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Miles Mogulescu

Miles Mogulescu

Posted: February 23, 2010 05:44 PM

The Real Reason Obama's Plan Doesn't Include a Public Option

What's Your Reaction:

The reason Robert Gibbs gives for President Obama's health care plan not including a public option -- that despite majority voter support, it can't get 51 Democratic votes in the Senate -- doesn't hold up. The real reason is that Obama made a backroom deal last summer with the for-profit hospital industry that there would be no meaningful public option.

This is one of the great under-reported stories of the health reform saga. Much has been written about the Obama administration's deal with big Pharma to continue to block Medicare from negotiating for lower drug prices or to allow consumers to buy cheaper drugs from Canada, in exchange for Pharma running pro-Democratic ads and giving campaign contributions to Democratic candidates. That's the reason, under pressure from the White House, that Senate Democrats voted down an amendment that would have allowed consumers to buy cheaper drugs from overseas.

But Obama's deal with the for-profit hospital lobby to insure there would be no public option has, as best I can tell, only been reported in two articles in The New York Times. On August 13, The Times reported that while President Obama had presented himself as "aloof from the legislative fray," particularly in connection with the public option, "Behind the scenes, however, Mr. Obama and advisors have been...negotiating deals with a degree of cold-eyed political realism potentially at odds with the president's rhetoric." One of the deals reported in The Times article was the Pharma deal. The other was a deal with the for-profit hospital lobby to limit its cost reductions to $155 billion over 10 years in exchange for a White House promise that there would be no meaningful public option.

According to The Times:

"Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying-Medicare rates...or controlled by the secretary of health and human services. 'We have an agreement with the White House that I'm very confident will be seen all the way through conference', one of the industry lobbyists, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter...Industry lobbyists say they are not worried [about a public option.] 'We trust the White House,' Mr. Kahn said."

Mr. Kahn's lobbying group, with whom the White House made the deal, represents America's investor-owned, hospitals whose profits could be diminished by a public option with the negotiating clout to negotiate lower prices. To say that the deal included ensuring that any public option would not be "controlled by the secretary of health and human services" is code for saying it would not be national in scope and would lack negotiating clout--In other words, the Obama administration made a deal that a national public option on day one comparable to Medicare was off the table.

On September 9, a few weeks after The Times reported Obama's deal to gut the public option, President Obama gave his big health care speech to a Joint Session of Congress. In the speech, Obama said one of the programs he was considering was a "not-for-profit public option available in the insurance exchange." Supporters of the public option took this as a sign that Obama was on their side.

But Washington insiders noticed that Obama parsed his words very carefully. The New York Times noted that:

"Mr. Obama's call for a public plan, however, omitted any discussion of what rates it might pay or who might control it...'He worded it really carefully, because he said 'not for profit' and he didn't say it had to be controlled by the government,' Mr. Kahn [the hospital lobbyist] added. 'The way he described it, we could support that!"

In other words, Obama signaled the private health care industry that his deal that there would be no meaningful public option still stood.

Throughout the process, the White House has given vague statements supporting the public option -- enough to keep liberals and progressive on board -- while repeatedly undermining the public option in practice. Jane Hamsher has written a useful timeline of White House efforts to undermine the public option.

There is no evidence that President Obama has ever twisted the arm of a single Senator to support a public option and plenty of evidence that he has assiduously avoided doing so, sending a message to Senators that he doesn't want a public option. When the Senate passed its version of the health reform bill, the reason the White House gave for there being no public option was that it couldn't garner 60 votes. But Joe Lieberman, who could have been the 60th vote, insists that the Obama administration never pressured him to support either a public option or a Medicare buy-in. And Sen. Russ Feingold blamed the demise of the public option in the Senate on the White House's failure to push for it.

Now the White House is saying they're not including a public option in Obama's plan because they can't get even 51 Democratic votes in the Senate. Does anyone really believe that if President Obama really wanted a public option -- if he hadn't dealt the public option away in a backroom deal with the for-profit hospital industry -- he couldn't get 51 out of 59 members of the Senate Democratic caucus to vote for it?

