Health Care

Transparency and Sausage Making

By

When the Democrats announced that they would be forgoing conference committee proceedings and negotiating a final health care reform bill informally, critics pounced on President Barack Obama for violating his promise of greater transparency in government. And I, for one, had no great urge to defend him.

As a presidential candidate, Obama had not merely promised to introduce more transparency to government. He had very specifically, and very repeatedly, promised to conduct deliberations over health care “in front of the cameras on C-SPAN.” Although I never took the pledge literally--clearly, you can’t negotiate an entire bill in public view--plenty of voters did. Now Obama was paying a political price for the boast. I figured it was punishment for rhetorical hubris.

But then, on Wednesday, a press release from the Republican National Committee came across my desk. It contained a statement by Rep. Tom Price, Ga., chairman of the Republican Study Committee. “If the Democrats aren’t engaging in more nefarious backroom deal-making, why do they refuse to pull back the curtains and let the public see what’s going on?” Price said. “What are they doing that they don’t want us to see?”

To call that statement priceless is not just a bad pun. It’s a gross understatement. As you may recall, the previous administration--that is, the very Republican George W. Bush administration--had its own problems with transparency. Perhaps most famously, Vice President Richard Cheney convened a task force to help the administration design energy policy. People were naturally curious about what this task force was doing, particularly given the administration’s close ties to the petroleum industry, but Cheney wouldn’t even reveal who was on the task force, let alone open its proceedings to the public.

If Republican leadership was in high dudgeon then, I must have missed it.

The energy task force episode was emblematic of the Bush administration’s approach to transparency. And that approach has changed pretty radically in the last year. According to Ellen Miller, president of the Sunlight Foundation, the Obama administration has made “enormous strides” towards open government. The record is “not perfect,” she says, but “no White House has been more open.”

One sign of this progress is the decision to make public the names of all visitors to the White House. Want to know how frequently Billy Tauzin, the former congressman who now lobbies for the drug industry, visited 1600 Pennsylvania Avenue? You can look it up at www.whitehouse.gov. There’s even a handy search tool.

Of course, if you do that search, you’ll see that Tauzin visited the White House 11 times last year--which is not unrelated to the fact that his organization, the Pharmaceutical Research and Manufacturers of America, struck a deal with the administration over health care reform. In a nutshell, PhRMA agreed not to fight reform and the administration, with Senate Finance Chairman Max Baucus, D-Mont., as a partner, agreed it wouldn’t seek changes that reduced drug industry revenues by more than $80 billion. While the existence of a deal was no secret--the administration itself announced it, as a sign of legislative progress--the details only came to light later on, in reports that appeared in the New York Times and Huffington Post. Those details suggest the industry will make out rather well.

Still, everything is relative. The health care industry seemed to have even more influence in 2003, when the Bush administration worked with the Republican congress to create a drug benefit for Medicare. The role of lobbyists in that episode was so obvious and the resulting giveaways to industry so egregious that it disgusted even some Republicans--like Rep. Walter Jones, R-N.C., who told “60 Minutes” that “the pharmaceutical lobbyists wrote this bill."

Nor did the Bush administration and its allies seem particularly concerned with transparency during that fight. On the contrary, when the chief actuary for Medicare concluded that the drug plan would cost more than its proponents were predicting, an administration official ordered the actuary to say nothing--to the point where the actuary believed his job was in jeopardy. That same actuary, Richard Foster, has spent much of the last year issuing (somewhat) critical projections about Obama’s reforms. But neither the president nor his allies have tried to squelch Foster. Instead, they’ve been content to argue their case, in public, on the merits.

One more fact to consider is that Obama and his supporters are pushing reforms that will, on their own, advance the cause of transparency--not transparency in government, mind you, but transparency in health care. When insurance carriers make decisions about what services or treatments to cover, they often do so in secret--and leave beneficiaries no legal recourse for challenging those decisions. Reform would create a standard set of benefits, to be determined by democratically accountable officials, that all insurers must cover. It would also create binding legal processes, through which patients could challenge decisions they thought were unfair.

Could Obama be doing more to bring health care--and its policy work--out into the open? Without a question. But he could also be doing a lot less. That's worth something.

Jonathan Cohn is a senior editor of The New Republic. This column is a collaboration between TNR and Kaiser Health News. KHN is an editorially independent news service and is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization, which is not affiliated with Kaiser Permanente.

For more TNR, become a fan on Facebook and follow us on Twitter.

Loading Related Articles...
Article Tools
SHARE YOUR THOUGHTS

Show all 3 comments

You must be a subscriber to post comments. Subscribe today.