The Washington Post Has No Shame
This morning's paper carries an op-ed criticizing health care reform primarily on the grounds that it will cost too much. It urges that the plan be sharply scaled back so that it will get bipartisan support.
If this op-ed were written by a Republican member of Congress it would be unremarkable; not even worth publishing. But this particular op-ed was authored by someone who appears to have meaningful expertise on the subject. The writer, Tom Scully, is identified as the former administrator of the Centers for Medicare and Medicaid Services and a White House official during the George H.W. Bush administration.
Given this resume, one might think that Scully was a career health professional, an expert that those on both sides of an issue might look to for counsel and guidance. In fact, Scully is a rank Republican political hack who was responsible for one of the most reprehensible episodes in recent American political history. It was Scully who helped ram through Congress the totally unfunded Medicare Part D program that will cost taxpayers roughly $1 trillion over the next decade--that's $1 trillion more than Obama's plan, which is fully paid for according to the Congressional Budget Office.
Scully was in fact critical to getting part D enacted because he personally hid from Congress critical details about its cost that would have torpedoed the legislation had those facts been known prior to the congressional vote in 2003.
Rather than go through the whole sorry story again, I am reprinting below my Forbes column from last year in which I discussed Scully's duplicitous behavior. Included are hyperlinks documenting his culpability for saddling taxpayers with trillions of dollars of debt just so his party could buy the votes of seniors and win the 2004 election.
Republican Deficit Hypocrisy
Remember the Medicare drug benefit?
Bruce Bartlett, 11.20.09
The human capacity for self-delusion never ceases to amaze me, so it shouldn't surprise me that so many Republicans seem to genuinely believe that they are the party of fiscal responsibility. Perhaps at one time they were, but those days are long gone.
This fact became blindingly obvious to me six years ago this month when a Republican president and a Republican Congress enacted the Medicare drug benefit, which former U.S. Comptroller General David Walker has called "the most fiscally irresponsible piece of legislation since the 1960s."
Recall the situation in 2003. The Bush administration was already projecting the largest deficit in American history--$475 billion in fiscal year 2004, according to the July 2003 mid-session budget review. But a big election was coming up that Bush and his party were desperately fearful of losing. So they decided to win it by buying the votes of America's seniors by giving them an expensive new program to pay for their prescription drugs.
Recall, too, that Medicare was already broke in every meaningful sense of the term. According to the 2003 Medicare trustees report, spending for Medicare was projected to rise much more rapidly than the payroll tax as the baby boomers retired. Consequently, the rational thing for Congress to do would have been to find ways of cutting its costs. Instead, Republicans voted to vastly increase them--and the federal deficit--by $395 billion between 2004 and 2013.
However, the Bush administration knew this figure was not accurate because Medicare's chief actuary, Richard Foster, had concluded, well before passage, that the more likely cost would be $534 billion. Tom Scully, a Republican political appointee at the Department of Health and Human Services, threatened to fire him if he dared to make that information public before the vote. (See this report by the HHS inspector general and this article by Foster.)
It's important to remember that the congressional budget resolution capped the projected cost of the drug benefit at $400 billion over 10 years. If there had been an official estimate from Medicare's chief actuary putting the cost at well more than that, then the legislation could have been killed by a single member in either the House or Senate by raising a point of order. Then-Senate Majority Leader Trent Lott, R-Miss., later said he regretted not doing so.
Even with a deceptively low estimate of the drug benefit's cost, there were still a few Republicans in the House of Representatives who wouldn't roll over and play dead just to buy re-election. Consequently, when the legislation came up for its final vote on Nov. 22, 2003, it was failing by 216 to 218 when the standard 15-minute time allowed for voting came to an end.
What followed was one of the most extraordinary events in congressional history. The vote was kept open for almost three hours while the House Republican leadership brought massive pressure to bear on the handful of principled Republicans who had the nerve to put country ahead of party. The leadership even froze the C-SPAN cameras so that no one outside the House chamber could see what was going on.
Among those congressmen strenuously pressed to change their vote was Nick Smith, R-Mich., who later charged that several members of Congress attempted to virtually bribe him, by promising to ensure that his son got his seat when he retired if he voted for the drug bill. One of those members, House Majority Leader Tom DeLay, R-Texas, was later admonished by the House Ethics Committee for going over the line in his efforts regarding Smith.
