Medicare Drug Plan: Worst Bill in History

This week marks the second anniversary of one of the most shameful episodes in the history of the Republican Party—indeed, of the House of Representatives itself. On Nov. 22, 2003, unprecedented pressure was brought to bear to pass the Medicare drug bill. In a forthcoming book, I characterize this as the worst legislation in history.

The Medicare system has been broken for many years. The 2003 Medicare trustees report put just Part A of that program in deficit to the tune of more than $6 trillion over the next 75 years. Yet despite this fact, Republican leaders were determined to make that deficit worse by adding yet another open-ended entitlement to this program.

The reason was simple: Republicans wanted the votes of the elderly to get re-elected in 2004. And they thought they could buy them by giving those over age 65 a huge new government benefit: free drugs.

It didn’t matter that there was no money to pay for this program or that there was no justification for giving new benefits even to the wealthy and those already being reimbursed for drugs. All that mattered was getting the votes of a constituency with a history of selling them to the highest bidder.

To trick conservatives into voting for this monstrosity, the drug bill’s supporters had to play a lot of games before the bill even reached the House floor. First, the cost of the bill was estimated for only 10 years, even though the program would be in effect forever. Second, the program’s start date was delayed for two years, during which time very little was spent, and then it was slowly phased in.

Although the Congressional Budget Office certified that the drug benefit would cost no more than $400 billion over 10 years, spending was more than twice as great in the second five years as in the first five. By the last year of the forecast, spending would be more than $120 billion per year higher.

Later, it was learned that Medicare’s actuaries had concluded well before the final vote that a more accurate estimate of the first 10 years of the drug benefit was in fact $534 billion.

The Bush administration and Republican leaders in Congress conspired to suppress this estimate. The head Medicare actuary, Richard Foster, was told that he would be fired if word of the higher estimate leaked out before the bill was enacted. Sadly, Foster complied—no whistleblower he, apparently.

But even the phony $400 billion figure was causing a lot of problems for Republican leaders in the House. When the final vote was taken in the early morning hours of Nov. 22, the bill was losing with 194 votes for it and 209 against it, owing to virtually united Democratic opposition and a few principled conservative Republicans.

Although the vote was scheduled, per standing House rules, to last just 15 minutes, the leadership kept the vote open. According to a fascinating report in The Hill newspaper last week, “door men” were stationed at exits from the House floor to prevent any Republicans who had voted “no” from leaving. A couple managed to sneak out, but Rep. Jo Ann Emerson, R-Mo., was unable to and hid over on the Democratic side of the aisle to avoid the aptly named Republican whips.

With the aid of Vice President Cheney, a few votes were turned. But 45 minutes later—an hour after the vote was supposed to end—the drug bill was still losing with 216 for and 218 against. At this point, the heat was turned to “high” on those Republicans still standing on principle against it.

One in particular was Rep. Nick Smith, R-Mich. According to The Hill, his fellow Michigan Republican, Rep. Candice Miller, cursed him for sticking to his no vote. Then House Majority Leader Tom DeLay, R-Texas, came over to play “good cop.” DeLay promised Smith, who was retiring, that he would support his son Brad in the primary to replace him and help raise money, as well. Rep. David Dreier, R-Calif., whose district covers part of Los Angeles, told Smith that he would help his actress daughter get a movie role.

A House Ethics Committee investigation later determined that DeLay had engaged in “improper” behavior, and he was “admonished” for doing so. But Smith stuck to his guns.

At 5:00 a.m., after the vote had been held open for two hours, President Bush was awakened, and he said he would be forced to sign an even more expensive Democratic bill should the Republican measure go down to defeat. This got a couple more Republicans to switch their votes and provided the margin of victory. Almost three hours after the vote began, the drug bill finally passed by a vote of 220 to 215.