ObamaCare’s Secret History

On Friday House Republicans released more documents that expose the collusion between the health-care industry and the White House that produced ObamaCare, and what a story of crony capitalism it is. If the trove of emails proves anything, it’s that the Tea Party isn’t angry enough.

Over the last year, the Energy and Commerce Committee has taken Nancy Pelosi’s advice to see what’s in the Affordable Care Act and how it passed. The White House refused to cooperate beyond printing out old press releases, but a dozen trade groups turned over thousands of emails and other files. A particular focus is the drug lobby, President Obama’s most loyal corporate ally in 2009 and 2010.

The business refrain in those days was that if you’re not at the table, you’re on the menu. But it turns out Big Pharma was also serving as head chef, maître d’hotel and dishwasher. Though some parts of the story have been reported before, the emails make clear that ObamaCare might never have passed without the drug companies. Thank you, Pfizer.

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The joint venture was forged in secret in spring 2009 amid an uneasy mix of menace and opportunism. The drug makers worried that health-care reform would revert to the liberal default of price controls and drug re-importation that Mr. Obama campaigned on, but they also understood that a new entitlement could be a windfall as taxpayers bought more of their products. The White House wanted industry financial help and knew that determined business opposition could tank the bill.

Initially, the Obamateers and Senate Finance Chairman Max Baucus asked for $100 billion, 90% of it from mandatory “rebates” through the Medicare prescription drug benefit like those that are imposed in Medicaid. The drug makers wheedled them down to $80 billion by offsetting cost-sharing for seniors on Medicare, in an explicit quid pro quo for protection against such rebates and re-importation. As Pfizer’s then-CEO Jeff Kindler put it, “our key deal points . . . are, to some extent, as important as the total dollars.” Mr. Kindler played a more influential role than we understood before, as the emails show.

Thus began a close if sometimes dysfunctional relationship with the Pharmaceutical Research and Manufacturers of America, or PhRMA, as led by Billy Tauzin, the Louisiana Democrat turned Republican turned lobbyist. As a White House staffer put it in May 2009, “Rahm’s calling Nancy-Ann and knows Billy is going to talk to Nancy-Ann tonight. Rahm will make it clear that PhRMA needs a direct line of communication, separate and apart from any coalition.” Nancy-Ann is Nancy-Ann DeParle, the White House health reform director, and Rahm is, of course, Rahm.

Editorial board member Joe Rago on emails that expose Big Pharma’s collusion with the White House to pass ObamaCare. Photo: Getty Images.

Terms were reached in June. Mr. Kindler’s chief of staff wrote a memo to her industry colleagues explaining that “Jeff would object to me telling you that his communication skills and breadth of knowledge on the issues was very helpful in keeping the meeting productive.” Soon the White House leaked the details to show that reform was making health-care progress, and lead PhRMA negotiator Bryant Hall wrote on June 12 that Mr. Obama “knows personally about our deal and is pushing no agenda.”

But Energy and Commerce Chairman Henry Waxman then announced that he was pocketing PhRMA’s concessions and demanding more, including re-importation. We wrote about the double-cross in a July 16, 2009 editorial called “Big Pharma Gets Played,” noting that Mr. Tauzin’s “corporate clients and their shareholders may soon pay for his attempt to get cozy with ObamaCare.”

Mr. Hall forwarded the piece to Ms. DeParle with the subject line, “This sucks.” The duo commiserated about how unreasonable House Democrats are, unlike Mr. Baucus and the Senators. The full exchange is among the excerpts from the emails printed nearby.

Then New York Times reporter Duff Wilson wrote to a PhRMA spokesman, “Tony, you see the WSJ editorial, ‘Big Pharma Gets Played”? I’m doing a story along that line for Monday.” The drug dealers had a problem.

The White House rode to the rescue. In September Mr. Hall informed Mr. Kindler that deputy White House chief of staff Jim Messina “is working on some very explicit language on importation to kill it in health care reform. This has to stay quiet.”

