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The Miami Herald explains why the Administration's Medicare reforms didn't quite go as expected. (Link via Healthlawblog):
Enactment of a sweeping Medicare reform law last year was supposed to be the crowning achievement of President Bush's "compassionate conservatism" as he readied himself for re-election.
By providing a federally subsidized prescription-drug benefit for senior citizens, albeit a limited one, administration officials felt they usurped a major issue from the Democrats and cut into Democratic support among seniors age 65 and over -- an especially important voting bloc in key battleground states such as Florida.
But less than four months after he signed it into law on Dec. 8, Bush's Medicare-reform dream has turned into a nightmare and a potential drag on his bid for re-election.
-- The Bush administration deliberately didn't tell Congress that the measure could cost more than $100 billion more than advertised.
-- House Republican leaders abused House rules to push the measure to a narrow victory. There are also allegations of threats and bribes that are under investigation.
-- The Bush administration spent millions of taxpayer dollars on public service TV ads touting the Medicare reform law that look suspiciously like Bush campaign commercials. Those, too, are now under investigation.
-- Polls show that a majority of Americans don't like the Medicare reforms.
"It's something that's eating away at the credibility of the administration in an election year on a bill that he (Bush) thought was a building block for his re-election," said Stephen Hess, a political analyst for the Brookings Institution, a centrist think tank, and a former aide to President Eisenhower.
I wouldn't go so far as to call the bill a "nightmare" for the Republican Party. It simply hasn't turned out to be the clear winner that people expected. The problem is that the bill doesn't seem to mesh well with the Republican self-image of low taxes and low domestic spending, which or course, is why in the past the Democrats have usually been the party that pushed for new domestic expenditure programs. (Defense expenditures, are, of course, another matter.). The Administration had to hide the costs of the bill from the members of its own party, and then twist arms to get the final couple of Republican votes. The result was a distinct sense that something fishy was going on in the bill. The fake journalism segments and the disguised campaign ads also added to the notion that the Administration wasn't being entirely honest.
This was a wasted opportunity for the Republicans, who could have lived off of the glow of this new entitlement program for some time.