Concessions to the pharmaceutical industry were added to the reconciliation bill after the industry agreed to provide additional savings requested by President Barack Obama. According to the Associated Press, Senator Max Baucus stated in an interview that the pharmaceutical industry agreed to provide an additional $10 billion to cover the coverage gap in Medicare Part D known as the "donut hole" in exchange for eliminating the expansion of drug discounts at certain health facilities initially included in the Senate health care bill.

The Senate health care bill would have expanded drug discounts under a Medicaid program that serves over 14,000 covered facilities. The Medicaid 340B program provides outpatient discounts on brand name drugs to a variety of health facilities that serve low-income communities. The provision removed in the reconciliation bill would have expanded access to the discount program to cover inpatient drug purchases. While the inpatient expansion was eliminated in reconciliation, an increase in the kinds of covered health facilities remained.

Last year, the pharmaceutical industry negotiated a behind-the-scenes deal with the White House and Sen. Baucus to limit the savings sought from the industry in the health reform bill to $80 billion. The deal involved the White House and Baucus to not pursue long-sought-after Democratic policies including allowing the government to negotiate for lower drug prices in the Medicare drug program and the reimportation of drugs from first world countries. The pharmaceutical industry would, in return, support the legislation through advertising and grassroots means. The industry ultimately spent upwards of $100 million on advertising to support passage of the legislation.

The extra money to fill the "donut hole"--a coverage gap in the Medicare prescription drug program--was proposed by the White House in the run-up to the Blair House Summit. The Washington Post reported at the time that industry lobbyists were not enamored with this new proposal, "PhRMA, which agreed to $80 billion in cuts in exchange for protection from other steps, has concerns about Obama’s proposal to add another $10 billion to that amount."

The industry had already beaten back the expansion of the 340B drug discount in earlier negotiations with the House of Representatives. The initial Tri-Committee House health care reform bill contained the same expansion that was included in the Senate bill, but was removed in November when the final version of the legislation was introduced and voted on. At the time, other industry leaders voiced their concerns over the exclusion of the expansion of coverage. The American Hospital Association (AHA) stated that the discount should be added to the bill later on: "Lawmakers also should restore a provision that would expand the outpatient 340B drug discount program to inpatient services for all eligible hospitals."

The Congressional Budget Office (CBO) projected that the expansion of 340B drug discounts to inpatient services would save hospitals $1 billion annually and Medicaid $1.7 billion over ten years.

The Lord giveth and the Lord taketh away.

Billy Tauzin was bounced from his perch as President and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA) after the deals he helped strike with the White House and Sen. Max Baucus were stalled with the health care bill.

Jeff Kindler, the CEO of Pfizer, the nation's largest drug company, got a 12.5% raise after he helped block drug reimportation and other cost cutting measures by striking a deal with the White House and Sen. Max Baucus. From the Pfizer statement:

During 2009, Mr. Kindler was actively involved, through both Pfizer and external organizations, in developing and advancing U.S. and global public policies that serve the overall interests of our Company and our shareholders, as well as doctors and patients. These efforts included constructive participation in the U.S. legislative process to advance Pfizer’s goals of achieving a more rational operating environment; improving Americans’ access to quality, affordable health care; preserving the doctor/patient relationship; and enhancing policies that promote innovation. Also, through both Pfizer and external organizations, he has sought to ensure the availability of safe medicines by opposing legislation that would allow for importation of prescription drugs that could jeopardize the integrity of the drug supply chain in the U.S.

For the full story on the deal struck between the pharmaceutical companies and the White House see this article.

(hat tip to Timothy Carney at the Washington Examiner.)

At the end of last year, the White House dropped a new pile of visitor log records into the public, online record. Upon returning in January from a near month long vacation I decided to take a look at these new records. One story that I wanted some more information on was the oft-reported on deal between the White House and the pharmaceutical companies. I started looking up meetings for pharmaceutical executives, PhRMA lobbyist Billy Tauzin and so on. After a bit of searching and reading some articles from last summer two things dawned on me: 1) There was no singular resource that brought together all of the reporting and all of the data in one place and 2) No one reporting on this deal seemed to know that Sen. Max Baucus posts his schedule online.

