Lessons From the Medicare Prescription Drug Bill Debate

Despite the fact that the successful Republican-led effort to pass the Medicare prescription drug benefit will saddle American taxpayers with an additional $395 billion over the next decade (and probably several times more than that, given the typical accuracy of government spending projections) in social spending that would make Franklin Delano Roosevelt and Lyndon Baines Johnson envious, there are a couple of positive outcomes of the vote. First, by turning an initially apparent loss on the supposed 15-minute vote into a victory, after the requisite arm-twisting and log rolling during what turned out to be a record three-hour vote, Republicans revealed how things are really done in Washington, D.C. In a striking similarity to the vote on the USA PATRIOT Act, the House majority’s leadership forced a vote on the monumental legislation in the middle of the night. In contrast to the case of that ill-advised, Orwellian bill, however, this time at least House Members were granted the courtesy of seeing the actual text of the bill before the vote. In fact, they had from Friday morning, November 21^st, all the way until about 3:00 AM Saturday morning to sift through the 681 pages of legalese.

In front of the entire nation, the Republican House leadership dispensed with the empty platitudes about being the party of limited government and demonstrated that either they do not believe in such values as limited government, individual liberty, and free enterprise any more than do the Democrats or they simply readily abandoned these principles to score a few short-term political points for the Bush administration. Either way, the wool was removed from the eyes of the electorate.

The other beneficial aspect of the vote was that it showed that there do exist some "fiscally conservative" congressman – perhaps even some with libertarian tendencies (other than Rep. Ron Paul of Texas) – that are willing to stand up for the aforementioned principles of freedom. They did so even in the face of intense pressure from within their own party to act to the contrary. Such examples of political courage are rare, indeed, on Capitol Hill.

It was fascinating – and sometimes exasperating – to watch the debate on the floors of the House and Senate on C-SPAN. In an effort to show what our elected officials really thought of the bill, I have selected excerpts of speeches from the prescription drug bill debate, as well as some comments made off the floor, and present them below. The selections include speeches from "fiscally conservative" and/or "limited government" Republicans opposed to the bill, "big government" Republicans in favor of the bill, Democrat presidential candidate John Edwards, who opposed the bill, in part, because of its corporate welfare handouts, a socialist Democrat that supported the bill because it was, well, socialist (although he did not seem to understand the meaning of the word), and Republicans that opposed the bill on principle despite the arm-twisting of their party’s leadership. Here are the good, the bad, and the ugly of the prescription drug bill debate:

The Good:

Freshman Rep. Tom Feeney (R-FL), on resisting last-minute lobbying efforts for the bill by President Bush: "I basically said it was a matter of principle, that I came to Washington not to ratify and expand Great Society programs. He wasn’t happy to hear that." (See "House stamps Medicare vote," USA Today, November 20, 2003.)

Rep. Jeff Flake (R-AZ):

This proposal flies in the face of the principles of limited government and individual responsibility that Republicans are supposed to stand for. The enormous cost of this proposal will only hasten Medicare’s insolvency, and we’ll have to rely on future Congresses to have the political courage that this Congress lacks. In the end, I think this looks like nothing more than an extremely expensive way to buy votes. (Office of Congressman Jeff Flake press release, November 17, 2003.)

Rep. Mike Pence (R-IN):

Mr. Speaker, despite the very best efforts of our House Republican leadership, I rise to oppose the prescription drug bill that will be considered before the Congress this week.

It would, in fact, represent the largest expansion of Medicare in 35 years. Nancy-Ann DeParle, President Clinton’s Medicare administrator, actually called this legislation the biggest expansion of government health benefits since the Great Society. And so it will be….

But the most ominous consequence of a universal drug entitlement could be that it will usher in the beginning of socialized medicine in America. This type of system which is built on unrealistic fiscal projections and incorrect assumptions about human behavior would invariably lead to escalating costs for which price controls and outright government control would be seen as a last resort. In an America where abortion is legal and euthanasia is increasingly accepted, the American people would do well to ponder the implications of government-run health care in America. (Congressional Record, p.H11368.)

Sen. John Edwards (D-NC):

This bill is a perfect example of the kind of legislation that should not go through the Senate. It is a giveaway to HMOs and insurance companies, a giveaway to big drug companies, a continuation of this administration's shifting of the tax burden in America from wealth and the wealthy to work and the middle class. It is not shocking that there is a $12 billion stabilization fund in this bill—$12 billion of taxpayer money that is going to go to HMOs so that they can compete? I thought the whole purpose of this bill was so that HMOs could provide competition. (Congressional Record, pp.S15696–S15697.)