Eventually, the arm-twisting got three Republicans to switch their votes from nay to yea: Ernest Istook of Oklahoma, Butch Otter of Idaho and Trent Franks of Arizona. Three Democrats also switched from nay to yea and two Republicans switched from yea to nay, for a final vote of 220 to 215. In the end, only 25 Republicans voted against the budget-busting drug bill. (All but 16 Democrats voted no.)
Otter and Istook are no longer in Congress, but Franks still is, so I checked to see what he has been saying about the health legislation now being debated. Like all Republicans, he has vowed to fight it with every ounce of strength he has, citing the increase in debt as his principal concern. "I would remind my Democratic colleagues that their children, and every generation thereafter, will bear the burden caused by this bill. They will be the ones asked to pay off the incredible debt," Franks declared on Nov. 7.
Just to be clear, the Medicare drug benefit was a pure giveaway with a gross cost greater than either the House or Senate health reform bills how being considered. Together the new bills would cost roughly $900 billion over the next 10 years, while Medicare Part D will cost $1 trillion.
Moreover, there is a critical distinction--the drug benefit had no dedicated financing, no offsets and no revenue-raisers; 100% of the cost simply added to the federal budget deficit, whereas the health reform measures now being debated will be paid for with a combination of spending cuts and tax increases, adding nothing to the deficit over the next 10 years, according to the Congressional Budget Office. (See here for the Senate bill estimate and here for the House bill.)
Maybe Franks isn't the worst hypocrite I've ever come across in Washington, but he's got to be in the top 10 because he apparently thinks the unfunded drug benefit, which added $15.5 trillion (in present value terms) to our nation's indebtedness, according to Medicare's trustees, was worth sacrificing his integrity to enact into law. But legislation expanding health coverage to the uninsured--which is deficit-neutral--somehow or other adds an unacceptable debt burden to future generations. We truly live in a world only George Orwell could comprehend when our elected representatives so easily conflate one with the other.
Of course, there are good reasons conservatives oppose expanding the government, as the pending health legislation would do, even if it adds nothing to the deficit. But anyone who voted for the drug benefit, especially someone who switched his vote to make its enactment possible, has zero credibility. People like Franks ought to have the decency to keep their mouths shut forever when it comes to blaming anyone else for increasing the national debt.
Franks is not alone among Republicans for whom fiscal responsibility never consists of anything other than talk. The worst, undoubtedly, is DeLay, who actually went so far as to attack Sen. John McCain, R-Ariz., last year for his principled vote against the drug benefit, one of only nine Republican senators to do so. (By my count, there are still 24 Republicans in the Senate who voted for the drug benefit, including such alleged conservatives as Jim Bunning and Mitch McConnell of Kentucky, John Cornyn of Texas, Mike Crapo of Idaho, Orrin Hatch of Utah and Jon Kyl of Arizona.)
Amazingly, leading Republicans still defend the drug benefit. Just the other day, former Senate Majority Leader Bill Frist, R-Tenn., celebrated its passage, and at a recent American Enterprise Institute forum, former House Ways and Means Committee Chairman Bill Thomas, R-Calif., berated me for criticizing it. In each case, their main argument was that it ended up costing a little less than originally projected. Somehow, I doubt that Frist or Thomas would feel the same way if their wives thought it was OK to buy a closet full of expensive new shoes just because they were on sale.
I don't mean to suggest that Democrats are any better when it comes to the deficit, although they have a better case for saying so based on the contrasting fiscal records of Bill Clinton and George W. Bush. The national debt belongs to both parties. But at least the Democrats don't go on Fox News day after day proclaiming how fiscally conservative they are, and organize tea parties to rant about deficits, without ever putting forward any plan for reducing them. Nor do they pretend that they have no responsibility whatsoever for projected deficits, at least half of which can be traced directly to Republican policies, according to Office of Management and Budget Director Peter Orszag.
It astonishes me that a party enacting anything like the drug benefit would have the chutzpah to view itself as fiscally responsible in any sense of the term. 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. Space prohibits listing all their names, but the final Senate vote can be found here and the House vote here.
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So much for the "Pravda on the Potomac"
The Post op-ed page has evolved into one of the most deceptive and thoroughly unprincipled propaganda organs in the country.
At least with Fox News and the Wall Street Journal op-ed page, you know exactly where they stand and who they stand for: The conservative movement and the Republican Party, usually in that order.
Fred Hiatt and his flunkies, on the other hand, insist they represent the sensible center, but increasingly fill their pages with the worst kind of right-wing hacks -- GOP hatchet men like Scully and ideological thugs like Marc Theissen. It's become the "stealth" conservative platform.
