Reform Can Be Pretty In Retrospect, but Ugly in the Making

President Lyndon Baines Johnson signs Medicare into law on July 30, 1965 as former President Harry Truman looks on. The bill signing took place in Independence, Mo.

Watching health care reform wend through Congress never is pretty.

Deals are cut behind closed doors. Leading politicians, anxiously eyeing the polls, change sides at the last moment. Unprecedented amounts of money are spent to influence the voting.

And to what end? Medicare, for one.

It took five years, an electoral landslide and a last-minute change of heart by U.S. Rep. Wilbur Mills, D-Ark., chairman of the House Ways and Means Committee, to secure its passage.

It also took a lot of back-room arm twisting. The American Medical Association, which strongly opposed Medicare, set aside $3.5 million in 1964 — the equivalent of $24.4 million today — to fight it.

Today, the stakes are higher: health insurance for about 94 percent of all Americans. Medicare supporters didn't think that could be achieved in 1965.

Opponents' war chests are larger now than they were 45 years ago, too.

Nearly 2,300 health industry groups are registered to lobby Congress. Health care professionals, including doctors, gave $95 million to candidates for federal office in 2008. They've since contributed another $22.3 million, according to the nonpartisan Center for Responsive Politics.

Reform opponents lately have been complaining about a lack of transparency. They've seized on President Barack Obama's promise to conduct health care negotiations in front of C-SPAN cameras. That will not happen. Congressional Democrats are meeting behind closed doors for "informal hearings" in which the bill's final language is being negotiated.

As a matter of policy, the president was correct — if, perhaps, a bit naive.

He's wrong not to do everything in his power to fulfill his promise.

As a practical matter, however, it's difficult to see how televised negotiations would work or avoid prolonging the process. They certainly wouldn't prevent deals from being cut any more than they do during regular Congressional sessions.

Instead, they would more likely become a platform for grandstanding by both supporters and opponents of reform.

They also would provide the last, best chance for opponents to delay and kill health care reform, just as Medicare opponents killed an early version of the bill in 1964.

Mr. Obama's change of heart is disappointing. But Republican opponents' sudden and convenient embrace of government transparency is downright comical.

Their 11th-hour conversion is perhaps best illustrated by the last major health care reform approved by Congress: the Medicare prescription drug benefit. It was approved in 2003, when Republicans controlled both Congress and the White House.

The bill squeaked through the House on a rare 3 a.m. vote that was extended so supporters could strong-arm enough votes to win passage.

Afterward, some House Republicans complained that much of the bill's language was written by pharmaceutical industry lobbyists.

Medicare's chief actuary later testified that he feared for his job after being threatened by White House officials. They warned him not to release his estimate that the bill's true cost would exceed what its supporters predicted.

Excesses of the Bush administration and Republican-controlled Congress, like those of the Johnson administration and its Democrat-controlled Congress, provide context to the current debate.

However, they don't excuse Mr. Obama from breaking his promises.

Like sausage-making, politics can be stomach-churning to witness. But in the end, both are judged by the product produced, not the process that bore it.

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