With reform dead, health care debate becomes pure politics

Answer: When he doesn’t have the pharmaceutical industry on his side.

The biggest changes Obama has proposed to the Senate bill — such as price controls on insurers and higher taxes on drug companies — don’t look like moves to get Republican votes or help the bill glide thought the filibuster-proof budget reconciliation process. It looks like Obama is simply trying to push his heretofore allies (drug makers) and uneasy partners (health insurers) fully onto the other side of the fence with the Republicans, thus painting a helpful political picture for 2010.

The White House spent 2009 publicly decrying the “special interests” supposedly undermining their “reform” of the health care market. But the White House also spent 2009 privately cutting deals with drug companies — deals that fueled public skepticism about the bill and left the president’s liberal base feeling jilted.

Even the insurers made out well in last year’s negotiations, successfully killing the public option, inserting insurance mandates on both individuals and employers, and securing massive subsidies for the purchase of health insurance. Former Democratic National Committee Chairman Howard Dean was exaggerating, but not all that much, when he called the Senate bill “a bigger bailout for the insurance industry than AIG.”

Still, Obama portrayed his “reform” effort as a struggle against “those who profit from the status quo.” For the most part, the White House never named these dastardly profiteers, possibly because industry was mostly on the president’s side.

So while he spent 2009 battling imaginary foes over a real bill, Obama now might be battling real foes over an imaginary bill. Without reading minds, we can’t know for sure if Obama believes he can still pass a health care bill, or if he truly sees the rough outline he issued Monday as the path toward making a bill become a law.

But there’s plenty of reason to believe his current proposal is simply a political wedge: An effort to actually drive the insurers and drug makers into fierce opposition, thus helping Democrats frame the 2010 elections as “reformers” vs. “fat-cat industries.”

In other words, it looks to me like the president has decided to engage the same game he has accused — not always unfairly — Republicans of playing: Drawing political battle lines rather than trying to reform anything.

Look at the Web page the White House debuted for this week’s proposal and summit. As of Tuesday morning, the page dedicated more words to attacking insurers than to laying out policies, highlighting blog posts with these headlines: “Nobody is Immune from Insurance Company Abuses,” “Premiums, Profits, and the Need for Health Reform,” “Putting Health Care in the Hands of Consumers — Not Insurance Companies,” “The Insurers and the Ultimate Irony.”

Insurers aren’t the only bad guys Obama’s proposal would drive into the nay camp (that is, the GOP camp). The bill would also slap a Medicare tax on “unearned income” such as investments and rent, thus drawing more blood from wealthy investors and landlords.

We saw the first glimpses of the Democrats’ 2010 strategy at Obama’s rally for Massachusetts Senate candidate Martha Coakley. “Whose side are you going to be on?” Obama asked, the side of the “special interests” or of working Americans.

The “whose side are you on” motif is a favorite of Democrats going back to Adlai Stevenson. But it’s an awkward one to ask about Obama’s first year, in which he sided with big energy companies in backing the House climate change bill, with the largest cigarette company in signing a tobacco bill, with the insurers in signing an expansion of subsidies for children’s health insurance, with the Chamber of Commerce in signing the largest spending bill in history (and Big Coal in including the largest earmark in history), with Wall Street in ramping up the bailouts of the financial industry, and of course with drug companies in backing the Senate’s subsidy-packed health care bill.

This renewed push for health care reform gives Obama an opportunity to set a different stage. Proposing federal price controls on insurance premiums is bad policy, but good politics. Bad policy proposals are fine and can get plenty of Democratic votes if the package is really just filibuster bait. If Obama can’t pass a reform, at least he can force the Republicans to stand with insurers, drug makers, landlords, and wealthy investors in killing a bill described as “reform.”

Timothy P. Carney, The Examiner‘s lobbying editor, can be reached at [email protected]. He writes an op-ed column that appears on Friday