These days when I hear conservatives rage against the "liberal" Post, I just have to laugh. All that pandering by the Graham family, and what has it gotten them?
I ensure that I read your
I ensure that I read your incisive articles whenever I find them , Mr Bartlett. Thank you for your great work. Some people must really think we have such short memory!
Rank Hypocrite
I'm talking about you, Mr. Bartlett. How can you in good conscience cite Richard Foster to attack Mr. Scully, but like every other hack who writes on this page, ignore or dismiss out of hand the series of estimates by Foster that show just what a disaster the House and Senate health bills are?
More and more your blog
More and more your blog resembles the 'Daily Kos'.
Great piece -- thanks
"The human capacity for self-delusion never ceases to amaze me"
Add to that the human capacity to work against one's own best interests.
Today I called a rep (who opposes HC reform) to voice my support for the reform bill. The young intern who answered the phone told me she was a recent college grad. I said, "Lucky you, the government is giving you health insurance."
She corrected me in a hurry. No, they are not, as she is an unpaid intern without benefits. "Who is paying for your insurance, your COBRA?" I asked.
The answer: "Nobody." She is flying naked, and hoping she doesn't get sick or have an accident.
I pointed out that the rep she is full-time volunteering for is opposing a bill that would ensure that she has insurance (as it would mandate coverage for children up to age 26 under their parent's company-paid plans). Why would she support someone who opposes a measure that would so clearly benefit her?
No answer to that question.
I find it stunning and shameful that our US reps have a gold-plated healthcare plan while the interns who work for them go completely uncovered.
The recent use of "arguing
The recent use of "arguing against one's own interests" as a progressive talking point really bugs me.
First, it assumes that the person in question really would be better off under a proposed new system. (This may be the case, but we need more people in society who are suspicious of being offered something for nothing.)
Second, isn't arguing against one's self-interest the sign of someone who truly believes in the cause? If I make $500,000 a year and argue that taxes should be higher on people with incomes over 250K, am I suddenly some imbecile because I'm arguing against my self-interest?
If two people would both benefit from policy X, and one likes it and one dislikes it, maybe it's worth listening to that second person a little closer. He's not necessarily right, but "arguing against his self-interest" should be a chit for him, not against him.
Choosing to put herself at great risk is admirable?
"First, it assumes that the person in question really would be better off under a proposed new system."
She would be better off -- much better off. Right now she risks one serious illness or accident putting her into bankruptcy.
In this case the young woman did not understand how the bill would benefit her directly. She was given the anti talking points, and that was all the information she had in front of her. She confessed that it was her first day on the job. I had to explain the part of the bill (mandating coverage under parent's plan up to age 26 for children) which would give her affordable healthcare.
As far as advocating for higher taxes (and being the one who would be taxed) -- quite frankly that's easy to do (especially at my income bracket -- I have more than enough money to sustain myself). It doesn't incur a dramatic hardship (not having enough money to buy food, for example, or giving up my ability to go to a doctor when I'm sick).
This young intern's situation puts her at high risk, quite different from choosing to pay a few more dollars in taxes when one is already quite comfortable and basic needs are filled.
I find it shameful that there is no affordable insurance plan for these interns.
Your post reminds me of a Doonesbury cartoon, the one where the grandmother burns her Medicare card. Most folks on Medicare won't do that . . . at least not the ones I know.
intellectual sloppiness
"...the totally unfunded Medicare Part D program that will cost taxpayers roughly $1 trillion over the next decade--that's $1 trillion more than Obama's plan, which is fully paid for according to the Congressional Budget Office."
Uh... what? There are TWO glaring factual errors in that single sentence. First, you are (oddly) engaging in what I consider a common liberal sleight-of-hand: confusing "deficits" with "costs". How can you say that Obamacare costs the taxpayers nothing? Then who is paying the several hundred billion dollars of tax increases in the bill? Martians? You seem to think that if a cost is paid for with taxes, then there isn't a cost. That's nonsense.
Second, part D is now expected to cost a little over $300 billion in the first decade, not $1 trillion. If you are comparing the "next" decade of part D with the "next" decade of Obamacare, then you are comparing apples to oranges because part D is fully implemented whereas Obamacare will only be fully implemented for the last 5 years of the decade. Either compare the first 10 years after enactment with the first 10 years after enactment, or compare the first 10 years of full implementation with the first 10 years of full implementation. You are doing neither. And you know better.
