Let's Learn From Gruber’s ‘Stupid’ Remarks On Health Care


We can learn a lot from the public-relations drubbing that Republicans are inflicting on Jonathan Gruber. He is the recently humbled MIT economist who has been a much-cited expert on the Obama administration’s health care plan.

Close attention to the scandal teaches how the Affordable Care Act (ACA), aka "Obamacare," was passed in part by faux-populist corporate technocrats who operated with an "ends justifies the means" mentality that's counter-productive when exposed.

Jonathan Gruber MITPart of their problem has been near-demonic opposition by GOP opponents of expanded health care and thereby save lives. But a big part also has been the phony PR campaign of which Gruber was a part to sell the plan.

Gruber, shown in a photo from his faculty website at the Massachusetts Institute of Technology (MIT), apparently made millions of dollars little known to the general public -- a group he has described with disdain.

More important, his secrets remind us how President Obama's major domestic achievement was shaped right from the beginning by technocrats who relied heavily on public relations strategies to outwit not simply Republicans but also progressives advocating universal health care that could have used a lower cost "public option" method of delivery like Medicare or systems used in other nations.

Right now, Republicans are gloating over what they call "Gruber-gate." Democrats are playing defense for a program that sought to extend coverage to an estimated 36 million Americans who could not afford health care.

There exists another and largely un-reported perspective these days worth remembering. The Obama White House secretly sabotaged from the beginning simpler, cheaper and more progressive alternatives to its complicated ACA, which was cobbled together to appease important special interests. Thus, Gruber and his arrogant behavior were just small parts of a larger PR spin machine.    

Earlier this month, a GOP-led House committee attacked Gruber for his recently revealed statements to lecture audiences.

Most disturbing, the professor confided to fellow technocrats during a 2013 conference at the University of Pennsylvania that ACA's passage required “the stupidity of the American voter.”

The conservative advocacy group American Commitment last month revealed the tapes showing Gruber making the disparaging comments as he described the narrow congressional passage of the ACA in 2010. The video clip shows Gruber saying “lack of transparency is a huge political advantage.” Gruber added that “the stupidity of the American voter . . . was really critical for the [ACA] to pass.”

Gruber issued many apologies at a House hearing Dec. 9 by the House Government Operations Committee.

Setting the stage for future brow-beating in the next Congress, outgoing Committee Chairman Darrell Issa (R-CA), right, demanded that Gruber cough up his financial records so the Darrell Issapublic could learn how much he has made in grants. Such funding, ostensibly awarded on a merit basis, can serve also as a control/reward system for academics and their institutions.

During the run-up to ACA passage in 2010, the Obama administration urged news outlets to quote Gruber because he was a supposedly independent expert who had calculated why ACA would meet its financial and other performance goals, including estimates reviewed by the influential Congressional Budget Office.

Far from being independent, Gruber was in the process of making at least $392,000 from two "sole-source" U.S. Department of Health and Human Services (HHS) grants, according to a 2010 report by progressive blogger Marcy Wheeler of FireDogLake. 

When the scandal broke last month about Gruber’s arrogant comments to fellow economists, President Obama downplayed Gruber’s role in the health care field. In a brief remark Nov. 16 during a trip to Australia, the president called Gruber, “some adviser who never worked on our staff.”

However, extensive background exists showing that the president knew and admired Gruber, whom he cited in an April 2006 speech before the Hamilton Project, a prestigious start-up think tank under the wing of the Brookings Institution.

Republicans have gone overboard also. Several, including Issa, have called Gruber an "architect" of Obamacare. But that description exaggerates Gruber's role, as Factcheck.com reported in The ACA-Gruber Connection. The true architects were White House staff along with a few major lobbyists and Senators with their staffers, many of whom have profited handsomely from their roles.

The Big Picture

In the spring of 2009 during Obama's first months in office, his team secretly reached a deal with pharmaceutical manufacturers by which the administration would secretly undertake what the Huffington Post would later headline as, Internal Memo Confirms Big Giveaways In White House Deal With Big Pharma.

