Tommy Thompson had had a long day. The secretary of Health and Human Services had been on Capitol Hill since morning, trying to persuade conservatives in the House and Senate to vote for a prescription drug bill he described as good policy, good medicine and good politics.
Now he had to speak to a room full of conservative codgers at a banquet celebrating the 10th Anniversary of the 60-Plus Association, a lobbying group that is a conservative alternative to the American Association of Retired Persons. The "60-Plus" members want the entrepreneurial spirit and private sector initiatives to drive programs for seniors, not the programs of the big government bureaucracies.
They were not in a mood to cheer a prescription for prescription drugs that expands entitlements in a government program already heavy at the top. Nevertheless, he waded in, insisting that his friends in the hall face the facts of the moment, for better and for worse.
Health and Human Services is an agency that has grown big and fat. It has 65,000 employees and an annual budget of $525 billion. In fact, this budget is bigger than the entire budgets of all but five nations (the United States, Britain, Germany, Japan and Italy). The U.S. Defense spending is puny by comparison: "We spend 23 cents of every federal dollar."
That's only part of the story. "We regulate the foods that you take, the medicines that you take, the health care you have," he said. "We run the largest research organizations in medicine and infectious disease. Plus we run Medicare, the largest health insurance program in the world, with 42 million Americans enrolled."
At this point the diners lost the buzz of the cocktail hour. They were beginning to feel a fading appetite for the surf (shrimp) and turf (steak) piled high atop the mashed potatoes. Then he seized their attention with a question. "Medicare was created in 1965," he said. "Does anyone know what movie and what actress won Academy Awards that year? A collective senior moment ran through the ballroom. No one could raise his hand.
"It was 'The Sound of Music,' with Julie Andrews," the secretary reminded them. "Since then movies have changed. Music has changed. But Medicare is still the same."