TNR's description of the Medicare Flim-FLam:

"Last summer, President Bush and the Republican congressional leadership had a problem. The legislative linchpin of the president's reelection effort, a bill to add prescription-drug coverage to Medicare, lacked the votes in Congress, where conservative Republicans were chafing at the expense. GOP leaders finally secured a bare majority by consenting to the demands of 13 Republican House members, who agreed to vote yes if the cost would not exceed $400 billion over ten years. But that created another problem: The administration knew the bill would cost considerably more--$534 billion, to be exact.

The only non-loyalist who seems to have known the real number was Richard Foster, a 31-year veteran of the bureaucracy who was serving as chief actuary of the Department of Health and Human Services. The job of putting a lid on Foster fell to his boss, Thomas Scully, appointed by Bush to run Medicare. Scully instructed Foster not to reveal the number, or even to answer queries from Democrats, without his approval. Foster later said he understood Scully to be operating at the White House's direction. In one e-mail obtained by The Wall Street Journal, Foster asked Scully for permission to answer congressional queries that "strike me as straightforward requests for technical information." No, replied Scully's assistant, who then warned, "The consequences for insubordination are extremely severe." (Scully, by the way, later admitted to having negotiated a job with lobbying firms while he helped craft the bill, in which they had a massive interest.)

The Medicare bill was therefore widely understood to cost $400 billion when, at three o'clock in the morning on November 23, the House of Representatives assembled to vote on it. Surprisingly, a majority voted no. In response, the GOP leadership violated the customary time limit on votes, holding the vote open for nearly three hours and twisting enough arms to reverse the result shortly before dawn. (A hint as to their methods of persuasion came from retiring Republican Representative Nick Smith, who offhandedly revealed a few days later that certain "members and groups" had offered to contribute $100,000 to the congressional campaign of his son Brad, who was running for Smith's seat, if he voted yes.) When Democrats controlled Congress, they had extended a vote once, in 1987, for 15 minutes, after a member inadvertently caused a budget bill's defeat and then left town--provoking spasms of indignation from Republicans. The three-hour Medicare vote, congressional scholar Norman Ornstein of the American Enterprise Institute later wrote, was "the ugliest and most outrageous breach of standards in the modern history of the House." (...)

http://www.tnr.com/doc.mhtml?i=20040726&s=chait072604