How Bush scammed Congress re Medicare law changes

US Senate approves McClellan for Medicare job
US Senate approves McClellan for Medicare job
Forbes - 3/11/04

WASHINGTON (Reuters) - The U.S. Senate approved by voice vote early Friday the nomination of Mark McClellan to run Medicare and Medicaid, the government health insurance programs that cover nearly 80 million poor, elderly and disabled Americans.

McClellan, a 40-year-old physician and economist, currently serves as commissioner of the Food and Drug Administration.

At the Medicare agency, he will oversee implementation of a new $530 billion law that provides prescription drug benefits for seniors.

"Dr. McClellan is the right person. ... He is an extremely bright and capable public servant," Senate Majority Leader Bill Frist said in a statement. Frist is also a physician.

McClellan is well-regarded by Republicans and Democrats, but his nomination to run the Centers for Medicare and Medicaid Services had run into resistance from some senators over his aggressive campaign to stop importation of lower-priced medicines from other countries.

To overcome the resistance, McClellan reversed himself and agreed to testify Thursday before the Senate Commerce Committee about drug pricing and importation of cheaper medicines.

In his new job, McClellan will be faced with the challenge of putting in place the complex Medicare changes, which are expected to be a centerpiece of President Bush's re-election campaign.

The law provides prescription drug coverage for seniors starting in 2006 and also encourages a bigger role in Medicare for private health insurers and managed care plans.

Before heading FDA, McClellan served on the Council of Economic Advisers. He was a deputy assistant treasury secretary during the Clinton administration.

His brother, Scott, is Bush's press secretary.

FDA Deputy Commissioner Lester Crawford is slated to become acting commissioner after McClellan's move.

Daschle calls for revote on Medicare drug bill
Mar. 13, 2004
Daschle calls for revote on Medicare drug bill
BY TONY PUGH
[email protected]

The Senate minority leader says a new vote is needed on the Medicare drug benefit bill after learning the administration's top cost analyst may have been ordered to provide skewed information to Congress.

WASHINGTON - Senate Minority Leader Tom Daschle said Friday that allegations of unfavorable cost estimates about the Medicare prescription drug bill being withheld from lawmakers justifies reopening the vote on the drug benefit.

The nation's top Medicare analyst confirmed Friday that his former boss, Thomas Scully, ordered him to withhold his estimates because they exceeded what Congress seemed willing to accept by more than $100 billion.

Richard Foster, the chief actuary at the Centers for Medicare and Medicaid Services, said Friday night that he received a handwritten note from Scully, then the centers' administrator, in early June ordering him to ignore information requests from members of Congress who were drafting the drug bill.

Knight Ridder, The Herald's parent company, reported the episode in an exclusive story published Friday, but Foster's comments were his first on the matter.

At the time of the estimate, the House was sharply divided on the proposed new Medicare drug benefit, which the administration strongly backed. Ultimately, the House passed the measure, 216-215, on June 27. In November, House members endorsed a House-Senate compromise version by a 220-215 vote. Approving the version were 13 Republican fiscal conservatives who had said they would vote against it if it cost more than $400 billion for its first 10 years.

On Friday, leaders in the House and Senate called for investigations into the alleged muzzling. Sen. Edward Kennedy, D-Mass., wrote President Bush demanding to know what cost estimates he used in pushing the new drug benefit.

DIRECT ORDER

Scully's note, according to Foster, ``was a direct order not to respond to certain requests and instead to provide the responses to him and [to] warn about the consequences of insubordination.''

The note was Scully's first threat in writing, Foster said, and came after at least three less formal threats. They ''came in different forms,'' he said. 'Sometimes he would make a comment that `I think I need another chief actuary,' or 'If you want to work for the Ways and Means Committee [which was drafting the bill] I can arrange it.' It was that sort of thing.''

Efforts to reach Scully at his office and home on Friday were unsuccessful. In a recent interview, he denied closing off Foster's lines of communication with Congress. On only one occasion, Scully said, did he block Foster's contact with lawmakers, in this case Democrats, saying their motives were purely political.

Foster said Scully insisted upon a pattern of withholding of information.

''Estimates that were supportive of the legislation were generally released and estimates that could be used to criticize the legislation were generally not released,'' Foster said.

