The Messy Business of Transparency

Picture 120President Obama’s latest plan for health reform brought a flurry of commentary in the last two days; including divergent views on whether his commitment to “transparency” is helping or hurting the process. Yesterday, the Los Angeles Times blamed the current “healthcare backlash” on Obama’s insistence that the messy business of hashing out health reform be done in Congress, not behind closed doors in the Oval Office. In the L.A. Times’ view, there’s been too much transparency:

“By leaving the overhaul in the hands of Congress, [Obama] has given the public a full view of how lawmakers do business. The result is an anti-Washington mood that Republicans have tapped into.”

Meanwhile, the House GOP leader John Boehner, calls the Obama plan—introduced yesterday on the eve of the “bipartisan” health summit—a “Democrats-only backroom deal” that “doubles down on the same failed approach that will drive up premiums, destroy jobs, raise taxes, and slash Medicare benefits.” In the Republican’s view of things, there’s been too little transparency in the health reform process.

So which is it: Back-room dealing or a too-public view of the dirty business of lawmaking?

At the very beginning of the health reform process, the Obama administration made a conscious decision not to repeat the mistakes that doomed Bill and Hillary Clinton’s plan for universal coverage in 1993. The consensus was that the Clinton plan ultimately failed because the bulk of the planning went on behind closed doors—Congress and the American people felt locked out and were blindsided by the cost of the proposal. “With a task force that operated largely in secret, the first lady drew up a detailed and complicated plan that met with fierce opposition by the health care industry and Republicans before it ultimately sank of its own weight in a Democratic Congress,” writes Peter Baker in the New York Times.

“Mr. Obama is approaching the issue in a different way. Rather than developing his own detailed proposal, he is setting out broad principles and letting lawmakers draft the specifics of a plan that they believe can pass.”

The wisdom of this approach—sanctioned by none other than Bill Clinton—will likely be debated for years to come; depending on whether or not comprehensive reform passes in the near future. Some argue that Obama should have taken control of health reform earlier, before debate over policy details had time to escalate into the current yawning partisan divide. Instead, the public got a first-hand look at the posturing, deal-making, seamy compromising and one-upmanship that is entrenched in the policy-making process.

As a relative political neophyte, I can relate to the public’s dismay over this entire health care reform process. I watched with disappointment as the progressive goals for health care reform got whittled away to gain support for legislation: deals were made with pharmaceutical companies, hospitals, providers and finally, insurers. As media coverage of town hall meetings grew into a summer of discontent, we witnessed Congress wrestling with—and ultimately sacrificing—the public option. We watched while the entire reform process got hijacked by the abortion debate and wild claims by some Conservatives that the government was going to establish “death panels” and gut Medicare. These have been painful days for everyone who has been committed to universal health coverage.

Painful, but I would argue, ultimately insightful. The push to pass health reform in the House and Senate has become an important civics lesson—played out as theater for the masses. The visceral response that the national audience had to Nebraska’s “Cornhusker Kickback” and other deals designed to secure the votes of holdouts like Sens. Ben Nelson, Joe Leiberman and Louisiana’s Mary Landrieu leads one to wonder if most Americans have ever witnessed the Congressional legislative process before. I’d argue that this outrage is an unplanned, but natural, goal of transparency.

Timothy Jost, writes in Politico that ultimately, that outrage over “backroom dealings,” fanned by disingenuous attacks from Republicans, becomes a calculated distraction to the legislative process. The goals of health reform—even with all the compromises designed to build consensus—remain the same: expanding health coverage to more Americans, slowing the growth of costs, and improving the quality of care.

“[W]hy is the health reform debate held up to standards of transparency not imposed on other, equally important pieces of legislation? Hours of health care debate were broadcast on C-SPAN for the dozen or so Americans who were watching. Some of the negotiations were not broadcast, but why demand of the health reform bill a level of transparency not required of any other legislation? Does anyone know what is in the most recent farm bill, which costs two-thirds as much as the health reform legislation will?

“The Republicans were never shy about backroom deals when they controlled Congress,” Jost continues, “Virtually all Democrats, as well as the public, were excluded from the deal making that resulted in the 2003 Medicare Modernization Act.”

Obama’s approach to health reform—crafting it on the open stage where we could watch the ugly posturing and deal making—is a painful, frustrating process. But maybe we will wrestle a lesson or two out of this spectacle. The net result of the public’s anger over “backroom deals” (and the loss of a Senate seat in Massachusetts) has been contrition from the administration, and a revised plan that attempts to remove the most pilloried give-aways: Gone is the Nebraska compromise and the Louisiana purchase, for example—replaced by a much fairer commitment by the federal government to provide 100% financing for all states’ Medicaid expansions for four years and significant support thereafter.

The upcoming health care summit is designed with transparency in mind; after all it will be a public, nationally-aired event. Republicans have been complaining all week that it’s a trap, a set-up by Obama to portray their party as one of obstructionists. They charge that the real goal of the summit is to rally listless Democrats, getting them primed to push health reform through the budget reconciliation process. That may be true, but Republicans have yet to present any alternative plan of their own at this summit beyond the usual commitment to market-driven, incremental changes that maintain the status quo.

It’s anyone’s guess if this media event will help end the stalemate over health reform—or if anyone outside the wonk crowd will even watch it after the first few minutes. Will it be thrilling political theater or like watching paint dry on the backdrop? In the best case scenario, this summit will help educate and convince more voters—those 6 in 10 Americans who in a recent Kaiser poll say that they support key provisions of health reform—to throw their weight behind Obama’s plan. At worst, the summit could end up being another messy, highly partisan slug-fest that changes nothing. But then, that’s the risk you run with being transparent.

Naomi Freundlich writes for the Century Foundation, where she works with THCB author Maggie Mahar on the HealthBeat project. Prior to joining the Century Foundation, she served as Science and Medicine Editor at Business Week from 1989 – 1997. Her work has appeared in numerous publications, including the New York Times, Business Week, Real Simple and Parents magazine.

4 replies »

  1. Where I live Only One Dr. in the city will accept medicare. It pays little and sometimes nothing, and it takes forever to get what payments it does cover to the Doctors. If the government can’ manage the programs it already has how do they think they can manage one even bigger and more complicated. I’m tired of all the blame games, the republicans may be the party of NO but the Democrats are the party of Blame someone else. The only part of the change we were told we were going to see is same game different faces, same bribes, same lies, same Bul****

  2. In principle : Physical exercise lessens the depressive symptoms, aswell as being exposed to light (paricularly in the winter seasons).

  3. “These have been painful days for everyone who has been committed to universal health coverage.”
    You should be happy and against any health care reform since the USA already has universal health coverage.