The CMA

California's fiscal problems and the CMA's support of diversions had been the governor's best defenses for diverting the Proposition 99 monies. Scott emphasized the importance of the CMA to the success of previous diversion efforts, saying,

I don't necessarily believe that you're going to find secret communiques between the tobacco industry and Steve Thompson [the CMA's chief lobbyist] or anybody with the California Medical Association. I don't think that there is direct contact and I don't think there was intentional collaboration. But what you had was a sort of a symbiosis which was acquiesced to by the Medical Association because it furthered their goals. As this relates to Prop 99, you had the Medical Association that wanted more money for direct medical services, specifically CHDP. You had the tobacco industry that was only too happy to let that happen. The Medical Association in the minds of the legislators who want to support the tobacco industry becomes their astroturf, their front. They say, “Well, I'm just following the views of the California Medical Association, which has always been very strong on tobacco issues, co-sponsors of Proposition 99, co-sponsors of AB 13.” Whatever else you want to say about them as a special interest, you can't impugn their reputation on tobacco. You could, but for a legislator who is inclined to vote tobacco's way, that gives them convenient cover.^[4]

In fact, there was a much more active and direct engagement between the CMA and the tobacco industry than Scott believed (see chapters 3-5).

An important leadership change in the CMA helped to shift the CMA away from its aggressive opposition to the anti-tobacco education and research programs. In 1995 Dr. Jack Lewin was appointed as the new executive vice president, replacing Robert Elsner. Lewin had headed the public health department in Hawaii prior to his CMA appointment and was personally sympathetic to tobacco control. When asked about finding Proposition 99 on his agenda almost immediately, Lewin said,

As I arrived on the scene, I was confronted with allegations from Dr. Glantz and others, who told me that CMA had been far from a proponent of anti-tobacco efforts and really had thwarted those efforts by virtue of its collusion with the tobacco industry and many other nefarious scenarios. I knew from my discussions with the leadership, the doctors of the association, that nothing could be further from the truth. And while I was greatly concerned, I knew that there had to be some complex relationship in the competition for funds or in government relations or in strategies and tactics, where you have competing agencies in a very awkward state of working against each other instead of with each other.^[10]

At the time, of course, Lewin was not aware of the secret tobacco industry memos documenting its relationship with the CMA. (These memos were not made public until 1998 as part of the State of Minnesota's lawsuit against the tobacco industry.) Lewin recognized that the CMA's history on tobacco control was a problem. He went on to say,

In the back of the history of CMA, there was clearly a part of the time when Prop 99 came out, where the person who was in charge of our government relations at that time was a wheeler-dealer type of very effective political strategist in Sacramento who was willing to work with whomever he needed to work with to get things done. Sometimes he would make a trade-off that would frankly not please me or the current leadership of CMA. But that was just the way things were then.^[10]

Like AHA, ANR, and ACS, Lewin believed that people outside the Sacramento lobbyists' circle needed to get involved in the decision making about Proposition 99:

If you talk to the constituencies in those [voluntary health] agencies, they're victims in my view because the doctors will be happy to get together with the Cancer, Heart and Lung boards and those constituencies and work on this. You're stuck at the political level of the agency staff and the government relations people that themselves have developed long-standing animosities they're not going to let go. …So what we decided to do was try to get out of that loop. That meant telling our government relations people to change the way they were relating to these other groups. If they couldn't do it, then we had to get some other people to make the relationships because the relationships were dysfunctional. …We're going to have to get through this whole epic of the past—“you did that to me, you did that to me, why did you do that to me?” Get beyond that and say, “Can we get together this year to go get this money?”^[10]

But Lewin could not act unilaterally. There was a strong animosity within the CMA toward the anti-tobacco education and research programs that had built up over the years, dating back to at least the Napkin Deal of 1987. Steve Thompson, Willie Brown's longtime aide, was an especially popular figure within the CMA.