Medicare expert says he was told to hide estimates

[IJ Reilly]

Meanwhile, back at the ranch...

WASHINGTON -- The government's top expert on Medicare costs was warned that he would be fired if he told key lawmakers about a series of Bush administration cost estimates that could have torpedoed congressional passage of the White House-backed Medicare prescription-drug plan.

When the House of Representatives passed the controversial benefit by five votes last November, the White House was embracing an estimate by the Congressional Budget Office that it would cost $395 billion in the first 10 years. But for months the administration's own analysts in the Centers for Medicare and Medicaid Services had concluded repeatedly that the drug benefit could cost upward of $100 billion more than that.

Withholding the higher cost projections was important because the White House was facing a revolt from 13 conservative House Republicans who'd vowed to vote against the Medicare drug bill if it cost more than $400 billion.

Rep. Sue Myrick of North Carolina, one of the 13 Republicans, said she was "very upset" when she learned of the higher estimate.

"I think a lot of people probably would have reconsidered (voting for the bill) because we said that $400 billion was our top of the line," Myrick said.

Five months before the November House vote, the government's chief Medicare actuary had estimated that a similar plan the Senate was considering would cost $551 billion over 10 years. Two months after Congress approved the new benefit, White House Budget Director Joshua Bolten disclosed that he expected it to cost $534 billion.

Richard S. Foster, the chief actuary for the Centers for Medicare and Medicaid Services, which produced the $551 billion estimate, told colleagues last June he would be fired if he revealed numbers relating to the higher estimate to lawmakers.

"This whole episode which has now gone on for three weeks has been pretty nightmarish," Foster wrote in an e-mail to some of his colleagues June 26, just before the first congressional vote on the drug bill. "I'm perhaps no longer in grave danger of being fired, but there remains a strong likelihood that I will have to resign in protest of the withholding of important technical information from key policy makers for political reasons."

Knight Ridder obtained a copy of the e-mail.

Foster didn't quit, but congressional staffers and lawmakers who worked on the bill said he no longer was permitted to answer important questions about the bill's cost.

http://www1.venturacountystar.com/vcs/national/article/0,1375,VCS_123_2724218,00.html

[zimv20]

maybe i was too kind when i said this administration is lousy at estimating -- they're good at it but lousy at telling the truth

[IJ Reilly]

I'm beginning to hope the Bush campaign presses Kerry on his "crooked Republicans" remark. If the man has any guts at all, he'll throw incidents like this right back in their faces, and let the American people decide if he's "going negative" or simply telling it like it is.

[IJ Reilly]

Part II of the story nobody seems to care about.

Democratic Move to Revisit Medicare Bill Rejected

WASHINGTON — The White House and congressional Republicans on Saturday rejected Democratic demands that Congress reconsider the landmark Medicare prescription legislation approved last year.

The call for revisiting the legislation followed statements by Richard S. Foster, the top financial analyst for Medicare, that Bush administration officials ordered him to withhold information from Congress during the Medicare prescription drug debate.

Foster said he believed last June that he would be fired if he responded to lawmakers' requests for information on how much specific provisions of the bill would cost and how the legislation would affect the traditional Medicare program.

[...]

Democratic lawmakers and presidential candidates began accusing the administration of a Medicare cover-up in January, when the administration said it expected the new law to cost taxpayers $534 billion over 10 years, more than a third more than the official $400-billion ceiling Republican and administration officials had committed themselves to during the debate.

The administration's higher cost estimate also angered many conservative Republicans who, pressured by the White House, had voted for the prescription drug bill despite their concerns about the growing federal deficit.

In June, an original version of the legislation passed the House by a 216-215 vote; in November the final legislation again squeezed through the House, passing by a vote of 220 to 215 after Republican leaders held the vote open for an unprecedented three hours.

Foster said Saturday he believed the narrow vote margins and high political stakes surrounding the debate prompted then-Medicare Administrator Thomas A. Scully to order him to withhold information from members of Congress.

"The concern I had at the time was that the results that we prepared that could be used to support the legislation … those were generally given to the congressional requesters," Foster said in an interview with The Times. "But anything we did that could perhaps be used against the legislation was not released or, in one case, was released only after" administration officials were pressured.

