Note: Updated on 7/21/2011.
Republican Congressman Paul Ryan of Wisconsin, the House Budget Chairman, this year announced with the GOP calls the "Path to Prosperity", a plan replete with significant cuts to Medicare and Medicaid. Ryan has projected $750 billion in cost savings should the initiative be adopted, but critics charge that the plan will only succeed in endangering the lives of America's elderly by reducing their healthcare coverage. Ryan's plan would change Medicare from a Federal system that pays the beneficiary directly to a system of state-level block grants controlled by state governors that pays private insurance providers directly. Given that each state will receive a grant under the plan, there exists the possibility that the seniors could face a lower quality of coverage due to several factors that include a lack of funds allocated to their state. Conversely, the reverse is true in that some states could be granted more money for Medicaid expenditures than could reasonably be expended. No matter what the future may or may not hold, the one sure thing is that Ryan failed to mention that any funding issues plaguing Medicare were themselves exacerbated by the actions of the very Republican party he is part of, the same Republican party that caved in to special interests in an orgy of greed and pandering on the morning of November 22, 2003.
The above date saw the Medicare Modernization Act (MMA) of 2003—of which Medicare Part D is part— pass through Congress due to backroom deals, overt pressure, an arrogant collection of Republicans and conservative Democrats with ulterior motives, lobbyists from managed care organizations, the insurance industry, the pharmaceutical industry and the American Association of Retired Persons (AARP) run amok. A Republican president and a Republican-dominated Congress enacted the Medicare drug benefit, which former U.S. Comptroller General David Walker called "the most fiscally irresponsible piece of legislation since the 1960s."  In passing the disastrous legislation, I strongly believe that the the guidelines for open and stable Federal rule-making found in the Administrative Provisions Act (APA) of 1946 were violated due to serious breaches of public policy ethics by the Bush administration and the Republican-controlled Congress.
In 2003, the beleaguered, increasingly unpopular Bush administration was already projecting the largest deficit to that date in American history, and a sweeping Republican loss in the impending 2004 general election was looming as a very real possibility. (Obviously, this was America before the so-called "Swift Boat Veterans for Truth" gained enough traction to help derail Senator John Kerry's presidential bid.) With the backing of the AARP and influential lobbying groups, the snake oil salesmen of the Bush administration and the Republicans in Congress worked to sway the election by appealing to the pocketbooks of America’s senior citizens via an expensive new program designed to pay for their prescription drugs—and thus was born Medicare Part D. 
At the time, Medicare was financially strapped, with spending for it projected to rise to unsustainable levels as baby boomers retired. Instead of following the Republican credo of financial conservatism, Bush and the Republican-dominated Congress chose to advance a bill that would add hundreds of billions to the federal deficit. The Bush administration knew the costs for the Medicare Modernization Act would be fiscally prohibitive, a fact that Medicare's chief actuary, Richard Foster, had concluded before the decisive, hours-long vote that passed the measure was taken in the Senate. However, it would later be revealed that the Bush administration decided to suppress that little tidbit of information from lawmakers and the general public. 
In addition to the above policy environment issues, the drug and HMO lobby boasted 30 former members of Congress. The list included former senators Dale Bumpers of Arkansas, Rod Grams of Minnesota, Walter D. Huddleston of Kentucky, former House Minority Leader Robert Michel of Illinois, and Bill McCollum of Florida. Additionally, no fewer than 11 top staffers who had previously left the Bush administration then lobbied for the drug industry and HMOs in 2003. 
Any plans Foster may have had to reveal any knowledge of the impending financial disaster were derailed by Tom Scully, a Republican political appointee at the Department of Health and Human Services. Scully threatened to fire Foster if he dared to reveal the economic impact of the legislation to the public before the vote. Even without knowledge of MMA’s true cost and impact, a few Republicans in the House of Representatives refused to toe the party line in favor of the expensive "Big Government" bill, so when the legislation came up for its final vote on Nov. 22, 2003, it was failing by 2 votes when the standard 15-minute time allowed for voting ended. 
It was then exactly 40 years since the national tragedy that was the JFK assassination took place, and what followed was yet another national tragedy. In a major breach of legislative protocol and in a display of highly questionable ethics, the voting time was kept open for several hours while the House Republican leadership brought crushing pressure to bear against the few rebellious Republicans who were remaining true to Republican principles. With television cameras blocked by the Republican leadership so that no one outside the House chamber could see the legislative farce unfold, many legislators were bullied outright into "rethinking" their votes to accommodate the pharmaceutical companies’ interests, but Republican congressmen such as Dan Burton remained steadfast and refused to bow to coercion. 