PhRMA more than repaid the favor, with a $150 million advertising campaign coordinated with the White House political shop. As one of Mr. Hall’s deputies put it earlier in the minutes of a meeting when the deal was being negotiated, “The WH-designated folks . . . would like us to start to define what ‘consensus health care reform’ means, and what it might include. . . . They definitely want us in the game and on the same side.”

In particular, the drug lobby would spend $70 million on two 501(c)(4) front groups called Healthy Economy Now and Americans for Stable Quality Care. In July, Mr. Hall wrote that “Rahm asked for Harry and Louise ads thru third party. We’ve already contacted the agent.”

Mr. Messina—known as “the fixer” in the West Wing—asked on December 15, 2009, “Can we get immediate robo calls in Nebraska urging nelson to vote for cloture?” Ben Nelson was the last Democratic holdout toward the Senate’s 60-vote threshold, and, as Mr. Messina wrote, “We are at 59, we have to have him.” They got him.

At least PhRMA deserves backhanded credit for the competence of its political operatives—unlike, say, the American Medical Association. A thread running through the emails is a hapless AMA lobbyist importuning Ms. DeParle and Mr. Messina for face-to-face meetings to discuss reforming the Medicare physician payment formula. The AMA supported ObamaCare in return for this “doc fix,” which it never got.

“We are running out of time,” this lobbyist, Richard Deem, writes in October 2009. How can he “tell my colleagues at AMA headquarters to proceed with $2m TV buy” without a permanent fix? The question answers itself: It was only $2 million.

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Mr. Waxman recently put out a rebuttal memo dismissing these email revelations as routine, “exactly what Presidents have always done to enact major legislation.” Which is precisely the point—the normality is the scandal. In 2003 PhRMA took a similar road trip with the Bush Republicans to create the Medicare drug benefit. That effort included building public support by heavily funding a shell outfit called Citizens for a Better Medicare.

Of course Democrats claim to be above this kind of merger of private profits and political power, as Mr. Obama did as a candidate. “The pharmaceutical industry wrote into the prescription drug plan that Medicare could not negotiate with drug companies,” he said in 2008. “And you know what? The chairman of the committee who pushed the law through”—that would be Mr. Tauzin— “went to work for the pharmaceutical industry making $2 million a year.”

Outrage over this kind of cronyism is what animates the Tea Party and Occupy Wall Street, whose members aren’t powerful enough to get special dispensations from the government—or even a fair hearing from their putative representatives.

In one email, an AARP lobbyist writes the White House to say “We really need to talk,” noting that calls from seniors are running 14 to one against ObamaCare. But she isn’t calling to say that AARP is withdrawing support—only that the White House needs to adjust its messaging. This is how a bill passes over the objections of most Americans.

The lesson for Republicans if they do end up running the country next year is that their job is to restore the free and fair market that creates broad-based economic growth. The temptation will be to return for the sake of power to the methods of Tom DeLay and Jack Abramoff. If they do, voters will return the GOP to private life as surely as they did the Democrats in 2010.

The warning to business is also fundamental. Crony capitalism undermines public trust in capitalism itself and risks blowback that erodes the free market that private companies need to prosper and that underlies the productivity and competitiveness of the U.S. economy. The political benefits of cronyism are inherently temporary, but the damage it does is far more lasting.

As for Big Pharma, the lobby ultimately staved off Mr. Waxman’s revolt and avoided some truly harmful drug policies—for now. But over the long term their products are far more vulnerable to the command-and-control central planning that will erode medical innovation, and their $80 billion fillip is merely the teaser rate.

Mr. Kindler resigned from Pfizer in December 2010 under pressure from directors, its stock having lost 35% of its value since he became CEO. Mr. Tauzin left PhRMA in February 2010, with the Affordable Care Act a month from passage.

The truth is that this destructive legislation wasn’t inevitable and far better reforms were possible. They still are, though they might have gained more traction in 2009 and 2010 with the right support. The miracle is that, despite this collusion of big government and big business, ObamaCare has received the public scorn that it deserves.