Back in 1997 the Congress had a decent enough idea. They wanted to restrict the growth of payments to Medicare doctors. Health inflation started to skyrocket in later years, far beyond regular inflation. So every year, Congress put a patch on this restriction, called the sustainable growth rate (SGR). People knew that Congress wouldn’t restrict the payments, but it became this “surprise” to the budget every single year.
The Obama Administration wanted to do away with the gimmick, and saw health care reform as an opportunity to do that, and admit the reality that Congress will never cut these payments. But Republicans saw a political opportunity. They could claim that Congress took the budget hit for health care reform “off the books,” when in fact they were just admitting that the real budgetary cost of Medicare is higher than what is typically acknowledged. So when it came up for a vote today it was sufficiently demagogued enough that it only mustered 47 votes, with fiscal scolds puffing out their chests and claiming that such an expense has to be “offset.” Even Steny Hoyer got in on that act, demanding that a doctor’s fix must be tied to adopting pay-go rules.
Never mind the fact that a one-year fix will pass with almost unanimous support. And all of these politicians will run back to their districts and tell people that they saved doctor’s livelihoods and hospitals and access to health care. It’s basically just a game.
But this is playing out in the middle of the health care debate. And it’s making the Democratic leadership look awful. Harry Reid is claiming that the AMA promised Republican votes for the fix, and he was led astray. The very notion of deals with the AMA to fatten the pockets of their Medicare doctors in exchange for health care support is unseemly. And nobody looks like they know how to count, in addition to the fact that they are relying on Republicans to be interested in governance rather than winning the day-to-day political battle.
Scarecrow has more.
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Oh man, please…just a little budgetary clarity would be nice.
The hypocrisy of the Republicans knows no bounds: it’s OK to spend on a war in Iraq ‘off the books’ but not when it comes to Medicare.
Reid’s office is giving all kinds of excuses for what went wrong. Here his office tells Politico it was all 11-dimensional chess to prevent the fix from being added to health care reform:
http://www.politico.com/livepulse/1009/Senate_fails_to_move_doc_fix_forward.html?showall
They didn’t seem to have good answer as to how losing a cloture vote can ever be considered a good strategy.
I think there are some very good questions here but they are not being asked as far as I can tell:
1) Why should doctor’s reimbursment match the rate of medical inflation? Is the real cost of an MRI really more this year than last? My impression has been the real drivers are rising costs of new technologies and an aging population. So 1) more services are needed but in a fee for service universe this should not raise the cost of individual services and 2) new services are defined and these should have new associated fees. Neither of these factors should lead to an across the board increase in rates, just overall cost.
2) WTF shouldn’t this change be subject to paygo. The only real question should be how do you pay? Propose it along with a surcharge on corporate cach or equity bonuses over $200K, for example.
The answer is the doc fix should be paid for using the savings from the Public Option! (Too simple, I know.)
Medicare payments are complicated and actually aren’t keeping pace with inflation right now on a per-beneficiary basis. But the logic is that the number of beneficiaries is increasing by about 2.5% per year so it works out pretty fair. Arguments between the government and doctors over reimbursement are a fact of life in every country. You just have to tune out the whining and remember that U.S. doctors make significantly more than the average for developed countries.
Harry Reid is pathologically incompetent.
Democratic leadership will continue to look awful as long as Harry Reid is part of it.
AND THE KILLIN’ GOEZ ON AND ON AND…
Citizen David Dayen and the Firepup Freedom Fighters:
Harry Reid is takin’ all the hits in public for those who have been suckin’ at the teats of the health insurance cartel…his weak leadership is bein’ played against ‘im and the forces that thought they owned ‘im. Yep, ObamaRahma’s got Reid hangin’ out there with no flak jacket drawin’ fire while the Blue Dogs and fascist fellow travelers get an object lesson on what happens to crooks and liars who carry the Democratic brand and cross the will of the people.
I predict that Senator Reid will lose his leadership spot in 2011 and Joe Likuderman will be drummed outta the caucus.
KEEP THE FAITH AND PASS THE AMMUNITION…KEEP YOUR EYES ON THE TARGET!!
Here is Reid’s office with yet a different explanation for why losing the cloture vote was a good idea:
http://www.politico.com/news/stories/1009/28593.html
(It gets Republicans on record voting against seniors and their doctors. Gotcha!)
Harry Reid is pathologically incompetent.
I used to think that (and still do). Then I started to think that he was crooked. Mix that in with a hunch that he is psychologically driven, somehow, to always lose, and I think I’ve now got Harry Reid down cold.
A Senator for sale, but without enough game to pull it off.
Hapless Harry strikes (out) again. Is he merely incompetent or actually a Republican plant?
