The Messy Business of Transparency

President Obama’s latest plan for health reform brought a flurry of commentary in the last two days; including divergent views on whether his commitment to "transparency" is helping or hurting the process.

Yesterday, the Los Angeles Times blamed the current “healthcare backlash” on Obama’s insistence that the messy business of hashing out health reform be done in Congress, not behind closed doors in the Oval Office. In the L.A. Times’ view, there’s been too much transparency:

“By leaving the overhaul in the hands of Congress, [Obama] has given the public a full view of how lawmakers do business. The result is an anti-Washington mood that Republicans have tapped into.”

Meanwhile, the House GOP leader John Boehner, calls the Obama plan—introduced yesterday on the eve of the “bipartisan” health summit—a “Democrats-only backroom deal” that “doubles down on the same failed approach that will drive up premiums, destroy jobs, raise taxes, and slash Medicare benefits.” In the Republican’s view of things, there’s been too little transparency in the health reform process.

So which is it: Back-room dealing or a too-public view of the dirty business of lawmaking?


At the very beginning of the health reform process, the Obama administration made a conscious decision not to repeat the mistakes that doomed Bill and Hillary Clinton’s plan for universal coverage in 1993. The consensus was that the Clinton plan ultimately failed because the bulk of the planning went on behind closed doors—Congress and the American people felt locked out and were blindsided by the cost of the proposal. 

“With a task force that operated largely in secret, the first lady drew up a detailed and complicated plan that met with fierce opposition by the health care industry and Republicans before it ultimately sank of its own weight in a Democratic Congress,” writes Peter Baker in the New York Times.

“Mr. Obama is approaching the issue in a different way. Rather than developing his own detailed proposal, he is setting out broad principles and letting lawmakers draft the specifics of a plan that they believe can pass.”

The wisdom of this approach—sanctioned by none other than Bill Clinton—will likely be debated for years to come; depending on whether or not comprehensive reform passes in the near future. Some argue that Obama should have taken control of health reform earlier, before debate over policy details had time to escalate into the current yawning partisan divide. Instead, the public got a first-hand look at the posturing, deal-making, seamy compromising and one-upmanship that is entrenched in the policy-making process.

As a relative political neophyte, I can relate to the public’s dismay over this entire health care reform process. I watched with disappointment as the progressive goals for health care reform got whittled away to gain support for legislation: deals were made with pharmaceutical companies, hospitals, providers and finally, insurers. As media coverage of town hall meetings grew into a summer of discontent, we witnessed Congress wrestling with—and ultimately sacrificing—the public option. We watched while the entire reform process got hijacked by the abortion debate and wild claims by some Conservatives that the government was going to establish “death panels” and gut Medicare. These have been painful days for everyone who has been committed to universal health coverage.

Painful, but I would argue, ultimately insightful. The push to pass health reform in the House and Senate has become an important civics lesson—played out as theater for the masses. The visceral response that the national audience had to Nebraska’s “Cornhusker Kickback” and other deals designed to secure the votes of holdouts like Sens. Ben Nelson, Joe Leiberman and Louisiana’s Mary Landrieu leads one to wonder if most Americans have ever witnessed the Congressional legislative process before. I’d argue that this outrage is an unplanned, but natural, goal of transparency.

Timothy Jost, writes in Politico that ultimately, that outrage over “backroom dealings,” fanned by disingenuous attacks from Republicans, becomes a calculated distraction to the legislative process. The goals of health reform—even with all the compromises designed to build consensus—remain the same: expanding health coverage to more Americans, slowing the growth of costs, and improving the quality of care.

“[W]hy is the health reform debate held up to standards of transparency not imposed on other, equally important pieces of legislation? Hours of health care debate were broadcast on C-SPAN for the dozen or so Americans who were watching. Some of the negotiations were not broadcast, but why demand of the health reform bill a level of transparency not required of any other legislation? Does anyone know what is in the most recent farm bill, which costs two-thirds as much as the health reform legislation will?

“The Republicans were never shy about backroom deals when they controlled Congress,” Jost continues, “Virtually all Democrats, as well as the public, were excluded from the deal making that resulted in the 2003 Medicare Modernization Act.”

Obama’s approach to health reform—crafting it on the open stage where we could watch the ugly posturing and deal making—is a painful, frustrating process. But maybe we will wrestle a lesson or two out of this spectacle. The net result of the public’s anger over “backroom deals” (and the loss of a Senate seat in Massachusetts) has been contrition from the administration, and a revised plan that attempts to remove the most pilloried give-aways: Gone is the Nebraska compromise and the Louisiana purchase, for example—replaced by a much fairer commitment by the federal government to provide 100% financing for all states’ Medicaid expansions for four years and significant support thereafter.

The upcoming health care summit is designed with transparency in mind; after all it will be a public, nationally-aired event. Republicans have been complaining all week that it’s a trap, a set-up by Obama to portray their party as one of obstructionists. They charge that the real goal of the summit is to rally listless Democrats, getting them primed to push health reform through the budget reconciliation process. That may be true, but Republicans have yet to present any alternative plan of their own at this summit beyond the usual commitment to market-driven, incremental changes that maintain the status quo.