Intellectual sloppiness?
What part of "fully paid for" don't you understand?
By "fully paid for" you mean...
* Assuming a new cut in Medicaid provider payments, to be repealed later, complimenting the cut in Medicare provider payments that gets overturned each year.
What? You can't reach your mandated cost target? No problem. Just throw in a provision in the law saying "In 2014 we cut Medicaid spending by $29 billion". Don't tell anyone, you don't want anyone getting the wrong (or right) idea. That doesn't matter anyhow. By law, CBO has to score it just as if it were true!
* Taking $50 billion of Social Security taxes to pay for health care -- ignoring the attached liability for SS benefits because they aren't payable until after the 10-year scoring window. So they don't matter. ;-)
That is: Yes, looting the Social Security Trust Fund.
* Taking a great deal more in Medicare taxes, and instead of using them for well, Medicare, using them for the health care program -- whilc simultaneously claiming this "strengthens" Medicare since the money is first to be run through the Medicare Trust fund, which increases the bonds issued by the US and the national debt.
Some "strengthening"! Even CBO has alredy called "bullspit" on this one, in it's most recent letter to Ryan.
* Assuming the excise tax that Obama couldn't get past the unions this year will nontheless be enacted later -- it will be so much easier then -- bringing in all that revenue to count today nonetheless.
* Pushing millions of people into Medicaid, then not counting the states' increased Medicaid costs as a cost of the bill that has to be covered.
* And then there is the 40% of reform's cost to be be paid for by "cuts to Medicare". We are "fully paing for" reform today by promising to make spending cuts later that nobody would come close to making today. Surely we can count on them!
As Hennessey put it, the program...
"Spends money on doctors in 2013 and 2014, but leaves out the permanent fix, as expected. This means there’s another $300-ish B of Medicare spending that is not counted in this bill. So much for true deficit neutrality."
That closer-to-$370 billion over eight years by itself virteually equals the entire 10-year cost of Bush's Part D.
That's what you mean by "fully paid for"?
Well, I hope Bruce enjoyed bashing the Repubs for the funding games they played with Medicare Part D this one last time.
Because after endorsing this HCR as "fully paid for" -- by a raid on the Social Security trust fund, a bigger raid on "Medicare" revenue, assuming the return to life of the excise tax the unions killed, counting more than $300 billion of Medicare cuts "to be named later", and when even all that wasn't enough, assuming a new 11-digit cut in Medicaid provider payments as needed to make things balance (as just some of the scoring ploys of this program) -- he's never going to be able to credibly bash the Repub's Part D scoring practices ever again.
Together the new bills would cost roughly $900 billion over the next 10 years, while Medicare Part D will cost $1 trillion
Oh, please. CBO estimates Part D's cost to the govt over ten years at $410 billion.
In 2008 Part D cost the govt $37.26 billion. Multiply by ten.
Let not our anger separate us from reality.
And just for the record...
Former CBO head Holtz-Eakin puts the deficit increase cost at $562 billion over ten years.
He doesn't even include some of the things I mentioned above. He does include the $53 billion of Social Security taxes, leaving at least that much in benefits unfunded after the scoring window closes ... accelerated corporate tax payment due dates to get the revenue within the budget window -- although of course this creates no net revenue increase at all ... new programs included in the law but labeled "discretionary" so Congress doesn't have to account for the $123 billion to pay for them yet ... and ...
"in perhaps the most amazing bit of unrealistic accounting, the legislation proposes to trim $463 billion from Medicare spending and use it to finance insurance subsidies.
"But Medicare is already bleeding red ink, and the health care bill has no reforms that would enable the program to operate more cheaply in the future. Instead, Congress is likely to continue to regularly override scheduled cuts in payments to Medicare doctors and other providers..." as it already has year after year after year.
Plus some other ploys.
Moreover, even the financing the plan has is, as pointed out by Hennessey , designed to be politically unsustainable.
~~~
The bills’ authors have cleverly constructed the promises so that they are paid for in an accounting sense, but are politically unsustainable.
New Medicare spending on doctors is paid for, as long as you believe Congress will allow even bigger cuts to take effect two years from now.
The new insurance subsidies are paid for, as long as you believe that a tax increase scheduled to begin in the future will survive eight years of labor union lobbying for repeal or perpetual delay.
The new insurance subsidies are designed to cover those who buy health insurance outside of employment, but not those with the same salary who get health insurance through their job.
