Biden Says He’ll Pass a Public Option. His For-Profit Health Industry Donors Don’t Want Him To.

Joe Biden says he plans to deal with the US health care crisis by passing a public health insurance option. But his campaign is being funded by the same health companies that killed it when he was vice president. Something has to give — and it probably won't be the corporate donors.

Former Vice President Joe Biden puts on a mask after speaking during an event about affordable health care in Lancaster, Pennsylvania. (Photo by Joshua Roberts / Getty Images)

If you’ve spent sleepless nights tossing and turning, asking yourself, “Is the United States really an oligarchy?” — a Joe Biden presidency might help to settle it once and for all.

The basic finding of a 2014 Princeton study that reached that conclusion was this: If the country’s economic elites and organized interests support a policy, it has about a 45 percent chance of becoming law. If they oppose it, even if it is backed by the middle-class and poor (i.e. the vast majority of the country), those odds drop to 18 percent. This certainly suggests a political establishment dependent on corporate interests, with little hope of enacting any major reforms that challenge those interests. But a Biden presidency would perhaps be the final word on the subject.

From its beginning to now, Biden’s campaign more than any other has relied on the largesse of pharmaceuticals, health insurers, and other parts of the broken US for-profit health care industry. Even his campaign chairman is a former pharmaceutical lobbyist.

At the same time, Biden’s policy on health care — still the number one issue keeping Americans up at night, particularly with tens of millions losing their employer coverage — is centered on a public health insurance option, which he briefly mentioned in an address on health care last month. The public option, while inferior to Medicare for All, is nevertheless popular with most of the US public, which in theory should make its passage likely.

The problem is that the corporate interests lavishing money on Biden’s campaign are also the same ones that killed the public option in 2009–10, when he was vice president. The health care industry was investing in Biden to stand as a bulwark against Medicare for All; it’s reasonable to wonder whether they’re also betting that he won’t follow through on the public option.

Judging from the last time Biden was anywhere near the White House, they’d have good reason to. The first year of Obama’s presidency was a masterclass in how corporate interests can capture and ultimately smooth down genuine reformist impulses.

As Lee Fang documented at the time, the industries now bankrolling Biden launched a two-pronged campaign against the administration’s attempt to pass a public option: they supported a vague notion of “reform” publicly while bankrolling front groups and right-wing media talking points on the sly to attack the idea.

It was America’s Health Insurance Plans (AHIP), the health insurers’ lobby, which distributed anti-public option talking points to local insurance offices, charging that it would undermine quality of care, limit patients’ choices, and “dismantle employer-based coverage”— the same talking points Biden and the industry’s other favorite marionette, Pete Buttigieg, repurposed to attack Medicare for All during this year’s primary.

It was all an extension of a campaign AHIP had launched against Michael Moore two years earlier, aimed at “disqualify[ing] government-run health care as a politically viable solution.” It’s easy to see why: as Biden himself recently put it, forcing health insurers to compete with a government plan that doesn’t aim to turn a profit means they could, in theory, be forced “to keep premiums low, offer better coverage” — neither of which are conducive to maintaining health insurers’ billions of dollars of annual profits.

One only needs to look at the dollar amounts the industry was throwing around at the time to understand just how much they felt threatened by a public option. In the first half of 2009 alone, the industry spent a grand total of $378 million on lobbyists, television ads, and political donations. By November of that year, the total overall spending by both opponents and supporters was more than $600 million.

The industry gave big to members of Congress who were key to hobbling the public option. Connecticut’s Joe Lieberman, a longtime friend to health insurers, successfully held Obama’s reform effort ransom with a filibuster threat, leading the then-president to order Senate Democrats to appease him by removing the public option from their legislation. Finance committee chairman Max Baucus, the senator put in charge of shepherding the reform effort despite his long and chummy relationship with the for-profit health sector, got its single biggest donation ($1.5 million). He, too, was a loyal opponent of the public option.

Such contributions weren’t just about buying anti-public option sentiment, but co-opting the entire reform effort. After years of favoring Republicans, the pharmaceutical industry suddenly began giving more to Democrats, with Obama raking in the most pharma dollars of any candidate in the 2008 cycle, and nearly three times the amount his Republican opponent took from the health care industry as a whole.

As a result of this full-court press, Obama gave the pharmaceutical and health insurance companies a leading role in shaping his reform of their own sector. That didn’t just mean killing off a public option, but blocking a host of other provisions, such as letting the government negotiate Medicare drug prices and drug reimportation. But maybe most outrageous was the “individual mandate,” which let the government force people to buy private insurance. It’s no wonder Steffie Woolhandler of Harvard Medical declared the law “a total victory for the health insurance industry.”

Biden will now be waging exactly the same fight all over again, except with several disadvantages: he likely won’t have Obama’s Senate supermajority, or his personal charisma, popularity, and the grass-roots movement that helped sweep him to power; and unlike Obama’s mandate for change, Biden’s only mandate as of right now is to not be Donald Trump.

But forget for the moment even the Herculean effort that will be required to overcome the institutional and political obstacles for getting a public option passed. Biden’s challenge will be far more elemental: to take colossal amounts of money from a set of industries that view his flagship policy as a near-existential threat, then enact that policy.

It’s certainly possible that Biden will happily take their money, then turn around and betray them. But that would be an exceptional event in today’s money-infused political system, particularly when Obama, after taking record amounts from Wall Street and health care during his election campaign, reciprocated by letting those industries shape his administration’s policies regulating them. Is the United States an oligarchy? Perhaps President Biden will give us the definitive answer.