Foster said he believed higher-ranking members of the administration than Scully knew of the higher cost estimates that his office had computed.

''Did the president know? Did [Health and Human Services] Secretary Tommy Thompson know? I don't know,'' Foster said.

The White House press office didn't respond to requests for comment.

HIGHER COST

Knight Ridder reported Friday that Foster's Office of the Actuary suggested that the drug benefit would cost at least $100 billion more than the $395 billion estimated by the Congressional Budget Office, whose job it is to project costs of legislation. One projection prepared in early June by Foster's office and obtained by Knight Ridder concluded that a Senate version of the bill might cost as much as $551 billion.

When Bush signed the bill in December, the drug benefit bore a $395 billion price tag. In January, the president's budget director, Joshua Bolten, upped the estimate by $139 billion.

Sen. Bill Frist of Tennessee, the majority leader and one of the few Republicans to address the controversy Friday, noted that Foster's estimates were based on different and more costly assumptions than those of the Congressional Budget Office.

Frist's spokesman, Bob Stevenson, added: ``If an individual's job was threatened and if they were trying to shield information from Congress, that could be an issue of concern.''

In a grim-faced floor speech Friday, Daschle, a South Dakota Democrat, called for reopening the vote on the drug benefit. He also called for an investigation into the firing threat and assertions that the administration had withheld its cost estimates from Congress.

''Whether this is criminal or not is a matter we will certainly want to clarify,'' Daschle said. ``But if not criminal, it was certainly unethical. And I think we need to know the facts.''

Robber barons influencing government was a bad thing 100 years ago, and it apparently has gotten worse, not better.

Economic power requires checks and balances as much as any other power. Too bad the Medicorp Bill denies any chance for checks and balances.

Buyer beware has become Buyer You Will Do As You Are Told

Not a good sign.

The mess this situation exhibits is undoubtedly spread much wider than just the pharmaceutical industry. When a hierarchy controls government, you have a kingdom, not a federal republic.

As the pretenses fall by the wayside, it is the people that suffer. We are allowing our rights and privledges and powers to be taken away from us by a hierarchy. Doesn't that give you even the slightest concern? What did we fight a revolution over if not to end the king's power over all of us?

Bush is acting like a king, and he has a gentry surrounding him that feels it is superior and empowered to rule over all the rest of us.

Doesn't this bother you at all?

Foster: White House Had Role In Withholding Medicare Data
Foster: White House Had Role In Withholding Medicare Data
HHS Actuary Feels Bush Aide Put Hold on Medicare Data
By Amy Goldstein
Washington Post Staff Writer
Friday, March 19, 2004; Page A02

Richard S. Foster, the government's chief analyst of Medicare costs who was threatened with firing last year if he disclosed too much information to Congress, said last night that he believes the White House participated in the decision to withhold analyses that Medicare legislation President Bush sought would be far more expensive than lawmakers knew.

Foster has said publicly in recent days that he was warned repeatedly by his former boss, Thomas A. Scully, the Medicare administrator for three years, that he would be dismissed if he replied directly to legislative requests for information about prescription drug bills pending in Congress. In an interview last night, Foster went further, saying that he understood Scully to be acting at times on White House instructions, probably coming from Bush's senior health policy adviser.

Foster said that he did not have concrete proof of a White House role, but that his inference was based on the nature of several conversations he had with Scully over data that Congress had asked for and that Foster wanted to release. "I just remember Tom being upset, saying he was caught in the middle. It was like he was getting dumped on," Foster said.

Foster added that he believed, but did not know for certain, that Scully had been referring to Doug Badger, the senior health policy analyst. He said that he concluded that Badger probably was involved because he was the White House official most steeped in the administration's negotiations with Congress over Medicare legislation enacted late last year and because Badger was intimately familiar with the analyses his office produced.

The account by Foster, a longtime civil servant who has been the Medicare program's chief actuary for nine years, diverges sharply from the explanations of why cost estimates were withheld that were given this week by White House spokesmen and Health and Human Services Secretary Tommy G. Thompson. They suggested that Scully, who left for jobs with law and investment firms four months ago, had acted unilaterally and that he was chastised by his superiors when they learned of the blocked information and the threat.

