HealthCare: no “Twilight of the Interest Groups”


Richard Moore

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In other words, this bill was negotiated using the standard, secret, sleazy Beltway lobbyist/industry practices that candidate Obama frequently condemned and vowed to defeat.  And these industries extracted such huge benefits as a result of these secret deals — a bill shaped to their liking and profit objectives — that they are essentially in favor of it.

Industry Interests are Not in Their “Twilight”

The Washington Post‘s Ezra Klein has an amazing post in which he trumpets what he calls the “Twilight of the Interest Groups” reflected by likely passage of the health care bill (h/t).  Why are Interest Groups — once so powerful in Washington — now banished to their “twilight”?  Because, says Ezra, “the Obama administration succeeded at neutralizing every single industry.”  If, by “neutralizing,” Ezra means “bribing and accommodating them to such an extreme degree that they ended up affirmatively supporting a bill that lavishes them with massive benefits,” then he’s absolutely right.  He himself notes what he calls the “remarkable level of industry consensus” in support of the bill:

Pharma supports the bill. Insurers are incoherent on it, but there’s not a ferocious and united campaign to kill the proposal. The American Medical Association has endorsed the Senate bill. The hospitals have endorsed the bill. Labor has endorsed the bill. The business community is split, with larger employers holding their fire.

Indeed, PhRMA is so in favor of this bill that, over the last week, they’ve spent $6 million on an ad campaign aimed at undecided House Democrats to try to pressure them to vote for the bill.  And while the most hackish Obama loyalists (echoing the administration) have been claiming that the health insurance industry is vehemently opposed to and working to defeat this bill, Ezra commendably acknowledges the reality that they have done little in that regard (Marcia Angell — Professor at Harvard Medical School and the former editor of The New England Journal of Medicine — said a few weeks ago of the health insurance industry:  “What they’re fighting for is the individual mandate. And if they get that mandate [which the final bill contains], if everyone does have to buy their commercial products, then they’re going to be extremely happy with it“).

Now, if someone wants to argue (as Kevin Drum has) that sleazily bribing these industry interests with secret deals was a necessary evil — a shrewd, pragmatic way to get a health care bill passed, without which it could not have happened  — that’s one thing.  I think that’s debatable  — after all, the central promise of the Obama campaign was that it would circumvent those factions by appealing directly to the armies of citizen-supporters they had lined up —  but at least that’s an honest, rational argument.  Bribing these industries was ugly and sleazy but necessary.

But to pretend that this bill represents the “Twilight of the Interest Groups,” that special interests have been “neutralized,” that this bill is some sort of great victory over the health insurance and drug lobbies, is just hagiography and propaganda.  Being able to force the Government to bribe and accommodate you is not a reflection of your powerlessness; quite the opposite.  Everyone would love to be forced into a “twilight” like that.  It’s one thing for the Obama administration and the DNC to issue self-serving claims like this (we’ve stood up to the insurance and drug companies!), but those who hold themselves out as independent commentators ought to keep their feet on their ground.

As for the related Obama defense that the way this bill was crafted fulfilled his campaign promises because he said he would include these industries “at the table”:  please.  It’s true that Obama did say that, and that this clearly meant he intended to try to accommodate some of their concerns so that they didn’t wage jihad against his bill.  That’s fair enough.  But it’s also true that he repeatedly railed against the Washington practice of crafting bills by negotiating in secret with lobbyists and industry interests, and his whole I’ll-put-these-negotations-on-C-SPAN promise was specifically designed, he said, to prevent a health care bill from being negotiated based on secret deals with the health care and pharmaceutical industries.

But that’s exactly how he ended up negotiating this bill — using the exact secret processes that he railed against and which he swore he would banish.  It was only because The Huffington Post‘s Ryan Grim uncovered the secret memo-deal the White House had entered into with PhRMA — a deal they had publicly denied until then and until PhRMA demanded they publicly affirm it — did we know that the administration had agreed to oppose drug re-importation and bulk price negotiations, measures Obama (and the Democrats generally) repeatedly promised to enact.  Indeed, when it came time to vote on drug re-importation, the administration concocted false “safety concerns” about re-importation in order to whip against Byron Dorgan’s re-importation amendment, rather than admit that they really opposed it because they secretly promised they would to PhRMA, which hates drug re-importation because it lowers prices.  And it was only two days agofinally had confirmed what (at least to me) was obvious all along:  namely, the White House had agreed in secret with health care industry representatives that there would be no public option in a final bill, even as the President publicly feigned support for it and pretended to be fighting for it. that we

In other words, this bill was negotiated using the standard, secret, sleazy Beltway lobbyist/industry practices that candidate Obama frequently condemned and vowed to defeat.  And these industries extracted such huge benefits as a result of these secret deals — a bill shaped to their liking and profit objectives — that they are essentially in favor of it.

Again, none of this is proof that the health care bill is a bad idea — it’s possible that a bill which pleases these industries also produces, on balance, more good than harm (by expanding coverage and restricting some industry abuses).  But being in favor of the bill is not a justification for making misleading claims to try to glorify what it achieves or, worse, claiming that it represents a change in the way Washington works and a fulfillment of Obama’s campaign pledges.  The way this bill has been shaped is the ultimate expression — and bolstering — of how Washington has long worked.  One can find reasonable excuses for why it had to be done that way, but one cannot reasonably deny that it was.  And one can truthfully say many things about the political power of industry interests in Washington after this is all done; that they were “neutralized” and are in their “twilight” is most assuredly not among them.

UPDATE:  Matt Yglesias also says Ezra Klein’s claims about interest groups are “wrong” and that the reality is the “reverse” of what Klein wrote:  “interest groups were able to get their way on most key points without needing to seriously attempt to deliver votes in exchange. . . . the interest groups were able to get 85 percent of what they wanted in exchange for absolutely nothing.”  Does that sound like their having been “neutralized” and sent to their “twilight”?  This highlights a primary point I’m making here:  Yglesias is as enthusiastic a supporter of this bill as one can find, yet, at least in this regard, is still able to be realistic about what it actually is and is not.

Glenn Greenwald was previously a constitutional law and civil rights litigator in New York. He is the author of the New York Times Bestselling book “How Would a Patriot Act?,” a critique of the Bush administration’s use of executive power, released in May 2006. His second book, “A Tragic Legacy“, examines the Bush legacy.