Undeterred by any rebuffs from principled legislators, lobbying continued and blatant arm-twisting came about. A particularly ugly accusation was leveled by Republican congressman Nick Smith of Michigan against several members of Congress for allegedly trying to coerce him into voting for measure by promising to oppose any efforts made by his son to gain his seat when he retired. One of those Republicans accused, House Majority Leader Tom DeLay of Texas, was later admonished by the House Ethics Committee for his overzealous actions towards Congressman Smith.  (Author's note: I once had respect for Tom DeLay due to his actions in championing the rights of the afflicted during the sad affair that was the orchestrated murder of Terri Schiavo. Several controversies, a short stay on "Dancing with the Stars" and a multi-year prison sentence later, Tom DeLay rots in prison as of this writing, my respect for him long gone.)
Eventually, the late hour, the face-to-face lobbying, and the blatant arm-twisting got three Republicans and three Democrats to switch allegiances and support the legislation. In the end, only 25 Republicans voted against the fiscally irresponsible bill. Conversely, only 16 Democrats voted for it. 
The largest point of contention—the Medicare Part D portion of the MMA—was projected to augment seniors’ ability to purchase prescription drugs, and that augmentation would then yield higher revenues and greater profits for the pharmaceutical industry, especially since no price controls—and no Federal bargaining controls— were incorporated into the legislation. That is, unlike many foreign governments and America’s own Veteran’s Administration, the legislation did not empower the Federal government with the power to bargain with drug makers since pharmaceutical industry lobbyists managed to have a provision removed that would have legalized the importation of cheaper drugs from Canada. The lobbyists also managed to excise a proposal that would have eliminated some of the ways drug makers overcome competition from generic manufacturers. 
As for insurance companies, now the proposed beneficiaries of Paul Ryan's Medicare "overhaul" effort, they made sure that MMA gave them new roles in the revised Medicare system: as providers of stand-alone drug benefits for beneficiaries who wished to remain in traditional Medicare and as a providers of traditional Medicare services and drugs for those beneficiaries who decide to use a private plan. However, because participation in Medicare Part D is entirely voluntary for the insurance companies, MMA authorizes the federal government to spend billions in order to entice them to enter the program.  And it is directly into the hands of the very insurance companies that both contributed to and greatly profited from the MMA debacle of 2003 that state-granted Medicare funds would placed if Paul Ryan and the GOP have their way. Additionally, medical industry lobbyists found success in that they managed to have a 1% increase in the money Medicare pays physicians placed into the legislation—a victory for them given that a 4% decrease would have been put in place had the previous Medicare cost calculations remained intact. 
The pharmaceutical and managed care industries spent a combined $141 million in 2003, according to an analysis of released federal lobbying disclosure records. Drugmakers and HMOs hired 952 individual lobbyists in 2003–nearly half of whom had “revolving door” connections to Congress, the White House or the executive branch to effect a nearly ten-to-one ratio between lobbyists and senators. “The Medicare Modernization Act, a top priority of President Bush, promises to safeguard industry profits at the expense of America’s taxpayers,” said Frank Clemente, director of Public Citizen’s Congress Watch. “Considering the legion of lobbyists unleashed by pharmaceutical companies, HMOs and allied industry front groups, no wonder taxpayers ended up with a bill tailor-made to serve these special interests instead of senior citizens.” 
Above: The GOP upholds its tradition of screwing over our seniors.
While the interaction between lobbyists and legislators is both a legal and expected part of the legislative environment, the particular interactions between the Bush administration and lobbies for the pharmaceutical and managed care industries is troubling. The "revolving door” that existed between the three contributed to the blending of the needs of those represented by lobbying groups into actual national policy even as the larger needs of the nation were not impressed upon those same lobbying groups. The net effect of the MMA legislation was reduced competition, more sales to “Big Pharma”, no incentive or pressure to control prices, greater government spending, a demonstration of the power of unfettered lobbying, and the absolute betrayal of Republican beliefs by President Bush and his fellow Republicans. Together, President Bush, his administration, lobbyists and the Republican-dominated Congress left a legacy of damaging, counter-productive legislation that continues to this day in the form of the GOP's so-called "Path to Prosperity".
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