Two days ago, Thompson told reporters: "Tom Scully was running this. Tom Scully was making those decisions." Thompson said the administration did not have final cost estimates until late December predicting that the law would cost $534 billion over 10 years, $139 billion more than the Congressional Budget Office's prediction. Foster has said his own analyses as early as last spring showed that the legislation's cost would exceed $500 billion.

Last night, White House deputy press secretary Trent Duffy said, "It is my understanding that Mr. Badger did not in any way ask anyone to withhold information from Congress or pressure anyone to do the same." Duffy said he asked Badger this week whether he had done so and that Badger replied he had not. Duffy said that Badger was traveling last night and was unreachable to comment. Calls to his home were not returned.

Foster suggested the White House had been involved as new details emerged of the manner in which he had been threatened. The actuary released an e-mail, dated last June 20, from Scully's top assistant at the time regarding one GOP request and two Democratic requests for information about the impact of provisions of the Medicare bill on which the House would vote a week later.

In a bold-faced section of the three-paragraph note -- reported in yesterday's Wall Street Journal -- Scully's assistant, Jeffrey Flick, instructed Foster to answer the Republican's question but warned him not to disclose answers to the Democratic queries "with anyone else until Tom Scully explicitly talks with you -- authorizing release of information. The consequences for insubordination are extremely severe."

The warning came in response to an e-mail Foster had sent to Scully that same Friday afternoon, 22 minutes earlier, in which he said the three questions "strike me as straightforward requests for technical information that would be useful in assessing drug and competition provisions in the House reform package." Foster offered in that e-mail to show Scully his proposed replies in advance.

Flick, who now oversees the Medicare agency's regional office in San Francisco, did not return several phone calls.

Scully was out of town and did not respond to efforts to reach him via e-mail last night. He said in an interview this week that he and Foster had disagreed over how helpful an executive branch employee needed to be to Congress. He called it "a separation of powers issue."

In 1997 budget legislation, Congress sought unsuccessfully to require the Medicare actuary to respond to all of its requests. Such language was included in a conference report on the bill but does not carry the force of law.

Foster said that the e-mail was the only instance in which he had been explicitly threatened in writing, but that "there were other instances in which Tom in an e-mail or just over the phone would clearly be unhappy and would say less formally something to the effect, 'If you want to work for the Ways and Means Committee, I can arrange that.' "

The actuary said that in June 2001, shortly after Scully arrived, he directed Foster to send weekly reports of any requests for information he had received from Capitol Hill or elsewhere in the administration.

Congressional Democrats yesterday called for the General Accounting Office to investigate the episode. Thompson announced Tuesday he had ordered HHS's inspector general to conduct an inquiry.

Bush Medicare Reform Bill Becomes a Nightmare for GOP
Posted on Fri, Mar. 19, 2004
Bush Medicare Reform Bill Become a Nightmare for GOP
By William Douglas, Knight Ridder Washington Bureau Knight Ridder/Tribune Business News

Mar. 19--WASHINGTON - Enactment of a sweeping Medicare reform law last year was supposed to be the crowning achievement of President Bush's "compassionate conservatism" as he readied himself for re-election.

By providing a federally subsidized prescription-drug benefit for senior citizens, albeit a limited one, administration officials felt they usurped a major issue from the Democrats and cut into Democratic support among seniors age 65 and over -- an especially important voting bloc in key battleground states such as Florida.

But less than four months after he signed it into law on Dec. 8, Bush's Medicare-reform dream has turned into a nightmare and a potential drag on his bid for re-election.

-- The Bush administration deliberately didn't tell Congress that the measure could cost more than $100 billion more than advertised.

-- House Republican leaders abused House rules to push the measure to a narrow victory. There are also allegations of threats and bribes that are under investigation.

-- The Bush administration spent millions of taxpayer dollars on public service TV ads touting the Medicare reform law that look suspiciously like Bush campaign commercials. Those, too, are now under investigation.

-- Polls show that a majority of Americans don't like the Medicare reforms.

"It's something that's eating away at the credibility of the administration in an election year on a bill that he (Bush) thought was a building block for his re-election," said Stephen Hess, a political analyst for the Brookings Institution, a centrist think tank, and a former aide to President Eisenhower.