The Bad:

Rep. Heather Wilson (R-NM):

I think all of us agree that Medicare is one of the most successful health care programs in the history of this country, and I think all of us have a right to be proud of what we are about to accomplish here because we have been elected to make a difference. All of us come here to make a difference on things that matter to the people we serve, and a large number of national organizations, including the AARP and the American Medical Association, the hospital association, have all endorsed what we are about to accomplish. (Congressional Record, pp.H11495–H11496.)

Sen. Mitch McConnell (R-KY):

Somewhere in my home State of Kentucky, a senior is beginning a new week. She will have to choose whether to take half a pill of her medication, skimp on her food, or endure some other belt tightening. She doesn't understand about filibusters or arcane Senate procedures. But she does know that the drug benefit she needs is one step away from her. She thinks because the majority rules in America she will get relief soon. Well, the majority rule is everywhere except here in the Senate, potentially. She may be wrong. Here in the Senate the will of the majority can be defeated by the minority. The will of the people can be thwarted by a handful—a handful. (Congressional Record, p.S15691.)

[Doesn’t this strike you as eerily reminiscent of the Democrats’ "Mediscare" campaign of 1995? How the times – and parties – have changed, but not the rhetoric!]

Sen. Bill Frist (R-TN):

When he signed Medicare into law in 1965, President Johnson said: "No longer will this Nation refuse the hand of justice to those who have given a lifetime of service and wisdom and labor to the progress of this...country." (Congressional Record, p.S15698.)

[A Republican quoting LBJ and supporting a $400 billion entitlement program? Again, how times have changed!]

Rep. McDermott (D-WA):

We have no problem in this country believing that fire departments and police departments and road systems and schools are issues of the common good. We all pay our taxes. We all get benefits from them, and we have since 1964 had a program in this country called Medicare which was a program in which everybody put their money and people over the age of 65 took out their money to pay for health care benefits when they needed them. Everybody got the same thing everywhere in the whole country.

But there have been people in this Congress who have always thought that the idea of doing something collectively was somehow, I do not know, socialism or something bad. I do not know. They believe that everybody should be individually responsible for themselves, that they should be on their own and that they should deal with these things in a market, like they were buying cars or buying refrigerators or television sets….

This attitude about the common good really began to be undermined under Mr. Reagan. It was his campaign slogan in 1980: Are you better off than you were 4 years ago? Not are "we" better off than we were 4 years ago, but are "you."

This bill is going to say we are going to guarantee a premium support to every senior citizen in this country; we are going to write them a check, $5,900, $6,000, $6,300, whatever; and we are going to say now you, grandma, take that check out and find yourself an insurance company that will take care of what your needs are. You can stay in the program of Medicare as we know it, but since the healthy and the least sick will go out and find these good deals somewhere, who will be left in the regular program? The old and the sick.

The price per person is going to go up, so they are going to raise the premium on anybody who stays in the regular program. Is that thinking about the common good, that we are going to pick on the ones who are the old and the sick, and we are going to let the young and the healthy seniors go off and make a good deal somewhere? No, it is not. It is wrong, it is un-American, and it is undermining the whole concept of Medicare. (Congressional Record, p.H11195.)

And the Ugly:

Rep. Nick Smith (R-MI):

I thought I knew "arm-twisting" serving 16 years in the Michigan legislature and 11 years in the United States Congress. However, this was the most intense and strongest pressure to change my vote that I’ve ever experienced.

Being a strong fiscal conservative and having voted no on the two prescription drug bills I was a target for early pressure to vote yes on this third go-round.

My only regret is that it might have hurt my son. Advocates of the Medicare prescription drug bill had figured out that my vulnerability might lie in my strong support for my family. Since I’m retiring and my son Brad is running for my seat. I got significant promises for help for his campaign and threats they’d work against him if I voted no.

Brad got word of the situation and called me and told me that he didn’t want to go to Congress this way. He told me to do the right thing. That helped my resolve. (Office of Congressman Nick Smith press release, November 24, 2003. See also Robert Novak’s November 27^th column in the Chicago Sun-Times.)

January 30, 2004

Adam B. Summers [send him mail] is a freelance writer and a Policy Analyst at the Reason Foundation. He holds a Master's degree in economics from George Mason University.

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