I’m glad to see that Nancy Pelosi and Steny Hoyer have an editorial on health care reform in the USA Today. I’m even happier to see them still making the case for a public option. On the other hand, Robert Reich has a thoughtful blogpost up today that examines the deal the administration cut with the pharmaceutical industry. If you want to know what the administration gets out of the deal, this is important:
In return, Big Pharma isn’t just supporting universal health care. It’s also spending a lots of money on TV and radio advertising in support. Sunday’s New York Times reports that Big Pharma has budgeted $150 million for TV ads promoting universal health insurance, starting this August (that’s more money than John McCain spent on TV advertising in last year’s presidential campaign), after having already spent a bundle through advocacy groups like Healthy Economies Now and Families USA.
That is a ginormous media buy. And it’s a buy that supports the passage of health care reform. It’s hard to estimate how much such a deal will help, but that $150 million could just as easily go to opposing reform (a net change of $300 million in advocacy spending). Yet, Reich raises concerns:
It’s bad enough when industry lobbyists extract concessions from members of Congress, which happens all the time. But when an industry gets secret concessions out of the White House in return for a promise to lend the industry’s support to a key piece of legislation, we’re in big trouble. That’s called extortion: An industry is using its capacity to threaten or prevent legislation as a means of altering that legislation for its own benefit. And it’s doing so at the highest reaches of our government, in the office of the President.
Of course, if this were a pure form of extortion, the drug industry wouldn’t be offering to affirmatively support reform, they’d just be offering not to break reform’s legs. This deal has mutual benefits. The larger question is whether the deal with the drug industry precludes the kind of cost savings we need in the bill. Reich recognizes the complexity of the issue:
I don’t want to be puritanical about all this. Politics is a rough game in which means and ends often get mixed and melded. Perhaps the White House deal with Big Pharma is a necessary step to get anything resembling universal health insurance. But if that’s the case, our democracy is in terrible shape. How soon until big industries and their Washington lobbyists have become so politically powerful that secret White House-industry deals like this are prerequisites to any important legislation?
I think that anyone who is looking around can tell you that our democracy is in terrible shape. But it will be in worse shape if we fail to pass health care reform this year.
In other news, the Congressional Budget Office continues to offer analysis that is unhelpful to the cause of health care reform. In this case, they refuse to acknowledge the potential of preventive care to reduce costs, and actually argue the opposite…that preventive care will increase costs. I know that there has been a debate about mammograms, for one example, where a lot of unnecessary treatment and surgery has resulted from increased access to cancer screening. On the other hand, getting people to eat better, quit smoking and exercise are more unambiguous cost savings measures. The key is to spend money wisely on preventive care. The CBO’s analysis seems one-sided.
Senate Majority Whip Dick Durbin says that he’s “open” to passing a bill without a public option, even though he personally supports one. He seems to be saying that they can fix things in Conference and he wants the Senate to pass something so they can get to Conference. Probably, too much will be made of Durbin’s comments. I don’t think they mean much.
What still means a lot is the Connecticut Compromise which resulted in each state getting two senators.
In the House, the big coal state of Wyoming has a single vote to New York’s 29 and California’s 53. In the Senate, each state has two. The two Dakotas (total population: 1.4 million) together have twice as much say in the Senate as does Florida (18.3 million) or Texas (24.3 million) or Illinois (12.9 million)…
…Virginia, the biggest of the original 13 states, had 538,000 people in 1780, or 12 times as many people as the smallest state, Delaware.
Today, California is 70 times as large as the smallest state, Wyoming, whose population of 533,000 is smaller than that of the average congressional district, and, yes, smaller than that of Washington D.C., which has zero votes in Congress to Wyoming’s three.
This is a bigger obstacle to progressive change than corporate lobbyists.
Update [2009-8-10 9:40:42 by BooMan]: The White House has a new Health Care Reality Check site.
The CBO’s analysis seems one-sided.