Under normal circumstances, the Office of the Actuary, which conducts technical financial analyses of Medicare- and Medicaid-related legislation, provides such information and often conducts specific analysis for members of Congress upon request.

But in an e-mail message in early June and in a subsequent telephone call from his assistant, Scully ordered him to suspend that practice, Foster said. Although he was not told he would be fired for following normal procedures, Foster said he understood that's what would happen if he did.

"I was told that the consequences of insubordination would be severe," he said. "I thought the meaning was very clear."

Efforts to reach Scully, who has left the administration to become a private healthcare consultant, were unsuccessful Saturday.

Scully is known in Washington as a negotiator whose fast-talking, shoot-from-the-hip style has often gotten him in trouble. In interviews with other media on the issue, Scully said Foster had misinterpreted a joke.

Several Democratic lawmakers called Friday for an investigation of Foster's allegations. But Feehery, Hastert's spokesman, dismissed the matter as a conflict "between those guys."

Foster stood by his account.

"Either his memory is incredibly faulty in this regard or he's being misleading," Foster said of Scully. "I'd gladly go find that e-mail and show it to the world."

Presumptive Democratic presidential nominee Sen. John F. Kerry of Massachusetts said Saturday that Foster's allegations would deepen what he said is a credibility problem for the president.

"With this new evidence that the Bush administration threatened to fire a public official if he told the truth to the public, President Bush's growing credibility gap has just gotten that much wider," Kerry said in a statement.

http://www.latimes.com/news/politics/la-na-medicare14mar14,1,644044.story

[Sayhey]

I know that if the Clinton administration did this there would be immediate hearings in Congressional Government Oversight committees, along with calls for the firing of the officials involved. Come to think of it, that sounds like a pretty good course of action.

[IJ Reilly]

This should be a major story, if not a scandal. Yet, it was buried in the back pages of my newspaper this morning. I don't watch much TV news but I haven't heard a peep about it anywhere else. And where are the Bush defenders on this board? Aren't they anxious to explain why the administration suppressed the true costs of a major government program?

[zimv20]

And where are the Bush defenders on this board? Aren't they anxious to explain why the administration suppressed the true costs of a major government program?
i guess it's my turn... hold on....

but bush is spending more of our money on healthcare! isn't that what you tax-happy liberals want?!??!??!??!??!?!???!????!??!????!?!!!?!?!?!??!

[wwworry]

I really don't see how Bush can expect to get re-elected. This kind of stuff happens way too frequently. Myself, I would have told congress the truth and gotten fired. It's not so bad to get fired for telling the truth.

I think democrats outside of the Kerry camp need to start shouting about stuff like this.

[IJ Reilly]

Forget proxy attacks -- I think Kerry needs to press these issues personally. The way I look at it, he's got essentially two choices: to allow the Bush campaign to characterize him and put him on the defensive, or to brush off the attacks and bring the fight directly to Bush on a whole litany of issues. The first way loses; the second way at least has a chance of winning.

[wwworry]

Then they'll say he is negative (for pointing out the truth).

No, I think it is up to the rest of us to do the dirty work. But I would love to see a debate where Kerry just asked questions of Bush:

Who outed Plame?
Why did your administration tell Richard S. Foster he would be fired for thelling the truth about the cost of the medicare bill?
Why did your administration fire the person (I forget his name) who gave an honest estimate of the cost of the war in Iraq?
Tenet told you that the intelligence about Iraq's WMDs was dubious. Why did you repeatedly proclaim false information to the American people?
You promiced that your tax cut would bring jobs. Where are the jobs?
Why does your administration muzzel science reports?
Who was in on Dick Cheney's energy task force meetings?
Who is responsible for breaking into the DNC computers?
Where's Ossama?
and finally Why did you hold up that stupid fake turkey in Iraq?

He's got a lot to answer for actually.

[zimv20]

Who was in on Dick Cheney's energy task force meetings?

i was thinking about that the other day. obviously, it was full of oil men. i'm wondering if medium to longterm research has indicated a substantial dropoff in production that would necessitate the US securing foreign fields. i've no proof, obviously, but it fits the pattern of a) not revealing what was said and b) some of the actions the administration has taken to putting troops in certain places

[wwworry]

It was full of Enron people - Bush's biggest contributors.

