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Lessons from the Medicare Prescription Drug Benefit vote

Here are some things that happened on the night the GOP pushed the Medicare Prescription Drug Benefit through the House of Representatives:

A 15-minute vote was scheduled, and at the end of 15 minutes, the Democrats had won. The Republican leadership froze the clock for three hours while they desperately whipped defectors. This had never been done before. The closest was a 15-minute extension in 1987 that then-congressman Dick Cheney called “the most arrogant, heavy-handed abuse of power I’ve ever seen in the 10 years that I’ve been here.”

Tom DeLay bribed Rep. Nick Smith to vote for the legislation, using the political future of Smith's son for leverage. DeLay was later reprimanded by the House Ethics Committee.

The leadership told Rep. Jim DeMint that they would cut off funding for his Senate race in South Carolina if he didn't vote for the bill.

The chief actuary of Medicare, Rick Foster, had scored the legislation as costing more than $500 billion. The Bush administration suppressed his report, in a move the Government Accounting Office later judged "illegal.”

Rep. Jo Ann Emerson, a "no" vote, spent the night "hiding on the Democratic side of the floor, crouching down to avoid eye contact with the Republican search team."

Rep. Butch Otter, who provided one of the final votes after hours of arm-twisting from the Republican leadership, said, “I thought there was a chance I would get sick on the floor.”

Remember all this? Probably not. There wasn't much reporting on it at the time. It wasn't a major controversy, despite resulting in multiple official investigations. I went back through the archives of National Review's “The Corner” to see if they covered the scandal. Not really. There are four or five posts on it, and the most substantive is Ramesh Ponnuru telling some columnist that "it's silly to act as though holding a vote open for a long time is an act of lawbreaking."

They're considerably more exercised about the use of reconciliation today. Obama is "shoving health care down the throats of the American people in the teeth of overwhelming public opposition and any sense of parliamentary decency," writes Mark Steyn, and I think he means "without" any sense of parliamentary decency.

But the point isn't to claim hypocrisy, as I think charges of hypocrisy are boring. First, it's to note that the health-care reform process has been a model of transparency and parliamentary decency in comparison to the Medicare Prescription Drug Benefit process (no actuaries have been intimidated into silence, for instance); second, to note that Americans don't really care about process, and people forget about even serious abuses of legislative power; and third, to suggest that Republicans are a whole lot better at making controversies out of their opponents’ behavior than Democrats are.

Whatever you think of the process that resulted in the Medicare Prescription Drug Benefit, the bill today is settled, and even popular, law. The abuses that ushered it into existence are mostly forgotten. Democrats spoke of its repeal in the months after its passage but are now strengthening it in the health-care reform bill. Republicans, meanwhile, were so confounded by Medicare's popularity that they authored and passed a massive expansion of the entitlement state. Democrats, who are currently trying to pass health-care reform in a way that doesn't break congressional rules but does upset some Republicans, should take note.

By Ezra Klein  |  March 8, 2010; 3:22 PM ET
Categories:  Congress , Health Reform  
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Next: The House's filibuster


Are you kidding me? I know you're barely old enough to remember anything before 2008, but DeLay's vote delay tactic was blasted by virtually all major media sources for a long time. You're crossing a line between fantasy and reality with some of the things you've posted on here recently. You need to stop sipping from the Democrat's cup of Kool-Aid and develop some independent thought of your own.

Posted by: novalfter | March 8, 2010 3:35 PM | Report abuse

Can you imagine any democrats having to hide on the republican side of the floor, crouching down in fear of being seen by Steny Hoyer or James Clyburn?

Can you imagine the pressure being so intense that someone siding with the republicans would want to vomit?

Neither can I.

Posted by: tomboy1 | March 8, 2010 3:37 PM | Report abuse

The tough measures the GOP used on the prescription drug bill WERE news...but only for a day or two. That's the difference here. Republicans know that in order to game the media, you just do what you have to do (ignore a report, hold a vote open, bribe officials, whatever) and uniformly deny all claims by the opposition. Don't telegraph your methods, float trial balloons, wait for editorial upon editorial to be written.... just DO IT. Republicans understand that the worst that can happen is that you'll get a day or two of bad press. After that, there will be a new outrage of the day -- a new piece of catnip for the media to play with. Ideally the outrage will be something you planted about the opposition with the Washington Post or Fox News or whomever, who will run with it either a) because of their ideological leanings or b) because they're all too happy for you to write their deadline story for them. And that is how the game is played.

