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Obama's Health Care Pledge: Getting a Deal Trumps Making the Process Transparent

5 years ago
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When candidate Barack Obama was criss-crossing the country in his two-year presidential campaign, a standard part of his stump speech -- lines that always won him applause -- had to do with his promise to negotiate health care reform in public, on C-SPAN, for all to see. As the wrangling over health overhaul legislation heads into its final stretch, it's clear that was a promise President Obama did not keep. The dealmaking remained behind closed doors.

Here's what Obama said in August 2008, at a town-hall meeting: "I'm going to have all the negotiations around a big table. We'll have doctors and nurses and hospital administrators. Insurance companies, drug companies -- they'll get a seat at the table, they just won't be able to buy every chair. But what we will do is, we'll have the negotiations televised on C-SPAN, so that people can see who is making arguments on behalf of their constituents, and who are making arguments on behalf of the drug companies or the insurance companies. And so, that approach, I think is what is going to allow people to stay involved in this process."

Obama offered variations of that at scores of campaign stops. At a Jan. 31, 2008, debate in Los Angeles, he said he would deal in the open, "not negotiating behind closed doors, but bringing all parties together, and broadcasting those negotiations on C-SPAN so that the American people can see what the choices are, because part of what we have to do is enlist the American people in this process."

As an Illinois senator, Obama was exposed to the real world of dealing with sensitive legislation; it often gets done in private. While a senator, after all, Obama never negotiated over anything on TV or on the web. It's hard to see how the parties involved in cutting that deal with Sen. Ben Nelson (D-Neb.) to get his crucial vote on the health package could have gotten it if the drama had played out in public. Even before the deals that resulted in the Senate vote, starting at 1:08 a.m. Monday, McClatchy reporters back in July wrote about negotiations on health reform behind closed doors. Politifact -- the project of the St. Petersburg Times that does fact-checking -- already has scored this as a promise broken.

Nothing opened up in the back room. In breaking the pledge, the Obama team decided that the final product -- providing millions more people in this nation with health insurance -- was vastly more important than the process or the promise. The Senate will likely approve its bill by Christmas Eve; in January House and Senate negotiators meet to pound out a merged version, with more wrangling expected.

The White House did take a stab at openness early on: in March, the Obama team gathered stakeholders (from a variety of medical, business and consumer groups) at the White House with experts to discuss health care needs and that was live-streamed on the White House web site and on C-SPAN. Linda Douglass, Communications Director for the White House Office of Health Reform, reminded me on Monday that there were 11 sessions with stakeholders at the White House. "There were numerous webstreamed and broadcast discussions," Douglass said, with insurance company executives to small business owners to doctors and nurses, some 260 people overall. "So we think there was a lot of openness in this process," she said.

Ellen Miller, the executive director of the Sunlight Foundation, a Washington non-profit, non-partisan group dedicated to making government more open, told me it was naïve of Obama to make that pledge in the first place.

"The promises of transparency and openness in government are always going to come smack up against the realities of politics,'' Miller said. "Not everything can be done in the open and I think most people realize that and are accepting of that. But I think the promise was a naïve promise because there are always decisions that have to be made not in the light of day."
When it comes to forging compromises, "it is unrealistic to assume and therefore foolhardy to promise government that is going to make all of its decisions with respect to policy in the open."

Miller is not letting the Obama team off the hook, however. "The administration could have done a lot more to put a lot of these deliberations in the public sphere." What is most important, Miller said, is that the final product is open to review before the vote. But that burden is on the House and Senate, to post bills on-line before a vote; Sunlight backs Congress mandating the posting of all bills online for at least 72 hours before a vote.

Obama's soft spot on this pledge is easy to find and Republicans have been beating up the president -- and Democrats -- for brokering the health bill in secret. That's a reason some Senate Republicans have tried to slow down the proceedings with a call for a clerk to read a 767-page amendment.
"Let's do what the President said last October a year ago,'' said Sen. John McCain (R-Az.), Obama's 2008 rival. "Let's all sit down together, Republicans and Democrats, with C-SPAN in the room and negotiate so that the American people can see what's going on here."

On Sunday, Sen. Lindsey Graham (R-S.C.) said, "Not only have we not had any negotiations on C-SPAN, you couldn't find the room where the negotiations were going on. The old way of doing business looks good compared to this process. There was a negotiation going on on the biggest proposal we will probably ever vote on, one-sixth of the economy, between two people: the Senate majority leader and the Senator from Nebraska."

When I first heard Obama make the promise to negotiate in public in 2007, I thought it would be hard to accomplish. For starters, it's one thing to gather the stakeholders around a table and seek their input -- even criticisms -- in a White House-controlled event. When it comes to real negotiations over health care, Congress was obviously going to be a player, and the White House could never dictate calling in a camera.

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