It’s anyone’s guess if this media event will help end the stalemate over health reform—or if anyone outside the wonk crowd will even watch it after the first few minutes. Will it be thrilling political theater or like watching paint dry on the backdrop? In the best case scenario, this summit will help educate and convince more voters—those 6 in 10 Americans who in a recent Kaiser poll say that they support key provisions of health reform—to throw their weight behind Obama’s plan. At worst, the summit could end up being another messy, highly partisan slug-fest that changes nothing. But then, that’s the risk you run with being transparent.

14 thoughts on “The Messy Business of Transparency

  1. “Laws, like sausages, cease to inspire respect in proportion as we know how they are made.”

  2. I suppose transparency is welcome, if not overdone, but I can’t help recall the remark I heard recently about the danger of emphasizing every unsavory detail of deal-making –
    “Legislation should be hidden behind a veil of secrecy for the same reason middle-aged people should wear clothes”.

  3. as someone who espouses transparency as a secular faith, I think this misses the point. no bill has ever failed because of opaque process. negotiations are inevitably tentative and deserve protection, but deals, as those Obama made with providers and Reid made with senators, must be disclosed. People are very wary of change. that was Clinton’s problem and it is the problem today. venue and process won’t make much difference in addressing their concerns.

  4. I haven’t seen any mention of it yet, but the president has a constitutional cudgel so far not touched or mentioned: the presidential veto.
    If he is serious about coming up with a real bipartisan compromise tomorrow he will have to whip a few people into line in his own party. This may be fantasy on my part but it is not a stretch. Should he need it, simply mentioning that weapon will be enough to keep arguments from Democrats in check.
    There is nothing constitutional about the filibuster. Both houses of Congress are constitutionally free to set their own rules. But the presidential veto is a matter of law as I’m sure a former constitutional law professor knows well.
    Tomorrow we may see what the president is made of. There’s an old saying about not getting into a fight with anyone who buys ink by the barrel. Actors know how hard it is to compete with animals and children. And since American Idol everyone knows it’s tough to become a rock star. Obama’s politics may be in the toilet but he still has ink, kids and glamor.
    Boehner was partly right, but this is not a “trap” as much as an ambush. I’m getting a little excited.

  5. At any country politicians are never shy about back room deals!And this is black spot of our country!The Republicans or Congress all are at the same stage.

  6. I apologize for the off-subject question, but I wonder if anybody here has an answer: Suppose the House and Senate Democratic leaders agree to a compromise comprehensive bill, somehow manage to get it past the Senate parlamentarian, who says it can be approved via reconciliation. Presumably this new Senate bill is an amended version of the previously Senate-passed bill. Now suppose the new bill fails to pass the Senate even with 51 votes(or alternatively it simply fails by not getting sixty without the parliamentary maneuvers). Having failed at that, now the House leaders decide they will settle for the original Senate bill, already passed with sixty votes. Is that bill still a legal candidate for consideration by the House, or has its passage by the Senate been cancelled by the failure of an amended version? Admittedly, this is politically a very unlikely scenario, but is it legally possible?

  7. Of course, there has been backroom dealings on HCR. This is always the case, and probably has to be if anything is to get done. It’s interesting that those who claim the administration has been transparent are those who support it. Those who argue it has been opaque, oppose the current versions of HCR. I have very low expectations for this morning’s ‘summit meeting’, and I suspect that most of the country does as well.

  8. “Transparency” was Obama’s campaign promise. It was not injected into the health debate by the Republicans ex nihilo. His word, his standard.
    And the deals did not become public because of transparency. They became public because they were written into the legislation, which was disclosed at the last possible moment.

  9. As much as I wanted to, I couldnt watch the debate. I’m bummed, but maybe I accidentally avoided heartache.
    I have said this before, but the truth I think is that we have to fix Washington before they can fix healthcare.
    PS to Richard K – they make the laws, of course it would be “legal”

  10. Ed,
    Thanks, perhaps that should have been obvious. So I guess what you are saying is that assuming the Senate-passed bill was not written with a time limit on how long the House has to pass it, it is irreversably eligible for House passage and Presidential signature, regardless of whether a conference committee version, the “Obama” version or some other version is rejected in the interim. I should have said “constitutional” instead of “legal,” I suppose.

  11. Transparency = more red tape. There’s way too much going on to follow, and the way Americans get their “news” these days is filtered through others, so how can we be sure the transparency we’re seeing is actually true?

  12. Well I spoke too soon below. I did get to watch much of the debate. I think it was simply political theater.
    Richard, what is “constitutional” is in the eye of the beholder, and since the govt makes (and enforces) the laws, it doesnt matter; what they say goes.

  13. It was remarkable to see these folks around a table all of whom have Federal health insurance with mandated minimum standards. Many of those folks, if not all of them would find it difficult or next to impossible to buy them on the open market for any premium amount.

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