March 11, 2004

Why Oh Why Are We Ruled by These Liars? (Prescription Drug Costs Edition)

If I were Chair of the Senate Finance or the House Ways and Means Committee, I would demand the resignations of Snow, Thompson, and Bolten over this:

KR Washington Bureau | 03/11/2004 | Bush administration ordered Medicare plan cost estimates withheld: Five months before the November House vote, the government's chief Medicare actuary had estimated that a similar plan the Senate was considering would cost $551 billion over 10 years. Two months after Congress approved the new benefit, White House Budget Director Joshua Bolten disclosed that he expected it to cost $534 billion. Richard S. Foster, the chief actuary for the Centers for Medicare and Medicaid Services, which produced the $551 billion estimate, told colleagues last June that he would be fired if he revealed numbers relating to the higher estimate to lawmakers.

"This whole episode which has now gone on for three weeks has been pretty nightmarish," Foster wrote in an e-mail to some of his colleagues June 26, just before the first congressional vote on the drug bill. "I'm perhaps no longer in grave danger of being fired, but there remains a strong likelihood that I will have to resign in protest of the withholding of important technical information from key policy makers for political reasons."...

Cybele Bjorklund, the Democratic staff director for the House Ways and Means health subcommittee, which worked on the drug benefit, said Thomas A. Scully - then the director of the Medicare office - told her he ordered Foster to withhold information and that Foster would be fired for insubordination if he disobeyed. Health and Human Services Department officials turned down repeated requests to interview Foster. The Medicare office falls under the control of HHS.

In an interview with Knight Ridder, Scully, a former health-industry lobbyist deeply involved in the administration's campaign to pass the drug benefit, denied Bjorklund's assertion that he'd threatened to fire Foster. He said he curbed Foster on only one specific request, made by Democrats on the eve of the first House vote in June, because he felt they'd use the cost estimates to disrupt the debate. "They were trying to be politically cute and get (Foster) to score (estimate the cost of the bill) and put something out publicly so they can walk out on the House floor and cause a political crisis, which is bogus," Scully said. "I just said, `Look, (Foster) works for the executive branch; he's not going to do it, period,'" he said.

Otherwise, Scully said, Foster was available to lawmakers and their staffs. " ... I don't think he ever felt - I don't think anybody (in the actuary's office) ever felt - that I restricted access. ... I think it's a very nice tradition that (the actuary) is perceived to be very nonpartisan and very accessible, and I continued that tradition."

Scully said Liz Fowler, the chief health lawyer for the Democrats on the Senate Finance Committee, could confirm the actuary's independence. Fowler didn't.

"He's a liar," she said of Scully.

At a Ways and Means Committee hearing last month, HHS Secretary Tommy Thompson all but repudiated Scully's tactics. "I may have been derelict in allowing my administrator, Tom Scully, to have more control over it than I should have. ... And maybe he micromanaged the actuary and the actuary services too much. ... I can assure you that from now (on), the remaining days that I am secretary you will have as much access as you want to anybody or anything in the department. All you have to do is call me."

Democrats asked Thompson on Feb. 3 and March 3 for a complete record of Foster's estimates. They've yet to get it. Said HHS spokesman Bill Pierce: "We respond to all inquiries in time and we will do the same" with these....

For years before Scully's arrival in 2001, key lawmakers had direct access to Medicare actuaries. In 1997, when Republicans were having trouble getting health-care cost information out of the Clinton administration, Rep. Bill Thomas, R-Calif., who's now the chairman of the House Ways and Means Committee, added language to the Balanced Budget Act conference report to emphasize the importance of free access to Foster. "The process of monitoring, updating and reforming the Medicare and Medicaid programs is greatly enhanced by the free flow of actuarial information from the Office of the Actuary to the committees of jurisdiction in the Congress," the report says....

Note that the administration's previous declarations that they learned of the higher estimates only after the bill was passed are now "inoperative."

Posted by DeLong at March 11, 2004 08:05 PM | TrackBack | | Other weblogs commenting on this post
Comments

How in the world, how AT ALL, can this be allowed?? Why aren't isn't stuff like this ALL OVER the media? This is a clear violation of any type of public trust. How sickening can this whole politics before policy thing get???

