[media id=11327] Only after both chambers of Congress had already voted on the health care reform bills which will cut the deficit, AP on Saturday be
December 28, 2009

Only after both chambers of Congress had already voted on the health care reform bills which will cut the deficit, AP on Saturday belatedly looked back at the deeply flawed and unfunded Medicare prescription drug program Republicans jammed through Congress in 2003. 24 hours later, Minority Leader Mitch McConnell appeared on ABC's This Week to add his to the chorus of Republican voices protesting that was then and this is now.

As Reagan Treasury official Bruce Bartlett told the AP, "As far as I am concerned, any Republican who voted for the Medicare drug benefit has no right to criticize anything the Democrats have done in terms of adding to the national debt." In response, Orrin Hatch, who promised a "holy war" to block Democratic success on health care, explained Republican behavior during the Bush years, "it was standard practice not to pay for things." And Olympia Snowe (R-ME), the GOP Senator courted in vain by President Obama, suggested the tale of the 2003 Medicare Rx benefit should be swept under the rug, "dredging up history is not the way to move forward."

But it was Mitch McConnell, who along with his lieutenants Jon Kyl (R-AZ) and Lamar Alexander (R-TN) backed President Bush's Medicare giveaway to the pharmaceutical industry, who turned to misdirection to explain it all away to ABC's Jake Tapper:

TAPPER: Senator, you voted for that Medicare prescription drug benefit, which some say will cost $1 trillion over 10 years and was not offset by revenue or spending cuts.

MCCONNELL: Well, the first thing, you should notice that it came in 30 percent underbudget because of the competitive mechanisms that are involving in extending a prescription drug benefit to seniors. The Democrats criticized it at the time because it was not generous enough. And look, they have gone far beyond any deficit spending discretions -- indiscretions that Republicans might have had. In their first year alone, they ran the deficit up more than the last four years of the Bush administration combined.

As an act of political fraud, McConnell's statement was impressive, if only because of the off-the-charts ratio of deceptions delivered per word spoken. For starters, while this year's projected $1.4 trillion deficit dwarfs the figures from Bush's tenure, McConnell conveniently omitted mentioning that the budget Barack Obama inherited was already $1.2 trillion in the red when he took office in January. But more cynical still is McConnell's whitewashing of the scandal regarding the original estimate of the cost of Medicare drug plan, a forecast the Bush White House withheld from Congress in order to secure its passage.

Here's a look back at the fuzzy math and the dirty politics Mitch McConnell and friends don't want to talk about.

A quick glance back to November 22, 2003 in the national rear view mirror shows a mirror image of this month's health care votes. The Bush White House, which flip-flopped on adding a prescription benefit within the Medicare program in order to win over elderly voters as the 2004 campaign neared, put last minute pressure on the caucus to back the program. President Bush touted the AARP's backing for a 678-page bill his administration duplicitously claimed would cost $400 billion over 10 years. Bill Thomas (R-CA), the legislation's architect, sounded a refrain that Democrats would repeat this week:

"If we are trying to destroy Medicare, why is the AARP supporting us?''

While only one of 177 Republicans supported Saturday's health care reform bill, six years ago 204 House Republicans voted yea on the Medicare prescription bill. Among them were current GOP leaders John Boehner (R-OH) and Eric Cantor (R-VA).

And to be sure, the Republican position then as now wasn't about preserving conservative principles, but instead a GOP majority at all costs. As House Majority Leader Tom Delay defended his party's fiscal recklessness that November night:

"We must forget about ideological absolutes."

But the similarities between Democratic Speaker Nancy Pelosi's victory last night and that of her Republican predecessor Dennis Hastert end there. From the GOP leadership's strong-arm tactics and the administration's budgetary chicanery deployed to secure the bill's passage to the industry giveaways it offered, the dirty dealing behind the Medicare drug plan showcased typical Republican politics in action.

For starters, consider Tom Delay's unprecedented machinations on the House floor to round up the needed votes. As the New York Times recalled:

Under heavy pressure from President Bush and Republican Congressional leaders, lawmakers backed the legislation by a vote of 220 to 215, sending it to the Senate, which is expected to act in the next few days. The vote, which ordinarily takes fifteen minutes to record, was kept open for an extraordinary three hours as Republicans struggled to switch votes and obtain a majority.