Additionally, the administration and its allies among corporate-friendly Democrats repeatedly undercut inclusion of "public" or "single-payer" options in the health care. International data consistently shows that all other Western nations deliver health care via systems costing just a third or at most a half of U.S. costs with no significant difference in care quality, according to numerous surveys, including by the multi-nation OECD. The international systems also provide universal coverage that even the ACA does not.

Yet the progressive alternatives have relatively little institutional support in United States business, media and political circles, in part because of fears it might hurt insurance, hospital, doctor, and pharmaceutical profits, as I reported during my coverage for the Huffington Post and OpEdNews of the proposed health reform law.

One column in 2009 -- Will An Oct. 27 DC Hearing Make History For Health Rights? -- generated videos of patients facing death because they could no longer afford their insurance or co-pays.  It featured also physicians urging a public option, and a 1960s civil rights icon urging that basic health care should be a fundamental human right, as in most of the industrialized world.

By the spring, however, I was writing Fans of House Health Option Cite Rights, Hopes, But Risk Big Defeat, which reported a senior health policy aide saying, "We’re not seeing enough political muscle to sustain a strong public option right now, and we might not get anything at all.”

Just as Obamacare was being pushed through Congress, former Vermont Gov. Howard Dean, well-known as a medical doctor before his time in politics, gave a rah-rah speech to progressives convened for an informal briefing in the House Judiciary Committee conference room.

Dean, who has worked as Democratic National chairman and as an advisor to a Washington lobbying firm after campaigning for the 2004 Democratic presidential nomination, told progressives that ACA was a great first step in universal health care, and that once any problems became apparent the public would urge Democrats to lead the way in fixing them and making it better.

Just after Dean breezed out of the conference room, I asked Judiciary Committee Chairman John Conyers (D-MI), a longtime advocate of single-payer plans, why anyone would trust Democrats to fix a much-hyped but flawed Obamacare program.

"Ask him," said Conyers, smiling slightly and pointing at the door through which Dean had left.

At the time, the public was not getting the full story. Congressional hearings, White House comments, and news coverage were almost totally dominated by the special interests. Few focused on lower-cost systems used in all other advanced industrial nations, much less on the plight of those sick and dying because they had no coverage or had exceeded their insurance caps. 

Amid the needless complexities of the ACA, President Obama signed the more general Plain Writing Act of 2010, which requires that federal agencies use "clear Government communication that the public can understand and use." 

Here and Now

Jerry PolicoffThese days, a progressive overview of Gruber-gate comes from Jerry Policoff, right, a senior editor at OpEdNews and a longtime advocate for single-payer health care, particularly in his home state of Pennsylvania.

“Gruber played a huge part in the creation and marketing of Obamacare while holding down an HHS contract that put hundreds of thousands of dollars in his pocket,” Policoff wrote me. “This created something of a scandal when Firedoglake revealed it. Back then all of the Obama people were defending Gruber. Now they say ‘Jonathan who?’”

Gruber has been a cog in the corporate cronyism that spreads from Washington to the rest of the country. While most attention has belatedly focused on his HHS grants awarded "sole-source" -- that is, with only him eligible for receipt -- that is only part of his income from such work.

In Did Jonathan Gruber earn ‘almost $400,000′ from the Obama administration? Washington Post fact-checker Glenn Kessler reported that Gruber has won at least eight state contracts likely averaging over $400,000 apiece based on the information available from four of them. Kessler reported that the dollar amounts could not be found for four of the contracts. "Gruber has also earned more than $2 million over the last seven years," Kessler wrote, "for an ongoing contract with HHS to assess choices made by the elderly in Medicare’s prescription-drug plan."

This largely hidden income from public sources was doubtless a factor -- along with partisan politics, of course -- in Congressman Issa's demand that Gruber stop stonewalling on the amounts.

As for the ACA, Policoff says:

I am planning to write a piece laying bare the premise that Obamacare is a success and is generally popular among people who understand it. It is not affordable in most cases, it is not even close to universal, and many people who have interacted with it are not at all pleased. It was basically a gift to the pharmaceutical industry and the insurance industry, as well as to the big hospital cartels.

"Gruber’s sin," Policoff concludes, "is that, in a weak honest moment, he admitted that Obamacare was sold with smoke and mirrors because the public never would have bought into it if they understood it. It remains unpopular not because it is being unfairly vilified, but rather because large swaths of the public have come to realize how bad it really is."


