12 July 2004

Medicare Mystery

The new Medicare law was supposed to be a showpiece the Republican Congress and President Bush could ballyhoo to election-year voters, especially seniors desperate for a break on prescription drug prices.     That trumpet may sound from now until November, but there remains the knotty question of whether the Bush administration was behind efforts to conceal the true cost of the law from Congress and the American public. It is a question that needs answering.    

The indications, even in the Department of Health and Human Services' report of its own internal investigation released last Tuesday, are troubling. They confirm that top Medicare officials withheld from Congress information that indicated the legislation containing new prescription drug benefits would cost taxpayers billions more than the White House was maintaining. The report also confirmed that Tom Scully, then the administrator of the Centers for Medicare and Medicaid Services, had threatened to fire chief actuary Richard S. Foster if he released information on the potential cost of overhauling Medicare. Congress repeatedly had sought Foster's estimate, which was that the legislation could cost $500 billion to $600 billion over 10 years.    

The Bush administration last year said it would not support a Medicare bill that exceeded $400 billion. In November, the Congressional Budget Office, without the benefit of Foster's numbers, estimated the cost at $395 billion and a sharply divided Congress passed the legislation.

President Bush signed the bill on Dec. 8, calling it "the greatest advance in health care coverage for America's seniors since the founding of Medicare" in 1965. Then, when the administration made its annual budget proposal to Congress in January, it placed the likely cost of the new law at $534 billion.    

Scully, who resigned in December, recently registered as a lobbyist for major drug and medical companies. The inspector general found that neither Scully's threat to Foster nor his withholding of information violated any criminal law. She accepted the Justice Department's view that Scully had the final say on what information was passed to Congress, a dubious claim notable for its reliance on dubious arguments that supported President Nixon's refusal to hand over the Watergate tapes to Congress.    

In May the nonpartisan Congressional Research Service found that Scully's order to Foster apparently violated a long-standing federal law that protects the right of federal employees to communicate with Congress.     The HHS inspector general's report was forwarded to the General Accounting Office, which has been investigating whether Medicaid officials violated federal laws by withholding the information.    

Since the Medicare actuary's figures usually have been provided to Congress for Medicare debates prior to 2003, it is fair to ask whether Foster's numbers were withheld for political purposes in order to get the necessary votes to pass the White House-backed legislation.    

Here's hoping the GAO can provide the answer.                    

© Copyright 2004, The Salt Lake Tribune.

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