‘We can no longer afford to put health-care reform on hold.”
It was on February 24, 2009, a little over a month after he assumed office, that President Obama spoke these words to a joint session of Congress. What happened next — behind the curtain, in the effort to pass Obamacare — is not pretty.
Negotiations started almost immediately. In his speech, the president had promised to bring together “businesses and workers, doctors and health-care providers” in order to shape the massive legislation. Bill and Hillary Clinton’s attempt to remake the health-care sector was thought to have failed because of industry hostility to their efforts. The Obama administration, therefore, would welcome health-industry lobbyists to the White House with open arms.
“After promising to conduct the health-care negotiations on C-SPAN,” a House Energy and Commerce Committee staffer tells National Review, “President Obama worked behind closed doors to cut deals with the various special-interest groups.” The health-care industry, for its part, was no longer focused on resisting a government intrusion into the private economy. It knew that an alliance between big business and big government could bear big fruits, so it loaded up with policy experts and lobbyists who would help it shape the legislation to its advantage. The American Hospital Association (AHA), the American Medical Association (AMA), and the Pharmaceutical Research and Manufacturers of America (PhRMA) have their fingerprints all over Obamacare.
On May 15, 2009, the AHA, the AMA, and PhRMA teamed up — along with the labor union SEIU, the insurance group AHIP, and the medical-device manufacturers’ association AdvaMed — to release a joint statement in support of the developing plan. “Health-care reform will not be sustainable,” it said, “unless the nation brings down the rate of growth of health-care spending. . . . To be successful, we must take action in a public-private partnership. We look forward to offering cost-savings recommendations in the weeks ahead.” What the public didn’t see was the furious wheeling and dealing between the industry and the Obama administration over these “cost-savings” recommendations. It was a “public-private partnership” that allowed both sides to get much of what they wanted from Congress.
Earlier this year, the House Energy and Commerce Committee concluded an investigation that revealed a startling degree of coordination between the White House and health-industry groups in these efforts. Representative Marsha Blackburn (R., Tenn.), vice chairman of the Subcommittee on Oversight and Investigations, did a lot of the legwork on that investigation. She tells National Review that “throughout 2009 and early 2010, the White House did engage in these closed-door negotiations.”
The key White House players were Nancy-Ann DeParle and Jim Messina. DeParle was head of the Office of Health Reform (which was created by President Obama) and was colloquially known as the “health-care czar.” Messina, a White House deputy chief of staff, acted as a liaison between health-industry groups and the president. DeParle and Messina were at the beck and call of lobbyists, working behind the scenes to secure the goodies that the groups wanted in exchange for their support.
The White House held a series of meetings with the major groups in April and May 2009, trying to discern which concessions would win them over. While every group was opposed to the idea of a government-run insurance plan (a “public option”), they were all cautiously hopeful that they’d somehow be able to protect their interests. Cultivating this attitude was an important goal for the White House: If President Obama could convince people that health-care reform was inevitable, he would be able to peel off opposition groups by offering specific provisions they desired. The industry was being given a choice: Join the team and try to get something out of the legislation or stay on the sidelines and lose.