In an interview with The Washington Post on Tuesday, President Barack Obama challenged his critics to identify any "gap" between what he campaigned on last year and the health care legislation Congress is on the verge of passing.
Critics, however, do have a few of his campaign pledges to point to. Most notably, Obama launched high-profile attacks against two of his campaign opponents for taking policy positions that are now reflected in the final Senate bill.
Obama made health care in general a major part of his campaign so that when he won, he could claim a mandate and push for reform during his first year.
In doing so, Obama savaged his primary opponent, Hillary Clinton, for arguing that people should be mandated to buy health insurance.
"If a mandate was the solution, we could try that to solve homelessness by mandating everybody buy a house," he said on a CNN morning show on Super Tuesday during the election. "The reason they don't have a house is they don't have the money. So our focus has been on reducing costs, making it available. I am confident that if people have a chance to buy high quality health care that is affordable, they will do so. And that's what our plan does, and nobody disputes that."
Obama ripped into his general election opponent, John McCain, for supporting a tax on private insurance, blanketing swing states with mailers and ads saying that McCain was raising taxes and that his plan would lead employers to drop coverage.
"He gives you a tax credit with one hand -- but he raises your taxes with the other," Obama said at the time. "Many employers will drop their healthcare plans altogether."
The mandate and the tax are now major portions of the Senate bill. Indeed, within months of inauguration, Obama was opening up to a tax on benefits. And while McCain's tax would have immediately captured more plans, Obama's tax on insurance -- aimed at so-called "Cadillac plans" -- will capture more and more as costs rise.
Obama also pledged to go after the anti-trust exemptions that drug makers and insurers enjoy: "When I'm President," he said in Iowa in early 2007, "we're going to make drug and insurance companies compete for their customers just like every other business in America. We'll investigate and prosecute the monopolization of the insurance industry."
The antitrust exemption is not revoked in the current Senate bill.
Obama also pledged to take on drug makers. "Congress specifically exempted Medicare from being able to negotiate for the cheapest available price. And that was a profound mistake," he said in 2007.
"We will break the stranglehold that a few big drug and insurance companies have on the health care market....It's become clear that some of these companies are dramatically overcharging Americans for what they offer.... We're not going to get change unless we can overcome the resistance the drug companies, the insurance companies, the HMOs, those who are making a major profit from the system currently."
But the Senate bill does not allow Medicare to negotiate with drugmakers thanks to a deal the White House cut with Big Pharma.
"And then we'll tell the pharmaceutical companies, 'Thanks, but no thanks, for overpriced drugs.' Drugs that cost twice as much here as they do in Europe and Canada and Mexico. We'll let Medicare negotiate for lower prices....We'll allow the safe reimportation of low-cost drugs from countries like Canada," he said.
The bill does not allow reimportation. The White House worked against it, citing that same Pharma deal.
"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 two million dollars a year," Obama said. "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."
Obama was referring to Billy Tauzin, the head of the Pharmaceutical Research and Manufacturers of America (PhRMA), the group the White House is now playing games with.