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The Hill reports the Senate failed to get even 50 votes Wednesday on a procedural motion on the Medicare “Doc fix,” the first health care reform-related bill.
On a vote of 47-53, the Senate knocked down Majority Leader Reid’s motion to proceed on the so-called “Doc fix,” a bill to eliminate automatic Medicare cuts for Medicare doctors and to provide funding over the next decade. Twelve Democrats — mostly conservaDems but including Feingold, McCaskill, and Wyden — joined Lieberman and all Republicans to defeat the motion.
You’ll recall that the “doc fix” springs from statutorily required cuts in Medicare payments to doctors. Every year, Congress “fixes” this by eliminating the cuts for that year and giving the doctors a raise. This recurring problem was “fixed” in the original House health reform bills for the full ten years, with the House bills fully accounting for the costs of doing so. In contrast, Baucus Senate Finance Bill had offered a solution only for the first year, with a promise to develop a permanent fix later.
Since the 10-year “fix” would cost about $247 billion, that difference in treatment was the principal reason why CBO scored the House bills as having a 10-year deficit of about the same amount, while pretending the Senate Finance bill had a slight surplus. The Finance bill “surplus” would have more than disappeared with each annual “doc fix.”
After Obama insisted the reform bills get below $900 billion over ten years, both House and Senate agreed to take the “Doc fix” out of the principal reform bills and deal with it and its costs separately. But neither House offered any revenue mechanism to fund the fix.
So, a key reason opponents gave for voting against the motion to proceed was the bill’s failure to include any funding from other cuts or new revenues. And that gave all of the conservaDems a reason/excuse to vote no.
Whatever the merits of the “fix,” we didn’t need this vote now. Harry Reid told the Hill he had been misled by the AMA, who, he claims, promised substantial Repubican support for a permanent fix. But once again, the Democratic leadership looks like it doesn’t know what it’s doing and can’t remember that the Republicans are not there to help them solve problems; they’re there to make Dems look like inept failures.
The lack of funding for the “doc fix” makes this different from the major health reform bills, which will presumably be fully funded. But it’s not helpful for the leadership to be giving conservaDems an opportunity to show they will vote against the leadership on a procedural matter to prevent a substantive health reform bill from reaching the floor.
54 Comments
Just curious: would you characterize voting against spending money that you don’t have as a “reason” or an “excuse”?
be interesting to hear Feingold and Wyden’s reasons for voting no.
Trillions (we don’t have) for wars? “Hey, you a DFH wot ‘hates Amerikkka’?”
Trillions (we don’t have) for ‘investment’ banks? “Notta problem, gotta do it, millionaires need their millions, you DFH – hey, ‘trickle down’ is good, (even if yellow & high in urea)”.
Billions (we don’t have) for public medical care? “Nah, can’t afford it, gotta be responsible…”
(durn escape chars)
Could be either; I’m not judging the motivations. The question is, why did the leadership bring this bill forward without knowing they couldn’t get enough votes? If they were being told they didn’t have the votes without funding or offsetting cuts, then what’s the point? Ordinarily, this might not matter, but this is a big bill (in $$) in its own right, important for the long-run Medicare funding issue, and it could be argued to undermine what needs to happen on the major reform bill.
If they don’t fund it, they shouldn’t pass it. If they want to fund that estimated $247bn, they are going to have to tax someone. Middle class people are going to have to pay a fortune for junk insurance. It looks like the doctors will get their money in exchange for a hefty tax hike on the rich, including the doctors. I expect the AMA will be calling for that tax hike tomorrow.
I wonder. The Hill reports Conrad may propose a short fix of only 0.5% increase in the next year or two, then pass the issue on to the MedPAC or other “independent commission” — which is what he was trying to do in the Baucus bill to begin with.
Thanks for this post. I went to the NY Times and found the roll call breakdown and e-mailed it to my boss (a surgeon), suggesting he get in touch with the two clowns who are Senators from Georgia.
why?
edit to add: why not fund it via deficit spending? (or are we in paygo territory?)
Like Bush’s fucking wars? Give me a fucking break.
nah, like the bankster bailouts. *g*
When I get annoyed my language sometimes slips! How be ye?
howdy marion. my language always sucks, so sometimes i don’t notice it in others. but i sure did with you just now. *g*
after all the trillions to the banksters and the warmongers, it’s hard to see all the faux concern re fed budget when it comes to healthcare.
oh, and the bankster bailout is especially relevant as no other senator joined bernie sanders in voting for his amendent for a temporary tax on those individuals with income over $500,000/year in order to pay for a portion of the TARP. guess they forgot to be worried about the fed budget then.
As I mentioned above both of the clowns Georgia sent to the Senate voted against this. As the icing on the cake they also voted against the Franken amendment. It’s enough to make a rational person tear their hair out.
Actually, selise, as you get deeper and deeper into debt it becomes more and more important to stop living beyond your means.