The law's afterglow faded fast once lawmakers learned it could cost at least $100 billion more than the $395 billion over 10 years that the White House originally advertised. That White House revelation in late January riled budget hawks who'd said they wouldn't vote for the measure if it cost more than $400 billion. The measure probably would have failed if the higher cost estimate had been known.

Lawmakers got steamed after the nation's top Medicare actuary, Richard S. Foster, told Knight Ridder that he had projected the higher cost long before Congress voted in November. Lawmakers were never told about his higher cost estimates because he says he was ordered by his boss, former Medicare Administrator Thomas Scully, to withhold them from Congress or he would be fired.

House Democrats, led by Rep. Henry Waxman, D-Calif., the ranking member of the House Government Reform Committee, are threatening a lawsuit to force Health and Human Services Secretary Tommy Thompson to turn over all of Foster's undisclosed estimates. And they're not stopping with Thompson.

Waxman and four other senior House Democrats fired off a letter Friday to White House chief of staff Andrew Card demanding that the White House disclose its role in withholding the information from Congress.

"In this case, there appears to have been extensive White House involvement in the development of the cost estimates for the prescription drug provisions," the letter asserts.

In an interview with Knight Ridder, Foster said he was reasonably sure that Doug Badger, a White House health policy adviser, was aware of the higher cost estimates. Foster said Scully hinted that he was being pressured by Bush administration officials to withhold the cost projections from Congress.

White House spokesman Trent Duffy said earlier this week that Badger didn't order Scully to muzzle Foster. Scully, who now works at a local law firm specializing in health care matters, didn't return a call for comment.

Duffy said Friday the White House isn't likely to cooperate with the investigation that the Democrats are requesting.

The HHS inspector general's office is investigating Foster's assertion that Scully ordered him to withhold cost estimates from members of Congress.

Karl Rove, Bush's chief political strategist, called the Medicare issue "much ado about nothing" on Friday because Congress relies on cost estimates for legislation made by the Congressional Budget Office, not the executive branch. In a Friday interview with the editorial board of The Miami Herald, Rove refused to say whether he was involved in the decision to withhold the high cost estimates.

Democrats hope to get answers Wednesday during a House Ways and Means Committee hearing on the long-term financial health of Medicare. However, Foster wasn't confirmed as a witness Friday; congressional witness lists are set by the majority party, currently Republicans.

Foster met Friday with Ways and Means members and staff from both parties and stood by his cost estimates while acknowledging that CBO's lower estimates were professionally executed and could be correct.

Many lawmakers felt abused when Republican leaders pushed the bill through the House of Representatives on Nov. 22 by keeping the vote open for nearly three hours -- usually votes are allowed only 15 minutes -- and by twisting GOP members' arms until they supported it.

The House Ethics Committee has launched an investigation into allegations by Rep. Nick Smith, R-Mich., that "bribes and special deals were offered" to induce him to vote for the bill in that period.

Smith, who voted against the bill, has said that unidentified Republican power brokers offered "extensive financial support and endorsements for my son, Brad, who is running for my seat. They also made threats of working against Brad if I voted no."

HHS Secretary Thompson sat beside Smith on the House floor, talking to him avidly for about an hour before the final Nov. 22 vote.

Smith later backed off his bribery claim, but the Ethics Committee is proceeding anyway.

In addition, the General Accounting Office, the investigative arm of Congress, is examining whether HHS television ads touting the new Medicare law -- with pictures of Bush prominent -- constitute illegal political propaganda. GAO already has concluded that the ads contain "notable omissions and errors," but its preliminary judgment was that they are legal.

The ads -- called "video news releases" by the administration -- feature an actor portraying a television news reporter and are being offered to local TV news shows. Critics say the ads are intended to make viewers think they are watching objective news reports.

The law provides limited prescription-drug coverage for about 40 million seniors. It also makes it easier for cheaper generic drugs to reach the marketplace.

The law's centerpiece is the drug benefit, which will not be available until 2006. Until then, seniors would get drug-discount cards that could net savings of 10 percent to 25 percent off market prices.