As a long-time supporter of single payer, I'm not the world's biggest fan of the public option and I've written about its limitations in these pages many times, included here. But at this point, when it comes to health care reform, the Democrats face a Hobson's choice of their own making between two suboptimal alternatives. Either they can use reconciliation to pass a defective health care bill that's supported by only 1/3 of the voters. Or, as in 1993, they can let health reform die for this year. The first choice means passing an unpopular bill, but at least it would show that when Democrats set out to accomplish something, they actually have the strength to do it. The second choice means admitting that their year-long efforts to pass health reform were a failure.

The most popular aspect of health care reform is the public option, which is supported by nearly 60% of voters while the overall bill is supported by only about 33%. Adding a public option to the final legislation may be the only thing that can boost its popularity among voters.

Will the Obama administration continue to cling to its deal with the for-profit hospital industry to block the public option, even at the price of public support? Or will it finally release at least 51 Democratic Senators to include a public option in the final bill through reconciliation? Its decision may be decisive in determining whether President Obama and a Democratic Congress can govern.

 
 
 
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HUFFPOST SUPER USER
racetoinfinity
restore Glass-Steagall now!
01:39 AM on 03/20/2010
You wrote:

"Will the Obama administration continue to cling to its deal with the for-profit hospital industry to block the public option, even at the price of public support? Or will it finally release at least 51 Democratic Senators to include a public option in the final bill through reconciliation? Its decision may be decisive in determining whether President Obama and a Democratic Congress can govern."

Well, we know the answer to that now. It's the former, and it's depressing; equally depressing but important is Glenn Greenwald's post over at Salon about how progressives have shown impotence and how that portends poorly for us in the future:

http://www.salon.com/news/opinion/glenn_greenwald/2010/03/18/progressives/index.html
05:32 PM on 03/18/2010
Why am i not surprised? I might have been surprised and incredulous if this had been alleged before the election. But once Obama appointed (1) Daschle, (2) Geithner, (3) Summers, Obama's halo had already begun to tarnish. When he diddled on Guantanamo, things got worse. Then he extended the Iraq and Afghanistan wars. Finally, healthcare 'reform.' We need a true progressive in 2012. I nominate Ralph Nader. (And Dennis Kucinich, you're no Ralph Nader.) Obama is one disappointment after another. His ambition is for himself and his daughters, not for the people of America.
01:57 PM on 03/18/2010
Hopefully this will open the eyes of all Democrats about this President's deceitful and shameless behaviour. Having been elected with the promise of 'no more back room deals', we now know he lied when he said this. Moreover, every time his operatives send out conflicting signals about a public option, they do this with Obama's directive. The men is a liar if ever I have seen one. Hopefully we see the end of this gentleman in 2010. The Republicans will make mince meat with him and it will be fun to look at his demise. Good riddance..
11:34 AM on 03/03/2010
I cannot even begin to say how mad this makes me. I was never a fan of Obama, but this is really low. I can understand needing to be practical and politically expedient in order to get stuff done. But how is bargaining away all meaningful reforms considered getting things done?
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HUFFPOST PUNDIT
Marcospinelli
an old liberal Democrat, a 'New Deal'-Democrat
02:46 PM on 03/01/2010
The White House insists no deal with PhRma:
http://www.huffingtonpost.com/2009/08/10/white-house-insists-it-di_n_255682.html

White House-PhRma Secret Memo Surfaces:
Since mid-July, the White House and the drug industry’s Washington lobby, PhRMA, have denied any specific agreement that would give the industry big benefits in exchange for its support for President Barack Obama’s health care overhaul effort.