Isn’t one of the consequences of trying to obtain a more affordable health care system that physicians will need to be paid less than they are currently? They will still live comfortable, and be able to afford vacation homes, and luxury cars, but still less than they are now.
Why is this bill a good idea? That’s an honest question, btw.
So I must assume you were wildly opposed to the 8 years of non-funded Bush wars?
its a start
Obama Pay Cuts: White House Forcing Bailed-Out Companies To Slash Compensation
http://www.huffingtonpost.com/2009/10/21/obama-pay-cuts-white-hous_n_328928.html
federal budget is not like a household budget. we aren’t on the gold standard anymore.
(granted it’s a lot more complicated than i am describing, but the first step imo is to recognize the nature of our monetary system… at least that has helped me as i’ve tried educate myself on these matters)
i have it easy. living in MA, i only have corrupt dems to hate. much better than batshit crazy republicans ((marion))
Yes, and also to TARP. Your tone indicates that surprises you(?)
Fuckin’ A !
*Where’s the Fuckin’ English Muffins and Orange Fuckin’ Marmalade ?* *g*
Then take that first step, selise, and recognize that the more fiat money you print, the less it’s worth.
I assume you don’t support unlimited deficit spending: what sort of restrictions would you favor?
In your honor I will serve “The Petrocelli Special” for breakfast tomorrow morning!
ROFL … Marion !
This is simply Harry Reid’s way of showing the DFHs (and Chuck Schumer) that he’s a lousy Majority Leader and can’t count. So stop yelling at him.
“Lowered Expectations”
My feeling is, this ‘failure’ could very well guarantee that Baucus’s Bill gets nixed and both Bills that end up in Conference contain a PO.
i disagree. was the dollar worth more or less after the tarp bailout passed?
depends on what you do with it. and depends on the economic situation.
the economic situation is that the private sector has made a big change from credit to attempting to save. so the public sector must compensate with some increased deficit spending (the temporary change in the current account balance has helped, i think). why should the warmongers and banksters get it all?
*Do.Not.Feed.*
We could fund a more lavish national health care plan than any currently on the table with what we pay in interest on the national debt, but posters opposed to deficit spending are trolls, huh?
petro and marion, you crack me up. thanks for the laugh!
there are lots of deficit hawks. probably not a bad idea to talk about it, but maybe not on scarecrow’s diary?
Perhaps the deficit hawks should have spoken up when Bush was spending like a drunken sailor.
As you wish, but just for the record: Scarecrow brought up funding as a reason the Bill failed, and you’re the one who said, “why not fund it via deficit spending?”
We did: perhaps you should have listened?
selise: sorry for putting in one last response; tbsa posted while I was typing.
I do not know whether it a good idea to vote on this now, and I do not know whether a ‘fix’ is needed to keep doctors getting a living wage, or how badly it will worsen the deficit.
My only comment is that it is a very strange market based system that reform opponents are trying to protect when doctors fees are so dependent on congressional votes.
The system is so absurd at this point, I don’t think it is a good idea to take strong sides for against individual votes trying to prop up an absurd system. Sometimes absurd nonsense is needed to keep an absurd system from crashing and burning in the very short run.
We need a find a way to determine doctor pay, and supply of doctors that is not dependent on a few small closed-off AMA committees (dominated by advanced specialty docs) and congressional budget votes.
oh, i’d love to discuss it. was just trying to be respectful of my fellow commenters wishes. perhaps a rain check, if you are willing?
amen! one of the “mad as hell doctors” talked about that in an interview with montanmaven.
here in MA there is a big shortage of primary care docs (and apparently, from the backlog, some specialties too)
I think the solution to the problem is that everyone in the health biz takes a haircut. We spend less by paying everyone less, certainly not by increasing the amounts we pay to one segment of the business. I’m fine with tax increases, and say so regularly. What I don’t want to do is to pay any more money into the health biz, and if we are going to, let’s raise taxes.
huh? don’t you think the amount we spend on health care as a nation is going to go up – a lot – with obamacare? i thought you were a supporter, am i wrong about that?
….
the bill scarecrow is referring to was, if i understood correctly, to prevent a cut in medicare payments. do you think we should be cutting medicare now?
….
again, why raise taxes? don’t you think that would be problematic at this point (given the state of the economy)?
…..
finally, i don’t understand the reluctance to pay for healthcare — while accepting the hundreds of billions of dollars that goes wasted every year on useless adminstration costs because we don’t have a single payer national health insurance program (as in hr 676).
What makes you think you can get away from them that easily, Selise? In case you hadn’t noticed the batshit-crazy republicans are what democrats are using to cover up their own corruption and complicity in the corporate looting.
“In the question lies the answer.”
As Teddy has already said, Reid did it precisely so he could fail on schedule.
Simply in order to lay the groundwork for all the fantastic healthcare kabuki that is yet to come.
