 
 Such involvement has become a prime factor in agenda-setting. Take Social Security. Few federal programs attract as much scrutiny. AARP, the nation's largest lobbying organization, is dedicated to keeping Social Security alive and well, as are groups such as the National Committee to Preserve Social Security and Medicare. The reason: Large portions of their membership depend on Social Security checks to survive in old age. AARP has taught a million and a half of its 35 million members how to hammer elected officials by mail, phone and in person, primarily about Social Security.
 
 But AARP has learned that it needs to be careful what it wishes for. Its obsession with the issue has made Social Security a front-of-the-mind topic and, therefore, a perennial contender to shoot to Washington's upper tier. Ideological opponents of the current Social Security system have also been active, raising the issue's profile even higher. Free market think tanks such as the Cato Institute and anti-tax-increase lobbies have been churning out position papers for a quarter-century promoting partial privatization of Social Security as a way to undercut what they see as "big government." One appreciator of that work: George W. Bush.
 
 So when the president went looking for a problem to solve that could guarantee him a lasting legacy -- and, perhaps, realign party domination -- he went for that old chestnut Social Security. He also embraced a proposal that AARP dislikes -- the creation of private accounts. That notion has fallen flat largely because of more than $15 million worth of AARP advertising against it. When the process moves to another phase and compromises are explored, AARP is likely to become an important negotiator and perhaps the key indicator of whether the effort will succeed or fail.
 
 The same high-stakes maneuvering couldn't have happened with, say, Medicaid, the health care program for the poor, even though it's in more dire financial straits. Medicaid doesn't have similarly situated citizens' groups beating the bushes on its behalf. So while saving Social Security is the watchword of the day, Medicaid's fate will be to languish and occasionally fend off budget cuts until its finances reach an emergency.
 
 Terri Schiavo is another example of interest-group politics at work. The 41-year-old brain-damaged woman was in many ways not out of the ordinary. She was one of thousands of people whose families annually struggle with the question of when a relative's life has ended. But skilled marketers on the well-established, pro-life side of the abortion debate seized on her situation. The National Right to Life Committee, Operation Rescue, Priests for Life, the Family Research Council and others set up Web sites, held news conferences and raised lots of money for lawyers and for themselves.
 
 Their pleas touched a chord with millions of Americans and made Schiavo's plight a cause celebre. The omnipresence of her situation in direct-mail communications from those groups and on talk radio made her synonymous with the battle over life and death issues of all kinds -- from the womb to the grave. By the time Schiavo's parents had finally exhausted their legal options and her feeding tube was about to be removed permanently, the public policy pump had been thoroughly primed. Republican leaders sympathetic to the cause brought Congress back for an extraordinary weekend session. Only later did it appear, based on various polls, that the majority of Americans did not see Schiavo's case the way the Republican leadership did.
 
 As a result, the starvation of a solitary middle-class woman in Florida riveted government for a couple of weeks while similar -- and more severe -- situations went almost unnoticed. Mass starvation in Sudan, for instance, was a legislative footnote by comparison. Why? It's not only that Sudan is far away and hard to solve. Help for the Sudan catastrophe lacks the backing of as many obsessively focused and widely dispersed interest groups.
 
 The brewing battle in the Senate over a mere seven judicial nominees is another telling example. Groups on the political left and right are making the coming confrontation seem like World War III. (Witness the use of the word "nuclear" to describe the Republicans' effort to force a vote.) In fact, the debate is a warm-up for the more consequential conflict over filling the next Supreme Court vacancy as well as a stand-in for other divisive issues, such as gay rights, abortion rights and affirmative action.
 
 Why such tumult and passion? Organizations with wide and longstanding interest have been on the prowl for supporters on these matters for years. On the anti-Bush side are the Alliance for Justice, the Leadership Conference on Civil Rights and People for the American Way, which was instrumental in derailing Robert Bork's nomination to the Supreme Court in 1987. The president's allies include groups such as the Committee for Justice, Focus on the Family, the Federalist Society, Americans for Tax Reform and FreedomWorks, which have not only raised millions for the purpose but coordinate their activities in conference calls among their leaders.
 
 In an odd way, all this attention to Washington ways is heartening. The common view is that elites run the show and sheep-like citizens allow them to. In fact, organized interests able to motivate blocs of voters really can make a difference, as long as they can stick around for a while.
 
 Unfortunately, not every vital issue has a group or groups that are clever or rich enough to generate unrelenting support from back home. That leaves out of the mix too many people with worthy woes: the unemployed, the uninsured, the unaligned.
 
 There's probably an opportunity there for yet another powerful interest.
 
 Author's e-mail:
 
 kstreetconfidential at washpost.com
 
 
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