The Big Idea

Are Republicans Serious About Fixing Health Care?

No, and here’s the proof.

GOP Sens. Charles Grassley and Orrin Hatch

Iowa Sen. Charles Grassley, the top Republican on the Senate finance committee, has emerged as one of the harshest critics of what the right likes to call “Obamacare.” After spending the first half of the year working with Democrats to find a bipartisan compromise, Grassley has spent the second half trying to prevent one. He attacks the bill now being debated on the Senate floor as an indefensible new entitlement. He complains that it expands the deficit, threatens Medicare, and does too little to restrain health care inflation. At a town hall meeting in August, the 76-year-old Iowan played the age card. “There is some fear, because in the House bill, there is counseling for end of life. And from that standpoint, you have every right to fear,”he told an audience in John Wayne’s hometown of Winterset.

One might credit the sincerity, if not the validity, of such concerns were it not for an inconvenient bit of history. Not so long ago, when Republicans controlled the Senate, Grassley was the chief architect of a bill that actually did most of the bad things he now accuses the Democrats of wanting. As chairman of the finance committee, Grassley championed the legislation that created a prescription-drug benefit under Medicare. The contrast between what he and his colleagues said during that debate in 2003 and what they’re saying in 2009 exposes the disingenuousness of their current complaints.

Today the Medicare prescription-drug debate is remembered mainly for the political shenanigans Republicans used to get their bill through.  Bush officials lied about the numbers and threatened to fire Medicare’s chief actuary if he shared honest cost estimates with Congress. House Republicans cut off C-SPAN and kept the roll call open for three hours—as opposed to the requisite 15 minutes—while cajoling the last few votes they needed for passage. Former Majority Leader Tom DeLay was admonished by the House ethics committee for winning the eleventh-hour support of Nick Smith, a Michigan Republican, by threatening to vaporize Smith’s son in an upcoming election. It’s worth remembering these moments when Republicans criticize Democratic Majority Leader Harry Reid for his hardball tactics. 

The real significance of that episode, however, is not their bad manners, but what Republicans ordered the last time health care was on the menu. Their bill, which stands as the biggest expansion of government’s role in health care since the creation of Medicare and Medicaid in 1965, created an entitlement for seniors to purchase low-cost drug coverage. Grassleycare, also known as Medicare Part D, employs a complicated structure of deductibles, co-pays, and coverage limits. Thanks to something called the “doughnut hole,” drug coverage disappears when out-of-pocket costs reach $2,400, returning only when they hit $3,850.  Simply stated, the bill cost a fortune, wasn’t paid for, is complicated as hell, and doesn’t do all that much—though it does include coverage for end-of life-counseling, or what Grassley now calls “pulling the plug on grandma.”

In their 2009 report to Congress, the Medicare trustees estimate the 10-year cost of Medicare D as high as $1.2 trillion. That figure—just for prescription-drug coverage that people over 65 still have to pay a lot of money for—dwarfs the $848 billion cost of the Senate bill. The Medicare D price tag continues to escalate because the bill explicitly bars the government from using its market power to negotiate drug prices with manufacturers or establishing a formulary with approved medications.

And unlike the Democratic bills, which won’t add to the deficit, the bill George W. Bush signed was financed entirely through deficit spending. While Grassley and his colleagues accuse Democrats of harming Medicare through cost cuts, it is their bill that has done the most to hasten Medicare’s coming insolvency. Between now and 2083, Medicare D’s unfunded obligations amount to $7.2 trillion according to the trustees. Numbers like these prompted former Comptroller General David M. Walker to call it “… probably the most fiscally irresponsible piece of legislation since the 1960s.”

Grassley is not alone in his incoherence. Of 28 current Republican senators who were in the Senate back in 2003, 24 voted for the Medicare prescription-drug benefit. Of 122 Republicans still in the House, 108 voted for it. There is not space here to fully review this hall of shame, which includes Lamar Alexander of Tennessee, Mike Enzi of Wyoming, Kay Bailey Hutchison of Texas, and Orrin Hatch of Utah, among many others. Here is Kansas Republican Sam Brownback in 2003: “The passage of the Medicare bill fulfills a promise that we made to my parents’ generation and keeps a promise to my kids’ generation.” Here is Brownback in 2009: “This hugely expensive bill will not lower costs and will not cover all uninsured.” Here is Jon Kyl of Arizona: “As a member of the bipartisan team that crafted the Part D legislation, I am committed to ensuring its successful implementation. I will fight attempts to erode Part D coverage.”* Kyl now calls Harry Reid’s legislation: “a trillion-dollar bill that raises premiums, increases taxes, and raids Medicare.”

The explanation for this vast collective flip-flop is—have you guessed?—politics. Medicare recipients are much more likely to vote Republican than the uninsured who would benefit most from the Democratic bills. In 2003, Karl Rove was pushing the traditional liberal tactic of solidifying senior support with a big new federal benefit, don’t worry about how to pay for it. Today, GOP incumbents are more worried about fending off primary challenges from the right, like the one Grassley may face in 2010, or being called traitors by Rush Limbaugh. But what happened the last time they were in charge gives the lie to their claim that they object to expanding government. They only object to expanding government in a way that doesn’t help them get re-elected.

Correction, Dec. 12, 2009: The article originally misspelled Jon Kyl’s first name. (Return  to the corrected sentence.)