Secret talks on health care? Where's the promised transparency?

Imagine a hearing room in the U.S. Senate. Imagine men and women trying to navigate the issues that surround health care in America and negotiate a solution.

Now imagine that the doors to the room are closed, and that the participants remain unidentified, and that, in fact, “Senate aides had threatened to expel anyone who divulged details of the work group,” reports The New York Times:

Since last fall, many of the leading figures in the nation’s long-running health care debate have been meeting secretly in a Senate hearing room. Now, with the blessing of the Senate’s leading proponent of universal health insurance, Edward M. Kennedy, they appear to be inching toward a consensus that could reshape the debate.

The 20 or so people in that room sitting around tables arranged in a square, says The Times, “include lobbyists for AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce.”

Well, I’m not inside that room, and neither are you. And we should be, because President Obama said we would be.

In a memorandum on the White House website headlined “Memorandum for the heads of executive departments and agencies,” President Obama said:

Government should be transparent. Transparency promotes accountability and provides information for citizens about what their Government is doing. …

Government should be participatory. Public engagement enhances the Government’s effectiveness and improves the quality of its decisions. Knowledge is widely dispersed in society, and public officials benefit from having access to that dispersed knowledge. [emphasis in original]

Now, these “talks” have not been arranged at the behest of the White House. Sen. Ted Kennedy and his aides have done so — and he ought to know better than to discuss such an issue behind closed doors. In its news story, The Times offers this thinly disguised opinion (surprise!): “It is not clear whether such back-room negotiations are still viable at a time when politicians are promising a new transparency and condemning the influence of lobbyists.”

Well, duh. The president promised transparency. But on health care, the White House has tolerated the secrecy and “has been kept informed and is encouraging the Senate effort as a way to get the ball rolling on health legislation.”

The “workhorse group,” as characterized in a summary by Senate aides, has addressed such questions as “how to enforce the requirement for everyone to have health insurance; how to make insurance affordable to the uninsured; and whether to require employers to help buy coverage for their employees.”

Health care constitutes 15 percent of gross domestic product. As a policy issue, it is probably responsible for more anxiety in the public’s mind than any other.

The public should be in that room. It should know what is said and who said it. At least provide a transcript posted on the White House website.

19 replies »

  1. I doubt it, Ann. Please don’t walk down any dark alleys – the people hiding in the shadows are seldom there t lend you assistance, should you need it.

    The list of hooligans includes the AMA – who do you think benefits from their inclusion? Hint: It’s not you or me.

  2. I am VERY concerned because it looks to me like these are the same folks who brought us the infamous Medicare Part D. I want HR 676 to be included, because I am SICK AND TIRED of the insurance companies “skimming” 25 to 30% off the top of my premiums, and then telling me, “No, we will not pay for that.”

    I want a single payer plan with no profit making corporations acting as “intermediaries” between me and my doctor. If Medicare can operate with a 3% overhead, why can’t the rest of our health care system operate with that same 3% overhead?

  3. Petey, I’ll try to remember. And don’t you walk down too many comment threads alone – sometimes thinly-veiled sarcasm turns to outright mockery. Hint: like this one.

  4. I’m torn on this. On the one hand, I’m all for openness, and Hillary Clinton’s 1993 effort to reform health care was skewered on secrecy. She simply didn’t move the country along the right path, prefering instead to present the plan as a fait accompli which left it open to all kinds of fair and unfair criticism.

    On the other hand, I’ve spent much of my life working for companies that try to help employers deal with rising health care costs, and I understand a lot more than most how complex this issue really is. Moreover, I have a fair understanding of the real drivers of ridiculous health care costs, and I know that the American public does not. I’m not at all confident that any widespread, informed debate is possible on this issue.

    I think Obama is between a rock and Charybdis here.

  5. just one more case of “Change?”, “what Change?”

    this chimp in the prez chair is just as corrupt and scummy as his predecessor, incurious george

  6. ANYTIME “experts” or other leaders of the same industry gather to talk in secret, it is ALWAYS to the detriment of the common man.


  7. JS: Wouldn’t opening up that debate help to inform the public and make debate possible?

    I agree with Tom on this. There is a good reason that the movers and shakers don’t want to discuss this publicly, because to do so would allow the common man to see their motivations. And i’ll bet dollars to doughnuts that a good many of those motivations have nothing to do with the health of the nation.