Barack Obama and Kathleen Sibelius with recipients Oct. 13, 2013

President Obama and HHS Secretary Kathleen Sebelius listen as Affordable Care Act enrollees told their stories in the Oval Office on Oct. 1, 2013.

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Related News Coverage

Jonathan Gruber and Health Care

FactCheck.org / Annenberg Public Policy Center, The ACA-Gruber Connection, Lori Robertson, Nov. 21, 2014. President Obama and Rep. Nancy Pelosi, shown in a photo, downplayed the contribution of MIT economist Jonathan Gruber to the Nancy Pelosi Affordable Care Act, after controversial comments by Gruber came to light, while Republicans exaggerated his role. We find both sides are stretching the facts. Pelosi, in a blog post, said the White House “sometimes consulted” with Gruber, who “testified at one Senate hearing.” He actually testified at three. Obama called him “some adviser who never worked on our staff.” Sure, he wasn’t on the White House staff, but he was a paid consultant on health care, earning hundreds of thousands of dollars over the course of a year. Meanwhile, conservatives, including Rep. Bill Cassidy of Louisiana, have overstated Gruber’s role, claiming he was “the architect” of the law. Those who worked closely on the law say he ran economic models to determine the outcome of certain proposals.

Washington Post, Issa subpoenas MIT economist Jonathan Gruber for Obamacare documents, Josh Hicks, Dec. 12, 2014.The MIT economist declined at a hearing this week to answer questions about how much the Obama administration paid him for work on Obamacare. Economist Jonathan Gruber apologized before a congressional panel this week for controversial comments he made about the political process behind the Affordable Care Act, but he declined to say how much the Obama administration paid him for consulting work on the health-care law. Rep. Darrell Issa (R-Calif.) isn’t letting him off the hook. As one of his final acts as chairman of the powerful House Oversight and Government Reform Committee, he issued a subpoena Thursday demanding that Gruber hand over all documents and communications with government officials related to his work on the health-care law. “As one of the architects of Obamacare, Jonathan Gruber is a unique position to shed light on the ‘lack of transparency’ surrounding the passage of the president’s health-care law,” Issa said in a statement Friday. “The American people deserve not just an apology, but a full accounting, which Mr. Gruber must provide.”

WMEX-AM (Boston), Happy New Year, Jonathan Gruber! Howie Carr, Dec. 26, 2014. I have a premonition – 2015 is not going to be a Happy New Year for crackpot MIT professor Jonathan Gruber. This is the Harvard Ph.D. who bragged in front of cameras about destroying the American health-care system, and for his dirty work was paid by some estimates as much as $5.2 million. That kind of dough buys a lot of protection in the corrupt, narcissistic circles Goober travels in. MassLive, Howie Carr ends run at WRKO, relaunches show in Boston on 1510 WMEX, Garrett Quinn, Nov. 17, 2014. Longtime Howie Carr listeners had to adjust their radio settings on Monday as their favorite yakker is on a different Boston station for the first time in decades when he appears on 1510 WMEX instead of 680 WRKO.

WMEX/Howie Carr Show, Gruber continues to stonewall Vermont state auditor, Howie Carr,  Dec. 29, 2014. Vermont State Auditor Doug Hoffer says Gov. Peter Shumlin’s administration has asked Professor Jonathan Gruber to provide the names, employment status, and contact information of the research assistants for whose work Gruber was personally paid $80,000 by the state of Vermont.

AP via Washington Post, Obama health adviser apologizes for 'glib' remarks, Ricardo Alonso-Zaldivar of AP, Dec. 9, 2014. MIT economist Jonathan Gruber -- an often-quoted adviser on the president's health care law -- told Congress on Tuesday he was glib and "inexcusably arrogant" when he said it was "the stupidity of the American voter" that led to the law's passage. Democrats tried to limit the damage as Republicans raked Gruber at a four-hour hearing, but acknowledged he gave the GOP a political gift "wrapped in a bow."