If you believe this inequity is politically sustainable, then the bill is paid for. If instead you think there will be unbearable political pressure to provide equal treatment and expand subsidies to some of the 100+ million Americans who today get their health insurance through their job, then the subsidies you enact now are only the camel’s nose under the tent, and you are setting us on a path to an even larger and unfunded government promise.
The bill’s architects have cleverly gamed the rules to minimally satisfy the requirements of getting the referee to say the new promise is funded, while creating real long-term fiscal risk.
There is an obvious parallel to the financial engineers who worked with credit rating agencies to tweak new risky credit derivatives until they barely qualified for a AAA rating. The financial engineers did not eliminate real risk, they instead solved for the rating agency’s scoring model. They then sold these products to clients as safe investments, with a wink.
The authors of the pending health care bills have done the same with the CBO scorekeepers. You are the potential client being asked to buy this product. The proponents assure you that the scorekeeper says it’s OK. Then they wink.
~~~~
This is not merely as bad a the Repubs' Part D follies, it is even worse in dollars and every other way, and by a lot.
And remember, Part D passed a Senate with only 51 Repubs by 76-21, a majority of Democrats voting for it. No reconciliation ploy necessary.
Nobody who describes this HCR bill as "fully paid for" can criticize the financing of Part D ever again.
I'm not sure who to believe
I'm not sure who to believe here, the Republican Keith Hennessey you quote and link to who on his blog brags about the deficit creating tax cuts he fought for as a part of the Bush administration as well as his work fighting against tax increases that would actually help fund Medicare part D and who has suddenly seen the light about deficits being bad; or Bruce Bartlett, who worked for Reagan and Bush 1 and has since proven himself to be honest enough to be critical or supportive of one on either side of the aisle. Actually I do know. I'll go with Bartlett there.
Don't know anything about Holtz-Eakin but his creds as director of the CBO are impressive so I'm willing to trust what he says as well for now.
I'm not schooled enough in economics or how estimates of costs of bills are determined to figure this all out on my own so I certainly have a lot to learn.
Your calculation of taking how much Medicare plan D cost (unfunded, mind you) in 2008 and multiplying by 10 is dubious at best. Costs can grow over time just as cot savings can grow over time so using the "one year fits all" technique doesn't work.
And the phrase "reconciliation ploy" is also dishonest. It's not a ploy or something unique. It's been used more by Republicans than Democrats including the big Bush tax cuts one of which did need a Dick Cheney tie breaker. And it also doesn't take into account the unheard of levels of obstructionism in the Senate since Democrats regained the majority. At least when they are the minority they do allow votes and don't force 60 for everything.
You may very well be correct that this health care bill will not reduce the deficit at all and that there were sneaky tactics used (again, as despicable as that is it isn't unique as tricks were also used for Medicare part D as well as tons of other bills). It's also certainly not a bill I think is great. But at least there are some efforts to pay for it, some via, GULP, taxes!!!
The thing that worries me the
The thing that worries me the most is how Newt Gingrich thinks the Republicans should handle this if by chance the Democrats' bill fails and the Republicans get another shot at running Congress. He came out and said that the Republicans should split the bill up into the popular and unpopular parts and just pass the popular bits.
I understood "popular bits" to be the hand-outs and the "unpopular bits" to be paying for them. That is exactly what they did with Medicare Part D.
Mind you, some of the Democrats weren't any better. After Massachusetts, a few of them were suggesting splitting the bill up into pieces too. It would be the same result no matter who did it.
Forbes article
I really appreciated your comments in Forbes on the Tea Party beliefs. We need a rational debate over policy and we are not getting it.
Re Forbes Article
bakho,
Other than "I really appreciated your comments," I completely agree with what you've written.
I find it interesting, Mr. Bartlett, that you would accuse someone of hackery the same day you publish an article in Forbes based entirely on intellectual laziness. On the basis of 57 interviews among 500 or so Tea Party protesters, you arrive at the blanket conclusion that all Tea Partiers don't understand tax issues.
Hundreds of thousands, or possibly millions, of people affiliate with the Tea Party movement, and this is the best you can do? I'm an attorney, and if I tried to present evidence this flimsy before a judge, I'd be laughed out of court and probably sued for legal malpractice.
No one looking at this evidence objectively could possibly conclude it's indicative of anything more than anecdotal observations. Because the results of these interviews buttress your preconceived beliefs, you were all too willing to shoot from the hip.
Next time, please provide real evidence. Thanks.