A more affordable HC system would tax the rich, cover everyone, now, focus on early prevention and good health, and compete directly with the insurance system to reduce costs by over 30% from admin and bonus savings alone.
Just MY humble opinion, about controlling costs.
Doc’s SHOULD be reimbursed better for their delivery of care, thru Medicare and Medicaid.
SOME doc’s doing boutique care delivery, some doc’s own their own practice groups, and the radiological services, and other testing services, and OVER PROSCRIBE those services for a profit motive, need to be reined in.
THAT’S done by regulation.
Yer a doctor, you don’t own other services groups, or have stock in them, or any entangling profit driven alliances.
Mostly, you either heavily regulate and enforce corporate insurers and the delivery system, or you simply nationalize it all and go single payer, to save money, and improve care for all.
Works in most of the other industrialized nations, rather well, I might suggest.
There are SOME things only orange marmalade and extra crunchy peanut butter on hot english muffins can cure.
Yeah, save the marmalade for the Pups!!!
Or at any other time in the past 40 years when we invested more and more into the MIC and weaponry for us and for sale, than we invested in our selves and our domestic needs.
Hmm, medicare and medicaid docs are under reimbursed.
At least that’s the mantra I keep hearing from many sources.
So THEY can’t be the source of our rising costs, right?
So, where’s the source(s) of our rising costs of delivering care?
Well, we KNOW 30% of admin, staffing and bonuses are spent on private insurers.
Is that the bulk of our problem, expense wise?
We know that pharms REFUSE to allow for Canadian imported meds, that are cheaper.
How much are we wasting there, to prop up pharma profits, bonuses, and admin staff?
We know that SOME specialty practices and doctors groups have bought into ancialliary services, and OVER REFER those services to increase revenue streams. How much are we losing there?
We know there are boomers galore going onto the rolls of medicare, taxing the revenue stream available with increased services. How much are we wasting there?
Question becomes, will reform reduce waste and greedy profiteering, or not? All the while increasing delivery of care to EVERYONE, which should be a right, in this country, as it is in so many other developed countries.
And, in the long run, if we DON’T reform HC delivery system, and break the back of health insurance system.
If we don’t break the back of the MIC stranglehold, and rethink our PURPOSE and NEED to chase, attack, and try and take resources and their distribution routes.
If we don’t nationalize energy, transportation and regulate banking/finance, separate banking from investing.
If we don’t do ALL of those things, in the name of improved domestic standards of living for us all, we will fail as an empire. We ARE failing as an empire. Tragically.
We are failing as a constitutional democracy, too. Tragically.
We SHOULD invest MORE into our HC delivery system! We SHOULD spend money on it!
And we can, without incurring deficit spending problems, if we reform, and reshape it.
And reform and reshape banking/finance.
And reform foreign policy waste on the war machine, that’s simply an extended version of upwards transferrance of wealth from the masses to the corporate feudalists.
We SHOULD spend more for our health delivery system.
We should.
But it takes a bigger lens to make it work.
“finally, i don’t understand the reluctance to pay for healthcare — while accepting the hundreds of billions of dollars that goes wasted every year on useless adminstration costs because we don’t have a single payer national health insurance program (as in hr 676).”
Badda boom, badda bing.
Bless ya. *G*
That is some bad news. I hate to see the the Democrats lose one. Some good news may step on that story. It looks like the health insurance companies will lose their antitrust exemption. People seem to be responding well to this story.
It is one of the top ten hot links at Reddit, and that’s not usually the kind of story that is the hottest link at Reddit.com. It is on Sen Reids Twitter page and on TheHill.com.
Here is the headline over at Reddit:
“Have the Democrats Suddenly Grown B*lls? Senators to strip health insurers of antitrust exemption.”
WTF Dude?
Your post is unintelligable – Try speaking and writing English and maybe we would get the point of your comment. Your lame attempt at snarky is too clever by half…
In most other industrialized nations doctors earn significantly less than they do here. If we want a more affordable system, don’t doctors salaries necessarily have to decline? Why should a radiologist earn $400K per year?
A 30% savings of current costs – wouldn’t we still be spending significantly more per capita on health care than the rest of the industrialized world?
Insurance companies also pay for doctor visits/fees. Maybe the doctors could ask the insurance company executives to take a little cut in salary to increase reimbursement to the docs … he he he. I think I need more coffee.
Ah! The old Doc Fix.
We can’t complain if were not paid enough, or refuse to see our customers, if we aren’t paid what we think we’re worth.
Maybe this was a blessing in disguise.
Not all, but far to many doctors are paid far to well for what they do. Here in Florida the ones who won’t treat medicare patients, use it for an excuse for more time on the golf course and their yachts.
They look at it as if you don’t pay me what I think I’m worth, I won’t play your silly game.
It is not like they say, that they can’t afford to do that.
and when that doesn’t work, they use the blue dogs.
yeah, i’ve noticed, zapkitty.