The second point is what really crystallized the need to write this piece for me. Last summer, I dug into Baucus' publicly available schedule (which wouldn't be available if it weren't for Sunlight's efforts) examining his meetings with leaders in the health care industry. When I was looking at the White House Visitor Logs, a lot of the dates looked familiar. That's because they matched up precisely with dates in Baucus' schedule with the same actors meeting at the White House and with Baucus. Data that was available online all this time showed how closely the White House and pharmaceutical companies were coordinating with Baucus' office in crafting a health care reform bill. In researching this project I pulled every important meeting in White House Visitor Logs and Baucus' schedule, found the most relevant and revealing articles already written, looked up voting records on the Senate's web site and dug into the lobbying team hired by PhRMA using the databases of the Center for Responsive Politics (CRP). The meetings and key moments (votes, revelations) written in previous articles became a five-page time-line, which was later whittled down to include just the major meetings with the White House and Baucus' office. (Image to the right is of the original time-line.)

One of the statistics in the piece took almost a full day to research. In looking through lobbying disclosure records on CRP's web site I counted 48 outside lobbying firms hired by PhRMA in 2009. These 48 lobbying firms, plus PhRMA's in-house operation, employed 165 lobbyists registered to lobby for PhRMA. Those are some extraordinary numbers, but it doesn't tell the whole story of influence. Having spent a lot of the past year digging into former staffers turned lobbyists I figured that PhRMA would likely be employing a large number of former government officials and employees. (For previous revolving door research see: Max Baucus Health Care Lobbyist Complex, Senate Finance Committee Lobbyist Complex [Dems, GOP], Blanche Lincoln Health Care Lobbyist Complex, Max Baucus Energy & Climate Lobbyist Complex.)

Digging into 165 lobbyist profiles is not the most fun thing in the world. CRP hosts a revolving door database that lists former government positions held by lobbyists. I had to create a spreadsheet for 165 lobbyists by clicking on each individual profile and determining, based on CRP's information, whether they were a former government employee and where they worked. In each case where no revolving door profile existed I turned to Google and the web sites of the respective lobbying firm for lobbyist profiles. Many times this helped identify lobbyists with past government experience who were not listed in CRP's database. In the end, it turned out the 137 of the 165 lobbyists hired by PhRMA had previous government experience, the majority of whom worked in Congress. Below is a Google spreadsheet of some of the more pertinent former congressional staffers turned lobbyists for PhRMA:

Aside from telling a story that is vital to understanding the health care reform effort and the reasons that led to such a drawn out process, this piece sought to take information that is publicly available—and online—and provide context to that information. When we talk about government transparency we often discuss the release of raw data sets. Those data sets are meaningless if they aren't taken and placed into context for the wider public. If the White House Visitor Logs just sat in a database they would provide no benefit to the American people. Someone has to go in and pick them apart and show the relevant information in the context of a story that people can understand.

There was also a lot of support from other Sunlighters in making the totality of this piece. The video included was created by Noah Kunin; the visual timeline was created by Alison Kim; Avelino Maestas helped fact-check the article; Bill Allison and Anupama Narayanswamy edited the piece.

More than a million spectators gathered before the Capitol on a frosty January afternoon to witness the inauguration of Barack Obama, who promised in his campaign to change Washington’s mercenary culture of lobbyists, special interest influence and backroom deals. But within a few months of being sworn in, the President and his top aides were sitting down with leaders from the pharmaceutical industry to hash out a deal that they thought would make health care reform possible.

Over the following months, pharmaceutical industry lobbyists and executives met with top White House aides dozens of times to hammer out a deal that would secure industry support for the administration's health care reform agenda in exchange for the White House abandoning key elements of the president's promises to reform the pharmaceutical industry. They flooded Congress with campaign contributions, and hired dozens of former Capitol Hill insiders to push their case. How they did it—pieced together from news accounts, disclosure forms including lobbying reports and Federal Election Commission records, White House visitor logs and the schedule Sen. Max Baucus releases voluntarily—is a testament to how ingrained the grip of special interests remains in Washington.

In the 2008 campaign, Obama declared his intention to include all stakeholders as he sought to reform the nation's health care system, but also supported key Democratic health reform policies. Among these were several that targeted the pharmaceutical industry: Allowing re-importation of drugs from first world countries with lower drug prices and providing Medicare with negotiating authority over prescription drug prices in the recently enacted Part D program. These weren't just promises, Obama had already voted for both of them as a senator in 2007. (Roll Call Vote 132 and Roll Call Vote 150.)