Washington Post, The Jonathan Gruber hearing was a zany coda to Darrell Issa’s tumultuous tenure, Dana Milbank, Dec. 9, 2014. A gaffe, under the oft-cited Michael Kinsley rule, is when somebody in Washington accidentally speaks the truth. But what happens when frankness leads you to say something so monumentally stupid — the verbal equivalent of a pratfall, a face-plant into a mud pit — that “gaffe” doesn’t cover it? In that case, you have Grubered yourself.

Washington Post, Did Jonathan Gruber earn ‘almost $400,000′ from the Obama administration? Glenn Kessler, Nov. 14, 2014. Republicans are demanding hearings into videos that have emerged in recent days of MIT professor Jonathan GruberJonathan Gruber making impolitic remarks about the Affordable Care Act. Why should Gruber’s comments matter? Because Gruber is well-known in health-care circles as one of the intellectual godfathers of Obamacare and the very similar law in Massachusetts (sometimes called Romneycare), though people involved in ACA deny he was “an architect” of the ACA. (House Democratic Leader Nancy Pelosi (Calif.) claimed she did not know who he is, even though she once had touted his work.) In 2009, just one month after President Obama took office, the Department of Health and Human Services put out a sole-source solicitation titled “Technical Assistance in Evaluating Options for Health Reform.” The contract would be with Gruber, who the document said was the only person “reasonably available to satisfy agency requirements.” Gruber’s consulting was largely unknown at the time, and eventually it became an issue as he had been frequently quoted by journalists and lawmakers who may not have known of his connection to the administration; he also generally did not disclose his connection when writing opinion articles. In one especially fishy circumstance, Nancy-Ann DeParle, at the time director of the White House Office of Health Reform, wrote about Gruber’s work on the White House blog on Nov. 29, 2009. “MIT Economist Confirms Senate Health Reform Bill Reduces Costs and Improves Coverage” was the headline on the post. DeParle made no reference to the fact that Gruber had already earned hundreds of thousands of dollars working for the administration. All told, he has been hired by at least eight states to provide advice or assist in creating the health-insurance exchanges that are at the heart of the Affordable Care Act: Colorado, Connecticut, Maine, Michigan, Minnesota, Vermont, West Virginia and Wisconsin.

WND, Obamacare guru shocks again with abortion boast, Jonathan Gruber now embroiled in 'stupid American voter' controversy, Jerome R. Corsi, Nov. 14, 2014. The Obamacare architect at the center of controversy for his frank admissions that passing the president’s signature legislation required lying to the American people published a paper during the Clinton administration observing that legalizing abortion saved the government $14 billion in assistance to economically disadvantaged mothers, including African Americans, and lowered crime. MIT economics professor Jonathan Gruber argued in his paper that without the 1973 Roe v. Wade decision, “marginal children” would have been born to many poor mothers. He said statistics show these children would have been 70 percent more likely to live in a single-parent family, 40 percent more likely to live in poverty, 50 percent more likely to receive welfare and 35 percent more likely to die as an infant. Economist Steven D. Levitt and journalist Stephen J. Dubner in their bestselling 2005 book, Freakonomics, relied on Gruber’s work to argue that legalizing abortion was responsible for an approximately 50 percent reduction of crime in major urban centers in the early 1990s. Initially, Gruber’s studies on abortion were well received by the political left, which sought to justify abortion as a reducer of costs to the welfare and criminal justice systems of major metropolitan areas. However, with the attention drawn after the publication of Freakonomics, Gruber’s argument drew fire not only from pro-life religious conservatives but also from the far left. His liberal allies objected to characterizing the children of key Democratic Party constituents as likely criminals.

Washington Post, Why we haven't seen the last of Jonathan Gruber, Jason Millman, Dec. 9, 2014. After Gruber's apology to Congress, his comments will hang over Obamacare debates in the months to come.

FireDogLake, Remembering Obama’s Biggest Broken Health Care Promise, Jon Walker, Nov. 13, 2014. Since there has been a lot of media focus on Jonathan Gruber’s recently uncovered remarks about the American voters, I want to put it in the proper historic context. During the 2008 election, Obama spent months convincing the American public that any change to the tax exempt status of employer-provide health insurance was a Republican idea. Yet almost immediately after getting elected President Obama became determined to end the full tax-exempt status of employer-provided health insurance.

