On the campaign trail last year, President Obama laid out several specific promises for health care -- both during the Democratic primaries and during the general election campaign. And in his first year in office, President Obama has made comprehensive health care reform the centerpiece of his domestic agenda.
But what happened to those promises?
To his credit, Mr. Obama has come closer to achieving many of those promises than many may have expected him to. For instance, the Congress is well on its way to facilitating health care coverage for nearly all Americans, providing subsidies for people who cannot afford insurance, implementing consumer protections, boosting federal funding for prevention and wellness programs, giving tax credits to small businesses that provide their employees with health coverage and implementing health information technology systems.
However, even though there is plenty of work left for Congress before it can put a health care bill on Mr. Obama's desk the bills in development indicate that some of Mr. Obama's promises may be long gone. Here is a look at five of Mr. Obama's health care campaign promises that are unlikely to come to fruition.
1. No Individual Mandate
During the 2008 Democratic primary, Mr. Obama and then-Sen. Hillary Clinton both shared the goal of health care reform. By Mr. Obama's own admission, the biggest difference between the two candidates was that Clinton supported a mandate for all Americans to acquire health care.
"Now, under any mandate, you are going to have problems with people who don't end up having health coverage," Mr. Obama said during a debate with Clinton on Jan. 31, 2008. "I think we can anticipate that there would also be people potentially who are not covered and are actually hurt if they have a mandate imposed on them."
Under the leadership of the late-Sen. Ted Kennedy (D-Mass.), however, Congress wrote bills that called for an individual mandate. In June, the president indicated in a letter to Kennedy and Sen. Max Baucus (D-Mont.) that he was changing his tune to accommodate their legislation.
"I understand the committees are moving towards a principle of shared responsibility -- making every American responsible for having health insurance coverage," he wrote. "I share the goal of ending lapses and gaps in coverage that make us less healthy and drive up everyone's costs, and I am open to your ideas on shared responsibility."
The president now fully supports an individual mandate.
"The only way this plan works is if everybody fulfills their responsibility," he said at a rally Thursday.
2. Complete Transparency
Candidate Obama promised that health care deliberations with Congress and special interests would be transparent to the extreme.
"That's what I will do in bringing all parties together, not negotiating behind closed doors, but bringing all parties together, and broadcasting those negotiations on C-SPAN so that the American people can see what the choices are," Mr. Obama said during his Jan. 31, 2008 debate with Clinton. "Because part of what we have to do is enlist the American people in this process. And overcoming the special interests and the lobbyists who -- Senator Clinton is right. They will resist anything that we try to do."
The president, members of Congress from both parties and special interest groups have indeed all participated in negotiations, but those conversations have not been broadcast. Instead, the president has announced deals with groups like the pharmaceutical industry and the insurance industry after they were worked out in backroom deals.
Meanwhile, Baucus, one of the most influential senators in the health care debate, not only shut out the public but shut out most of his own committee from his "bipartisan negotiations."
"We spent virtually an entire year with most of the Finance Committee being excluded," Sen. Jay Rockefeller (D-W.V.) reportedly said after Baucus released his health care bill. "You don't run a committee that way."
3. Enable the Government to Directly Negotiate Drug Prices
In the Jan. 31, 2008 debate, Mr. Obama said, "If a drug company -- if the drug companies or a member of Congress who's carrying water for the drug companies wants to argue that we should not negotiate for the cheapest available price on drugs, then I want them to make that argument in front of the American people."
"We'll negotiate with the drug companies for the cheapest available price on drugs," Mr. Obama said again in an Oct. 15, 2008 debate with Sen. John McCain (R-Ariz.).
It turns out, however, Mr. Obama reneged on this promise in a secretive way. In July the president praised the drug industry for its agreement to reduce its revenues by $80 billion over 10 years by discounting the cost of medicines for some seniors. After Congress sought to extract further funds from the pharmaceutical industry, however, it was revealed that the White House made some previously undisclosed deals to get the industry to stay at the negotiating table.
"The White House had tracked the negotiations throughout, assenting to decisions to move away from ideas like the government negotiation of prices or the importation of cheaper drugs from Canada," the New York Times reported.
4. Allow Drug Importation
During the campaign, Mr. Obama said his plan (PDF) would "Allow consumers to import safe drugs from other countries" because "some companies are exploiting Americans by dramatically overcharging U.S. consumers."
As noted above, the Obama administration secretly conceded to forgo the importation of cheaper drugs in its deal with the pharmaceutical industry.