[IJ Reilly]

Just noting once again: this thread's been up for three days now, and not one Bush supporter has posted a comment, let alone made a stab at an explanation or a defense of the administration's behavior. What are we to make of this? Do they condone it, or just wish it would go away? Enquiring minds demand to know.

[2jaded2care]

Sorry I'm late... :)

Actually, I can't defend this either, even if it was truly a joke which was misinterpreted (highly unlikely). Even if it was, you don't make jokes like that, and if you do, you make it clear immediately that it is. If you don't, you should be called on it and disciplined. (Maybe Mr. Scully's current employer will consider his "cavalier" attitude when raise-time comes around.)

Even though this appears to have been an underhanded political dirty trick, I'd think it would be hard for Dems to complain too much, since I was under the impression they were arguing all along that the program didn't go far enough (IOW, spend more money). The real offended parties are the Reps who went along reluctantly, only to find out that they were likely duped.

It's a shame, but maybe Congress needs to make these experts testify what the likely cost will be. Regardless of who's POTUS.

[IJ Reilly]

Thanks for the comment. Leaving aside the political questions for the time being, I'm wondering whether stunts like this have any impact on your opinion of the Bush administration. Not to try to spin your answer before you offer it, but there's little question but that they were determined to deliberately mislead both Congress and the American people about this cost of this major program. Is this a betrayal of trust in your eyes, or just a minor matter?

[2jaded2care]

Well, if I were to trust any politician, I guess I'd consider being misled a betrayal of that trust...

It does suggest a certain "cavalier attitude" toward the truth by this administration. As opposed to, maybe, the Carter administration.

I don't think we can expect much different nowadays. Why, yes, I am somewhat cynical. Why do you ask?

[zimv20]

It does suggest a certain "cavalier attitude" toward the truth by this administration. As opposed to, maybe, the Carter administration.

I don't think we can expect much different nowadays.

if you expect it and accept it, then it's probably not going to change.

i submit that the willful intention of this administration to mislead the public, through use of false evidence and numbers, doublespeak and lack of accountability is far worse than any administration before it. on sunday, i'll say it's worse than all previous administrations combined.

[IJ Reilly]

Well, if I were to trust any politician, I guess I'd consider being misled a betrayal of that trust...

It does suggest a certain "cavalier attitude" toward the truth by this administration. As opposed to, maybe, the Carter administration.

I don't think we can expect much different nowadays. Why, yes, I am somewhat cynical. Why do you ask?

This is a variation on the "they all do it" rationalization. Even if this was true, it would not function as an excuse. No need to go back to Carter -- go back to Clinton, who was excoriated by his opposition and impeached for lying about his sex life. Surely you think what Bush has done is at least a serious a breach of the public trust?

[wwworry]

Well, if I were to trust any politician, I guess I'd consider being misled a betrayal of that trust...

It does suggest a certain "cavalier attitude" toward the truth by this administration. As opposed to, maybe, the Carter administration.

I don't think we can expect much different nowadays. Why, yes, I am somewhat cynical. Why do you ask?

First of all if they lie and get away with it because you are "cynical" we might as well just give up on ever having a responsible government.

And Dems are not against the bill because they "want to spend even more money". We are against the bill because it is a give-away to drug companies. Do you realize that it is now illegal for states to bargain with drug companies to get a better price? It is also illegal to buy the same drug from Canada where the price is a lot less. What kind of crap is that? Anti-consumer Anti-competitive crap. They would not even let the democrats participate in the committees that wrote the legislation.

Did you know that the guy who wrote most of this legislation is about to get a cushy job in the drug industry with a big pay boost?

In short, we were sold out. They lied about the cost. They gave away our tax dollars. They benefit personally from the give-away. That's why I don't like the bill.

[2jaded2care]

"The Democratic plan would cost an estimated $700 billion to $900 billion, more expensive than the $400 billion Bush has vowed to commit to overhauling Medicare." link: http://www.cnn.com/2003/ALLPOLITICS/03/04/bush.medicare/

Granted, Bush was wrong/inaccurate/misleading/mistaken/lyingthroughhisteeth with the estimate.

Yes, definitely, I think that we should throw out every politician who's ever misled anyone. I assume we'll all be voting for Nader.

