The Bush administration [3] "spent $250 million on public relations [4] contracts during its first term, compared with $128 million spent for President Clinton [5] between 1997 and 2000," including $88 million in fiscal year 2004, according to a report [6] by the Democratic staff of the House Government Reform Committee. "While not all public relations spending is illegal or inappropriate, this rapid rise in public relations contracts at a time of growing budget deficits raises questions," stated the report. The Center for Medicare and Medicaid Services [7] spent the most on PR over the past four years, $94 million, and the largest recipient of government PR contracts was Ketchum [8], at $97 million.