[Congressional Record Volume 155, Number 200 (Wednesday, December 23, 2009)]
[Senate]
[Pages S13875-S13878]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              RESPONSE TO SLATE ARTICLE BY JACOB WEISBERG

  Mr. GRASSLEY. Mr. President, I would like to address an article 
written by Jacob Weisberg for Slate magazine on December 12, 2009. This 
article is entitled, ``Are Republicans Serious About Fixing Health 
Care? No, and here's the proof.'' In this article, Mr. Weisberg 
unfairly and misleadingly takes aim at my position in the current 
health reform debate.
  The author reports that I have criticized the Reid bill for creating 
an ``indefensible new entitlement'' and that it ``expands the deficit, 
threatens Medicare, and does too little to restrain health care 
inflation.''
  I don't dispute Mr. Weisberg attributing these criticisms of the Reid 
bill to me. But, Mr. Weisberg can't dispute these serious shortcomings 
of the Reid bill that I and other Members on this side of the aisle 
have been discussing on the Senate floor for the past weeks. In fact, 
both the nonpartisan Congressional Budget Office, CBO, and the 
independent Department of Health and Human Services, HHS, Chief Actuary 
have confirmed that the Reid bill would not only establish this 
indefensible new entitlement, but also represent the largest expansion 
of government-run health care in history. But let me go through each 
criticism of the Reid bill that Mr. Weisberg has correctly reported.
  The Reid bill will expand the deficit. Mr. Weisberg identifies the 
10-year CBO score of the bill to be $848 billion, but that is comprised 
of 10 years of Medicare cuts and tax increases and only 6 years of 
outlays. So if he were intellectually honest, Mr. Weisberg would have 
used the cost of 10 years of outlays, which budget analysts assume to 
be closer to $2.5 trillion. But the use of budget gimmickry does not 
end there when supporters of the Reid bill claim that it is deficit 
neutral.
  One of the biggest problems in Medicare that we have to address in 
Congress every year is the Medicare physician payment formula or the 
sustainable growth rate, SGR. Comprehensively fixing the SGR costs well 
over $200 billion. Only providing a two-month temporary patch for the 
problem will result in a more than 20-percent drop in Medicare 
physician payments beginning in March of next year. To me and many 
other Members of Congress, health care reform includes fixing the SGR 
so that physicians can be assured of not facing drastic Medicare 
payment cuts year after year and so that beneficiaries can be assured 
of having access to physicians. But there is no SGR fix in the Reid 
bill. Do the math and you will see why. A comprehensive SGR fix of over 
$200 billion would wipe away the $132 billion in budgetary savings that 
the Reid bill is currently reported to have.
  In fact, the Congressional Budget Office noted that the estimated 
cost of repealing the SGR and replacing it with a permanent freeze 
would be about $207 billion once physician-administered drugs were 
removed from the calculation of the SGR formula. That was done in the 
physician rule that CMS finalized on October 30, 2009. However, 
according to CBO, the removal of those drugs from the SGR formula will 
increase Medicare's spending for physician services, as well as federal 
spending under TRICARE by $78 billion over the 2010-2019 period. The 
net impact on the budget would be close to $300 billion over 10 years, 
none of which is reflected in the Reid bill.
  And let's take a look at what is in the bill. I certainly hope Mr. 
Weisberg did when he wrote his article. A good portion of the budgetary 
savings in the Reid bill is from the CLASS Act. This program apparently 
produces budgetary savings during the first 10 years, but only because 
no benefits pay out for the first 5 years. This makes the revenues 
outpace the program's outlays. But CBO has stated that outlays will 
outpace revenues after the first 10 years. This means that the CLASS 