Not sure, but allegedly he was a boxer.
Reid couldn’t punch his way out of a wet paper bag.
Did he ever win a fight? Just wondering.
wow… Harry pulls all the levers of power…
Reid needs to fix his caucus. The breakdown of his caucus – the usual suspects is what defeated it. At least now he knows who he can trust and whose arms he has to twist.
It’s likely the AMA got punked by the GOP for signing on to healthcare reform.
It’s Nevada. It’s possible he threw them all.
This is Harry Reid’s version of “the dog hate my homework.” Reid and Obama fit Einstein’s definition of insanity. They keep thinking they can work with Republicans and they keep getting burned. Maybe they should replace the party logo of the donkey with Charlie Brown.
Reid’s excuse doesn’t pass the smell test. The assertion that a Dem Senate leader believed he had enough Republican votes to pass ANYTHING at this point is absurd.
Of course the party won’t strip him of leadership now because it would make them look (ahem) weak. I think it might not be only Reid that is psychologically driven to fail but the entire party.
I can’t find any answer to that question.
Harry’s boxing career ended after he lost successive bouts to Bob Denver and Don Knotts.
:)
He was also knocked out while shadow boxing…
I think Harry Reid is brilliant & everybody’s missing the point. Of course he knew he didn’t have the votes. He’s got somebody on his staff who can count. But now he can blame (& has blamed) the Republicans for not saving the doctors’ incomes, so he can keep the medicos on his side, AND he saves you & me $297 billion.
The Constant Weader at http://www.RealityChex.com
huh?
So what happens if the matter is tabled for now, but the “fix” (new rate schedule) is included in an amendment to the public option?
Would that teach blue dogs, repubs, and the AMA anything of value?
Any more unseemly than:
1. a deal with trial attorneys for ZERO liability reforms
2. a deal with private insurers to get millions of new customers through the exchanges, where new competition has to fight a bureaucracy bought off by the biggest insurers
3. a deal with insurers and PhRMA to get millions of new customers or make them pay fines, nearly all of which is from the middle class that the President offered a “read my lips” pledge not to tax
4. a deal with private insurers and House leadership to allow them to outsource running the public option to private insurance companies and Unions
5. a deal with unions to exempt them from the same rules that non-unionized Americans will have to follow
6. a deal with each other keeping members of Congress from having to participate in the public option
7. a deal with AARP to kill medicare advantage, giving AARP medigap policies millions of new customers
8. a deal with hospitals exempting them from payment cuts by the new independent medicare payment commission
and that is just a very, very short list…
Sounds like a variation on the “failing upward” strategy. In fairness, only something similar could explain Harry’s rise in politics.
no, Harry, you are the punching bag.
I’m not a boxer, but I play one on TV.
I honestly have always been puzzled why they chose him. As far as I can tell he has no leadership qualities at all. He has a soft, whiny voice and a weak appearance. Why?
Citizen constantweader:
Ah…how is the weather on that side a the moon Citizen? There is only one explaination for Reid’s failure on this and that’s that he got punked by the folks that have paid his bills lo these many years and ObamaRhama is lettin ‘im hang out there to take the hits as an object lesson to other Blue Dogs and fascist fellow travelers.
Harry Reid is in ObamaRhama’s pocket and it’s slowly beginnin’ to dawn on ‘im that if he wants to stay in the Senate, let alone hold ‘is leadership he’s gotta start followin’ where the votes are.
Prediction: Harry Reid loses the Senate leadership in 2011 and Joe Likuderman gets unceremoniously kicked outta the Democratic caucus.
Congressional Budget Office (CBO) score’s the baucus plan at $829 Billion over a 10 year period, that is paid for. The CBO also states that it will lower the deficit by $80 Billion and it would be much lower if there was a public option.Criminally corrupt politicians are the reason the U.S. is ranked near the bottom of every catagory when ranked next to other modern, industrialized nations. Time for publically funded elections. lieberman $12.6M, mcconnell $7.8M, baucus $7.7M, cornyn $6.7M, kyl $5.6M, grassley $5.4M, ensign $5.2M, conrad $5.1M, cantor $4.9M, nelson $4.9M, burr $4.8M, boehner $4.4M, hatch $4.4M, lincoln $4.1M, vitter $3.9M, carper $3.6M were paid by the Medical Industrial Complex to kill Health Care Reform. (Source: OpenSecrets.org, Aug. 09)Follow the Money: LinkCall Congress and demand, Single-Payer Health Care for All!(Toll Free # House and Senate)1-866-338-1015 _____ 1-866-220-00441-866-311-3405Sign Single-Payer, Public Option and Health Care as a Civil Rights Petitions: Link Link Link kucinichpetition Don’t let the Medical Industrial Complex steal your Health Care from you and your family by donating huge sums of money to Crooked Politicians in order to maintain the Status Quo. Keep up the good fight.SEMPER FI!
