Why Is Tommy Thompson Sad?

The erstwhile secretary's secret sorrow


Tommy Thompson sends his regrets. According to The Washington Times, the former Wisconsin governor and Secretary of Health and Human Services during President Bush's first term recently confessed, "I really feel sad that what I didn't get done is Medicaid."

Thompson referred to the still-unreformed health care program for the poor. Costs are exploding, partly because Medicaid subsidizes medical care for a lot of people who aren't truly needy.

No one should doubt Thompson's sincerity. The former Wisconsin governor was a pioneer in the effort to reform welfare in the 1990s. Wisconsin led the nation in requiring welfare recipients to work and breaking the cycle of dependency that had trapped generations of Americans in poverty and sapped their spirit.

Like other relics of the Great Society, Medicaid promotes dependency and discourages private effort. It cries out for someone like Thompson, who has saved millions of Americans from dependency by paring down such programs to their core mission. Thompson no doubt saw that need, and regrets not having turned Medicaid around the way he did welfare.

Still, Thompson's expression of regret is curious, in light of both its timing and what Thompson did accomplish as Bush's top health advisor.

In 2003, Thompson was the point man in the successful effort to add a drug benefit to Medicare, the entitlement program that subsidizes health care for the elderly. The drug benefit has been controversial for its size and for the ethical cloud under which it was enacted.

Even though the president promised to take no more than $400 billion from taxpayers over 10 years to pay for the drug benefit, the administration's number-crunchers had estimated the benefit's actual cost would fall between $500 billion and $600 billion. The administration hid these estimates from the public and Congress until after the drug benefit became law.

Secretary Thompson himself went on national television to say the cost would be $400 billion. In the uproar following the publication of the administration estimates, Thompson claimed that they had been made available to Congress before the vote.

Thompson played a role in another part of the drug benefit's ugly birth. After a majority of the House voted against the bill in the wee hours of the morning, the House leadership violated the long-standing tradition of 15-minute votes by holding the vote open until they could turn enough votes to change the outcome. American Enterprise Institute Congressional scholar Norman Ornstein wrote in The Washington Post:

The Medicare prescription drug vote—three hours instead of 15 minutes, hours after a clear majority of the House had signaled its will—was the ugliest and most outrageous breach of standards in the modern history of the House. It was made dramatically worse when the speaker violated the longstanding tradition of the House floor's being off limits to lobbying by outsiders (other than former members) by allowing Health and Human Services Secretary Tommy G. Thompson on the floor during the vote to twist arms—another shameful first.

Finally, Thompson voiced his regret just one day after Medicare's trustees announced that the drug benefit by itself has an unfunded liability 60 percent larger than that of the entire Social Security program. (The unfunded liability for all of Medicare is nearly six times that of Social Security.) Medicare's financial outlook has grown so dire that its two public trustees broke with the trustees who are members of Bush's Cabinet to say that it is in far worse shape that Social Security.

Thompson's efforts in improving the lives of those who had been trapped in welfare should not be forgotten. But neither should he sit on the sidelines while Medicare threatens to bankrupt taxpayers, and Medicaid continues to pull Americans into dependency. If Thompson channels his remorse into a ceaseless campaign to reform both Medicare and Medicaid, it wouldn't be the first time that his leadership spurred a president into action.