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Al Capone Health Care

Al Capone Health Care

4 Min.
March 10, 2010

The Obama administration wants no one to focus on the process involved in the production and passage of its health care takeover—not that it wants us to focus much on the substance, either. After all, politics always involves some trade-offs and even a little bit of arm-twisting. Like making sausage, it’s not nice to watch but the products can be mighty tasty.

But the process in this case is very relevant to the policy because it highlights exactly what sort of regime this administration would inflict on Americans. Consider two aspects of that process.


Recently resigned New York House Democrat Eric Massa alleged that Obama chief-of-staff Rahm Emanuel helped push him out of office on ethics charges because he, Massa, wouldn’t back Obamacare. Massa said that Emanuel “would sell his mother to get a vote. He would strap his children to the front end of a steam locomotive.”

Rahm Emanuel has a reputation of being a nasty, thuggish, intimidating character.

As evidence, Massa offered: “I was in the congressional gym, and I went down and I worked out and I went into the showers. . . . I'm sitting there showering, naked as a jaybird, and here comes Rahm Emanuel not even with a towel wrapped around his tush, poking his finger in my chest, yelling at me because I wasn't going to vote for the president's budget. Do you know how awkward it is to have a political argument with a naked man?”

Emanuel has a reputation of being a nasty, thuggish, intimidating character. “So what?” you might ask. There are probably nasty, thuggish, intimidating Republicans as well, though perhaps not as deserving of getting punched in the face in the shower room as Rahm.

The Emanuel story comes on top of nearly a year of House Democratic Speaker Nancy Pelosi using hardball politics and arm-twisting to get her fellow Democrats to vote for Obamacare as well as Obama’s heavy-handed environmental regulations. Again you might ask, “So what?” After all, former Republican House Whip Tom DeLay didn’t get the nickname “The Hammer” for being a laid-back softy.


But consider the second revealing aspect of the process of passing Obamacare. It was with the “Louisiana purchase,” $300 million in extra Medicaid funding, that the plan’s supporters bought the vote of that state’s Democratic senator Mary Landrieu. It was with the “Cornhusker Kickback,” exempting Nebraskans from paying an extra $100 million for the cost of putting millions of new beneficiaries on Medicaid, that they bought the vote of that state’s Democratic senator Ben Nelson.

Florida ’s Democratic senator Bill Nelson secured for his state’s 800,000 beneficiaries of Medicare Advantage exemptions from cuts in that program. And high-valued labor union health insurance policies were exempted from a new 40 percent tax, allowing senators in the pay of such unions to vote comfortably for the Senate bill while railing against fat-cat businessmen with “Cadillac” insurance plans.

You get the point. Obamacare has brought vote-buying to a new, outrageous level.


Again, you might ask, “Why harp on process? Isn’t it the end product that counts?”

Obamacare’s end product—bringing one-sixth of the American economy under tighter control of the federal government, degrading our medical care, limiting our liberty—is indeed horrible and  should be defeated on those grounds. But consider what the process of passing such laws presages.

For better or worse—usually the latter—government entitlement programs are supposed to be administrated in a fair and impartial manner. Individuals who qualify for specific, defined benefits are to receive those benefits regardless of political influence or affiliation.

Obamacare brings one-sixth of the American economy under tighter government control, degrades our medical care, and limits our liberty.

Of course, in the case of the legal bribes used to secure the Senate votes, benefits do depend on whether an individual lives in a state with a politically influential senator. If you want to keep your Medicare Advantage benefits and you live in Arizona rather than Florida, you’re out of luck.

While we can hope that such provisions are declared unconstitutional, the process of producing Obamacare highlights the politicized nature of the regime favored by statists and paternalists. Our system of government is decaying into a new kind of klyptocracy based on raw power. It will make limited government, the rule of law, and individual liberty casualties in a war of all against all.


And what about Rahm Emanuel’s Al Capone tactics? Surely they’ll be confined to securing passage of legislation.

To begin with, remember that the current government regulations of health care are enforced with an iron fist. Physicians have suffered fines and even jail for innocently running afoul of incomprehensible Medicare and Medicaid rules. Government agents with guns have taken their money and their freedom. Obamacare would subject both healers and we the patients to an even harsher regime.

Rahm’s rough Chicago gangster ways remind us of the nature of the goals and the souls of statists and paternalists. While posing as our benefactors, they lust for power. They are obsessed with the need to control our lives. And such control is ultimately predicated on the force of government.

Under their regime, bribery and threats rather than free exchange between individuals determine who gets what. The nature of the regime that statists and paternalists are creating was perfectly manifest in the process of producing Obamacare. And this is why the welfare and entitlement state must be challenged not just on the particulars of any given policy, but on a fundamental level, lest America become one big gangland run by the likes of a Rahm Emanuel.

Edward Hudgins


Edward Hudgins

Edward Hudgins ist Forschungsdirektor am Heartland Institute und ehemaliger Direktor für Interessenvertretung und leitender Wissenschaftler bei The Atlas Society.

Edward Hudgins
About the author:
Edward Hudgins

Edward Hudgins, former Director of Advocacy and Senior Scholar at The Atlas Society, is now President of the Human Achievement Alliance and can be reached at