Christian Science Monitor, Obamacare architect says 'stupid' voters let bill pass, Peter Grier, Nov. 12, 2014. Video footage surfaced this week of MIT economist and chief architect of the Affordable Care Act Jonathan Gruber saying that the health law only passed because of the 'stupidity of the American voter.' How far will the repercussions reverberate? But by referring to the “stupidity of the American voter” as a reason the law was able to pass, the MIT professor and Affordable Care Act (ACA) architect has outraged Republicans, caused Democrats to face-palm, and generally lived up to the conservative stereotype of a tone-deaf academic elitist. First, some background: Professor Gruber is an economist with lots of experience in designing public health programs. For instance, he was a key designer of the 2006 Massachusetts state health plan signed into law by then-Gov. Mitt Romney (R). From 2009 to 2010 he served as a technical consultant to the White House as it pulled together the ACA. Reportedly, he was one of the people who convinced Obama that the bill needed to include an individual mandate – a provision requiring that almost everybody in the US get health insurance coverage of some kind.

FireDogLake, Jonathan Gruber Failed to Disclose His $392,600 Contracts with HHS, Marcy Wheeler, Jan. 7, 2010. MIT health economist Jonathan Gruber has been the go-to source that all the health care bill apologists point to to defend otherwise dubious arguments. But he has consistently failed to disclose that he has had a sole-source contract with the Department of Health and Human Services since June 19, 2009 to consult on the “President’s health reform proposal.”He is one source for the claim that the excise tax will result in raises for workers (though his underlying study is in-apt to the excise tax question). He is the basis for the argument that the Senate bill reduces families’ risk–even if it remains totally unaffordable. Even Politico stenographer Mike Allen points to Gruber’s research. But none of the references to Gruber I’ve seen have revealed that Gruber has a $297,600 contract with HHS to produce, a technical memorandum on the estimated changes in health insurance coverage and associated costs and impacts to the government under alternative specifications of health system reform. The requirement includes developing estimates of various health reform proposals on health insurance coverage and cost. The alternative specifications to be considered will be derived from the President’s health reform proposal. [My emphasis, Wheeler wrote, before continuing below.]

The President’s health reform proposal? But I thought this was the Senate’s health reform proposal?!?!? (wink!) Now, HHS says they had to put Dr. Gruber in charge of evaluating health care reform proposals because he’s got, a proven micro-simulation model with the flexibility to ascertain the distribution of changes in health care spending and public and private sector health care costs due to a large variety of changes in health insurance benefit design, public program eligibility criteria, and tax policy. Even assuming that Gruber is the only one in the world who can run these simulations, don’t you think it’s rather, um, dubious that the guy evaluating the heath care reform–for $300,000–is also the package’s single biggest champion? Update: Actually, Gruber failed to disclose his $392,600 contracts with HSS.

FireDogLake, Jonathan Gruber, 'Paid Consultant' to the Obama Administration, Jane Hamsher, Jan. 12, 2010. Marcy Wheeler was just on MSNBC talking to David Shuster about her work uncovering Jonathan Gruber’s government contracts. Yesterday, Paul Krugman defended Jonathan Gruber’s failure to disclose his consulting contract by saying: "Gruber’s grant is from HHS, not the West Wing; it’s basically the same kind of thing as, say, an epidemiologist receiving a grant from the National Institutes of Health  You wouldn’t ordinarily say that this tarnishes the epidemiologist’s credentials as an independent analyst on infectious diseases, unless you want to say that nobody receiving a research grant can be considered independent." But last night Gruber appeared on The News Hour, and here’s how Gwen Ifil introduced him: “For more on the pros and the cons of the so-called Cadillac tax, we turn to Jonathan Gruber, a health economist at the Massachusetts Institute of Technology — he is also a paid consultant to the Obama administration — and Josh Bivens, an economist at the Economic Policy Institute, a think tank that receives some money from labor groups.”

