The Republican Party's Health-Care Hypocrisy

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 warned, "There is some fear because in the House bill, there is counseling for end of life."

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 to do. As chairman of the Finance Committee, Grassley championed the legislation that created a prescription-drug benefit under Medicare. The comparison of what he and his colleagues said during that debate in 2003 to what they're saying in 2009 exposes the disingenuousness of their current complaints.

Today the Medicare prescription-drug debate is remembered mainly for the shenanigans Republicans pulled to get the bill through. Bush officials 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 to cajole the last few votes they needed for passage. Majority Leader Tom DeLay was admonished by the House ethics committee for threatening to vaporize the son of one Michigan Republican in an upcoming election.

The real significance of that episode, however, is not their bad manners but the policy Republicans produced 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 passage of Medicare and Medicaid in 1965, created an entitlement for seniors to purchase low-cost drug coverage. Simply stated, the law is complicated as hell, costs a fortune, still isn't paid for, 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 that the 10-year cost of Medicare Part D is 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 price of prescription coverage continues to escalate because the law 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 the Congressional Budget Office says won't add to the deficit, the bill George W. Bush signed was financed entirely through deficit spending. Former comptroller general David M. Walker has called it "probably the most fiscally irresponsible piece of legislation since the 1960s."

Of the 28 remaining Republicans 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. This hall of shame includes Alexander of Tennessee, Enzi of Wyoming, Brownback of Kansas, and Hatch of Utah. Here, for example, is John Kyl of Arizona in 2003: "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." Six years later, Kyl calls Harry Reid's Democratic health-care legislation "a trillion-dollar bill that raises premiums, increases taxes, and raids Medicare."

The explanation for this vast collective flip-flop is—can you guess?—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 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 the claim that they object to expanding government. What they object to is expanding government in a way that doesn't help them get reelected.