The so called 'agenda' in no way undermines/ refutes the

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Just two policies dating from the Bush Administration — tax cuts and the wars in Iraq and Afghanistan — accounted for over $500 billion of the deficit in 2009 and will account for nearly $6 trillion in deficits in 2009 through 2019 (including associated debt-service costs of $1.4 trillion). By 2019, we estimate that these two policies will account for almost half — over $8 trillion — of the $17 trillion in debt that will be owed under current policies .[7]

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[8] The new Medicare prescription drug benefit, enacted in 2003, also adds to deficits over this period — by over $700 billion, net of premiums from enrollees and payments from states, in 2009 through 2019 — but for reasons explained in our October 2012 paper, we cannot quantify the net budgetary effect of the Medicare Modernization Act that added the drug benefit.

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Through 2012, Medicare Part D added $318 billion to the national debt (see “General Revenue” on Page 111 in the 2013 Medicare trustees report). That same report projects that Medicare Part D will add $852 billion to the debt over the next 10 years.

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Medicare Part Republican Budget-Busting

By Bruce Bartlett
November 19, 2013 12:01 am November 19, 2013 12:01 am 53

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Bruce Bartlett held senior policy roles in the Reagan and George H.W. Bush administrations and served on the staffs of Representatives Jack Kemp and Ron Paul. He is the author of “The Benefit and the Burden: Tax Reform — Why We Need It and What It Will Take.”

Ten years ago this week, Republicans enacted the largest expansion of the welfare state since the creation of Medicare in 1965 by adding a huge unfunded program providing coverage for prescription drugs to the Medicare program.

For years, responsible critics had said it was a system flaw that Medicare did not pay for prescription drugs along with hospitalization and doctors’ visits. By 2003, strong bipartisan support existed for expanding Medicare to include prescription drugs.

Republicans were keen to make sure that the legislation enacted was theirs, because the Democrats were certain to include cost containment for drugs in their legislation.

It was widely believed that if the federal government used its buying power to pressure drug companies to cut drug prices, the cost of providing drugs to Medicare recipients would be substantially reduced.

But forcing down drug prices would diminish the drug companies’ profits and Republicans were adamantly opposed to that.

Consequently, despite their oft-repeated opposition to new entitlement programs, they got behind the new drug benefit, now known as Medicare Part D, and made sure there was no cost-containment provision.

George W. Bush strongly supported this effort. Looking ahead to a close re-election in 2004, he thought a new government giveaway to the elderly would increase his vote share among this group. According to exit polls, those over age 65 gave Mr. Bush only 47 percent of their vote in 2000, with 51 percent going to Al Gore.

From the beginning, Republicans decided to forgo dedicated financing for Part D. Except for trivial premiums paid by recipients, the entire cost would fall on taxpayers. Moreover, Republicans Through 2012, Medicare Part D added $318 billion to the national debt (see “General Revenue” on Page 111 in the 2013 Medicare trustees report). That same report projects that Medicare Part D will add $852 billion to the debt over the next 10 years.refused to raise the Medicare tax or cut spending to cover Part D. Hence, the deficit increased by virtually the entire cost of the program.



An important precondition to enactment of the prescription drug benefit was that it not cost more than $400 billion over the first 10 years, a figure established in the budget resolution. Any figure higher than that would have been subject to a “point of order” by a single member of the House or Senate that would probably have derailed the legislation.

Thus it was a huge problem for Republicans when the chief actuary of the Medicare system, Richard S. Foster, concluded during the summer of 2003 that Part D would actually cost $530 billion over its first 10 years. But this fact was hidden from Congress and not revealed until it was reported by The New York Times on Jan. 30, 2004 — almost two months after the bill was signed into law.

Mr. Foster later discussed in detail the pressure exerted on him by Bush administration political appointees, in particular, Thomas A. Scully, administrator of the Centers for Medicare and Medicaid Services. In a 2004 article for a professional journal, Mr. Foster said:


Congressional activity on the legislation that became the Medicare modernization act got underway in May of 2003. In June, the then-administrator of C.M.S. ordered me to cease responding directly to congressional requests for actuarial assistance. Instead, I was directed to provide the responses to him for his review, approval and ultimate disposition.

Following several vigorous discussions, the administrator made it clear that this was a direct order and that if I failed to follow it, “the consequences of insubordination are extremely severe.” I understood this statement to mean that I would be fired if I provided the requested information to Congress.

The inspector general for the Department of Health and Human Services later determined that Mr. Scully’s action was inappropriate, but by then Part D was in law and he had left government to become a lobbyist for drug companies.

The fact that Mr. Foster’s estimate and another from the Congressional Budget Office were well above the actual cost of Medicare Part D over the first 10 years is irrelevant.

The point is that the legislation was thought to cost $400 billion in 2003. An estimate of $530 billion from the Medicare actuary would have killed the legislation or possibly forced Republicans to accept cost-containment measures opposed by the pharmaceutical industry.


But that is not the end of Republican manipulation to get the prescription drug giveaway enacted. When the legislation came up for a final vote in the House of Representatives at 3 a.m. on Nov. 22, 2003, it failed after a standard 15-minute vote, with 194 for and 209 against.

Rather than accept defeat, Republican leaders simply kept the vote open while they twisted arms to get opponents to switch their votes. By 4 a.m., the legislation was still losing, 216 yeas to 218 nays, according to an excellent report in The Hill. Finally, at 5:52 a.m., the vote closed, with Republicans eking out a 220-to-215 victory.

The record indicates that the following Republicans switched their votes from nay to yea: Ernest Istook of Oklahoma, Trent Franks of Arizona, C.L. Otter of Idaho and Calvin Dooley of California. Two Democrats, Jim Marshall and David Scott, both of Georgia, also switched from nay to yea (see Page H12296 in The Congressional Record).

The record also shows that such “deficit hawks” as the current House speaker, John Boehner of Ohio; the current House majority leader, Eric Cantor of Virginia; and the current House Budget Committee chairman, Paul Ryan of Wisconsin, voted for Medicare Part D all the way. Although out of Congress, the former speaker, Newt Gingrich, wrote a commentary in The Wall Street Journal on Nov. 20, 2003, urging all Republicans to vote yes.

Tom DeLay of Texas, then House majority leader, was later criticized by the House ethics committee for bringing undue pressure on Representative Nick Smith of Michigan to switch his vote, which he did not. Mr. DeLay later told a conservative news service that those who voted against Medicare Part D took “the easy way out.”

Three days later, the Senate joined the House in supporting the legislation, which passed by a vote of 54 to 44, with 42 Republicans voting yea and 9 nay. Among those voting yea were such staunch conservatives as Mitch McConnell of Kentucky, Orrin Hatch of Utah and Rick Santorum of Pennsylvania.

When Senator Hatch was later asked why Republicans did not provide Medicare Part D with proper financing, he said, “We didn’t have the votes to pay for it.”

But at least President Bush achieved his goal. According to exit polls, he increased his share of the over-65 vote to 52 percent in 2004.