Who Gave Us Obamacare?
The medical industry provided crucial support


Messina told a New York Times reporter to reiterate that the White House was standing behind the original deal, and Hall had a PhRMA spokesperson persuade CBS News not to run a story reporting that the White House wasn’t sticking by its end of the deal and drug reimportation would be back on the table. These efforts finally sealed the deal: While reimportation and the public option would continue to be mentioned occasionally, by the fall the White House had gotten PhRMA behind Obamacare.

Now they just had to sell the thing to the American people.

With the White House’s blessing, a 501(c)(4) organization was set up to run a pro-health-care-reform ad campaign in April 2009. Explicit in PhRMA’s deal with the White House was PhRMA’s promise to donate significant amounts of money to this organization, known as Healthy Economy Now. It received over $10 million from PhRMA, alongside smaller donations from the AMA, the Federation of American Hospitals, the AARP, and Blue Cross/Blue Shield. Throughout the spring and summer of 2009, Healthy Economy Now spent tens of millions on ads in states whose congressional representatives were thought to be persuadable.

Another group, Americans for Stable Quality Care, was set up in a joint effort by health-industry groups and received and spent even more money than Healthy Economy Now had. PhRMA poured almost $60 million into it. Because the legislation had started to come together in its specifics, this group was even more explicit in its advocacy of particular measures in Obamacare, including the individual mandate, the Medicare expansion, and the requirement that insurers cover individuals with preexisting conditions.

Part of PhRMA’s deal with the White House was that it would team up with Families USA, an SEIU-connected 501(c)(4) group, to bring back “Harry and Louise,” a series of advertisements run against the 1993–94 Clinton health-care plan. This time Harry and Louise would be staunchly pro-reform, and they would be supported by PhRMA and Families USA to the tune of $4 million.

The American Medical Association, increasingly concerned that its doc fix wouldn’t make it into the final legislation, took to the airwaves with some major ad buys separate from the campaigns it helped run with Healthy Economy Now and Americans for Stable Quality Care. The AMA ran two multimillion-dollar campaigns, in October 2009 and January 2010, upping the pressure on Congress for the permanent doc fix. With no pressure from the White House, however, the campaigns failed, and the AMA was denied one of its key policy goals.

President Obama signed his health-care legislation on March 23, 2010, 13 months after his address on the subject to the joint session of Congress. The process had been messy, but he had succeeded where President Clinton had failed, because he had learned the lessons of the 1990s reform fight. He bought off big business, he played the media, he demanded that the health-care industry pony up millions of dollars to support his message — and he won. But he has not owned up to his backroom tactics. “The administration essentially told the American people that how the law was written was none of their business,” a congressional staffer tells  National Review. Representative Blackburn notes that “everybody but the White House has cooperated” with her investigation.

Industry groups paid up big time, got some things they wanted, and failed to get others. Big business has long tried to steer government policy, but in this instance the stakes were greater than usual. The AMA, the AHA, and PhRMA — all of which declined interview requests for this piece — saw a future with an expanded government role in the health-care industry, and they worked to shape that future with an eye to their own interests. Their efforts helped bring about a new system in which the government has more power than ever before over the health-care industry, from macro issues to the smallest minutiae. They must accordingly bear a large portion of the blame for this massive and unprecedented intrusion of government into private life.

Mr. Glass is the managing editor of

August 13, 2012    |     Volume LXIV, NO. 15

Books, Arts & Manners
  • Steven Hayward reviews How to Think Seriously about the Planet: The Case for an Environmental Conservatism, by Roger Scruton.
  • Samuel R. Staley reviews Debacle: Obama’s War on Jobs and Growth and What We Can Do Now to Regain Our Future, by Grover G. Norquist and John R. Lott Jr.
  • Scott Winship reviews The Great Divergence: America’s Growing Inequality Crisis and What We Can Do About It, by Timothy Noah.
  • Florence King reviews Winter King: Henry VII and the Dawn of Tudor England, by Thomas Penn.
  • Ross Douthat reviews The Dark Knight Rises.
  • Richard Brookhiser offers Kerouacian haikus.
The Long View  .  .  .  .  .  .  .  .  
Athwart  .  .  .  .  .  .  .  .  
Poetry  .  .  .  .  .  .  .  .  
Happy Warrior  .  .  .  .  .  .  .  .