Set to carry out this agenda were two Capitol Hill veterans, schooled in the monied Washington culture, chief of staff Rahm Emanuel and deputy chief of staff Jim Messina. Emanuel was a former fundraiser, Clinton administration official, investment banker and member of the Democratic leadership in Congress. Messina was the former campaign manager and chief of staff to the powerful Senate Finance Committee chairman Max Baucus. Both were known for their unparalleled legislative abilities.

Because of Obama's decision to develop a plan operating through the legislative process, members of Congress also played key roles. Early on, the pharmaceutical companies were told to deal directly with Senate Finance Committee chairman Max Baucus. Baucus would be the vehicle for the deal worked out behind the scenes by the White House and PhRMA.

Central to this effort was PhRMA president, CEO and top lobbyist Billy Tauzin, a longtime Democratic member of Congress who switched party affiliations after Republicans gained control of Congress in 1994. By switching parties Tauzin was able to maintain his influence and even rose to be Chairman of the House Committee on Energy & Commerce. Tauzin became the poster child of Washington’s mercenary culture. He crafted a bill to provide prescription drug access to Medicare recipients, one that provided major concessions to the pharmaceutical industry. Medicare would not be able to negotiate for lower prescription drug costs and reimportation of drugs from first world countries would not be allowed. A few months after the bill passed, Tauzin announced that he was retiring from Congress and would be taking a job helming PhRMA for a salary of $2 million.

Tauzin’s job change became fodder for a campaign ad that then presidential candidate Barack Obama ran in the spring of 2008 simply titled “Billy.” It featured the candidate, sleeves rolled up, talking to a salon of gasping Americans about the ways of Washington. “The pharmaceutical industry wrote into the prescription drug plan that Medicare could not negotiate with drug companies. And you know what, the chairman of the committee, who pushed the law through, went to work for the pharmaceutical industry making $2 million a year.” The screen fades to black to inform the viewer that, “Barack Obama is the only candidate who refuses Washington lobbyist money,” while the candidate continues his lecture, “Imagine that. That's an example of the same old game playing in Washington. You know, I don't want to learn how to play the game better, I want to put an end to the game playing.”

Aiding PhRMA in their outreach to Congress would be a squadron of lobbyists to push their health care reform priorities. Over the course of 2009, the drug industry trade group spent over $28 million on in house and hired lobbyists. Aside from PhRMA's massive in-house lobbying operation, the trade group hired 48 outside lobbying firms. The total number of lobbyists working for PhRMA in 2009 reached 165. Some 137 of those 165 lobbyists representing PhRMA were former employees of either the legislative or executive branches. Of these dozens were former congressional staffers including two former chiefs of staff to Max Baucus.

According to data compiled by the Center for Responsive Politics, drug makers contributed huge sums to congressional campaign committees during the same period—from January to the end of October (4th quarter numbers are still being totaled), industry political action committees, employees and their family members flooded lawmakers with over $8 million. Those contributions tilted heavily to Democrats over Republicans by a 57 to 42 percent margin—the first time in any election cycle going back to 1990, the first year that the Center for Responsive Politics began tracking industry giving, that Democrats were so favored. Given their majorities on Capitol Hill, and the new President’s intention to reform America’s health care system, the new tilt was perhaps not surprising.

On March 5, the White House held a meeting with major health care industry leaders to try to bring them to the table and see what could be done to gain their support. In attendance were Billy Tauzin, president, CEO and top lobbyist for PhRMA, Pfizer CEO Jeff Kindler, America's Health Care Plans (AHIP) Chairman Karen Ignani, Tom Donohue of the Chamber of Commerce and Robert Wood Johnson Foundations’ Risa Lavizzo-Mourey. A day before the White House meeting Tauzin appeared on CNBC touting health care reform and promising to work closely with the Obama administration. In the interview he touted it as an “optimistic plan”, acknowledging that the industry did have a few problems but was glad to have a chance to discuss these. Some were caught dumb-founded by this apparent change of heart on behalf of an industry long adverse to health care reforms.

On April 15, Jim Messina and Jon Selib, chief of staff to Senate Finance Committee chairman Max Baucus, convened a meeting at the headquarters of the Democratic Senatorial Campaign Committee (DSCC) with leaders of organized labor and health care groups, including PhRMA. At the meeting, the groups decided to form two nonprofit entities to promote reform efforts, Healthy Economy Now and Americans for Stable Quality Care, that would be almost entirely funded by PhRMA. The two groups spent $24 million on their advertising campaigns; the contract to produce and place ads went to White House Senior Advisor David Axelrod’s former firm, AKPD, which owed Axelrod $2 million.