It seems a bit disingenuous to call it anti-competitive to bar drugs from Canada. I thought the gov't there dictated the prices they would like to pay to drug companies. Plus, everything there is priced lower, even taking the exchange rate into account, because they just plain don't have as much money as we do. I read somewhere (mainstream news source, I'll try to look it up) that the car manufacturers must price cars lower in Canada just to sell to the av'g Canadian. I thought that seemed unfair, but it is the way competition works, I guess.

I could probably be talked into some form of restrictions on advertising by drug companies. That consumers have to pay for this nonstop "ask your doctor if Norflamitrocitrinocor is right for you" blather is outrageous.

[IJ Reilly]

I'm sorry, but this is at least a partially disingenuous answer. What the Democrats may or may not propose is completely irrelevant to the issue of the Bush administration deliberately withholding the true costs of the program they proposed. Where is the outrage, I wonder?

[IJ Reilly]

I suppose so long as this story remains buried in the back pages of the newspaper, it isn't a real scandal. I especially liked Scully's explanation that the threat of termination ("the consequences for insubordination are extremely severe"), was made "in jest." What a comedian.


Democrats want to learn whether White House officials had a higher quote withheld.

By Vicki Kemper, Times Staff Writer

WASHINGTON — Several Democratic lawmakers on Friday asked the White House to produce documents that they hoped would show whether officials there were behind a decision to withhold from Congress a higher cost estimate for the Medicare prescription drug bill.

Administration officials said that while they did not tell Richard S. Foster, Medicare's top financial analyst, or his boss, Thomas A. Scully, to keep Congress in the dark, they would not release related correspondence or records of meetings and telephone calls.

"There is a long-standing rule that deliberative materials remain nonpublic," White House spokesman Trent Duffy said. "That's an essential tool for the executive branch to be able to do its business."

Foster has said in interviews that Scully told him he would be fired if he provided Congress with his analysis of the Medicare bill. But Duffy on Friday denied the White House was behind any alleged threats.

Throughout the contentious debate over the drug benefit last fall, President Bush and Republican lawmakers insisted they would not approve a bill that cost more than $400 billion. In June, Foster estimated that the bill would cost $515 billion over 10 years.

Several conservative Republicans have said that they would have voted against the bill had they known of the higher estimate.

Scully has denied that he seriously threatened to fire Foster.

Doug Badger, White House senior health policy analyst, said Friday that "to the best of [his] recollection," he learned about a threat by Scully "in jest" to fire Foster only after it had happened — sometime in June — and did not instigate it. "I was not involved in that," he said in a telephone interview.

The Wall Street Journal on Thursday printed an e-mail that Foster had received from Scully's assistant, telling Foster not to release certain information without Scully's approval and warning him that "the consequences for insubordination are extremely severe."

In January, the administration announced that its estimate of the bill's cost was $534 billion, far surpassing the $400-billion figure from the Congressional Budget Office.

Administration officials continued to insist, however, that the CBO estimate was the official one.

Democrats, most of whom had voted against the legislation, have seized on the dispute over the estimate, saying it raises questions about the administration's credibility.

Letters sent to the White House on Friday by Rep. Henry A. Waxman (D-Los Angeles) and four other House members represent the Democrats' effort to directly connect the Bush White House to the controversy.

The Department of Health and Human Services "rarely acts on its own on issues of this magnitude, especially when they have major ramifications for the federal budget," Waxman said in letters to White House Chief of Staff Andrew H. Card Jr. and Josh Bolten, director of the Office of Management and Budget.

Health and Human Services Secretary Tommy G. Thompson has ordered an internal investigation of the matter. Foster has said in interviews that he suspects other administration officials, possibly including Badger, were behind the order to silence him.

On Thursday, 18 Democratic senators requested a General Accounting Office investigation into whether federal laws that cover providing information to Congress were violated.

Duffy accused Democrats of "spinning up the Washington process" in an effort to undermine a law they opposed.

[2jaded2care]

I'm sorry, but this is at least a partially disingenuous answer. What the Democrats may or may not propose is completely irrelevant to the issue of the Bush administration deliberately withholding the true costs of the program they proposed. Where is the outrage, I wonder?

My quote about the Dems' proposal costing more was in reference to my earliest post about the real offended parties being the Reps who were suckered, more so than the Dems who would've spent more. I thought it seemed relevant to that point. You probably disagree, it's only my opinion.