Has everyone written or e-mailed their Senators and told them that you want Harry out of Leadership? I have several times and will continue to do so. They need to know how we feel.
Citizen carolbeth:
This entire thing is a teachin’ moment for the general public and an object lesson to the Blue Dogs and the health insurance cartel. The rate is gunna get a one-year fix and the only folks who look like fools are the Blue Dogs and the Rethugs.
Not sure that Reid could succeed at two dimensional checkers – forget the eleven dimensional chess crap.
I am not clear as to what the issue being discussed is all about. As I understand it Medicare pays MDs a certain amount for every prodedure and service they provide, and the cost assigned to these may increase over time.
So if Medicare wants to reimburse less for the services and procrdures it simply will. And whatever associated costs accrue to the hospital and others for these serviices they will be reimbursed less as well. The rationale by Medicare for these lower reimbursements is to lower these very costs which are increasing at an unsustainable rate. In addition and for the same reason many of these procedures should be utilized less.
Whatever the cumulative cost associated with all these reimbursements it should definitely be reflected in the expemses assumed by Medicare, under what rationale would these costs not be?
Tak, with a grin~
Jane has a fresh cross-post up: “Nevada Phone Bank Tool On Harry Reid and Public Option Live Now”
That photo of a wheelchair is a twin to mine. I use one for CFS/ME, so I can exit my apartment, which is infrequent, due to CFS/ME. (See NYTimes, op ed, Oct. 21, 2009 by Hillary Johnson on the politics around this illness)
Medicare and paying of doctors: many doctors complain about the paperwork for Medicare. Do you know that we have to get medigap private coverage for the 20% not covered by Medicare (deductibles are something in addition to be paid). It is costing me about $2300. a year now for the Medigap.
“Misled” my ass. This is his flimsy excuse for his political cowardice and substantial lack of leadership skills. He is too much of a coward to take any risk so Reid plays both sides of the issue with his insipid waffling.
Step aside Harry, and let someone with some integrity and fortitude take over.
The only way Reid will loose his Party leadership position is if he looses his seat in 2010. The Senate is a club that cares more about their relationship with each other than the people they represent. They answer to their paymasters in corporate America and provide cover for one another. Good grief, you have to be a five star felon to even warrant an ethics investigation from these guys. The only time you get anything even resembling representation from most of them is if their seat is on the line or there is the potential for a lot of camera time in it from the national media. If they were listening to the people, the PO modeled after medicare would be the essential benchmark of the entire reform effort because 3/4 of the country supports this idea. The Democrats would also be talking about passing this reform as a tribute to the late Senator Kennedy’s lifes work on healthcare. But, neither is happening. Just wait, even those that have been most vocal like Rockefeller, Schumer and Sherrod Brown will cave and spin whatever is passed in the end. The only hope we have is to convince them they will loose their seats if they fail. We have to convince them that our memory is long and our rage will not fade.
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?
I would like to respond in part to this:
Medicare doctors – exactly who are they? The same doctors who treat every other patient.
“Medicare doctors” are not getting fat off Medicare payments. For example. Our family doc got reimbursed by Blue Cross for a half-hour visit by my husband at about $65. Once he turned 65 and went on Medicare, that reimbursement dropped to $37. This is the exact same patient, who, as he aged required more care for a series of strokes and finally a malignant brain tumor. The doctor’s costs did not go down because my husband turned 65. If anything, over time, his costs like everything else in the economy went up.
Why is it that a doctor caring for an elderly patient gets paid almost half as much to care for them as they get reimbursed by the rip-off insurance cartel? And all of you think this is okay? Sorry I don’t.
Part of making our health care costs go down doesn’t have to do with reimbursing doctors less for the same care they provide to the elderly.
One of the things that is driving costs in any doctors office is filling out the interminable number of insurance forms. Each company has their own form, and there are so many and they are constantly changing that there is no computer program that can do this job. So here we are, still doing this job by hand. Our family doc had one other doc in his practice and they had THREE billing clerks to deal with this crap. C. Everett Koop proposed requiring all the insurance companies to accept the Medicare superbill as a claim form. At the time he made that recommendation, almost 30 years ago, he said it would have saved over $144 billion per year. Nothing like a quick, easy fix for something that really doesn’t have anything to do with health care.
One other thing, the Medicare reimbursement rates are so low in some areas that if you aren’t already a patient, most docs will not accept you as a new patient. Even having Medicare doesn’t guarantee you access to healthcare if you can’t find a doc to see you.