In the next month, CEO’s from pharmaceutical companies would meet with Baucus and administration officials at least four times. These talks preceded a major public event at the White House, one critical to its strategy to promote health care reform. On May 11, PhRMA and other trade industry groups pledged cost cutting measures to the White House that would save, they claimed, upwards of $2 trillion over the next decade. President Obama announced the deal in the State Dining Room, flanked by leaders of the various trade groups; the administration followed up with a media blitz in the press and on the White House Web site.

The next day, Healthy Economy Now's PhRMA funded ad campaign ran their first advertisement in support of the health care reform process calling for the government to finally “fix” the nation's health care cost problems. While many elements of the $2 trillion cost cutting pledge fell apart, the drug industry remained committed to the process in the hopes that they could ultimately win out and defeat the provisions they most feared in closed-door meetings with the White House.

The first occurred on June 2. White House visitor logs show PhRMA’s top executives, including Tauzin, and industry CEOs met with Sarah Fenn from the White House Office of Health Care Reform. On the same day, the publicly available schedule of Senator Max Baucus shows Tauzin and the same industry CEOs met the Senate Finance Committee chairman. What ultimately resulted from these coordinated meetings would be revealed by Baucus on June 20.

In a press release featuring a statement by Tauzin, Baucus revealed that the pharmaceutical industry had accepted $80 billion in cost cutting measures to be included in the Senate Finance Committee version of the bill. According to news reports, Baucus initially proposed $100 billion in cost cutting measures, but the executives and lobbyists meeting on June 2 were able to win the lower figure.

The terms of the initial cost-cutting deal included $30 billion go directly towards closing the “donut hole” in Medicare prescription drug coverage.  The “donut hole” is a term for the gap in coverage that occurs within the Medicare prescription drug coverage. For those purchasing prescription drugs through the Medicare program coverage cuts off at $2,700 spent and does not pick back up again until $6,154 is spent by the participant. The amount proposed in the deal, 50 percent coverage for drugs within the coverage gap, however, would not completely close the “donut hole.”

In Baucus' press release, Tauzin is quoted as saying, “This is a once-in-a-lifetime opportunity and, working together, we can make this hope for a better tomorrow a reality today.” This “once-in-a-lifetime” opportunity also extended to the pharmaceutical industry's ability to blunt the long-term Democratic agenda of lowering prescription drug prices through Medicare negotiations, re-importation and quicker release of generics onto the market. After making such a grand statement of support through cost cutting proposals it was time for the pharmaceutical industry to finally force the White House and Democrats to take certain chips off the table.

Baucus proceeded with a plan to convene a bipartisan group in an effort to craft the bill desired by the White House. These participants included Democrats Kent Conrad and Jeff Bingaman and Republicans Chuck Grassley, Mike Enzi and Olympia Snowe. Baucus' decision and the need to solidify deals with groups like the pharmaceutical industry – which were reliant on Baucus producing a bill – slowed down the legislative process making it impossible for Congress to meet the White House's announced August recess deadline for passing health care reform.

Soon after, PhRMA’s big guns and industry lobbyists paid the White House another visit on July 7 and this time met with Rahm Emanuel and Jim Messina (Baucus' chief of staff Jon Selib is also listed in White House visitor logs for this meeting). In August, The Huffington Post's Ryan Grim reported on an internal memo that was drafted at that meeting that outlined the policies that would not be allowed into any final version of health care reform. These included Medicare prescription drug negotiations, drug re-importation, and the lowering of prices for drugs available through Medicare Part D and Part B. The deal would be $80 billion in cost cutting and absolutely no more.

While the $80 billion deal was cut with Baucus' committee, other congressional committees continued to mark-up their own versions of health care reform without the knowledge that the White House was relying on Baucus to produce the final product. In the House of Representatives, the House Energy & Commerce Committee leveled a direct threat to the $80 billion deal. Energy & Commerce Chair Henry Waxman sought to include all of the provisions that PhRMA had gotten the White House and Baucus to cut out of the reform bill. These included drug reimportation, Medicare negotiating power and speedier release of generics to the market. According to previous analysis of the measures proposed by the committee, these measures would have totaled hundreds of billions in cost cuts, far exceeding the $80 billion cap agreed to by the White House, Baucus and PhRMA.

