A lesson in dishonesty
PRESIDENT BUSH'S latest, self-inflicted budget wound is more of a lesson in the dangers of partisanship than an example of the consequences of dishonesty.
To an extent, the White House is correct in its cynical remarks that the estimates of the real cost of the impending prescription drug benefit for retired people was low-balled at the time the system was enacted in 2003.
However, these remarks miss the most important point. The president had a choice that year, between a prescription drug benefit passed with the backing of leaders in both parties by a wide margin and one rammed down the throats of Republican lawmakers -- with the aid of cost estimates known by those who made them to be false -- and passed by the narrowest of margins.
Bush chose the latter course, and that is making all the difference.
What was forgotten last week as Bush disclosed in his budget that the cost of the benefit that is due to take effect next year had mushroomed from $400 million over the first 10 years to well over $700 million is that there had been a different version of the proposal before the Senate earlier that year.
A prescription drug benefit was fashioned in legislation that got through the Senate with more than 70 yes votes. Had Bush shown both leadership and a willingness to work hard, a final version could have cleared the House with more than 300 yes votes.
This version of the program was a compromise. The drug benefit had holes and was less than generous for average-income retirees, but it established the principle of a drug benefit within the Medicare system; in return, progressives gave ground on such important issues as requiring that the government negotiate bulk purchases and therefore lower prices with the major drug companies.
By going the partisan route, Bush ended up losing the support of most Democrats. And to cement his support with fellow right-wingers, he allowed the bill to become cluttered with pork for insurance companies and the pharmaceutical lobby. In the end, to keep a handful of Republicans in the House from defecting, Bush suppressed an administration projection of the costs through 2013 that was more than $100 billion higher than the $400 billion then on the table. This was the occasion when civil servants were threatened with the loss of their jobs if they told anyone on Capitol Hill the truth.
Bush got his legislative ''victory," but at the cost of consensus. Today, the program is being assaulted from the left and center, and has no committed defenders among conservatives. And no wonder. In walking away from compromise, Bush opened the program up to lobbyist pork. To bribe otherwise unwilling insurance operations called preferred provider organizations into participation, Republicans created a $12 billion slush fund to be doled out to the companies at the whim of the secretary of health and human services.
In addition to banning negotiation over prices with suppliers, the Republicans also jettisoned provisions that at least provided for a degree of competition in the new system. Now, it is possible for there to be monopolies -- one insurance outfit offering but a single drug plan in a coverage area.
The Republicans also tilted the risk adjustment mechanisms in the program designed to deal with the tendency by insurance operations to enter a market and pick off the most healthy people as their customers. The formulas now benefit health maintenance organizations at the expense of those who need the drug benefit the most.
And finally, the bill was loaded with new breaks to promote special investment accounts for health care that primarily benefit the wealthy who already have insurance.
As always, Bush is unwilling to confront the consequences of his colossal goof. The most his spokesman could manage last week was an offer to work with those in Congress who offer ideas for change. From the right has come a call to ''cap" the drug costs, in effect to cut the currently guaranteed benefits before an already inadequate system takes effect. Conservatives would love to do that, but going into an election year it is hard to imagine such an effort succeeding in Congress.
Meanwhile, pressure is growing from progressives and moderate Republicans to reopen the issue of allowing negotiations for lower prices and to permit the importing of lower-priced prescription drugs -- two issues where Bush is ideologically opposed to taking on his biggest campaign contributors. Both measures have bipartisan support.
This is a mess of the president's making, and it illustrates the basic political truth that major steps involving entitlement programs almost always demand broad, bipartisan support before they are taken.
Thomas Oliphant's e-mail address is firstname.lastname@example.org.