And what happened during those three hours was a new low, even for Tom Delay. As the Washington Post later reported, before Ben Nelson's "Cash for Cloture" imbroglio, the House Ethics Committee later reprimanded Delay for trying to buy votes for the Medicare bill:

After a six-month investigation, the committee concluded that DeLay had told Rep. Nick Smith (R-Mich.) he would endorse the congressional bid of Smith's son if the congressman gave GOP leaders a much-needed vote in a contentious pre-dawn roll call on Nov. 22.

Then there's the matter of the Medicare bill's price tag. As I wrote four years ago:

A White House desperate for an election year win on Medicare deliberately misrepresented the program's costs in order to ensure passage. On December 8, 2003, President Bush rolled out a program he claimed would cost $400 billion over 10 years. Within two months, however, the White House notified Congress that the real price tag would approach $550 billion. When Medicare actuary Richard Foster sought to present the true price tag to Congress in late 2003, then agency chief Thomas Scully threatened to fire him. Fast forward two years and the estimated 10 year price tag for the Medicare prescription plan now exceeds $720 billion for its 43 million beneficiaries.

(As the Times reported in 2004, the GAO ultimately concluded that the Bush administration "illegally withheld data from Congress on the cost of the new Medicare law" and that Scully "should repay seven months of his salary to the government." While Scully was later fined for other ethics violations, he was never held accountable for his role in the Medicare fraud. Today, Thomas Scully "now works for a law firm and a private investment firm, has registered as a lobbyist for Abbott Laboratories, Aventis Pharmaceuticals, Caremark Rx and other health care companies.")

Then there's the small matter of public policy itself. From its inception, the Republicans' Medicare prescription benefit was designed to fail. With its confusing and costly "donut hole" limiting payments for beneficiaries and its prohibition on direct government price negotiations with pharmaceutical companies, Medicare Part D was a headache for recipients and a windfall for the drug companies.

For starters, the White House and its GOP allies on Capitol Hill insisted that the final December 2003 Medicare Drug bill prohibit the government from negotiating prices directly with drug companies, a key demand of the pharmaceutical lobby. The same price leverage enjoyed by the Veterans Affairs Department and its program beneficiaries was surrendered by Medicare, with the predictable results described in a 2006 House analysis.

That report released by Democratic staff on the House Government Reform Committee showed that under the new Medicare plan, prices for 10 commonly prescribed drugs were 80% higher than those negotiated by the Veterans Department, 60% above that paid by Canadian consumers and still 3% higher than volume pharmacies such as Costco and Drugstore.com. The report concluded that:

"The prices offered by the Medicare drug plans are higher than all four benchmarks, in some cases significantly so. This increases costs to seniors and federal taxpayers and makes it doubtful that the complicated design of Medicare Part D provides any tangible benefit to anyone but drug manufacturers and insurers."

Which is exactly as Louisiana Republican Bill Tauzin designed it. Just months after shepherding the Medicare prescription bill he wrote through the House, Tauzin, the chairman of the Energy and Commerce committee, left Congress and accepted a $2 million-a-year job as president of PhRMA -- Pharmaceutical Research and Manufacturers of America.

In Mitch McConnell's defense, the $720 billion nightmare scenario forecast in 2005 did not come to pass. But it was lower enrollment and the rapid adoption of generic drugs, rather than "competitive mechanisms" which largely explain the lower Medicare Part D bill for taxpayers. Still, the Medicare drug plan may cost as much as $1 trillion over the next 10 years (higher than the $900 billion overall price tag for Democratic health care reform) making it, as Bartlett noted, an "unfunded drug benefit, which added $15.5 trillion (in present value terms) to our nation's indebtedness." As for McConnell and the GOP's willing executioners of health care reform in Congress, Ezra Klein may have put it best:

"The health-care reform bills currently under consideration in both the Senate and the House actually cut money from the deficit, but they are being criticized as fiscally irresponsible by many of the people who voted for Medicare Part D. It's like watching arsonists calling the fire department reckless."

(This piece also appears at Perrspectives.)

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