Unfortunately, politics being what they are, it's even more disappointing that it's only Dems who are questioning the information provided to Congress. I mentioned making people testify about these things to Congress, but to tell you the truth I thought it was already a crime to intentionally provide false information (lie) to Congress...

Now that I think about this issue, I would be pretty upset if, say, I agreed to have a house built based on someone's "good faith" estimate of the costs, and I found out later that the estimate was intentionally misleading. Maybe if people looked at it like that -- even fellow Reps who are so fond of saying "it's our money" -- then things might change. But then we tolerate porkbarrel spending every year too, right? :(

[zimv20]

My quote about the Dems' proposal costing more was in reference to my earliest post about the real offended parties being the Reps who were suckered, more so than the Dems who would've spent more. I thought it seemed relevant to that point.
but is it a fair comparison if the plans have differing features?

[numediaman]

but is it a fair comparison if the plans have differing features?

I think this misses the point completely. The Democratic plan never had a chance. The issue is that the administration lied to both the Congress and the American public about the costs of the plan. It is not relevant whether this plan had a better chance of passing than another plan. They lied.

This is the same BS reasoning I'm hearing about Iraq. Yes, the Bush administration lied about WMDs and Saddam's connections with Al Qaeda, but isn't it a good thing Saddam's gone? They lied.

A lie is a lie is a lie.

[zimv20]

The Democratic plan never had a chance.
true. i was just questioning the validity of comparing the prices of apples and oranges. "the GOP plan was better because it was cheaper"

[2jaded2care]

Agreed, lying is bad. Should people, including politicians, lie? Usually, no. Do people, including politicians, lie? Yes.

You believe that Bush or the Bush administration has willfully lied. I admit some of what is reported can be construed to support that view. However, I have yet to see a "smoking gun". Call me naive, I want proof before stating that as fact. You are free to believe what you wish, as am I.

I hope that "a lie is a lie" remains true no matter which party's in charge. But, even lying doesn't necessarily disqualify one from serving as President -- if so, I imagine we'd have gone through the order of succession a few times and had quite a few Secretaries of Education serving as President if that were the case.

[zimv20]

I have yet to see a "smoking gun".
the facts:
- congress said they wouldn't pass the bill if it exceeded $400 billion
- the WH estimate did not exceed that amount
- the bill was passed
- very soon thereafter, a revised figure was released by the WH

afaict, there are two possibilities:
1. the WH intentionally misled congress on the true cost, or
2. the WH did not perform due diligence on the costs until after the vote

so either they lied, or they're incompetent. either way, congress is mad at passing such an expensive bill and we're all stuck w/ the cost.

[2jaded2care]

There's still the fact that the CBO came up with different numbers...

I have re-read the news articles. What a mess to keep straight.

The WH denies involvement. Dems are convinced otherwise. The "heavy" has moved on. The "whistle-blower" waits until after the fact to speak up. (Hope if I'm ever in a similar position, I don't wait so long.)

Don't know if it's better to reopen the legislation or not. More time wasted. Is that a good or bad thing? Maybe they should just for clarity's sake.

[wwworry]

However, I have yet to see a "smoking gun".

to add to zimv20's post
also there are reports (to bring this full circle) that information was supressed - see first post.

That seems like a pretty good case though I do not think it will ever go to trial. And the higher ups just took high paying jobs in the drug industry.

And don't you think states should be able to bargain for lower prices? Isn't that natural? The whole thing stinks.

As far as "all politicians lie", can you tell me another administration that lied as much as this one besides the Nixon administration? Maybe it's a much more sinister republican plot. First get the public immune to lies by yelling about stupid ones (like Lewinski) making up fake ones (like Vince Foster). Then the sheer number of new ones. People don't care anymore and accept lying lying down.

[numediaman]

. . .People don't care anymore and accept lying lying down . . .

sadly true. or at least those that support the administration don't care about the lies -- the other 50% are completely appalled. There seems to be no middle ground. Can't we all just agree that lying is not a good thing?

[IJ Reilly]

However, I have yet to see a "smoking gun". Call me naive, I want proof before stating that as fact.

Okay then, you're naive. What you really want is a confession, which you aren't going to get.

All of the pertinent facts are on the table. You seem like a thoughtful and intelligent person, so please, explain to me why this situation leaves you in such a moral quandary.

