Monday, March 22, 2010

House Democrats Deliver on White House Back Room Deals

Tom Daschle, a close outside adviser, said Mr. Obama believed that health care would be his legacy. “This is what his presidency is about,” he said. (NYT)

Make no mistake, the Blue Team's credibility rested on delivering health care reform. Last year Nancy-Ann DeParle, Ezekiel Emanuel, and Peter Orzag negotiated back room deals with major industry players. Jim Messina led a campaign style push with big donor money. It failed miserably.

The public paid attention, while the Fourth Estate didn't. WaPo's Ezra Klein interviewed Nancy-Ann DeParle. Her calling big Pharma "our industry" flew over his head. At one point the White House bragged about these deals.

After Congressional sausage making added "sweeteners" for holdouts, atop vague White House deals, the public threw up their hands in disgust. A politically astute President Obama recanted.
"I didn't make a bunch of back room deals."
He failed to mention his White House staffers did.

Reform's death meant huge problems for the Blues. Industry leaders expected Obama to live up to his commitments. They wouldn't lock up corporate donors for years as Rahm Emanuel intended, but they needed to deliver for the ones they had left. Thus Jim Messina got another chance to run his campaign magic. NYT reported:

At the White House, Mr. Obama’s political arm was mobilizing, as Jim Messina, a deputy chief of staff, guided a team of party strategists. Fed by information from lobbyists, Hill aides and others, they tracked how every lawmaker intended to vote and prepared a television and radio campaign to counter the bill’s opponents, who were vastly outspending them.
The coalition of about 50 groups, from the AARP to labor unions — some of whom called themselves “Winter Soldiers” to describe their steadfast support — held daily conference calls. They isolated three dozen lawmakers and had influential people in their communities — doctors, insurance agents, business owners — reach out to them.

Who stood steadfast in Obama's corner? The For-Profit hospital lobby, ironically the man who brought America Harry & Louise, the ad campaign that sunk Clinton era health reform. NYT reported:

Some White House allies say the session proved critical in putting health care back on the national agenda. “When the history of this is written, it will be looked at as both a turning point and a brilliant idea,” said Chip Kahn, who as president of the Federation of American Hospitals has been one of the administration’s main supporters.

What did Chip get out of the bill? Nonprofit community hospitals were renamed "private tax exempt facilities." Kahn had two reasons to drink champagne, given the weekend's news. With reform's passage, Kahn's for-profit hospitals have four years to pick off weak PTEF's.

Despite promises that 32 million Americans will get coverage, major enrollment doesn't start until 2014. Under Reconciliation CBO projects Medicaid & CHIP to decline by 6 million enrollees between 2011 & 2013. Hospitals caring for the uninsured will struggle under the crushing burden for four years.

Health risk and responsibility will shift from employers to individuals and a tapped out Uncle Sam. In 2008 176 million Americans had employer coverage (Census data). CBO projects 150 million to have workplace insurance in 2010. That's a drop of 26 million before the bill is enacted. The bleeding continues under Reconciliation. More than the cost curve is bent.

But there's good news, the U.S. Presidency is bolstered.

If we fail at this,” Rep. Grijalva recalled Mr. Obama saying, “it’s going to be harder for us to pull the line on this other stuff. It is going to weaken our presidency.”

The Blue Team delivered on its industry promises. Jim Messina's campaign magic is back. Congress kept any legislative entrails out of the public eye. Thus celebration was in order.

It was nearly midnight when Obama invited aides to the Truman Balcony for champagne.

Obama's privatization/pay for performance train chugs past the health care station. Onward to public infrastructure and education. Obama's legacy is "populist rhetoric, corporatist implementation."

Update 1-13-11:  The employer risk shift to the individual is on, as "large employers are moving away from traditional retiree benefits and are eyeing a defined-contribution approach and the individual market."

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