How the Game Used to Be Played

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Medicare's chief actuary, Richard Foster, has caused congressional Democrats a few headaches with a report on health care reform. Ezra Klein had an interesting item this morning, reminding us of the last time Foster wrote a report congressional leaders didn't like.

In 2003, when Republicans were forging ahead on the Medicare Prescription Drug Benefit, Foster wrote an analysis suggesting that the bill would cost $534 billion over the first 10 years -- quite a bit more than the $394 billion estimate by the Congressional Budget Office. He handed his report over to the White House, the OMB and the Department of Health and Human Services. And that's where it died.

As we learned later, Tom Scully, the Bush-appointed head of CMS, told Foster that he'd lose his job if he released that report. Despite believing the demand was "inappropriate" and "unethical," Foster, after consulting with an HHS lawyer who told him that Scully could indeed make good on his threat, buried the report.

Say what you will about the Democrats this year, but compared with the Medicare Part D process (remember the shenanigans of the House vote that literally led ethics investigations against Tom DeLay?), health-care reform has been a model of good government.

I remember the scandal well. In fact, if anything, Ezra may be underselling what transpired.

During the congressional debate over Medicare Part D, Foster prepared a cost estimate. Administration officials specifically told the actuary that his findings were unhelpful -- Scully was warned specifically not to share the truth with Congress. "The consequences for insubordination are extremely severe," Foster was told at the time.

Independent analyses, including one from the Congressional Research Service, said the Bush administration's threats and efforts to deliberately hide information from lawmakers may have been literally criminal.

Why didn't this become a bigger story? In large part because congressional Republicans, in the majority at the time, decided not to pursue it. As months went by, other Bush-related scandals emerged, and the coordinated effort to mislead Congress faded.

Five years later, I'm trying to imagine what it would be like if the Obama administration deliberately hid discouraging information about health care reform from Congress, and threatened government officials in order to keep inconvenient information from public view.

Hell, when HHS told Humana to stop using taxpayer money to mislead the public about health care reform, Republicans labeled it a "gag order" and began blocking literally every health-related nominee sent to the Senate for confirmation. If they want to talk about "gag orders," it's a discussion Democrats should welcome.

For all the hyperventilating this year from the right about alleged abuses of power, it's fun to take a stroll down memory lane once in a while.

http://www.washingtonmonthly.com/