The news that HHS Secretary Tommy Thompson has ordered an investigation into the alleged suppression of cost estimates on the Medicare prescription drug bill offered some of last week's best entertainment. The script is so rich with irony, surrealism and humor that it could have been co-written by Franz Kafka and Neil Simon.
The plot catalyst for this comedy was the assertion by Richard Foster, the Medicare program's veteran actuary, that former CMS chief Tom Scully last summer threatened to fire Foster if he provided lawmakers with information on the true cost of the Rube Goldberg-like Medicare drug bill while it was pending before Congress. Foster's analyses of the legislation estimated the price tag at $500 billion to $600 billion over a decade, well above the Bush administration's public claim of $400 billion. Since the bill cleared President Bush's desk, the administration's own budget office has acknowledged that the cost will be much higher-$534 billion. That angered some conservative, deficit-hawk Republicans as well as Democrats. New howls of indignation from politicos started about a nanosecond after Foster's allegations became public. Then last week, Foster released an e-mail from Scully's top aide that backed his story of threats.
Scully, a key figure behind the Medicare bill, has denied any wrongdoing, issuing a variety of lamely exculpatory statements. Regardless, it's clear that he is the administration's favorite candidate to take the fall for this fiasco. Thompson last week reiterated previous congressional testimony that he should have supervised Scully more closely and suggested that Scully was a loose cannon.
The former CMS czar certainly is a convenient scapegoat. Scully is a walking bottle of nitroglycerin, whose temper erupts with more regularity than Old Faithful. He is hypersensitive to criticism-a bad trait in a public official-and so combative that he angers even fellow Republicans such as Senate Finance Committee Chairman Charles Grassley of Iowa. Scully, who proceeds toward his goals like Sherman marching toward Atlanta, left for greener (as in the color of money) pastures once the Medicare bill was passed. To top it off, he's gone from office, so the administration doesn't have to respond to daily calls for his resignation.
We should keep a few things in mind during the "it's all Scully's fault" movement: Thompson and the administration hired Scully, presumably knowing full well his reputation for volatility and militancy. One has to assume that Scully was the kind of boy they wanted for this job. And when Scully, either by desire or upper-level suggestion, decided to leave the government after alienating almost everyone in it, HHS blessed him with an "ethics waiver" to talk with potential employers with a vested interest in the Medicare bill.
But most of all, we should remember that a lot of public- and private-sector people hungered for passage of the Medicare legislation, which is long on giveaways to drugmakers, insurers, hospitals and doctors and short on benefits to citizens. From Bush to congressional Republicans and a handful of Democrats and legions of lobbyists, there was intense pressure to gain political and financial advantages by foisting this turkey on the country ahead of the 2004 elections.
As if to reinforce that point, the House ethics committee last week voted to launch a formal investigation into accusations of bribery surrounding the November vote on the drug bill. There were widespread reports in and outside of the Beltway that official cost estimates from the administration and congressional bean counters were baloney. Regardless of whether Foster was silenced, anyone in Washington who really thought the check would come in at $400 billion probably believes "reality" TV shows are real.
So by all means, Mr. Secretary, let's have an investigation of Medicare-gate. But don't stop with Scully-be sure to investigate yourself and the rest of Washington.