Back in 2003, the Republicans passed their version of healthcare reform, the Medicare Prescription Drug, Improvement, and Modernization Act (often abbreviated as the MMA). I remember the outrage at the tactics used by Republicans and the sworn vows of progressives and Democrats to never forget or forgive.
So one would figure that as Republicans wail disingenuously about last year's legislative maneuvering, and gear up to wail some more about the apparent Democratic response to their unprecedented obstructionism, that the blogosphere and the airwaves would be rife with recollections of what it really looks like to ram-rod crappy legislation down the throat of the country.
Please join below to recall those glorious days of yesteryear (before the GOP and the RWCM try to rewrite this particularly ugly episode of history)
It so happens that Rep. Louise Slaughter (D-NY) published some of her recollections on the process of passing the MMA in the New England Journal of Medicine in 2006.
The summary assessment:
"The political process used to pass Part D was the worst abuse of the legislative process I have seen during my 20 years in Congress."
Well, that's just partisan sniping, right? Let's pretend I'm a typical hack journalist and ask a Republican to get "the other side" of the story - maybe, say, Walter Jones (R-NC)?
"I've been in politics for 22 years," says Jones, "and it was the ugliest night I have ever seen in 22 years."
Oh. Well, maybe if we had asked the right Republican - maybe Billy Tauzin who played a critical role in shepherding the bill through the House... (More on him in a minute.)
Why was it so ugly? Back to Slaughter:
In the months before its passage, a few powerful Republican leaders worked to undermine conscientious reform proposals. In early 2003, while the House bill was being drafted, Democrats and Republicans authored 59 sensible amendments to it. At the behest of the Republican leadership, however, the House Committee on Rules rejected all but one, preventing them from being debated by Congress. Many of those amendments — among them, one requiring the administration to use beneficiaries' collective purchasing power to negotiate lower prices and one allowing Americans to import cheaper drugs from Canada — would have made the legislation far more effective and probably would have received bipartisan support, had they been allowed onto the floor.
Who could possibly believe any more that Republicans care about reining in deficits? They clearly don't believe in market forces, if they're so willing to dismantle the market forces that would have saved taxpayers $ billions in Medicare Part D.
"Next, the conference process, whereby the House and Senate versions of legislation are reconciled, was fundamentally corrupted and kept almost entirely secret by senior Republicans. Democrats on the conference committee were excluded from deliberations, to the point of being physically barred from the conference room on one occasion. The pharmaceutical industry, however, was invited in."
It seems easy these days to just let this kind of anecdote fly by. But let's step back for a minute and really consider it.
Republican legislators, who regularly lecture Americans on the "original intent" of those who drafted the Constitution, locked elected Representatives out of a House-Senate conference, but brought industry lobbyists in to edit the text of the bill.
Was it Madison or Hamilton who thought this was how our legislative branch should work?
Back to Slaughter:
"Serious conflicts of interest on the part of the bill's primary authors were common. The chairman of the Commerce Committee, Representative Billy Tauzin (R-La.), coauthored the bill while negotiating a $2-million-per-year job as a lobbyist for the Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry's trade organization. The top Republican aide on a subcommittee involved in writing the legislation also left his position soon afterward to lobby for PhRMA. Thomas Scully, the administration's top Medicare official, deliberately understated the program's projected cost by $134 billion, and when the chief actuary of the Centers for Medicare and Medicaid Services (CMS) objected, Scully reportedly threatened to fire him if he shared his true estimate with Congress. Soon after the legislation passed, Scully resumed his career as a health care–industry lobbyist."
Scully was reportedly negotiating his new job at the same time he was representing the Bush Administration in the conference negotiations. The conflict of interest story could stretch on and on. Someone in a thread the other day asked how corporatism and corruption are interlinked. It is in these revolving doors and crony nepotistic relationships that the rubber most obviously meets the road.
"When the conference report was brought to the House for a vote, members were given less than one day to read the 850-page bill, a violation of House rules. When the vote was called at almost 3 a.m., voting Democrats stood unanimously with 22 Republicans in opposing the legislation. Had the vote been gaveled down in the customary 15 minutes, the bill would not have passed. So the Republican leadership held the vote open for a record three hours while attempting to change the outcome — through intimidation and other tactics that, again, violated House rules. Finding itself with a narrow lead at 5:53 a.m., the Republican leadership immediately brought the vote to a close..."
"...Many abuses undoubtedly took place that night. Representative Nick Smith (R-Mich.) later revealed what may have been the worst: that former Majority Leader Tom DeLay (R-Tex.) and Representative Candice Miller (R-Mich.) tried to bribe him with political favors to change his vote — an infraction for which the House Ethics Committee later admonished them. Through these means, the Republican leadership succeeded in passing a bill whose goal was, according to Representative Bill Thomas (R-Calif.), to "end Medicare as we know it."
Tell me more about "sweetheart deals", Mitch. Of course, Republicans redefined the practice of the sweetheart deal, ramping up the use of earmarks and targeted tax breaks - which hit the treasury an estimated 4x as hard - by orders of magnitude beyond anything that had occurred before.
When I was trying to remember all this, I also recalled an incident wherein Republican leaders Hastert and Frist inserted a "sweetheart deal" for vaccine makers (lobbying clients of Hastert's son) into a bill in the middle of the night outside the conference process. It was a provision that House and Senate conferees had explicitly rejected. But, hey, it was for clients of Hastert's son! It turns out, though, that this incident happened a few years later. So - essentially - that was a case of same story, different day.
One would think this kind of towering corruption and hypocrisy would weigh heavily on legislators, even Republicans. At the end of the day, you have to ask: why such furious effort, why so much abuse of due process to ram this kind of thing through?
Well, independent analysts predicted that the MMA would increase drug-industry profits by $139 billion over the following eight years.
In a nutshell, the pharmaceutical industry and insurance industry invested a couple $ hundred million in campaign contributions, lobbyists, messaging support, and soft jobs for key legislators and their relatives. In return, they got another $139 billion in revenue from taxpayers. That is a good ROI.
One last point from Slaughter:
The elderly and disabled, pharmacists, nursing homes, and families, for their part, have been burdened by a flawed plan that was not drafted with them in mind. Unlike existing government health plans, Part D does not allow the administration to negotiate drug prices with pharmaceutical companies. As a result, these companies are charging taxpayers up to 80 percent more for drugs purchased under Part D than for those purchased under other plans.
I've written diaries on this point before. There is a group of unfortunate citizens out there - the elderly poor, and the disabled poor - who qualify for both Medicare and Medicaid. They're called "dual eligibles." Up until Part D, they got their drugs through Medicaid. The MMA flipped them all into Medicare Part D. After which taxpayers had to pay about $8 billion a year more for the exact same drugs for the exact same people.
The next time you hear some Republican twit boast that Medicare Part D "costs less than expected!" remind him that it still costs 20% more than it should.
And about that ~$100-$200 billion overage that Republicans generously funneled to insurance companies and pharma companies (gift-wrapped, with a bow on top)? Taxpayers deserve to get it back. We could kind of use it right now.
The MMA passed 54-44 in the Senate, after a couple very brief, half-hearted Democratic attempts at filibusters.
I guess in those days it didn't take 60 votes to pass something in the Senate?
The next time Republicans start carping about legislative mechanics in healthcare reform, let's pointedly remind them that they had their chance to fix healthcare, and that they decided to create a new giant pork sluice, instead, deploying some of the most disgraceful tactics in Congressional history along the way.