Is the CBO Orzag’s outfit? Or Elmendorf? Either way, both used to work for that Pete Peterson outfit called the Hamilton Project. Anyone who likes the social safety net America has ought to be concerned about that.
But now the White House is backing away from the deal?
Obama Reverses Stand on Drug Industry Deal
So, what’s really going on and why do Congressional Dems enjoy shooting themselves (and us) in the foot so much?
If I recall there was a moment in the primaries last year where someone in the Obama camp pointed out that H. Clinton got gobs of money from insurance companies and someone in the Clinton camp rejoined that Obama got gobs of money from Big Pharma.
Should I take credit for this?
It is pure extortion; Harry and Louise’s ads can turn on a dime; they probably already have the negative ads in the can ready to go.
It’s nice to see that PhRMA wants to close the doughnut hole and has offered token lowering of prices.
But the article Tauzin placed making the deal public has all the earmarks of wanting have an excuse for unleashing Harry and Louise to kill healthcare reform once again.
It is pure extortion. The extortion letter is just in a pretty envelope.
Sorry, but my distinction is valid.
In a classic case of extortion, a gangster shows up at your hardware store and tells you that you have to pay protection money or they will break your windows, harass your customers, and drive you out of business. Maybe they’ll break your legs. You pay them protection money to avoid the problems they are going to create, but you get nothing out of it. You don’t get increased business.
It is completely normal for like-minded people/industries to band together to oppose or support legislation. A promise to support legislation with an enormous media campaign in return for significant concessions is not a classic case of extortion. It’s a negotiation. And if they are threatening to run a massive media campaign against the legislation if it doesn’t contain concessions, well, that’s why they got organized in the first place.
Reich tries to make a distinction between negotiating with Congress and negotiating with the president, but neither case is more extortionate than the other.
Reich might be right that the latter case is worse, but that would be for different reasons.
This is all hair-splitting. When I’m an old man, living under a bridge and coughing up blood, I’m not going to care very much which kind of corruption led to my being there.
I assume you take some responsibility for living under a bridge. But, the point is that the health care bill is more likely to pass with support from industry stakeholders rather than implacable opposition. The battle is to make the bill work, or be set up so it can be made to work, and to pass it.
If I’m living under a bridge because I dig living under bridges, sure. I’ve been pauperized by medical costs, not so much.
The battle to get something passed is only as important as what’s in the final bill. If we end up with a bunch of marginal and insubstantial changes, then it’s arguably better that it fail than to find ourselves several years down the road with a resurgent GOP pointing at an insincere effort at reform as just another example of the inability of government to do anything well.
And why not? It won’t be the first time the GOP has systematically sabotaged a social program and then used its planned failure to oppose future reforms.
There are circumstances where a bill would be worse than no bill. But there are more circumstances where a bad bill is better than no bill. It’s hard to judge where that line is, and impossible to know our prospects at the moment.
A bailout for the insurancecos would be much, much worse than no bill. There is no reason for them to exist, much less get a dime in subsidies.
The pharma Medicare drug “benefit” is a good example of how a good and necessary concept can be twisted to do little more than funnel dollars to the corporate leeches. It ended up not helping seniors that much, keeping the cost of drugs outrageous for everybody else, and helping bankrupt state governments. We don’t need another one of those.
I agree we don’t know what the real outlook is at the moment, but there’s certainly a very large possibility for a bill worse than nothing. I just new heard a headline saying that Obama said a Canadian-style system couldn’t work in the US. If true, that’s a very bad sign.
That particular argument annoys the crap out of me. It’s always offered as a blunt assertion with nothing to back it up. Why couldn’t a Canadian-style system work here? Are Americans not competent enough to handle one?
What’s even more than annoying is the explanation I most often hear: we are so much more “diverse”.
One, not really.
Two, so what if we were.
The diversity line is a coded racist reference, the idea being that minorities will somehow abuse the system. Never mind that no one is going to intentionally injure themselves or contract diseases to get cheap medical care, but then again, once someone walks down the road toward racism, they are delusional, so there’s no telling what they’ll believe.