act will result in deficit spending over the long run. In fact, the 
chairman of the Budget Committee, a Democrat, called the CLASS Act a 
massive government ponzi scheme. So this casts serious doubt on those 
who tout that the Reid bill is deficit neutral or saves money.
  The Reid bill also threatens Medicare. I don't think Mr. Weisberg can 
argue that close to $\1/2\ trillion in Medicare cuts won't jeopardize 
beneficiary access to care. Even the White House's own Chief Actuary 
confirmed that the Reid bill jeopardizes beneficiary access to care. He 
raised concerns in particular about two categories of these Medicare 
cuts. First, the Chief Actuary warned about the permanent productivity 
adjustments to annual payment updates. Under the Reid bill, these 
productivity adjustments automatically cut annual Medicare payment 
updates based on productivity measures of the entire economy. Referring 
to these cuts, he wrote that ``the estimated savings . . . may be 
unrealistic.'' In his analysis of these provisions, Medicare's own 
Chief Actuary stated, ``it is doubtful that many could improve their 
own productivity to the degree achieved by the economy at large,'' and 
that they ``are not aware of any empirical evidence demonstrating the 
medical community's ability to achieve productivity improvements equal 
to those of the overall economy.'' In fact, the Chief Actuary's 
conclusion is that it would be difficult for providers to even remain 
profitable over time as Medicare payments fail to keep up with the 
costs of caring for beneficiaries. Ultimately, the Chief Actuary's 
conclusion is that providers who rely on Medicare might end their 
participation in Medicare, ``possibly jeopardizing access to care for 
beneficiaries.''
  The Chief Actuary even has numbers to back up these statements. His 
office ran simulations of the effects of these drastic and permanent 
cuts. And based on these simulations, the Chief Actuary found that 
during the first 10 years, `` 20 percent of Medicare Part A providers 
would become unprofitable as a result of the productivity 
adjustments.'' That's one out of five hospitals, nursing homes and 
hospices. It is for this reason that the Chief Actuary found, 
``reductions in payment updates based on economy-wide productivity 
gains, are unlikely to be sustainable on a permanent annual basis.''
  The second category of Medicare cuts that the Chief Actuary raised 
concerns about would be imposed by the new Independent Payment Advisory 
Board created in the Reid bill. This is the new body of unelected 
officials that would have broad authority to make even further cuts in 
Medicare. These additional cuts in Medicare would be driven by 
arbitrary cost growth targets. This board would have the authority to 
impose further automatic Medicare cuts even absent any Congressional 
action. The Chief Actuary gave a reality check to this proposal. He 
showed how tall an order the Reid bill's target for health care cost 
growth actually is. According to the HHS Chief Actuary, limiting cost 
growth to a level below medical price inflation ``would represent an 
exceedingly difficult challenge.'' He pointed out in this analysis that 
Medicare cost growth was below this target in only 4 of the last 25 
years.
  The HHS Chief Actuary also pointed out that the backroom deals that 
carved out certain types of providers would complicate this board's 
efforts to cut Medicare cost growth. According to the analysis, ``[t]he 
necessary savings would have to be achieved primarily through changes 
affecting physician services, Medicare Advantage payments and Part D.'' 
So providers like hospitals will escape from this board's cuts at the 
expenses of doctors, seniors enrolled in Medicare Advantage plans and 
seniors who will pay higher premiums for their Medicare drug coverage. 
If we surveyed the nation's seniors, I doubt very much they would say 
that raising their premiums for Medicare drug coverage or limiting 
preventive benefits in Medicare Advantage is

