If you’ve been following the health care debate closely, this is not news to you:
Emanuel and other White House advisers made a calculation early in the healthcare debate that they needed at least one powerful industry on board with their plans to overhaul the nation’s healthcare system. Suspecting that the insurance industry would probably not be on board, the divide-and-conquer strategy focused on the pharmaceutical industry.
A veteran of the Clinton White House, Emanuel witnessed the death of healthcare reform in 1994 after it was attacked repeatedly by powerful players in the healthcare community.
Fifteen years later, that experience appears to be guiding Emanuel’s thinking.
Despite being a huge advocate as a congressman for the reimportation of drugs from Canada and negotiated bulk-purchasing of drugs by Medicare, Emanuel negotiated away both of those items in a deal with PhRMA. In return, PhRMA agreed to cut the price of brand-name drugs for seniors by $80 billion over the next decade. More importantly, they agreed not to oppose the legislation moving through Congress, and to actually spend money supporting it. This last piece is a classic double-whammy. As we look at the political landscape today, it is easy to take for granted that we haven’t been fighting off Harry and Louise ads from pharmaceutical industry. It’s easy to assume that positive advertising from PhRMA has had no positive impact.
I think the benefits of this deal are self-evident, even if they aren’t as obvious as the down side. I don’t think Emanuel’s thinking was any more complex than what I’ve just laid out. But, it remains quite possible that Congress will not honor the deal. And, if that happens, it will be very interesting how Emanuel’s gambit is viewed by historians.
In the weeks ahead, Democratic Policy Committee Chairman Byron Dorgan (N.D.), Senate Health, Education, Labor and Pensions (HELP) Committee Chairman Tom Harkin (D-Iowa) and others will push policies that the White House pledged to fend off.
Dorgan said he “wasn’t involved” in the deal. Dorgan added that a senior White House official denied that the president would oppose drug re-importation provisions in healthcare reform.
Dorgan said he will offer an importation amendment to the healthcare reform bill when it reaches the Senate floor, something that administration officials may find difficult to lobby against. Not only did Emanuel sponsor drug re-importation bill that passed the House in 2003, Obama himself was a former co-sponsor of Dorgan’s proposal and campaigned on the issue last year.
Unlike many Democratic proposals, Dorgan can count on the support of a few Republicans. Sen. Olympia Snowe (R-Maine), whom many Democrats consider a crucial vote in the healthcare debate, is the lead GOP co-sponsor of the measure. Sens. John McCain (R-Ariz.) and David Vitter (R-La.) have also supported it.
If Dorgan is correct that the president will not veto a bill that allows for the reimportation of drugs, that’s an invitation to renege on that part of the deal. And what would PhRMA do? Would they turn on a dime and oppose the legislation? How much impact could they have in a just a few days between the passage of such an amendment and the vote on final passage? Wouldn’t the drug industry find that it was too late to credibly and effectively challenge a bill that they had been supporting all year?
No, I think PhRMA would be stuck. Their only option would be to raise hell with the White House for breaking their word and pour money into electing a Republican president in 2012.
I’m not saying that this was Emanuel’s plan all along. I think his strategy has been fairly sophisticated, but not here. He’ll probably fight to see that the deal is honored. The mystery will be whether he does that for show, or he really means it.
