Dear Congress,
I hate what is happening to us. We used to be so happy.
Remember when we first met and made that deal; I would vote for you and you would represent me? I trusted you and you worked hard to make sure that I was not being taken advantage of or lied to. It was a great relationship, but then we allowed those lobbyist into our lives. We agreed that we would put an end to that, but then I just caught you philandering behind my back. That lead to us seeing our therapist who helped us live in the “trust tree”. After several years of sessions with Dr. Smith I thought that we would be just like this couple. Happy forever and ever….. 
However, I woke up this morning and I realized that you have a long history of stretching the truth. This goes back all the way to the 60’s when LBJ came up with the idea of Medicaid and Medicare. You remember, that was when you told me that Medicaid would only cost me $238 million in the first year. Instead the actual cost was close to $1 billion. Medicaid cost me and my friends 37 times more than it did when it was launched – after adjusting for inflation. It currently costs us $251 billion. Annually.
But hey who am I to point fingers, I want to make this work out as well so I guess this could be an innocent mistake. Even I make mistakes, like that time I left the hanging chad on my ballot in Florida.
Surely you did better in your Medicare projections. In 1965, you told be that Medicare would cost me $12 billion in 1990. It’s actually costs $90 billion. Whoops. The hospitalization program alone was supposed to cost $9 billion but wound up costing $67 billion. The rate of increase in Medicare spending has outpaced overall inflation in nearly every year (up 9.8% in 2009), so a program that began at $4 billion now costs $428 billion.
Wow. $428 billion. That is a lot more different than you and you could have ever anticipated.
Or is it?
I read this about you and your history and I can hardly believe that you are same person that I thought I knew. Apparently you have been lying to me from the beginning.
According to James Morone, co-author of The Heart of Power: Health and Politics in the Oval Office, LBJ’s Medicare push is “one of the great untold stories.” During a phone call to a young Ted Kennedy in 1962, LBJ explained how to get the Medicare/Medicaid bill passed:
“A health program yesterday runs $300 million, but the fools had to go to projecting it down the road five or six years, and when you project it the first year, it runs $900 million. Now I don’t know whether I would approve $900 million second year or not. I might approve 450 or 500. But the first thing Dick Russell comes running in saying, ‘My God, you’ve got a billion-dollar program for next year on health, therefore I’m against any of it now.’ Do you follow me?”
Morone goes on to say:
“We believe, after looking at the evidence, my co-author [David Blumenthal] and I, that if the true cost of Medicare had been known — if Johnson hadn’t basically hidden them — the program would never have passed. America’s second-most beloved program would never have happened, if we had had genuine cost estimates.” (emphasis mine)
Wait, this means that you knew all along that the first year Medicaid costs where going to be closer to the actual $1 billion that they where? You knew and then you still told me that they where going to be $238 million.
What about this new Baucus Bill that you are working on?
You tell me that it is going to cost me $900 billion, but I think you are missing the bigger point. This bill does nothing material to change the forces that cost us $2.4 trillion for healthcare last year. Doctors still get reimbursed the same, patients still don’t care about the actual costs because they are insulated by insurance (public AND private) and we are still obese, ridden with diabetes and other preventable ailments. I feel like our relationship has been a fraud from the beginning and this is just the latest lie you are telling me.
We want and need reform, but the kind of reform you are cooking up is going to do very little to change healthcare and we will be $900 billion poorer (if that is the real estimate).
I am sorry congress, I wanted to make this work, but it seems like it is “your way or the highway”. In my book that is a dysfunctional relationship and we must end this. I’ll see you at the polls very soon.
PS: In case you think that this is a partisan issue, you are wrong. The left is mad for leaving out the public option, the right is mad that you want to increase the welfare state and you have nothing for us except more of the same. More of the same lies, more of the same missed projections and more of the same out of touch with reality responses.