Under the full drug benefit, seniors would pay a $250 deductible, a $34 monthly premium and 25 percent of the cost of drugs between $250 and $2,250. Seniors would encounter a gap in coverage after $2250 until their out-of-pocket expenses reaches $3,600 or $5,100 in total drug expenses. At that point, they'd pay only 5 percent of their additional drug costs.

A Gallup poll in January revealed public dissatisfaction with the reforms. Fifty-three percent of those surveyed said the new prescription drug benefit didn't go far enough; 27 percent said it was about right while 9 percent said it went too far. Eleven percent of the poll's respondents had no opinion.

The mushrooming controversy is spurring cries of cover-up from Democrats.

"There is no place for silencing the truth," said Sen. John Kerry of Massachusetts, the Democratic presidential candidate. "I believe the American people deserve real answers on why this administration is keeping public officials quiet and keeping facts from the American people. We deserve better than this."

Sen. Edward Kennedy, D-Mass., echoed the Watergate-era line this week: "What did the president know and when did he know it?"

By week's end, congressional Republicans were rallying behind Bush and the Medicare reforms. They dismissed complaints about the bill's hidden cost estimates, ongoing investigations and controversy over the HHS ads as simply a Democratic scheme to discredit a GOP triumph.

The controversy "says more about the Democratic attack machine than it says about the bill," said John Feehery, spokesman for House Speaker Dennis Hastert, R-Ill.

Independent analysts, including conservatives, weren't so sanguine.

"This bill will not go down in the annals of good government," said Robert E Moffitt, the director of the Center for Health Policy Studies at the Heritage Foundation. "Now it's a political problem."

Rep. Waxman's letters to Bush & OMB re medicare law misi
Reps. Waxman, Rangel, Dingell, Stark, and Sherrod Brown ask the White House and OMB about their involvement in the development and withholding of cost estimates of the Medicare prescription drug bill. 3/20
Letter to the White House and Letter to OMB:

http://www.house.gov/reform/min/inves_admin/admin_medicare_cost_estimates.htm

King George
"Bush is acting like a king, and he has a gentry surrounding him that feels it is superior and empowered to rule over all the rest of us.

Doesn't this bother you at all?

Yes, it bothers a me a lot.

In my view, the only criminal indictements of the Bush Crime Syndicate will be the V. Plame Outing. VP will not be indicted. The perps will not implicate the VP in fear for their lives and their families' lives.

All the other Bush Crime Syndicate Crimes will not be brought to indictement because the Oligarchy will not allow them to be brought forth.

Legislative Riders
How many Legislative Riders are attached to the Medicare Bill? 300-something sticks in my head. I'm a Senator or Representative from Podunksville. We need a porkbarrel road, or bridge, or building to the tune of $22 million. Make it a Legislative Rider and I'll be glad to sign the bill!

[quote]2.rider - a clause that is appended to a legislative bill

clause, article - a separate section of a legal document (as a statute or
contract or will)

bill, measure - a statute in draft before it becomes law; "they held a public hearing on the bill"

legislative act, statute - an act passed by a legislative body

From "The Free Dictionary."

[/quote]

$11 Billion "Porkbarrel"
Considering that the overall Medicare Bill will cost around $515 billion, maybe $11 billion for "legislative riders" (earmarks, porkbarrel, boondoggle, etc.) isn't all that much. Here's Senator McCain on the subject:

[/color]Senator McCain and the $11 Billion "Earmarks"

Big Pharma gets a big payback for supporting Bush and Cheney.

Meanwhile, America's seniors get a slap across the face -- GOP style.

Actuary tells of pressure to keep estimate from Congress
Posted on Thu, Mar. 25, 2004
Actuary tells of pressure to keep estimate from Congress
JESSE J. HOLLAND
Associated Press

WASHINGTON - Medicare actuary Richard Foster was between a rock and a hard place.

If he told Congress the Medicare bill could cost more than $100 billion more than they thought, he could be fired. If he quit and went public, it would make a big splash but nothing likely would change for the next actuary. If he did nothing, Congress would pass a bill without having the best information, but he'd be around to fight another day.

Foster did nothing, and Congress last year passed what some people have called the most sweeping changes in history to Medicare, the government's main health care program for older and disabled Americans.

But Foster now is telling lawmakers that the Bush administration's top Medicare official last year withheld from Congress the legislation's actual estimated cost for political gain.