Posted by: vvf2 | March 8, 2010 3:49 PM | Report abuse

It was mentioned, but I'll repeat again: there wasn't much reporting on it at the time, and it wasn't a major issue when it came time to vote on the final bill. in part, that's because some of these abuses only came out later. The award-winning article that documented them -- the night the scoreboards stood still -- wasn't published till a year or two later.

But no, there was no equivalency between the Medicare House vote and the way reconciliation has come to dominate the conversation over health-care reform. I'd guess another reason for that is that the House abuses happened all at once and then were over, while reconciliation is lasting for weeks.

Posted by: Ezra Klein | March 8, 2010 3:49 PM | Report abuse


I remember this being a story for about one day, then everyone forgot. Most importantly, the Republicans were never punished by the voters, nor are people holding it against them now. It's a valuable lesson that the public doesn't care about procedure past the very short term, so you can feel free to do what you want. Outcomes are what matter to voters.

Posted by: etdean1 | March 8, 2010 3:52 PM | Report abuse

Medicare Part D was bi-partisan unlike Obama's health care reform (as in both Dems and Repubs worked on it and contributed ideas). And a bunch of Dems in the House and Senate voted for it. And it was popular with the public. can't say the same thing about HC reform.

and don't forget: House Dems biggest quarrel with the bill was that it didn't spend ENOUGH MONEY. Ted Kennedy's bill was scored at costing $800 billion over 10 years.

Posted by: mbp3 | March 8, 2010 3:54 PM | Report abuse

"people forget about even serious abuses of legislative power" -- indeed, some do, which is sad.

"no actuaries have been intimidated into silence, for instance" -- oh, really??

Has anyone listened to Democratic Representative Massa today? Perhaps we all do need to take a closer look at what's going on in the House.

Posted by: rmgregory | March 8, 2010 3:59 PM | Report abuse

"Ted Kennedy's bill was scored at costing $800 billion over 10 years. "

I seem to remember it having an actual funding mechanism, unlike what what ultimately passed, which didn't have one, or one that didn't involve MasterCard.....

Posted by: davis_x_machina | March 8, 2010 4:08 PM | Report abuse

Another key difference between Bush's Medicare Part D and "Obamacare"? Medicare Part D wasn't paid for. At all. A program that now has a 10-year cost of $700 billion-$1.0 trillion (about the same as the health reform bills), and it's 100% new debt year after year. No need for unpopular new taxes or benefit cuts. No need for controversial cost controls.. Boy, wouldn't that have made this whole process a lot easier? I guess Obama's just a doofus for not doing it the smart way like the GOP in 2003.

Posted by: vvf2 | March 8, 2010 4:10 PM | Report abuse

----"no actuaries have been intimidated into silence, for instance"

Umm, no actuaries have been asked what the health bill will do. Richard Foster, as credible a source as you'll find, says this bill will bend the cost curve upwards, yet the Democrats (and Ezra) ignore him and keep claiming it will do the opposite. The American Academy of Actuaries has a great team of qualified experts that could help, yet the Administration has not reached out to accept their offer of assistance. They're not intimidating, just ignoring.

Posted by: ab13 | March 8, 2010 4:13 PM | Report abuse


I remember this being a story for about one day, then everyone forgot. Most importantly, the Republicans were never punished by the voters, nor are people holding it against them now. It's a valuable lesson that the public doesn't care about procedure past the very short term, so you can feel free to do what you want. Outcomes are what matter to voters.

Posted by: etdean1 | March 8, 2010 3:52 PM | Report abuse

NEVER PUNISHED? Wait, aren't the Dems in power now? If that's what you want to call what they're doing. Sure they were punished in several successive elections that brought in Nancy, Harry and Barack. Now let's see how long they stay in power.

I was also going to bring up Massa as well but it seems as if others have beaten me to it. Dems try to force their will as much as Republicans. They're just not as good at it.

Posted by: visionbrkr | March 8, 2010 4:21 PM | Report abuse

ab13, um, yes they have. The Center for Medicare Services actuarial report (the analogous report to precisely what was Ezra was talking about as being suppressed by the Bush administration on Part D) WAS released and is even posted on the Republican House Ways and Means website

Here's the Washington Post article from November referring to the report, which had both good and bad news about the proposed reforms. Republicans (obviously) seized upon the "bad" news.

