A POLITICO look at the deals shows the liberals have it right, at least in regard to key reform proposals. Several cherished Democratic goals — including a government-run insurance plan, bringing in cheaper drugs from other countries and expanding Medicare — faced steeper, and ultimately insurmountable, odds of passage after the hospitals and drug companies said they would oppose any bill that included them.
This was no idle threat, but instead a serious challenge to Obama’s goal of winning reform — and pocketing a major achievement in his presidency’s first year.
But the liberal attacks glide past a hard reality. By bringing industry players inside the room, Obama and Senate Finance Committee Chairman Max Baucus (D-Mont.) holstered some of the very guns that defeated reform in 1994. PhRMA, for instance, will spend nearly $200 million on reform this year — and clearly it could spend it endorsing or opposing the bill.
Cutting deals to neutralize would-be antagonists was one of the Democrats’ key takeaways from the failed “Hillarycare” effort. And the Obama White House followed a basic tenet of negotiating: first in, best deal. PhRMA agreed to give up $80 billion over 10 years to pay for reform — a figure that infuriated some House members who thought it was too light and who tried to negate the agreement.
Conversely, tardy negotiators risked getting clobbered. Exhibit A: the medical device lobby, which misplayed its early hand and nearly got slammed with a big tax.
Ken Thorpe, a former Clinton administration health care adviser who has participated in this year’s drive, said Obama’s critics are missing a larger truth: With so many powerful interests poised to attack to protect the plan, some deal making was inevitable.
“It’s a balancing act,” Thorpe said. “Could we have gotten more out of the drug industry? Perhaps. On the other hand, keeping them positively engaged allowed momentum to continue. Had they not engaged them early on, and didn’t bring them to the table, who knows how this would have turned out?”