2019-08-26 Bloomberg Businessweek

◼ POLITICS Bloomberg Businessweek August 26, 2019

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Thelobbyistsmaynothavea voteinCongress,

buttheyhavedemonstrableinfluenceoverthe

legislativeprocess.AskJimManley, a former

Democraticaidewhobeganhistwo-decadeSenate

careera fewyearsbeforeBillClintontriedtopass

universalhealthcare.Hesawthebillrunintoa

buzzsawofoppositionafterinsurancelobbyists

rana multimillion-dollarTVcampaigninwhicha

couplenamedHarryandLouiselamentedbeing

stuckwithbadgovernmentoptions.

A decadeanda halflater,Democratsheldpains-

takingnegotiationswithkeyindustryfiguresto

neutralizeopposition.Insurerswouldcomeunder

tougherrulesandhavetocoverpeoplewithpre-

existingconditionsatreasonablerates;drugcom-

panieswouldpayrebatesforsomeprescription

medication;doctorsandhospitalswouldfacesome

paymentcuts.Butthey’dalsobeguaranteedmil-

lionsofnewcustomersthankstothesubsidiesthat

extendedcoverage.TheresultwastheAffordable

CareAct—orObamacare.

“OneofthebigtakeawaysfromClintoncare

is,whenyouhavea powerfulopponentsuchas

thehealth-insuranceindustry,it’sverydifficultto

getanythingdone,”saysManley,whoworkedfor

then-SenateMajorityLeaderHarryReidwhenthe

ACApassedwithnota votetospare.“Theyman-

agedtodemonizetheissueandmakeit radioactive

tomanyDemocrats.Whichiswhythetakeaway

fromObamacarewastotrytobuilda coalitionto

takeawaysomeofthosepolitics.”

Evenif DemocratswintheWhiteHouse,hold

theHouse,andregaintheSenate, theirbest-

casemarginintheupperchamberwouldfallfar

shortofthe 60 votesneededtopasslegislation.

Republicans,whoin 2009 and 2010 refusedtosup-

plya singlevoteforObamacare,aren’tlikelytosign

ontoanyDemocraticidea.OneSenateRepublican

aide,speakingonconditionofanonymity,saysthe

majorityhasnointentionofcompromisingona

publicoption,callingit a “radical”ideanomatter

howmoderatethecandidate.

Manleydoesn’tseesingle-payergettingthekind

ofsupportit wouldneedtoovercomeRepublican

andindustryopposition.A publicoptionmayhave

moreDemocraticsupport,hesays,“butit’sfairto

pointoutthattheseareverypowerfulinterests

thatarepreparedtoopposejustaboutanything

that’sbeingdiscussedrightnow.”Industryplayers

killedit in2009,andthistime,justlikelasttime,

“there’sa wholebunchofgroupsthataredeadset

againstit.”�SahilKapur

noamountofcarefulmessagingwillhelpthem

overcome: Even the most modest Democratic plan

would face intense opposition from health-related

industries, not to mention Republicans.

Already, powerful interest groups are mobilizing

and pooling resources to undermine the Democrats’

plans. The Partnership for America’s Health Care

Future—alobbyinggroupthatrepresentsinsurance

companies,drugmakers,hospitals,andotherindus-

tryplayers—isrunningTVadsandcommissioning

pollsdesignedtoundercutsupportforanyexpan-

sionofgovernment-provided coverage.

The industry coalition despises Medicare for

All, which would end private insurance, hammer

pharmaceutical profits, and slash provider pay-

ments as much as 40% in the hope of making cov-

erage universal and accessible. But the group’s also

against letting Americans buy into a Medicare-like

plan at lower cost. “We want to build upon what

is currently working and fix what is not,” says

Lauren Crawford Shaver, the Partnership’s execu-

tive director, who worked in the Obama adminis-

tration and on Hillary Clinton’s 2016 presidential

campaign. “Candidly, we do not see Medicare for

All, Medicare buy-in, or public option helping to

accomplish those goals. Our members are not

really together on many things in this town, but

they are united in this.”

So far, voters disagree. A July poll commissioned

by NPR and Marist found that 41% of Americans

favor a Medicare for All plan that replaces private

insurance, while 70% said they support having

the choice of being covered by a government-run

plan or private insurance. A public option may poll

well now, Shaver says, but “people genuinely don’t

know what it means.” Once the industry makes its

case about what a government-sponsored plan

would mean for people’s coverage, she expects

opinion will change.

Its recent six-figure TV and digital ad campaign,

rolled out nationwide, is just the first step. “The

politicians may call it Medicare for All, Medicare

buy-in, or the public option,” say a rotating cast

of seemingly ordinary people. “But they mean

the same thing: higher taxes or higher premi-

ums, or lower-quality care.” The industry coali-

tion argues that Medicare for All could pummel

rural physicians and cause many hospitals to close.

Proponents have responded that only insurance

would be centralized and that the program would

allow all Americans to go to doctors and hospitals

of their choice. But the real impact on the indus-

try depends on the extent of reimbursement cuts

to providers, a detail that remains unspecified in

many Democratic proposals.

THE BOTTOM LINE The Obama administration was able to win

over the health-care industry only by killing the public option, which

even the most moderate Democratic candidates are promoting.

● Tweets on issues by

Democraticcandidates

sinceJan. 1

◼Onhealthcare

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Booker

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= 10 tweets