The Case of the Healthcare Coverup

The question is: Can Richard S. Foster—a low-key, Baltimore-based accounting expert—finally expose President Bush’s pattern of intimidation and deception?

Foster is Medicare’s chief actuary, the government’s top nonpartisan analyst of Medicare costs. An award-winning mathematician with—as The New York Times recently described it—a “reputation for being careful in his assessments,” Foster estimated (after “dozens and dozens of analyses”) that Bush’s prescription drug benefit bill would cost about $150 billion more over 10 years than the White House told Congress.

Bush’s drug proposal was set for House and Senate votes on June 27 of last year. On about June 13, according to The Washington Post, Foster says he told Thomas A. Scully, the Bush-appointed Medicare administrator, that the White House numbers were many billions off the mark. Foster also says he sent his calculations to Doug Badger, the administration’s top health policy analyst, and to executives within the Office of Management and Budget (OMB) and the Department of Health and Human Services (HHS).

Ordinarily, someone in Foster’s job would have gone straight to Congressional representatives with his news. Indeed, the Medicare actuary’s office has a “tradition of dealing directly with the legislative branch.” And after all, senators and representatives were about to vote on a bill that actually cost 37 percent more than they were told.

But Scully ordered Foster to keep quiet—and, according to Foster as well as others, threatened to fire him if he didn’t. Rep. Pete Stark, D-Calif., told The New York Times that “Tom Scully told my staff that Rick Foster would be ‘fired so fast his head would spin’ if he released [the drug bill’s costs] to us.”

Neither Scully nor OMB officials nor any senior White House aides—all of whom knew Congress was about to vote under false pretenses, and none of whom could have acted without higher authority—lifted a finger to stop the cover-up.

Bush’s bill passed the House by a single vote. And getting even a “$400 billion” entitlement through the Republican Congress was a challenge. Already we know that (according to Chicago Sun-Times journalist Robert Novak) retiring Rep. Nick Smith, R-Mich., received threats because he opposes deficit spending. With the Bush-controlled House leadership’s endorsement, Novak reported, Rep. Duke Cunningham, R-Calif., and others told the disloyalist that his son—running in Michigan to succeed Smith—would lose funding from GOP loyalists.

But the columns and editorials that express nothing but shock, shock, shock at all the Republican hardball miss the pattern. This is the way Bush plays the game. This is the way he governs as president. Step one: Suppress dissent. Step two: If it happens anyway, punish the dissenter. Step three: Dismiss the offending facts.

Steven J. Kelman ’70, who directed federal procurement policy from 1993 to 1997 and is now Weatherhead professor of public management at the Kennedy School of Government, said that the Bush administration is “much more extreme” about restricting civil servants’ conversations with Congress and the media than its predecessors.

And no wonder. It seems that even those who have loyally served presidents for decades, or are members of Bush’s own party, get knee-capped for exposing politically pesky realities.

This president, like many right-wing populists before him, loves publicly knocking “the bureaucrats”—and there is certainly nothing immoral about that. But what about Sept. 2002, when career scientists at the Environmental Protection Agency objected to White House demands that they erase a report disproving Bush’s position on global warming? According to The New York Times, Bush (step one) sent a signal that no more inconvenient science could be released, (step two) publicly demeaned the report’s writers and (step three) had the White House-hired environmental policy director repudiate the report’s substance.

And what about Sept. 2001, when Richard Clarke, Bush’s top anti-terrorism adviser, who has served in national security positions for four presidents, opposed the immediate push to bomb Iraq, not al Qaeda? According to an interview broadcast Sunday on “60 Minutes,” Bush (step one) listened only to Defense Secretary Donald Rumsfeld and Vice President Dick Cheney, (step two) called those who opposed the unrelated Iraq operation “not interested in the security of the American people” and (step three) pushed the CIA to minimize bothersome intelligence.

And what about the Medicare cover-up of June 2003?

A winning game plan for Democrats: (step one) discuss the dissent, (step two) welcome the dissenters and (step three) expose the facts.

Brian M. Goldsmith ’05 is a government concentrator in Lowell House.