The cost cutting measures passed in the Energy & Commerce bill spooked the board of PhRMA, which included all of the CEOs involved in the deal-cutting meetings with the White House and Baucus. The board pressured Tauzin to go public with the deal to ensure that the White House would recognize it and not renege. On August 4, the Los Angeles Times, in an exclusive report, featured quotes from Tauzin claiming that a deal between the White House and PhRMA existed and that, as Tauzin put it, “The White House blessed it.” Tom Hamburger wrote in the article, “For his part, Tauzin said he had not only received the White House pledge to forswear Medicare drug price bargaining, but also a separate promise not to pursue another proposal Obama supported during the campaign: importing cheaper drugs from Canada or Europe.”

The White House's Jim Messina later confirmed Tauzin's claim, stating, “The president encouraged this approach … He wanted to bring all the parties to the table to discuss health insurance reform.”

Democratic lawmakers were furious. Rep. Raul Grijalva, chairman of the Progressive Caucus, asked, “Are industry groups going to be the ones at the table who get the first big piece of the pie and we just fight over the crust?”

On September 7, Baucus' bill made a private circulation on the Hill; pharmaceutical industry cost-cutting did not exceed $80 billion. Five days later, the New York Times reported that PhRMA planned to spend up to $150 million in an advertising blitz in support of Baucus' bill. The Times noted that the ad spending “…would be a follow-up to the deal that drug makers struck in June with Mr. Baucus and the White House.” On September 16, Baucus released the full text of his legislation to the public.

The White House, PhRMA and Baucus still had to fight a few battles to keep the deal intact. The key amendment targeting the PhRMA deal in committee mark-up came from Sen. Bill Nelson from Florida, which has one of the largest Medicare participant populations in the nation. The pull of constituent needs clearly put Bill Nelson into a position to push for further cost cutting in Medicare prescription drug pricing. His target: closing the “donut hole” completely.

Nelson claimed that his amendment would generate $106 billion in revenue, or from PhRMA's perspective increase their cost-cutting to $186 billion.  That would be unacceptable to PhRMA, to Baucus, to the White House and to the pharmaceutical industry who had made the deal. Other Senate Democrats, Tom Carper and Robert Menendez voted with Republicans and Baucus on the committee to defeat the amendment.  It is little surprise the Carper's Delaware is home to AstraZeneca and Menendez' New Jersey is home to Merck and Bristol-Myers-Squibb, all of which lobbied for the $80 billion cap.

Senate Majority Leader Harry Reid introduced the final bill, with the cap in place, on November 19. Debate began on Dec. 3, and with it come one more attempt by members to change the terms of the deal. Senator Byron Dorgan introduced an amendment that would allow for drug re-importation, but as the date for voting drew near, the Federal Drug Administration (FDA) released a letter objecting to the proposal that echoed pharmaceutical industry talking points: “…as currently written, the resulting structure would be logistically challenging to implement and resource intensive. In addition, there are significant safety concerns.” Dorgan's amendment was defeated with numerous Democrats previously in support of reimportation switching to "no" votes.

On Christmas Eve, the bill passed the Senate with the PhRMA deal fully intact.

New Year's Eve passed with no further action on health care reform. Public opinion regarding the health care reform bill had been slipping throughout 2009. It reached a fulcrum in the special election to replace the deceased senator Ted Kennedy in Massachusetts on January 19, 2010. Newly minted senator Scott Brown campaigned that he would be the senator to provide Republicans with the votes to filibuster the final health care reform bill. Democrats ran for cover. Despite having the largest majorities of any party since the 1970s, Democrats put the brakes on their agenda, particularly health care reform.

In the end, the pharmaceutical industry's support for health care reform would be left up in the air. After spending $100 million in advertising in support of legislation that Tauzin and key executives hoped would be a windfall for the pharmaceutical industry, the legislative process had flat-lined. In February, the board of PhRMA, split over the deal cut by Tauzin, pushed Tauzin to resign his post.

In an interview with Diane Sawyer, President Obama owed up to failures in the process of passing health care reform, “[T]he health care debate as it unfolded legitimately raised concerns not just among my opponents, but also amongst supporters that we just don't know what's going on … And it's an ugly process and it looks like there are a bunch of back room deals.”