Since President Bush signed the bill in December, the administration has acknowledged it believes the Medicare law will cost $534 billion over 10 years - more than the $395 billion estimated by congressional budget analysts.

Keeping the bill's cost below $400 billion was considered crucial for winning enough votes of conservative Republicans so it would pass in the House.

Foster said he was forced to give his cost estimate - higher than Congress' estimate - to Thomas Scully, head of the Medicare agency until December. Scully would then decide whether to give the information to Congress, Foster was told.

But Foster said Scully did not pass on some of the information to lawmakers - a move that he suspects was politically motivated.

"I considered that inappropriate and, in fact, unethical," Foster told the House Ways and Means Committee on Wednesday.

Democrats argue that is proof the White House schemed to keep from Congress the actuary's higher estimate to get its bill passed. They've called on the Justice Department to investigate for possible criminal violations.

"Officials at the highest levels of the Bush administration knew that the new Medicare bill was based on a lie," Rep. Lloyd Doggett, D-Texas. "Threatening to fire the top actuary for fulfilling his professional responsibilities, just because they disagree with the facts he reveals, represents only the latest example of an administration that intimidates those who dare to disagree."

Republicans - and Foster himself - said Scully had the authority to stop Foster from giving the information to Democrats.

House Ways and Means Chairman Bill Thomas, R-Calif., said that the Clinton administration also tried to stop Foster from giving Medicare information to Congress back in 1997, and that he told the actuary in "identical telephone conversations in different administrations" that he would stand up for him.

Foster has complained that Scully, now a lobbyist, stopped him from telling lawmakers about his higher estimates of the bill's cost.

The Associated Press, quoting several officials, reported last June that Scully had threatened to fire Foster. Scully had then characterized his remarks as "heated rhetoric in middle of the night."

After a lawyer told him Scully did have the legal right to tell him not to give Congress the information, Foster said he had three choices: give Congress the information and be fired, quit and go public, or follow orders and do nothing.

After discussing it with his staff, he decided to stay. "I would be better off working in the system," said Foster, noting that he now has assurances from Health and Human Services Secretary Tommy Thompson and Scully's successor, Mark McClellan, that he can respond to congressional requests.

A telephone message left for Scully was not immediately returned.

Health and Human Services, which oversees Medicare, recently began an investigation. Democrats also requested a review by the General Accounting Office, the investigative arm of Congress.

Four Democratic senators, in a letter to Attorney General John Ashcroft, said the instructions that Foster says he received could constitute criminal violations.

"These potential violations" by the department, the White House budget office and the White House "are a serious matter that must be investigated," wrote Sens. Debbie Stabenow of Michigan, Frank Lautenberg of New Jersey, Edward Kennedy of Massachusetts and Hillary Clinton of New York.

ON THE NET

Medicare: http://www.medicare.gov

Report: White House wrong on Medicare
SEATTLE POST-INTELLIGENCER
Tuesday, May 4, 2004
Report: White House wrong on Medicare
THE ASSOCIATED PRESS

WASHINGTON -- Bush administration officials were wrong to prevent a budget expert from giving Congress estimates of the cost of Medicare legislation, congressional researchers have concluded.

In a report made public Monday, the nonpartisan Congressional Research Service said efforts to keep Richard Foster, the chief Medicare actuary, from giving Democratic lawmakers his projections of the bill's cost - $100 billion more than the president and other officials were acknowledging - probably violated federal law.

Recent estimates set the bill's cost at more than $500 billion.

Foster testified in March that he was prevented by then-Medicare administrator Thomas Scully from turning over information over to lawmakers. Scully, in a letter to the House Ways and Means Committee, said he had told Foster "that I, as his supervisor, would decide when he would communicate with Congress."

Congressional researchers chided the move. "Such 'gag orders' have been expressly prohibited by federal law since 1912," Jack Maskell, a CRS attorney, wrote in the report.

The report was requested by committee Democrats after majority Republicans refused to subpoena Scully and White House adviser Doug Badger to testify about their roles in keeping cost estimates from lawmakers.

Rep. Bill Thomas, R-Calif., the committee chairman, said he would be willing to issue subpoenas if laws had been broken.

A spokesman for Thomas did not immediately respond to requests for comment.