http://blogs.wsj.com/washwire/2009/08/17/white-house-phrma-memo-surfaces-again/

http://politics.theatlantic.com/2009/08/ive_been_trying_to_peel_1.php

Obama cut secret deals with hospitals, insurance companies and PhRma on profits:

http://www.nbc11news.com/home/headlines/53311447.html

http://www.msnbc.msn.com/id/31464689/ns/politics-white_house

http://online.wsj.com/article/SB124567211118336815.html

http://www.pbs.org/newshour/updates/health/jan-june09/pharma_06-22.html

http://www.huffingtonpost.com/2009/08/13/internal-memo-confirms-bi_n_258285.html

http://www.nytimes.com/2009/08/13/health/policy/13health.html?_r=3&hp

http://www.alternet.org/story/141856/obama's_$80_billion_deal_with_pharma_is_a_very_bad_deal_for_us/
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HUFFPOST PUNDIT
Marcospinelli
an old liberal Democrat, a 'New Deal'-Democrat
02:44 PM on 03/01/2010
Obama's timidity is myth -- He's plenty tough when it comes to standing up to the Democratic base.

Democratic voters have mistakenly believed that Obama&Democrats want public health care. The DLC-controlled Democratic party gives lip service to public health care & all populist issues.

If the Bush years taught us nothing else, it's that anyone can sell anything to Americans, if you're stolid & relentless in your sales pitch & tactics. It's not that Bush&R0ve were geniuses & knew something that nobody else knew; Bush&R0ve were just more ruthless (clumsy & careless many political graybeards would say) in doing what politicians & the parties had gone to great lengths to hide from Americans.

Obama didn't get to be the first black president, vanquish the Clinton machine & the oldest, most experienced politicians in our nation's history (including the Rove machine) by not having mastered these skills. Nor do Democratic politicians (more incumbents than ever, in office longer) not know how to do it. How do you think Democrats managed to keep the impeachment of Bush&Cheney off the table & have us still reelecting them, not marching on Washington with torches&pitchforks?

Obama&Democrats know how to do it -- They don't want to do it.

The trick for them has been to keep the many different populist groups believing that they really do support our issues, but that they're merely inept. And to get us to keep voting for them in spite of their failure to deliver on any of our alleged
05:57 PM on 02/25/2010
If you are correct, then I say let it die. The Senate bill is appalling, and, if you believe the reporting so far, Obama's plan is essentially the Senate bill. I really dislike Obama, and I hope he is not re-elected. I certainly will not vote for him. BTW, I was astonished the other night when I heard H. Dean endorse Obama's bill. I truly hope that H. Dean has not been co-opted. Does anyone know why Dean supports Obama's plan because if you ask me, I think Liberals should run on electing more Liberals in November, and we should essentially give notice that we intend to go around Obama. I say F&%^ Obama. He is so contemptible and undeserving of support. He's worse than Bush because with Bush I always knew he was a liar, but Obama will be (and is) responsible essentially for alienating everyone down to basically age 6 in this country. He almost single-handedly assured no Democrat will ever be elected President again.
10:59 PM on 02/25/2010
.
Have you considered what the alternative might be?

Seriously, can this country survive another tax-cuts-for-the-rich, union-busting, middle-class-destroying, lie-based-war-to-profit-greedy-corporations, education-ignoring-so-there-will-be-enough-dropouts-to-fight-those-wars, extremist-religion-pushing, all-I-care-about-is-myself, fear-and-hate-mongering Republican?

Obama may not be as progressive as we would like, but he is definitely trying to do what is best for all Americans, particularly the bottom 99%, and given the unimaginably huge pile of sh it he inherited from Bushco, that is no easy task.

Think about it.

.
12:46 PM on 02/26/2010
Yeah, think about it. This nation's government will continuously create cozy deals with large corporate business interests because, hey... at least they're better than what we would have gotten otherwise. Are you really satisfied with the Democratic Party having you over a barrel like that? The only way to put any fear into the Democratic Party is for them to see significant losses of membership and donations. We should stop voting to avoid the Palinesque type candidates and instead just strictly vote for progressives.
11:36 AM on 02/27/2010
The only alternative should be a strong public option, what the majority of people want and the only thing that will protect us from the health insurance corporations.
11:37 AM on 02/27/2010
It's amazing how Dr. Dean began supporting this bill late last year, less than a week after he stuck to his convictions, and only now people are learning that he has supported it (you're far from the first person I've seen on this website alone who just discovered that).

http://thehill.com/homenews/senate/73485--howard-dean-cites-gop-opposition-as-reason-to-pass-senate-bill
05:31 PM on 02/25/2010
I drank the cool aid, I worked hard to get him elected. I've been feeling sold down the river for some time, this is just another example why.