[[Page S13876]]

what they would call health care reform.
  And this board is guaranteed to have to impose these additional 
Medicare cuts. According to the Chief Actuary's analysis of the 
Medicare cuts in the Reid bill, even though the Medicare cuts already 
in the Reid bill are ``quite substantial'' they ``would not be 
sufficient to meet the growth rate targets.'' So this means the board 
will be required by law to impose even more Medicare cuts in addition 
to the massive Medicare cuts already in the Reid bill. And this will 
make it even harder for our seniors to find providers who will treat 
them.
  Not only does the Reid bill ``[do] too little to restrain health care 
inflation,'' it actually increases health care inflation. According to 
the HHS Chief Actuary, the Reid bill would bend the health care cost 
curve the wrong way. Over the next 10 years, the Administration's own 
Actuary stated that ``total national health expenditures under this 
bill would increase by an estimated total of $234 billion.'' As a 
result of that increase, health care would then be projected to grow 
from 17 percent to 20.9 percent of the gross domestic product in 2019. 
So using the Reid bill to curb health care cost growth would be like 
putting out a fire with gasoline.
  The Chief Actuary also found that a good portion of the increase in 
national health expenditures would be caused by the so-called fees in 
this bill on medical devices, on prescription drugs and on health 
insurance premiums. He stated, that these ``fees would be passed 
through to health consumers in the form of higher drug and device 
prices and higher insurance premiums.'' This would result in, ``an 
associated increase of approximately 11 billion dollars per year in 
overall national health expenditures.''
  Higher premiums from the Reid bill are no trifling matter. In fact, 
one estimate concluded that the Senate bill would increase premiums by 
about 50 percent on average for individuals without employer-based 
coverage, and more than 20 percent for small businesses. And even the 
Congressional Budget Office's more conservative analysis predicts that 
premiums will increase 10 to 13 percent for 14 million Americans as a 
result of the Reid bill.
  But that is where my agreement with Mr. Weisberg ends. He then 
proceeds to lob several troubling and incorrect claims at me in his 
attempt to portray me as ``incoherent.''
  Mr. Weisberg distorts what I said in response to a constituent's 
question at a town hall meeting in Iowa last August when he accuses me 
of playing the ``age card.'' This is what Mr. Weisberg claims that I 
said: ``There is some fear, because in the House bill, there is 
counseling at the end of life. And from that standpoint, you have every 
right to fear ``
  But this is what was actually said at that meeting:

       Question from Iowan: ``Thank you, Senator Grassley, for 
     coming. The Democrats tell us all the time that it's a right 
     of every American to have health care. Yet it seems this 
     Obama plan will systematically deny those rights to certain 
     groups like the elderly. And I, as a person in my 60's I'm 
     getting very concerned about the health care that I might be 
     able to have if this bill passes. . . .
       Iowan Restating the Question: ``Ok . . . [the question] 
     involves limited coverage because of a person's background 
     and age, race, physical condition such as that. Basically it 
     was on the lady's age.''
       Senator Grassley: ``"[V]ery recently in things that we've 
     been talking about in our negotiations has been just exactly 
     what you brought up. I won't name people in Congress or 
     people in Washington, but there's some people that think that 
     it's a terrible problem that Grandma's laying in the hospital 
     bed with tubes in her, and think that there ought to be some 
     government policy that enters into that. I'm just on the 
     opposite. I think that's a family and a religious and or 
     ethical thing that needs to be dealt with and there's some 
     fear because in the House bill there's counseling for end of 
     life. And from that standpoint, you have every right to fear. 
     You shouldn't have counseling at the end of life. You ought 
     to have counseling 20 years before you're going to die. You 
     ought to plan these things out. And, you know, I don't have 
     any problem with things like living wills, but they ought to 
     be done within the family. We should not have a government 
     program that determines you're going to pull the plug on 
     Grandma. Thank you all very much for coming.''

  Mr. Weisberg is not the first who has taken what I said during this 
exchange and twisted it to attempt to portray me as a fearmongerer. And 
unfortunately he probably won't be the last. What's even more 
unfortunate is that Mr. Weisberg and those like him fail to see the 
legitimate cause for concern when you have a combination of the 
expanded role of government in health care generally plus funding for 
advance care planning consultations alongside cost containment 
proposals. Some commentators took my comments and twisted them and even 
quoted me as saying the House health care reform bill would establish 
death panels, and this was blatantly incorrect. As you can see from 
what was said at the town meeting, I said no such thing. As I said 
then, putting end-of-life consultations alongside cost containment and 
government-run health care causes legitimate concern.
  And to address another point that Mr. Weisberg makes, a provision 
that provided for the option of advance care planning was in a bill I 
supported. In 2003, Congress enacted a narrow provision to offer 
coverage for hospice consultation services for Medicare beneficiaries 
who have been diagnosed as terminally ill. Under this provision, this 
consultation would be covered only when provided by a health care 
provider with expertise in end-of-life issues such as a hospice 
physician. The covered services include a pain and care management 
evaluation, counseling about hospice care and other optional services 
such as advice on advance care planning. This provision was designed to 
assure that advice on advance care planning in this context is only 
offered by qualified professionals and done in an appropriate manner.
  In his article, Mr. Weisberg misses the point. The core of this issue 
is when it comes to advance care planning, what role, if any, the 
government should play. When the government attempts to influence these 
sensitive decisions, it raises the possibility that the government's 
interests may be different and potentially incompatible with the 
patient's interests.
  When provisions to increase the government role in advance care 
planning are included alongside cost containment provisions, it raises 
the concern that the purpose for the proposal is to save money rather 
than to ensure appropriate care at the end of life. And that is in fact 
what has already happened. This idea of encouraging living wills was 
originally proposed by the Carter administration in 1977 as an option 
to produce both federal and system-wide savings in health expenditures. 
More recently, the Urban Institute published a paper in July 2009 that 
identified proposals like advance care planning consultations as a way 
to help cut costs to offset spending for health care reform. Compassion 
and Choices, formerly known as the Hemlock Society, has also advocated 
for the inclusion of advance care planning consultations in health care 
reform legislation. Minimizing such an important issue or trying to 
turn it into an amusing story as Mr. Weisberg has done debases the 
important discussion that needs to occur on this sensitive and personal 
issue.
  Mr. Weisberg then criticizes Medicare Part D, which I championed, in 
his attempt to question my opposition to the Reid bill. In 2003, 
Medicare was 37 years old and functioning a lot like it had on day one. 
It emphasized treatment, not prevention, not disease management. It was 
a horse-and-buggy version of health care compared with the kind of 
coverage that other Americans received through their employers. Then, 
as now, employer-based health plans often covered prescription drugs. 
Employers realized it was cost-effective to pay for a relatively cheap 
cholesterol-lowering drug if it meant avoiding a triple bypass down the 
road. But Medicare beneficiaries were stuck in 1965 when prescription 
drugs were less vital than they are today. And because Medicare didn't 
cover prescription drugs, they often were forced to forgo medications, 
pay out of pocket, try to find an affordable supplemental policy, or 
take a bus to Canada to get their medicines.
  Republicans and Democrats alike agreed Medicare beneficiaries 
deserved 21st century health care coverage, including prescription drug 
coverage. However, there were still differences on how much the 
government could afford to spend on providing this new benefit. In May 
of 2002, Republicans put forth a $350 billion proposal to provide 
comprehensive drug coverage to America's

