Politics, especially Republican politics, makes for strange bedfellows. With the AARP by their side, President Bush and his GOP allies in 2003 pushed for their unfunded and deeply flawed Medicare prescription drug plan. Now in their scorched earth campaign to block health care reform backed by the seniors' organization, the right-wing has declared war on the AARP. And the Republican partner swapping doesn't end there. Six years before Republicans hailed chief Medicare actuary Richard Foster this weekend for questioning the savings in the House Democrats' health care bill, the Bush administration threatened to fire him.
In response to a request from House Republicans, the Centers for Medicare and Medicaid Services (CMS) prepared an analysis of the Democratic legislation's cost containment benefits and implications for Medicare. While CMS' Richard Foster concluded that 34 million more Americans would be insured and the life of the Medicare trust fund would be extended by five years under the House plan, he warned that due to the influx of new patients into the system, "total national health expenditures [NHE] in the U.S. during 2010-2019 would increase by about 0.8 percent" while potentially "exacerbating existing access problems" in the Medicaid program:

The increase in total NHE is estimated to occur primarily as a net result of the substantial expansions in coverage under H.R. 3962, together with the expenditure reductions for Medicare...The availability of coverage would typically result in a fairly substantial increase in the utilization of health care services, with a corresponding impact on total health expenditures. These higher costs would be partially offset by the sizable discounts imposed on providers by State Medicaid payment rules, together with the significant discounts negotiated by private and public health insurance plans.

Foster also cautioned that the House bill could lead some Medicare providers "for whom Medicare constitutes a substantive portion of their business" to stop seeing Medicare patients.
Despite the fact that Foster made clear his analysis did not take into account "the various income or excise tax proposals or the impact of income or payroll taxes" that could alter utilization of health care services, Republican leaders were quick to embrace his report to bludgeon Congressional Democrats. Rep. Dave Camp, the ranking Republican on the House Ways and Means Committee, crowed:

"This report confirms what virtually every independent expert has been saying: Speaker Pelosi's health care bill will increase costs, not decrease them. This is a stark warning to every Republican, Democrat and Independent worried about the financial future of this nation. I hope my colleagues in the Senate heed CMS' findings and refuse to rush ahead until any bill under consideration can be certified to actually reduce health care costs."

While Speaker Pelosi's spokesman Brendan Daly noted the same report "estimates that our bill will cover 10 percent more of the population with less than a 1.3 percent increase in national health expenditures that illustrates a bending of the cost curve," Minority Leader John Boehner simply declared:

"[Richard Foster's study] confirms that this bill violates President Obama's promise to 'bend the cost curve.' It's now beyond dispute that their bill will raise costs."

But six years ago, Republicans in the Bush White House and Congress did not speak so kindly about Richard S. Foster. When Foster tried to share the true cost of the Medicare Part D drug benefit with Congress (a program supported by both Boehner and Camp), he almost lost his job.
As I wrote four years ago ("Medicare's Prescription for Failure"):

A White House desperate for an election year win on Medicare deliberately misrepresented the program's costs in order to ensure passage. On December 8, 2003, President Bush rolled out a program he claimed would cost $400 billion over 10 years. Within two months, however, the White House notified Congress that the real price tag would approach $550 billion. When Medicare actuary Richard Foster sought to present the true price tag to Congress in late 2003, then agency chief Thomas Scully threatened to fire him. Fast forward two years and the estimated 10 year price tag for the Medicare prescription plan now exceeds $720 billion for its 43 million beneficiaries.

In March 2004, the same Richard Foster testified before the House Ways and Committee about the threats of retaliation he faced from the Bush administration. As the New York Times recounted his testimony:

Mr. Foster said he had shared his cost estimates with Doug Badger, the president's special assistant for health policy, and with James C. Capretta, associate director of the White House Office of Management and Budget. But he said that Thomas A. Scully, who was then administrator of the Medicare program, directed him to withhold the information from Congress, citing orders from the White House in one instance.
In testimony before the House Ways and Means Committee, Mr. Foster said he had struggled to preserve the independence and integrity of his office. It was his first public appearance since a furor erupted over his assertions that Mr. Scully threatened to fire him if he disclosed his cost estimates to Congress during debate on the Medicare bill...
Mr. Foster said he had been told to withhold information from lawmakers of both parties. Moreover, he said, Mr. Scully stated that he was ''acting under direct White House orders'' in telling the actuary not to respond to a request from the chairman of the Ways and Means Committee, Representative Bill Thomas, Republican of California. Mr. Thomas was a principal architect of the Medicare bill...
Mr. Foster was calm and even-tempered in his testimony. ''I did not especially want to be fired, but I was not afraid of it,'' he said. Last summer, he said, ''I ultimately decided to resign in protest.'' But he added, ''the staff talked me out of that.''

As the New York Times reported later in 2004, the GAO ultimately concluded that the Bush administration "illegally withheld data from Congress on the cost of the new Medicare law" and that Scully "should repay seven months of his salary to the government." While Scully was later fined for other ethics violations, he was never held accountable for his role in the Medicare fraud. Today, Thomas Scully "now works for a law firm and a private investment firm, has registered as a lobbyist for Abbott Laboratories, Aventis Pharmaceuticals, Caremark Rx and other health care companies."
And so it goes. While Richard Foster's report will no doubt make life uncomfortable for the Obama administration in its pursuit of health care reform, in 2003 the Bush White House tried to silence him altogether when he was the bearer of bad news. Alas, that was then and this is now. And now, Democrats control Congress and the White House.
UPDATE: Amazingly, former Senate Majority Leader Bill Frist (R-TN) and John Breaux (D-LA) offered a Politico op-ed Monday proclaiming Medicare Part D, which was overwhelming opposed by Democrats, as a model bipartisan health reform. Frist and Breaux conveniently omit mentioning that unlike the House Democrats' health care bill, the 2003 Medicare Modernization Act was not paid for. In addition to unleashing a torrent of red ink, their Medicare drug benefit prohibited the government from negotiating directly with drug companies, resulting in higher costs to consumer. And the Bush administration's coercion of Richard Foster, as well as Tom Delay's unethical tactics on the House floor, never appear in the Frist/Breaux revisionist history. As Ezra Klein rightly concluded of these two friends of the industry:

The health-care reform bills currently under consideration in both the Senate and the House actually cut money from the deficit, but they are being criticized as fiscally irresponsible by many of the people who voted for Medicare Part D. It's like watching arsonists calling the fire department reckless.