With its talking babies and warnings of government takeovers and terrified seniors, the grandstanding by House Republicans during Saturday's narrow 220-215 passage of the Democratic Affordable Health Care for America Act was entirely predictable. And if that vote count sounds familiar, it should. Six years ago with the AARP by its side, it was the House GOP which eked out a victory for its deeply flawed and unfunded Medicare prescription drug program by an identical margin. But while the roles may be reversed from 2003 to 2009, the Republican objective of stopping Democratic gains at the polls is unchanged.

A quick glance back to November 22, 2003 in the national rear view mirror shows a mirror image of last night's House vote. The Bush White House, which flip-flopped on adding a prescription benefit within the Medicare program in order to win over elderly voters as the 2004 campaign neared, put last minute pressure on the caucus to back the program. President Bush touted the AARP's backing for a 678-page bill his administration duplicitously claimed would cost $400 billion over 10 years. Bill Thomas (R-CA), the legislation's architect, sounded a refrain that Democrats would repeat this week:

"If we are trying to destroy Medicare, why is the AARP supporting us?''

While only one of 177 Republicans supported Saturday's health care reform bill, six years ago 204 House Republicans voted yea on the Medicare prescription bill. Among them were current GOP leaders John Boehner (R-OH) and Eric Cantor (R-VA).
And to be sure, the Republican position then as now wasn't about preserving conservative principles, but instead a GOP majority at all costs. As House Majority Leader Tom Delay defended his party's fiscal recklessness that November night:

"We must forget about ideological absolutes."

But the similarities between Democratic Speaker Nancy Pelosi's victory last night and that of her Republican predecessor Dennis Hastert end there. From the GOP leadership's strong-arm tactics and the administration's budgetary chicanery deployed to secure the bill's passage to the industry giveaways it offered, the dirty dealing behind the Medicare drug plan showcased typical Republican politics in action.
For starters, consider Tom Delay's unprecedented machinations on the House floor to round up the needed votes. As the New York Times recalled:

Under heavy pressure from President Bush and Republican Congressional leaders, lawmakers backed the legislation by a vote of 220 to 215, sending it to the Senate, which is expected to act in the next few days. The vote, which ordinarily takes fifteen minutes to record, was kept open for an extraordinary three hours as Republicans struggled to switch votes and obtain a majority.

And what happened during those three hours was a new low, even for Tom Delay. As the Washington Post later reported, the House Ethics Committee later reprimanded Delay for trying to buy votes for the Medicare bill:

After a six-month investigation, the committee concluded that DeLay had told Rep. Nick Smith (R-Mich.) he would endorse the congressional bid of Smith's son if the congressman gave GOP leaders a much-needed vote in a contentious pre-dawn roll call on Nov. 22.

Then there's the matter of the Medicare bill's price tag. 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.

(As the Times reported 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.")
Then there's the small matter of public policy itself. From its inception, the Republicans' Medicare prescription benefit was designed to fail. With its confusing and costly "donut hole" limiting payments for beneficiaries and its prohibition on direct government price negotiations with pharmaceutical companies, Medicare Part D was a headache for recipients and a windfall for the drug companies.
For starters, the White House and its GOP allies on Capitol Hill insisted that the final December 2003 Medicare Drug bill prohibit the government from negotiating prices directly with drug companies, a key demand of the pharmaceutical lobby. The same price leverage enjoyed by the Veterans Affairs Department and its program beneficiaries was surrendered by Medicare, with the predictable results described in a 2006 House analysis.
That report released by Democratic staff on the House Government Reform Committee showed that under the new Medicare plan, prices for 10 commonly prescribed drugs were 80% higher than those negotiated by the Veterans Department, 60% above that paid by Canadian consumers and still 3% higher than volume pharmacies such as Costco and Drugstore.com. The report concluded that:

"The prices offered by the Medicare drug plans are higher than all four benchmarks, in some cases significantly so. This increases costs to seniors and federal taxpayers and makes it doubtful that the complicated design of Medicare Part D provides any tangible benefit to anyone but drug manufacturers and insurers."

Which is exactly as Louisiana Republican Bill Tauzin designed it. Just months after shepherding the Medicare prescription bill he wrote through the House, Tauzin, the chairman of the Energy and Commerce committee, left Congress and accepted a $2 million-a-year job as president of PhRMA -- Pharmaceutical Research and Manufacturers of America.
And so it goes. Five days before proclaiming the House health reform bill "the greatest threat to freedom that I have seen," the man RNC Chairman Michael Steele is now calling "Speaker Boehner" warned it was "breaking the bank." But six years ago, Boehner stood with President Bush and 203 House Republicans to bring American voters the Medicare prescription bill just in time for the 2004 elections.