2019-08-26 Bloomberg Businessweek

(Frankie) #1
◼ 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
◼Onotherissues

Klobuchar

Sanders

Biden

Harris

Booker

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Yang

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= 10 tweets
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