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The surprisingly exciting life of Medicare's chief actuary

richardfoster.JPGRichard Foster testifies before Congress.

The CMS report that's caused House Democrats some trouble this week was authored by Richard Foster, the chief actuary of Medicare. But this isn't the first time he's prepared a troubling report on a major new program. In 2003, when Republicans were forging ahead on the Medicare Prescription Drug Benefit, Foster wrote an analysis suggesting that the bill would cost $534 billion over the first 10 years -- quite a bit more than the $394 billion estimate by the Congressional Budget Office. He handed his report over to the White House, the OMB and the Department of Health and Human Services. And that's where it died.

As we learned later, Tom Scully, the Bush-appointed head of CMS, told Foster that he'd lose his job if he released that report. Despite believing the demand was "inappropriate" and "unethical," Foster, after consulting with an HHS lawyer who told him that Scully could indeed make good on his threat, buried the report.

Say what you will about the Democrats this year, but compared with the Medicare Part D process (remember the shenanigans of the House vote that literally led ethics investigations against Tom DeLay?), health-care reform has been a model of good government.

(Thanks to Jon Perr for reminding me of Foster's history.)

Photo credit: Thomas Rangel/AP.

By Ezra Klein  |  November 17, 2009; 11:11 AM ET
Categories:  Health Reform  
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Next: Why the Senate will have to use the House health-care reform bill [CORRECTED]

Comments

I'll be reminding you of the last sentence if the Dems try to use reconcillation.

Posted by: besnyder1 | November 17, 2009 11:25 AM | Report abuse

Using reconciliation wouldn't change that sentence at all. Reconciliation is a normal procedure of the House and Senate. Threatening to fire actuaries who release threatening data is not.

Posted by: Ezra Klein | November 17, 2009 11:29 AM | Report abuse

the question is will liberals allow Alan Frumin to do his job or pull a Trent Lott if he doesn't give them what they want. If they don't I'm sure you'll be all over here Ezra making that point.

Again Ezra the idea of "Mom, he hit me first" doesn't hold water. No one is saying that the Bush administration was right for doing the things they did. Because they did them doesn't make the Democrats right for what they do. It just makes them less like a totalitarian by at least allowing them to see the light of day.

And so basically you're saying we can't trust what CBO reports? Doesn't that shed a whole new light on the "defecit neutral" game being played here.

Posted by: visionbrkr | November 17, 2009 11:58 AM | Report abuse

Correct my if i'm wrong, but didn't Foster's analysis of Part D also significantly over-estimate the costs?

His estimate was $139 billion higher than CBO's (http://waysandmeans.house.gov/hearings.asp?formmode=printfriendly&id=1303), which turned out in fact to be considerably too high (http://www.nytimes.com/2009/08/26/opinion/26gabel.html?pagewanted=all)

Could that be relevant, do you think?

Posted by: tomwoods | November 17, 2009 12:30 PM | Report abuse

If, as we now know, Fosters 2003 $534 billion estimate was wildly low, what are we to make of his 2009 estimate?

Well, it barely matters. Nothing the government undertakes costs what is promised, and delivers even less.

Get the stupid government out of health care.

Posted by: msoja | November 17, 2009 12:32 PM | Report abuse

msoja - did you by any chance look at the links in the comment right above yours? which state pretty clearly that the actual cost of Part D was BELOW Foster's estimate?

which isn't a slam on him, btw, just a note that it's hard to estimate costs of something like health reform & Foster's record (like CBO's) is to err on the side of under-estimating savings from system reform.

Posted by: tomwoods | November 17, 2009 5:54 PM | Report abuse

--"msoja - did you by any chance look at the links in the comment right above yours?"--

Not 'til just now, but I followed the last link in Klein's post and read there:

"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."

It seems to me that there's an apples/oranges thing going on. There were two major parts to the '03 legislation, and it looks a little like the links you gave are talking about one part of the bill, while Klein's paragraphs were about the whole thing. It's fun with government generated statistics, too.

Posted by: msoja | November 17, 2009 9:06 PM | Report abuse

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