As public pitchman, President Barack Obama accuses special interests of fighting to block his health care overhaul. "They run their ads. And let's face it, they scare people," he told one weekend audience.
Yet Obama has spent months assembling a formidable lineup of special interests of his own, an essential element of a plan to remake the health care system and succeed where President Bill Clinton memorably failed.
"We have the American Nurses Association, we have the American Medical Association on board," Obama told the weekend crowd in Grand Junction, Colo. "We have an agreement from drug companies to make prescription drugs more affordable for seniors. ... The AARP supports this policy."
In the parlance of Washington, the organizations on both sides are special interests — the insurance industry and business groups strongly opposed to the direction health care legislation is taking in Congress, as well as the groups of doctors, nurses, drug makers and labor unions working to pass an overhaul despite any misgivings they may have.
Part of the permanent landscape in the capital, they all lobby Congress and federal agencies on the issues they care most about. Many purchase political ads in campaign season or try to turn out their own memberships to vote for preferred candidates. They have enormous sums at stakes in the outcome of the struggle over Obama's proposed remaking of the health care system.
Take just two:
- America's Health Insurance Plans has emerged as a leading opponent of the portion of Obama's plan that calls for the government to sell insurance in competition with private companies.
- The Pharmaceutical Research and Manufacturers Association is unhappy about the same provision but has pledged to spend a staggering $150 million on television commercials in support of the administration's quest for legislation.
What's the difference?
"They're stakeholders when they're with you, and they're interest groups when they're against you," Mary Matalin, a Republican, said recently, a tongue-in-cheek explanation that hints at the unappealing aroma associated with the label "special interests."
White House spokesman Robert Gibbs seemed to understand as much when he said the administration is benefiting from the help of "interest groups," avoiding the more unsavory term "special interests."
"It'd be sort of odd to go to a town hall meeting and rail against interest groups that are supporting reform ... who have acknowledged that it's time for health care reform," he said. The president's criticism is aimed at "interest groups that are aligned to keep the status quo either because it benefits them or they have a vested interest."
Far more than semantics is involved.
Eager to succeed where Clinton failed, Obama nailed down agreements with deep-pocketed drug makers and others. The effect was not only to secure allies who could pay for grass-roots and advertising campaigns but also to drive a wedge between Republicans and organizations that have supported them in the past.
Despite the obvious turbulence surrounding Obama's proposals, there is evidence the strategy is working. GOP discomfort was obvious when Rep. John Boehner, the House Republican leader, accused the drug industry of trying to protect its own profits by "cutting a deal with the bully" on health care.
It marked a turnabout from the days when congressional Republicans received two-thirds of the political contributions handed out by the pharmaceutical industry.
Ken Johnson, a senior vice president at PhRMA, sought the high ground in response. "We have been working diligently for more than a year to advance bipartisan health care reform. We're proud of those efforts, and they are completely consistent with our core principles."
The drug makers went first in making a deal with the White House, agreeing to pick up $80 billion in additional costs over the next decade to help defray the expenses of the legislation.
The American Hospital Association agreed to shoulder an additional $155 billion.
In exchange, both won assurances the White House would protect them against attempts in Congress to seek additional cuts in their projected Medicare and Medicaid payments.
The American Medical Association's key issue was different. Doctors hope the legislation will allow them to avoid a looming 21 percent cut in payments under Medicare. The cost to the government for that would be about $230 billion over a decade.
Obama also agreed to require individuals to purchase insurance, reversing a position he held during his campaign. "My thinking on the issue of mandates has evolved. And I think that that is typical of most people who study this problem deeper," he said.
It was a bow to the special interests — some now with Obama, others not — that suddenly opened up the possibility of millions of new customers with insurance to help pay for their health care.