Obama had a real chance to really change things for the better. He blew it and he blew it right out of the gate. Rahm, Summers, Geithner. That made the tea leaves pretty clear.

A lot of us should have known that the corporately owned media would not allow anyone too far left get too close to the White House.

This is a most perilous time for America. More and more are feeling disenfranchised every day, some of them very misguided as to why and how to go forward. Obama had an historic chance to make a difference and he might well do that - just not in a good way.
01:12 AM on 02/25/2010
There are three problems here:

1 is the well-established (in the public opinion) yet somehow hard to prove (in the *corporate* media's opinion) ongoing quid pro quo between Congress and Corporate America with respect to ANY Corporate America-pertinent legislation.

2 is the indifference in the Obama Administration to address this problem (through public financing or some other meaningful campaign finance reform) BEFORE it attempted health care reform. Doing one without doing the other first necessarily meant a bill that merely regulated (and rewarded with millions of new customers) an existing predatory private industry, rather than punishing it for its past and ongoing misdeeds by enacting a new public entity by which conscientious objectors to private insurance could vote with their wallet.

3 is, if substantiated, the gentleman's agreement between the Obama Admin. and the hospitals to not create a public option, and the ensuing disingenuous pandering to the base that they were for a public option, when they were starving it with neglect behind the scenes.
11:51 PM on 02/24/2010
If publicly financed healthcare in the form of tax money subsidies to private health insurance companies becomes law, then you can kiss goodbye for the next 1 or 2 generations any possibility of a public option. But strangely enough, the abortion issue via the Hyde Amendment will very, very possibly come to the rescue - the abortion issue via the Hyde Amendment will very, very possibly make a public option law. Here's how: No matter what language they come up with to try to satisfy the Hyde Amendment, like the Senate Bill language, enough of one or the other side will find it unacceptable enough to kill the bill that contains the language. That makes publicly financed healthcare in the form of tax money subsidies to private health insurance companies politically impossible. The only thing left would be a public option - or no help ever for those very many tens of millions with no healthcare. -------- These health insurance companies know all this. They will pressure these selfproclaimed prolife House Democrats to vote for the Senate Bill language. Which "master" will these selfproclaimed prolife politicians serve? The prolife voters? Or the ones with all the vast amounts of cash, the private health insurance companies? This will test these selfproclaimed prolife politicians. Note: Recall the reaction in Nebraska Sen. Nelson got - he did not pass the test according to prolife voters. This is going to get really interesting.
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11:02 PM on 02/24/2010
I have to remind myself he ran as a "centrist" and is owned by his contributors ... as are most politicians. Campaign finance reform .... until we get it, we're electing Governor Monsanto, sigh.
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HUFFPOST PUNDIT
Marcospinelli
an old liberal Democrat, a 'New Deal'-Democrat
03:01 PM on 03/01/2010
Obama's most ardent supporters claim that he's a 'centrist'. They say that he always has been (as his record shows) and that those Democratic voters who voted for him because they believed him to be a populist weren't listening. And those conservatives who insist Obama's a liberal are either stup!d or so far right and unpolitically savvy, they don't even belong svcking up space and time on political discussion threads.

To those who thought that during the 2008 campaign, Obama was a moderate and wasn't trying to deceive anyone, what did you think he meant when you heard him saying during the campaign that people had to stay involved after the election, that they couldn't just vote for him, go away for four years and expect that he would do what they had hoped. He said that there were powerful interests working against what the people wanted, and if We The People wanted Obama to do our bidding, we would have to MAKE HIM DO IT.

What did you think he was talking about? Did you think he was trying to deceive the liberals and progressives into believing that he was one of them?
02:36 PM on 03/02/2010
I'm not sure I get your point? So what Obama said that we would have to stay involved? My response: as if....

