If any single issue crystallizes the defects of Republican rule in the age of George W. Bush that issue is the Medicare Prescription Drug Improvement and Modernization Act. (It's also the single issue most likely to lead to the end of Washington's one-party regime.) Spawned by a White House under the influence of the pharmaceutical and insurance industries, rubber-stamped in a Congress bought by lobbyists for those interests, and imposed on the nation with prevarication, duplicity and outright bribery, the drug bill represents everything Americans hate about the federal government today. Within its 400-plus pages, the act contains something to offend everyone, including a potential majority of voters in November.
Congressional leaders still proclaim that problems with the new program will be worked out and smoothed over well before Election Day, but they know that their political survival is threatened. On Tuesday, a delegation of some 30 Republican senators attended a closed meeting with Health and Human Services Secretary Mike Leavitt and Medicare administrator Mark McClellan (the older brother of the White House press secretary) to discuss how to prepare a political defense against anticipated Democratic attacks against the program. Meanwhile, newly elected House Majority Leader John Boehner has admitted that the program's inauguration was "a disaster."
As elderly citizens across the country continued to struggle with the program's complexities and inequities last week, the Bush White House quietly admitted that its own cost estimate over the coming decade has risen from $400 billion to $1.2 trillion.
That rather substantial budgetary revision brings back bad memories of the bill's passage in 2003, when the administration concealed its true expense -- and, as the press revealed in 2004, threatened to fire Medicare's chief actuary, Richard S. Foster, if he spoke honestly about that subject. (Foster's secret $600 billion estimate has now turned out to be too modest by half.) The Government Accountability Office later determined that the silencing of Foster was not only unethical but probably illegal as well.
Unlawful suppression of central facts is merely one aspect of the bill's disgraceful history, however. The entire tale deserves to be told again, now that people are suffering the consequences and may, perhaps, pay closer attention this time.
For years before Bush ascended to the Oval Office, politicians had debated how to deal with the rapidly growing expense of prescription drugs, which play a more critical role in medicine today than when Medicare began in 1966. The essential question was whether to use the Medicare program's market power to negotiate lower prices with the pharmaceutical industry, as other nations do, so that senior citizens could afford their medication -- or to let the industry write the legislation to protect its enormous profits, as Congress ultimately did.
That is an antiseptic description of what turned out to be an extraordinarily dirty deal.
Many months before Bush introduced his bill in 2002, Big Pharma and its squadrons of lawyers and publicists mobilized to control the legislative process. Spending on lobbying rose sharply to more than $78 million, with a total force of 623 lobbyists that outnumbered all the members of the House and Senate. (Most of those lobbyists were former members of Congress, former staffers of congressional committees or former federal officials who had passed through the "revolving door.") PhRMA, the industry's dominant trade association, increased its own spending that year by 50 percent, from $7.5 million to $11.3 million.
Among the key lobbyists for the industry was the Alexander Strategy Group, the small but powerful firm linked to both Tom DeLay and Jack Abramoff. Alexander Strategy shut down last month after Tony Rudy, who formerly worked for both the super-lobbyist and the former Republican leader, and who had registered as a drug lobbyist, was named as "Staffer A" in the Abramoff indictment.
In the meantime, of course, the pharmaceutical industry continued to provide millions of dollars in contributions directly to members of Congress as well as the president and the Republican National Committee. But the influence campaign became still more insidious as the industry reached inside the Bush administration.
While Medicare administrator Thomas Scully oversaw passage of the bill for the White House, he was simultaneously discussing possible job offers from pharmaceutical and insurance companies. Scully, the bureaucrat who had threatened Foster to keep him silent about the program's likely costs, accepted a well-paid position as a lobbyist at Alston & Bird, a Washington firm that represents several drug companies. (The Bush administration gave him a "waiver" from the usual ethics rules that forbid such crooked conflicts of interest.)
After the compromised Scully had performed his part, the Republican congressional leadership took over. When the bill reached the House floor, Democrats were not permitted to offer a single substantive amendment. Roll-call voting on the final bill was held open for three hours instead of the normal 15 minutes so that DeLay and his deputies would have extra time to break arms and stuff pockets. At least one reluctant Republican, Nick Smith of Michigan, who finally voted "yea," later said that DeLay -- whose wife was paid by Alexander Strategy Group -- had both threatened him and offered a $100,000 bribe in the form of promised campaign contributions to his son, who planned to run for the father's House seat.
And again, the industry reached inside to fix the process. Billy Tauzin, the Louisiana Republican who chaired the House Energy and Commerce Committee and served as the bill's lead sponsor, soon retired from politics to accept one of the most lucrative jobs in Washington. The smooth-talking Tauzin became the new president of ... PhRMA!
To Washington insiders, this tawdry chronology is not news. To voters who rarely see how the legislative sausage is made in the capital, however, the manufacturing of the hated Medicare drug bill could prove decisive. They're already angry, and they don't even know what happened to them yet.
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