[2jaded2care]

It is unclear to me strictly from reading these articles whether the alleged suppression of facts in any way figured into the lower CBO numbers. If they were arrived at independently, I do not see why one set of numbers is "better" than another. Are we saying that whoever prepared the CBO numbers is incapable of math? Or were these taken from Mr. Foster's information? (It's very possible I missed some fact regarding this in the articles. I am not an expert on gov't budgetary processes, nor do I wish to become one, or assume that I am qualified to act as one simply from reading some news articles.)

I cannot say for certain that Mr. Scully's email was not a badly-received joke, as he claims. I can say that it seems in poor taste to me regardless, but I cannot pass judgement on his motives given the facts at hand. Perhaps you have greater insight into or personal knowledge of Mr. Scully's character than I.

While I do not like to blame the messenger, it seems that if Mr. Foster was truly concerned, he should have requested clarification from Mr. Scully, to the effect of, are you telling me I'll be fired if I do my job? (Instead of inferring that from an email about "severe consequences".) I would have preferred that Mr. Foster had come forward before the legislation was approved (and his boss had moved onto a position in the health care industry). I would like to think that I would have done differently in his position, but obviously I hope never to be in a similar position.

The situation seems muddled to me given the facts as I see them. I am trying not to infer innocence or guilt based on suppositions, inferences or appearances. Personally, I would prefer more facts. It is apparent many of you do not find that necessary to make a judgement. That is your prerogative.

[2jaded2care]

BTW, Rower CPU, I may disagree with you politically, but you're doing a damn fine job as moderator. :)

[IJ Reilly]

We know the higher cost estimate existed before the floor vote and was surpressed, because it was released shortly afterwards. It made some headlines, remember? What we're hearing now is entirely consistent with what we knew before. It simply completes the picture.

This discussion reminds me of an old Far Side cartoon. Several people wearing lab coats are writing on clipboards and a blackboard. The caption, "The staff at Consumer Reports deciding where to go to lunch."

At some point, you have to decide what the data is telling you. Continuing to demand further analysis in the face of clear evidence begins to look ridiculous.

[2jaded2care]

This discussion reminds me of an old Far Side cartoon. Several people wearing lab coats are writing on clipboards and a blackboard. The caption, "The staff at Consumer Reports deciding where to go to lunch."

In my observation, whenever several people try to decide where to go to lunch something similar happens. Two or three people, it's relatively simple. Trying to account for different tastes/budgets/styles of several people is difficult. Ridiculous as it may be, I like to account for everyone's preferences, even when it's only lunch. I've been told I suffer "analysis paralysis", but then again, I rarely suffer "buyer's remorse".

[IJ Reilly]

I've been told the same thing, but it's a habit I've tried to shake. I work in a highly analytical profession, so I understand the importance of critical analysis. But its worth keeping in mind that excessive analysis often leads to indecisiveness (sometimes, deliberately). In my experience, most analytical excesses are caused by a failure to see the clearly evident, or a desire to rationalize a predetermined outcome.

[numediaman]

An update, in case you missed it:

Analysts: Medicare could go broke by 2019
Surplus shrinking as baby boomers retire

Tuesday, March 23, 2004 Posted: 12:16 PM EST (1716 GMT)

WASHINGTON (AP) -- Medicare will go broke by 2019 without changes in a program that is swelling in cost because of a new prescription drug benefit, trustees were to report Tuesday.

A source familiar with the trustees' report, who spoke on condition of anonymity, said the go-broke date for Medicare has been moved up to 2019, seven years sooner than last year's estimate . . .

. . . Republicans pressed for the overhaul of Medicare last year to give private insurers a much larger role in the program as a way, Bush and others said, to control long-term costs.

But the government's own projections are that private managed care plans will cost taxpayers more than traditional Medicare for the foreseeable future.

A big reason for an earlier insolvency date "will be a direct result of increased payments to private health plans," said Terri Shaw, an analyst with the liberal Center for American Progress.

http://www.cnn.com/2004/ALLPOLITICS/03/23/medicare.report.ap/index.html

[zimv20]

WASHINGTON (AP) -- Medicare will go broke by 2019 without changes in a program that is swelling in cost because of a new prescription drug benefit, trustees were to report Tuesday.
the starving of this and other social programs is what i believe the adminstration has really been up to all along. "we had to destroy the village in order to save it"