[[Page S13877]]

seniors. The Democrats thought this was insufficient and put forth 
their own proposal totaling close to $600 billion. At the end of the 
day, the fiscal year 2004 budget resolution included a $400 billion 
reserve fund for the creation of the drug benefit.
  While there was bipartisan support for the drug benefit, Democrats 
nevertheless continued to argue that Congress should be spending more. 
For example, former Senator Bob Graham of Florida said, ``Some would 
argue that this budget includes $400 billion for a Medicare 
prescription drug benefit. They know full well that $400 billion is 
inadequate to provide an affordable, comprehensive, universal 
prescription drug benefit for America's seniors.'' The late Senator 
Edward Kennedy stated, ``This budget has far less funding than is 
necessary to provide a meaningful prescription drug benefit for all 
seniors.'' And Senator Tom Harkin stated, ``We need a budget that is 
balanced, that takes the approach that we need to reduce the debt to 
take care of the baby boomers and provide for a decent drug benefit for 
the elderly. Clearly, the $400 billion proposed for prescription drugs 
and other medical reforms is far too low for that purpose.'' Congress 
eventually passed the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003, Medicare Modernization Act, Public Law 108-
173, on a bipartisan basis and created the drug benefit that year. In 
contrast to the process we are witnessing this year on health care 
reform, the final conference report from the MMA passed the Senate with 
the support of 11 Democrats and one Independent. And yet I can't help 
but think that if the Democrats had their way on the total amount of 
spending almost twice as much on the drug benefit, then far more than 
this responsible bipartisan amount would have been spent. And certainly 
despite the criticism that the new drug benefit is often subjected to 
from the left, not even the most staunch opponents of Part D have 
proposed repealing the drug benefit for our Nation's seniors.
  Now in addition to the bipartisan support for the creation of the 
benefit, the vast majority of Medicare beneficiaries also like their 
prescription drug coverage. Survey after survey consistently shows that 
the benefit enjoys broad support from beneficiaries. According to 
Medicare Today, 88 percent of Part D enrollees are satisfied with the 
program. And the program has come in $239 billion under budget. When 
was the last time you could say that about a government program? 
Furthermore, the fact that Medicare beneficiaries are able to obtain 
their prescription drugs and afford them means fewer hospitalization 
and emergency room visits when diseases like diabetes, heart disease, 
and pulmonary disease are properly managed with modern prescription 
drug therapy.
  How is adding prescription drug coverage to Medicare different from 
the current health care debate?
  Medicare was already 37 years old when Congress added prescription 
drug coverage. The Medicare structure was well-established. Congress 
worked in a bipartisan way to set aside the funding to improve the 
program and do so without disrupting the parts that already worked for 
tens of millions of people. Don't forget that 76 senators voted in 
favor of the Senate bill for the drug benefit including 35 Democrats 
and one Independent. We certainly can't say the same for the current 
health care reform effort in the Senate.
  One key difference is the fact that the prescription drug benefit is 
purely voluntary, unlike the mandatory system of insurance coverage for 
everyone proposed in the current health reform bills that is backed up 
with the imposition of stiff fines on those who don't comply. Under the 
Medicare benefit, seniors who don't need prescription coverage or who 
don't see it is a good value for the premium don't have to get it. The 
drug benefit is provided and administered by private entities, which 
compete for beneficiaries' business. And this competition between plans 
has kept the overall cost of the program down.
  And let's not forget what we were trying to do back in 2003 compared 
to what is happening in Congress now. Back in 2003, we were operating 
on a budget surplus, and there was bipartisan support to address a need 
by creating the Medicare drug benefit. The Medicare Modernization Act 
met this need.
  The situation is totally different in 2009. We are now operating on 
record budget deficits. So the goal of any health reform legislation 
should be to bend the cost curve. But as the HHS Chief Actuary has 
established, the Reid bill fails to do so.
  In response to those who say the drug benefit only added to 
Medicare's expenses, the Medicare Modernization Act also expanded 
coverage of preventive services to emphasize less expensive prevention 
over more costly treatment. The law created a specific process for 
overall program review if general revenue spending exceeded a specified 
threshold. And it took the politically bold step of introducing the 
concept of income testing into Medicare, with higher income people 
paying larger Part B premiums beginning in 2007.
  Also, Mr. Weisberg makes several additional points about Medicare 
Part D that are simply wrong. For example, he states that the 
government prohibition from negotiating drug prices with manufacturers 
only raises the Medicare Part D pricetag. CBO, the Chief Actuary, and 
noted economists have all found the exact opposite to be true. The 
Chief Actuary stated that ``direct price negotiation by the Secretary 
would be unlikely to achieve prescription drug discounts of greater 
magnitude that those negotiated by Medicare prescription drug plans 
responding to competitive forces.'' And CBO has concluded that ``the 
Secretary would be unable to negotiate prices across the broad range of 
covered Part D drugs that are more favorable than those obtained by 
PDPs under current law.'' Even the Washington Post editorial page has 
stated that ``governments are notoriously bad at setting prices, and 
the U.S. government is notoriously bad at setting prices in the medical 
realm.'' What's more, the idea of private negotiation on drug costs 
originated with none other than President Bill Clinton. Under President 
Clinton's plan, he proposed that ``[p]rices would be determined through 
negotiations between the private benefit administrators and drug 
manufacturers.'' President Clinton's plan was introduced on April 4, 
2000 as S. 2342 by the late Senator Moynihan by request.
  Mr. Weisberg also uses incorrect data to compare the 10-year cost of 
Medicare Part D and the Reid bill. Medicare Part D costs do not 
``dwarf'' the Reid bill costs as Mr. Weisberg claims because the true 
10-year cost of the Reid bill, as acknowledged by supporters of the 
bill on the Senate floor, is $2.5 trillion and not the $848 billion 
figure that he uses.
  So attempting to portray me as being ``incoherent'' for opposing the 
Reid bill even though I championed the Medicare Modernization Act is 
absolute nonsense.
  The Medicare Modernization Act did not impose a $2\1/2\ trillion tab 
on Americans. It did not kill jobs with taxes and fees that go into 
effect 4 years before the reforms kick in. It did not kill jobs and 
lower wages with an employer mandate. It did not impose a half a 
trillion in higher taxes on premiums, on medical devices, on 
prescription drugs, and more. It did not jeopardize access to care with 
massive Medicare cuts. It did not impose higher health care costs. And 
it did not raise health premiums for millions of Americans like the 
Reid bill will do.
  Mr. President, I ask unanimous consent to have printed in the Record 
the December 12, 2009, Slate article by Jacob Weisberg.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                    [From the Slate, Dec. 12, 2009]

           Are Republicans Serious About Fixing Health Care?

                          (By Jacob Weisberg)

       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.

[[Page S13878]]

       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.

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