Posted by: JC on March 11, 2004 08:43 PM

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Violation of public trust? Hell, it's a crime, if Congress asked for the information and CMMS didn't provide it, or provided misleading information - and from my reading of the article, that's exactly what happened.

Ollie North was convicted and went to prison for withholding information from Congress.

Posted by: Cyclopatra on March 11, 2004 09:34 PM

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Isn't that Ollie North was convicted and went on to a career at MSGOP?

Posted by: M. Tullius on March 11, 2004 09:57 PM

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The implosion expands.

Posted by: bakho on March 11, 2004 10:32 PM

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I love Fowler's brevity, "He's a liar."

Maybe we should introduce her to some of the Republicans who wanted John Kerry to apologize for saying much the same thing.

Posted by: Sensical on March 12, 2004 12:12 AM

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There's no mention of a blow job, so what's all
the fuss about?

Posted by: jimbo on March 12, 2004 05:07 AM

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This was the one of the biggest pieces of domestic legislation in twenty years and the Administration knowingly lied about its cost to Congress, underrepresenting the cost by more than 100 billion dollars.

You can't rely on the GOP leadership in the Congress to hold the Administration accountable for these lies, but Daschle should pledge to filibuster everything until there is hearings and accountability. How can the Legislature function if the Executive can knowingly misstate evidence? Every Senator and Congressperson should be demanding these resignations simply out of responsibility to the offices they hold.

Posted by: wetzel on March 12, 2004 06:06 AM

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As I said in a previous post, more fresh material is being generated daily. All lying all the time. Go Kerry!!

Posted by: tstreet on March 12, 2004 07:17 AM

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I'm a little surprised that Rick Foster didn't resign over this. He's a very stand-up guy; if anything, perhaps a bit too stubborn. It certainly makes sense that Scully would have had to order Rick to conceal information, and that Rick would have been really upset by that. I'm also willing to bet that Rick didn't leak the e-mail to Knight Ridder; again, he's too righteous (in both the good and bad senses of the word) to do that.

The actuaries (the ones at SSA, too) are civil servants and should be insulated from political pressures. I'm sure the last thing one of them wants to see is his/her name in the paper in a story like this. It's just like these b******s in the Bush administration to treat these people, who work incredibly hard for the public, like dirt. I did see Donna Shalala interact with Rick a few times, and she was very solicitous of him, in a good way.

Posted by: Dave on March 12, 2004 09:01 AM

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What do you think Congress's reaction to this would have been if the President were a Democrat? Hearings would start when, and last until when/what?

Posted by: Jonathan Goldberg on March 12, 2004 10:58 AM

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This is pretty awful. But the cynic in me wonders if it's standard operating procedure. Anybody notice that Republican law makers couldn't get access as recently as 1997 under Clinton's administration. And of course, then, they were the ones complaining.

So while obviously wrong, what makes you all sure this isn't just the way it's done (other than the fact that it's not your man doing it)? That doesn't excuse, but it does raise the question of whether this sort of thing would be better under Kerry.

Posted by: redhgs on March 12, 2004 02:45 PM

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This story was partially reported on 26 June 2003.


http://www.nctimes.net/news/2003/20030626/71717.html

White House won't release Medicare memo. By Laura Meckler, AP Writer. WASHINGTON - The Bush administration's top Medicare accountant has calculated how millions of senior citizens would be affected by bringing private managed care into the program, but the administration won't release the information.

An earlier analysis suggested that a Republican plan to inject market forces into Medicare could increase premiums for those who stay in traditional programs by as much as 25 percent. If that's still the case, it could help Democrats who argue that the GOP plan is risky for those who want to stay in traditional Medicare, where they can pick any doctor, rather than move to a managed care plan.

The administration's Medicare chief threatened to fire his top actuary, Rick Foster, if Foster released his calculations to Capitol Hill Democrats who requested the analysis, officials said.

Medicare chief Tom Scully said in an interview Wednesday that Democrats had no right to request the information from Foster in the first place.

"They don't have the right on the Hill to call up my actuary and demand things," said Scully, chief of the Centers for Medicare and Medicaid Services. "These people work for the executive branch, period."

Scully said he would release the analysis "if I feel like it."


Well, now it's clear why Scully was hiding Foster's numbers. But it was clear 9 months ago in general what was going on. The question now becomes: what could or should have been done in June 2003 (by Daschle, the press, whomever) given what was known then?

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