I guess Obama's just a doofus again for not just hiding the report like Bush did! Why is he making this health care thing tough on himself?

Posted by: vvf2 | March 8, 2010 4:22 PM | Report abuse

Interesting how quickly our right-leaning commenters are willing to embrace Massa's complete about-face in the span of 48 hours. They must have inside information that he was lying BEFORE but he's really telling the truth NOW.

And @vvf has it spot-on. Your advice to Democrats is dangerous, Ezra, because they do not know how to manipulate the media narrative (or they're too scared to try). Just because something blew over when the GOP was in power doesn't mean the same will happen with Dems.

Posted by: BigTunaTim | March 8, 2010 4:32 PM | Report abuse

visionbrkr ,

The Dems are in power now, but do you really think that the Medicare Part D vote was a major factor? A factor at all? The Republicans had plenty of problems, but outrage over their legislative tactics wasn't an issue.

Posted by: etdean1 | March 8, 2010 4:33 PM | Report abuse

vvf2, the article says "The report, requested by House Republicans". My point is that the administration is not interested in hearing any objective actuarial analysis of their bill. They didn't ask CMS to do an analysis, they just rely on a CBO score, after crafting a bill with the specific purpose of getting a favorable CBO score. I have the utmost respect for what the CBO does, but they score what they are given, and as long as you have a good understanding of how they operate (as Peter Orszag does) you can craft your bill to get a good score from them. There are a number of reasons to be skeptical of the CBO projections actually playing out. Richard Foster directly contradicts their claims about the cost curve effects of this bill, but they're not interested in engaging with his criticism. Sure they're not suppressing what he says like Bush did, but "better than Bush" is a pretty low bar to set for yourself.

Posted by: ab13 | March 8, 2010 4:40 PM | Report abuse


It wasn't a major factor but the way that Dems played up the Republicans "abuse of power" I believe was.

And now today, turnabout is fair way as the saying goes.

Posted by: visionbrkr | March 8, 2010 4:46 PM | Report abuse

I hate unadjustable posts.

Should read "turnabout is fair PLAY"

Posted by: visionbrkr | March 8, 2010 4:52 PM | Report abuse

Ezra, I appreciate your bringing back the details of this legislative malpractice but I believe that novalfltr is basically right. I was no political junkie at the time but I recall every detail of the Republican conduct that you recount here; I think it was widely reported and long remembered.

Also, it's a kind of faux cool to claim that charges of hypocrisy are boring -- why? Because Republican hypocrisy today is so shameless and so readily documented that you've become inured? It's certainly politically germane when people who lauded reconciliation as "majority rule" five years ago excoriate it now. Those gotcha moments are politically crucial.

Posted by: sprung4 | March 8, 2010 5:03 PM | Report abuse

ab13, fair enough -- though I think you could never satisfy every economist on every issue on a proposal as broad as this one. That's what the CBO is there for. Anyways, the "better than Bush" argument is only relevant because Ezra's post is comparing the reaction and perceived "outrage" over Obama "shoving health care down America's throats" to ACTUAL abuses that occurred during the Bush administration's efforts on Part D. My point is that, if Obama is (as his opponents claim) this ruthless Chicago politician that will stop at nothing to trample his opposition and deceive his way to getting his agenda passed, then, on multiple counts, he's doing a pretty poor job of it compared to his predecessor.

Posted by: vvf2 | March 8, 2010 5:30 PM | Report abuse

"no actuaries have been intimidated into silence, for instance"

Even Ezra Klein here understates what actually happened. Foster computed the estimated cost, and was told by his supervisor that if he released that information he'd be fired. Those are the facts as GAO determined them. The more accurate numbers came out a month of two after the bill's passing, if I recall correctly.

Posted by: ADCWonk | March 8, 2010 8:16 PM | Report abuse

vvf2, I see your point and I don't disagree, the Republicans are framing this as an unprecedented abuse of power to shove an unpopular bill down our throats, a very dishonest line of attack. But I'm not all that interested in attacks on congressional Republicans, it's too easy a target. Yes, they are behaving like disingenuous liars and displaying blatant hypocrisy about this bill, the methods that may be used to pass it, and historical precedents. But I'd rather engage the bill on its merits or lack thereof. I'd rather have an honest and objective discussion about what the bill will do and the unintended consequences, I'd like to see Ezra and other pundits address the points raised by very qualified and objective people who are making good faith arguments about the many negative outcomes this could bill could give us. But unfortunately Ezra and others choose to take the low-hanging fruit of lying Republicans, because that is way easier than having a debate with Richard Foster about whether this bill will bend the cost curve up or down. Ezra is in an enviable position of having access to a lot of smart people who bring a lot to the table, so why not focus on that instead of yet another "omg John Boehner is a liar" post.