Throughout this year I've spent quite a bit of time looking at the connections between powerful players in the health care debate and their former staffers turned health care lobbyists. The reason to highlight these connections is simple: it shows how outside organizations get the ear of key lawmakers.

You and I can't hire a the former chief of staff to Senate Finance Committee chairman Max Baucus, but America's Health Insurance Plans (AHIP) can. Nor can we hire Sen. Blanche Lincoln's former chief of staff, but a dozen health care companies can. These people have connections that worth more than gold in Washington. They have the ears of the players in Washington.

Roll Call did some more reporting on this and brought us some crucial information on these lobbyists. In particular, I'd like to point to one relationship that I've written about more than once. That's Sen. Blanche Lincoln's former chief of staff Kelly Bingel. Here's a visualization that we created showing Lincoln's connection to Bingel. And here's what Roll Call has to say:

In the case of key fence-sitter Sen. Blanche Lincoln (D-Ark.), Mehlman Vogel Castagnetti lobbyist Kelly Bingel is said to have the ear of her former boss. Bingel declined to be interviewed for this article, but a former colleague called her “first on the list” of the Senator’s callbacks. ... “She’s Sen. Lincoln’s alter ego,” a former colleague said.

Organizations with a stake in legislation know that the best way to get the attention of lawmakers is to poach their most connected, most knowledgable staffers and hire them as lobbyists. The ordinary constituent can't call up a senator and lobby them on a policy issue, but their close buddy and former employee can. Just look at this quote from the Roll Call article:

"It is helpful. We have lines of communication open,” a lobbyist and former Senate Democratic staffer said. “We have access to lay out our argument.”

Without that access you can't get anything done.

(Most of our coverage of health care lobbyists and the revolving door can be found here.)

As noted below, the Baucus health care bill was finally released in legislative language (soon to be available on Open Congress) -- finally. The bill has jumped from 262 pages in plain language to 1,502 page in legislative language. Ezra Klein does a good job of explaining why the bill is so long:

...writing laws is not like writing blog posts, or newspaper articles: It requires an archaic, clunky vernacular that spends a lot of time explaining how one piece of text amends another piece of text, and expends a lot of words clarifying the most technical matters at the most granular level. Legal language requires more words than plain English, just as Chinese uses more characters. When people complain that legislation is slightly longer than a very long book, they're saying something about their understanding of the difference between legal language and plain English, not about the law in question.

This is perfectly true and important to note. Bills that cover a giant issue like health care reform are bound to really long. This is still no excuse for Congress to not read or review the contents of the legislation (not that Klein is making this argument).

The Finance Committee's original, plain language bill version did a decent job covering the major parts of the legislation. I don't think any reasonable person is going to be surprised by the insurance mandates or Medicare waste reduction or, if it's included, a version of the public option. These pieces have been debated and read over and over again. What should be most concerning are the provisions that no one is talking about, the enticements inserted for specific states or specific industries that fly under the radar.

Bloomberg reports on some of these enticements in a report today. Increased Medicaid funding for Sen. Harry Reid's Nevada, extra money for Medicare Advantage recipients in Sen. Bill Nelson's Florida and Sen. Ron Wyden's Oregon, breaks for unions and high risk workers (miners). These are just a few of the enticements inserted into the bill in obscure legislative jargon. We aren't sure what other nuggets could be out there.

The final bill should be made available for at least 72 hours prior to consideration so that these provisions can be found out and determined if they are harmful or not. There have been too many instances of bills passing in the past with small provisions slipped in that have a large effect.

The mark-up of the Senate Finance Committee health care reform bill is currently underway. (You can watch the proceedings on C-Span here.) While much of this morning may be filled with vacuous speech-making by the committee's members, there are over 500 amendments to be voted on over the next few days. Slate has done an excellent job in creating a Google spreadsheet of every (or almost every) amendment to the bill. Check it out as a guide to the process.

I'd also like to flag this important comment by Karen Tumulty at Time's Swampland blog:

One of the worst kept secrets on Capitol Hill is that "mark-ups"--the formal public sessions in which legislation is ostensibly drafted--are not where any real work gets done. Where the real deals get cut, and where the favors get traded back and forth, is in private. The mark-up itself is little more than theater, a chance for everyone to give speeches and then march toward a pre-ordained conclusion.

Whatever you're watching has already been written and planned by the committee members. Lawmakers don't like to take their messy discussions onto the television screens; sort of a side effect of putting video cameras into a room.