If you ask me I must be one of those who thought he was a liberal, but guess what it doesn't matter because he, and all our public representatives, are there to represent us, and when 60-75 want the elimination of private insurance (i.e. single payer) they are duty bound to listen to us, or in other words that would be representing us. The same thing goes for the illegal wars, which a sizable majority wants done. The problem if you ask me is that the system is irreparably broken, and there will be no fix especially in light of Citizens United and that Roberts and Alito still sit on the bench.
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HUFFPOST PUNDIT
Marcospinelli
an old liberal Democrat, a 'New Deal'-Democrat
03:49 PM on 03/01/2010
For the record, Obama didn't actually run as a centrist. He ran all over the place, depending on who was talking to at any given time and what day it was in the campaign, which primaries were done with and who he didn't need to woo anymore.

During the campaign, Obama supported "healthcare reform". Now even Obama can't look into the cameras and say that what's happening is 'healthcare form' -- Obama and Democrats are now ALL calling it a "health INSURANCE bill".

But again for the record, Obama actually did campaign on single payer, universal health care. In addition to the (now) infamous video clip from 2003 (http://www.youtube.com/watch?v=fpAyan1fXCE), there's a campaign ad featuring Obama himself - http://www.factcheck.org/video/obama_motherwmv.wmv .

See the part where he says he has a plan to "cover everyone'? That's called "universal coverage". Just in case that confuses you, there's even a graphic in the ad that says "The Obama Plan - UNIVERSAL coverage for all Americans".

Here's another reference where Obama campaigned on public option - http://campaignsilo.firedoglake.com/2009/09/10/yes-obama-campaigned-on-a-public-option/
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HUFFPOST SUPER USER
Kiku
08:34 PM on 02/24/2010
The Dems seem to be breaking the Republican stonewalling, as the Republicants have voted for to remove the anti-trust protections from insurance companies. Maybe the dam has broken. It will take the continued pressure from the Dems, though. Hope they have the stomach for it, they certainly have the public's support.
02:38 PM on 03/02/2010
In a state like New York, the additional regulations imposed on insurance companies protect consumers. How much you want to bet that the lifting of said anti-trust exemptions will pre-empt state regulations?
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HUFFPOST SUPER USER
Kiku
08:31 PM on 02/24/2010
Thanks Miles. I have supported Obama making deals, I think it's the only way to get stuff done, as he has focussed solely on the insurance aspect. He also got the hospitals to agree to lower their profits, although I'm beginning to wonder how they measure profits they could have made, and if this is just smoke and mirrors.

I supported it with Pharma, but I'm having a harder time with the public option. This was the protection against the mandates from the insurance companies. At this point, Obama has given so much away, that the bill is almost just what the insurance companies wanted.

Obama's bipartisanship has cost him alot, he hasn't gotten a bill past, he's lost the VA and NJ governorships, Kennedy's seat in MA, and he doesn't have much left in his bill but give aways to insurance. Insurance companies have always pushed for mandates.

I don't think Obama has sold us under the bridge, I just think his plan didn't work. He should have been strong to show Republican hypocracy and stonewalling from the start. Maybe now he has the material he needs to make a strong case.

I hope so.
03:19 PM on 02/24/2010
It is clear there will NEVER be a government for the people - no matter whom we elect. I am remembering the sea of people at the Inauguration - all praying for a new day in this country. I took that day off as I considered it a true holiday. We have all clearly just fallen off the Christmas tree. Silly us, indeed.
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larmar
The vile maxim of the masters of mankind
05:07 PM on 02/25/2010
I'm with ya.
03:02 PM on 02/24/2010
Why not have a simple Medicare buy-in for all, sliding scale based on income, continue payroll tax but without a cut-off and at a lower rate to keep the buy-in cost low; those without means for any buy-in get government subsidy. Private insurers can give better service/coverage beyond Medicare or whatever they think the customers will buy from them with whatever conditions they choose.

http://www.healthcare-now.org/sidewalk/

Feb 25: Sidewalk Summit for Medicare for All!

NEW LOCATION: H St NW and Vermont Ave NW, Washington, DC

http://www.healthcare-now.org/hr-676/
The United States National Health Care Act, H.R. 676