Posted by: ab13 | March 8, 2010 10:06 PM | Report abuse

The strong arm tactics that allowed for the passing of Medicare Part D were widely covered...but the way so many staffers got jobs in pharma directly or as lobbyists in the next year was even more frightening and less well covered.

I personally think it is a horrible bit of legislation- a gift to the drug makers and something that really just shouldn't have existed. As long as we distort the price of everything, there is no way for an effective market to function.

Posted by: staticvars | March 8, 2010 11:08 PM | Report abuse

When the Clinton Budget Reconiliation Act was passed in 1993, it passed over the no vote of every single GOP member in both houses, and Al Gore had to break a tie in the Senate. The Republicans decried its tax increases, and argued that the bill should fail because polling showed that it was unpopular (and by the time it passed, it had been made pretty unpopular through a concerted GOP and corporate media effort). The GOP opposition cried in rage that the tax increases would kill economic recovery, trigger runaway inflation (just like the Carter), increase unemployment, and do all sorts of economic harm. Combined with the 1993-94 health care reform debacle, the backlash to Clinton's initial focus on gays rights in military service, and a few Democratic congressional scandals, the Dems paid a political price in the midterms (probably much worse than the "price" this Congress will supposedly pay for actually growing a pair and doing something about much needed health care reform in the face of a very well funded, fearmongering and almost insanely vitriolic opposition). But as history would have it, the Clinton budget actually turned out to be a huge success, and instead of the predicted harms, it led to 7 years of peace and prosperity, and budget surpluses. That was reality then.

The moral of the story is simple" Don't let a bunch of lying, obstructionist Republicans, doing the work of their corporate overlords, prevent us from putting an end to the worst insurance industry abuses, like denial of coverage for pre-existing conditions, or arbotrary limits on coverage. Universal coverage won in the last election. Majority rules except in cases of violating fundamental constitutional rights. Obama won the 2008 election by more than 9 million votes. Dems won big in both houses. They should apologize to nobody -- nobody -- for passing what the voters elected them to pass. If conservatives don't like it, there is alwys the next election. But the only poll that matters prior to November 2010 is the one taken in November 2008, and in that poll, health care reform won bigger than the media has been letting on ever since.

Posted by: MTfromCC | March 9, 2010 12:50 AM | Report abuse

One other thing - for all of its problems (and I for one would have favored expansion of Medicare to replace private insurance altogether) - the Senate bill, unamended, means that for the first time ever, the insurance industry will actually have a financial incentive in promoting a healthier US population. When they can no longer deny coverage to the sick or obese or unhealthy among us, or exclude coverage for the illnesses people really need to have covered, then they will actually work to promote better nutrition, preventative care, and will work harder to fight fraud (because they can't exclude their way out of hte problem). A healthier population by itself, has the potential to save hundreds of billions in costs that don't get quantified in COB budget scorecards. The reality is that this bill, for all its flaws, will represent a major step in the right direction, and the best chance -- arguably the only chance for the next 10 years or more -- to correct the worst abuses and problems our health care system engenders. We have the rest of the decade to improve upon it, to make it better, and to get rid of the political crap that it got loaded up with to get to the 60 votes that will allow the House to pass the Senate bill and send it to Obama for signature next week.

Posted by: MTfromCC | March 9, 2010 12:58 AM | Report abuse

The Medicare D may be popular, but the Democratic criticisms of it still stand:

A) The government was handcuffed from negotiating favorable rates, resulting in a massive corporate giveaway to Big Pharma and harming both the taxpayer and the consumers the bill allegedly helped.

B) Republicans made no attempt to pay for the bill, and Obama is now getting blamed for the increased deficits it caused. Republicans may blast Democrats as "Tax & Spend", but it's far better than their "Borrow & Spend" approach to government expansion.

Hypocrisy does matter and it's not boring. Orrin Hatch is trying to tell the world how horrible Reid is for doing the same thing that Hatch has voted for several times.

Posted by: AxelDC | March 9, 2010 10:28 AM | Report abuse

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