  8. Lex:

    Nope. Opening it up would only allow those with particular interests to distort the real issues in their favor by manipulating public opinion. In this case, public opinion can be too easily manipulated because the public doesn’t know jack. And though the people who write for this blog are pretty smart, I would submit that they also don’t know much about the systemic Gordion knot that is our health care system.

    What is likely to happen in an open process is that the insurance companies, medical equipment makers, pharmaceutical firms, physician organizations, hosptial organizations, AARP, and a host of others would crank their PR machines into high gear and completely obfuscate the real issues, going instead for “silver bullets” that have no chance of working (tort reform, for instance).

    The real issue with US health care, from 50,000 feet, is that there is a strong, financial incentive to develop new and ruinously expensive technologies of marginal utility that, nevertheless, generate enormous profits because of the way the system pays off. This has led to further distortions as the payers try to figure out how to limit use of the technologies, with limited success.

    The politically unpalatable answer to this issue is that health care must be rationed in one way or another. Right now, we ration it by ability to pay.

  9. JS, sounds to me like we’re back to the complicating factor simply being that too many people want to keep their fingers in the pot. Which, again, is only furthered by keeping all the agendas hidden behind closed doors.

    I don’t see anything complicated about this. Linking “health care” to the “larger economic engine” only serves to undermine the need for better health care in this country, available to more people. Yes, we’ll have impacts on industry in general, but the way our economic model has been working so far has mostly served the very few while pretending to be needed by the very many. That engine is driven by perception, not anything in reality. Having a functioning economy seems to be as much about managing perceptions as anything else, and today, the perception is “I can have anything I want any time I want and there’s only a straight up small $$ cost to that”. That flawed and not-connected-to-reality perception is killing the planet, and making massive long term problems for all of us.

    Time to change the paradigm. .. and that’s going to piss off just about _all_ of the insanely rich people out there. But, since they got their money through a gamed system to begin with, I don’t really care if they get mad. We need to look at the bigger picture, I think, and do what’s in the best interest of the vast majority. If that ruffles the feathers of the tiny minority, so be it.

    When preserving a house, you sometimes find that there are simply too many layers of paint.. and it all has to be stripped away. Then, sometimes, you find rotten timbers that need replacing. The alternatives tend to be just slap more paint on the mess and ignore the rotting timbers, but that leads to a house that will fall on your head, and likely kill you. House repairs aren’t cheap, but they are required if you want to keep your house in livable order.

  10. JS: I’ll freely admit to knowing almost nothing about it…beyond that it’s pretty fucked up. My guess, however, would have been pretty much what you said.

    That it all boils down to maximizing profit doesn’t surprise me, and i know that such a state will be the biggest obstacle to any meaningful reform. I also understand that attempting to remove a for-profit industry by force is likely to end in failure. My only real question is how long the maximized profit health care industry can continue on before it fails all on its own.

    Thankfully i’m already rationed out of the system. Combined with my unmitigated cynicism that sees no real reform in the near future, i suppose that i really don’t have a dog in this fight. Maybe i should be thankful.

  11. Did you ever wonder why medical services providers are controlled by management and law firms aren’t? The lawyers aren’t about to let that happen.

  12. Grandma JS is right, grandpa Lex. People are just too stupid to understand complicated things like health care. Their weak brains are better suited to manual labor. Let them enjoy their simple amusements while we, the more refined and better educatedm take upon ourselves the onerous burden of equitable health care distribution.

  13. AlanSmithee:

    Well, I don’t know if people are too stupid, but they are certainly too uninformed and WAY too gullible. It’s the way politics works these days. Any politician can say just about any ridiculous thing and be believed so long as what he/she says is simple, intuitive, and completely false.

  14. I’m not sure I understand, Alan – explain to me how being better informed is not a good thing? Has anyone here claimed that most people are incapable of understanding complex ideas? I thought the point of the original post, and most of the comments, was that as long as a decision-making process is hidden and information is kept secret (or misinformation is widespread), the majority of people affected by that decision are powerless to influence the outcome.

    Apathy, or even despair, caused by disillusionment and frustration is very different from purposeful ignorance or outright stupidity.

  15. i’m not too keen on the idea of secret meetings, but i’m going to continue to assume until i hear further that there will in fact be plenty of public debate on this.

    the screaming can start when they refuse to say who was in those meetings or release the records.