Salon, http://krugman.blogs.nytimes.com/2010/01/15/more-on-jon-gruber%20" target="_blank" data-mce-href="http://www.salon.com/news/op.inion/glenn_greenwald/2010/01/16/krugman/index.html;%20Paul%20Krugman,%20“More%20On%20Jon%20Gruber,”%20New%20York%20Times,%20January%2015,%202010,%20http://krugman.blogs.nytimes.com/2010/01/15/more-on-jon-gruber%20">Krugman, Gruber And Non-Disclosure Issues, Glenn Greenwald, Jan. 16, 2010. In the midst of my lengthy discussion yesterday of Cass Sunstein’s proposal to “cognitively infiltrate extremist groups” by employing covert Glenn Greenwaldagents and secretly paying so-called “independent” analysts to tout the government line, I noted the recent controversy surrounding MIT Professor Jonathan Gruber. Specifically, Gruber was receiving large, undisclosed payments from the Obama administration at exactly the time when the Obama White House (and Gruber himself) were holding him out as an “objective” expert endorsing various parts of the President’s health care plan. Consistent with Sunstein’s view that certain actions may be wrong when done by Bad People but acceptable when done by those who are “well intentioned” and trying to ”improve social welfare,” I noted that many Democrats who strenuously objected to non-disclosure scandals during the Bush years have been minimizing the conduct at issue in the Gruber matter, and cited Paul Krugman as an example. Krugman responded last night on his blog, and I want to discuss a few of the points he makes because I think they have significance beyond the Gruber issue. 

2009-10 Background On Affordable Health Care Act Drafting

Huffington Post, Internal Memo Confirms Big Giveaways In White House Deal With Big Pharma, Ryan Grim, Sept. 13, 2009. A memo obtained by the Huffington Post confirms that the White House and the pharmaceutical lobby secretly agreed to precisely the sort of wide-ranging deal that both parties have been denying over the past week. The memo, which according to a knowledgeable health care lobbyist was prepared by a person directly involved in the negotiations, lists exactly what the White House gave up, and what it got in return. It says the White House agreed to oppose any congressional efforts to use the government's leverage to bargain for lower drug prices or import drugs from Canada -- and also agreed not to pursue Medicare rebates or shift some drugs from Medicare Part B to Medicare Part D, which would cost Big Pharma billions in reduced reimbursements. In exchange, the Pharmaceutical Researchers and Manufacturers Association (PhRMA) agreed to cut $80 billion in projected costs to taxpayers and senior citizens over ten years. Or, as the memo says: "Commitment of up to $80 billion, but not more than $80 billion."

OpEdNews, Should Dems Oppose Health Reform Without Strong Public Option? Andrew Kreig, Oct. 22, 2009.

OpEdNews, Will An Oct. 27 DC Hearing Make History For Health Rights? Andrew Kreig, OpEd News, Oct. 21, 2009. See also, Huffington Post, Will An Oct. 27 DC Hearing Make History For Health Rights? Andrew Kreig, Oct. 20, 2009. Defying Washington’s conventional wisdom on health care reform, two senior Democratic House members are preparing a grassroots campaign to sustain a vigorous public option following a vote scheduled Saturday. To John Conyerskeep Speaker Nancy Pelosi’s proposed successor to H.R. 3200 as strong as possible during conference negotiations with the Senate, House Judiciary Committee Chairman John Conyers, Jr. of Michigan, shown at right, and Rep. Sheila Jackson Lee of Texas are building on momentum from the unique town hall-style hearing they hosted Oct. 27. The hearing generated videos of patients facing death because they could no longer afford their insurance or co-pays. It featured also physicians urging a public option, and a 1960s civil rights icon urging that basic health care should be a fundamental human right, as in most of the industrialized world.

Huffington Post, Fans of House Health Option Cite Rights, Hopes, But Risk Big Defeat, March 18, 2010. Defying Washington’s conventional wisdom on health care reform, two senior Democratic House members are preparing a grassroots campaign to sustain a vigorous public option following a vote scheduled Saturday. To keep Speaker Nancy Pelosi’s proposed successor to H.R. 3200 as strong as possible during conference negotiations with the Senate, House Judiciary Committee Chairman John Conyers, Jr. of Michigan and Rep. Sheila Jackson Lee of Texas are building on momentum from the unique town hall-style hearing they hosted Oct. 27. The hearing generated videos of patients facing death because they could no longer afford their insurance or co-pays. It featured also physicians urging a public option, and a 1960s civil rights icon urging that basic health care should be a fundamental human right, as in most of the industrialized world.