Also, our family doc told us horror stories of his own about spending anywhere from 2-4 hours out of every single day arguing on the phone with bean counters at the various insurance companies about payments for his patients. That is time that he cannot see patients, but the staff is still getting paid and the rent and the utilities and the malpractice insurance…
I know one doctor who quit his practice and re-started it. He said he would accept no insurance payments. Cash only. $25 per visit. Worked fine since he didn’t have to have billing clerks and spend hours arguing with the bean counters etc.
Just sayin’.
The Medigap thing is another issue. A lot of doctors “accept assignment”, that is, they take whatever Medicare gives them as payment. And under the terms of that agreement, if they get any additional money from the patient they are in violation and can be prosecuted.
Only if a doctor does not accept assignment does the co-pay come into effect.
So this is something that depends on the doctor. If you have a doctor that accepts assignment, you don’t need the Medigap coverage. You still have to pay the $900 hospital deductible per year if you use it even if the hospital accepts assignment (most non-profit hospitals do).
Here again, the docs and hospitals are being paid far less then they get even under capitation from the insurance cartel. They are not getting rich off Medicare.
The reason those docs can and do earn less is that they have less expenses. No huge malpractice insurance policies to pay. No multiple billing clerks. No hassling with bean counters instead of seeing patients.
I get my healthcare through the VA. My surgeon left a lucrative private practice in New York to come to work in the Montana VA. The reason? He was tired of the hassle. He likes the idea of a fixed salary, a reasonable schedule and no hassles.
My eye doctor has a reputation as one of the best eye specialists west of the Mississippi. He left his lucrative (supposedly) practice in Denver and moved here. For the same reason.
I think that lots of doctors in this country would be perfectly satisfied with less money if they had less hassle and less ridiculous bills to pay.
And in most other countries, doctors don’t come out of medical school owing a quarter million dollars for their education.
It’s a lot of money, true. But the radiologist is the one who is responsible for your diagnosis. It is said that when they read a set of films/scans their first call is to their lawyer to see what they can or cannot say to avoid a lawsuit. Keeping a lawyer on retainer like that is expensive. And I am always suspicious of figures like this – sure they may get $400K in income. But how much do they get to keep? For a radiologist, his malpractice insurance alone can be as much as $50,000 per year. And servicing the student loan debt if they haven’t got it paid off yet.
And here we are objecting to a doctor who is responsible for life and death decisions making $400K. I’ve seen less outrage about the multi-gazillion dollar football/basketball/baseball and other sports players. And boxers? $12 million for an hour’s work? Movie and TV stars – $20 million for a few months?
Priorities people!
Yes and no. The thing to remember is that doctors generally do not work for salary as such. They are partners, owners of the business. Fee for service probably will come down–I certainly hope so, anyway–but one can at least argue that this is at worst a net wash for doctors. The reason is overhead.
The medical practices that I know anything about appear to derive at least 30-50% of their cost of doing business from the overhead of processing insurance claims. If we ever do healthcare reform right–with a new single-payer system or expanded Medicare–that cost evaporates almost entirely. Doctors ought to be able to have as much real income while charging much less. I wonder whether that isn’t a big part of the lower cost of doctor’s care in Europe.
What also fries me is that the Idiot Democrats only focus on the “spend” side of the budget.
Why not say, “look, your derelict Republican President, George W. Bush, spent this country into a hole AND cut the means for it to raise revenue. We’re going to bring some of that revenue back, and we’re going to get it from the same rich bastards to whom George was so generous.”
Is there REALLY a lot of push-back against a tax hike [or surtax] on the rich guys?
Why, since no one will look at the “cost” of the immoral wars, don’t folks get off this “cut spending now” kick and take a glance at the “raise revenue” side of the budget?
I agree that the educational costs are a significant factor in the cost of US medicine. In Europe, you can, for the most part, go to med school for free if you are good enough to get in.
But the claim that malpractice costs are driving health costs is nonsense. Malpractice insurance is expensive for two reasons: because medical malpractice causes horrific, extremely expensive injuries and because there is a lot of malpractice. Combine high cost per incident and high frequency of incidents and you have expensive insurance.
Malpractice is more common than it should be because MDs do not, as a rule, police their own as they are supposed to. They will exclude a grossly negligent doctor from their own practice in order to avoid direct liability, but they will not invoke oversight boards and regulators and will not get bad doctors struck off. As a result, the bad doctors stay in the risk pool, raising everyone’s costs until they finally kill someone in some egregiously obvious way.
This is why so-called “tort reform” has made no difference in the states that have adopted it. The claim is that there are frivolous lawsuits being filed by scheming patients and lawyers. But, if there are, the statistics aren’t showing it. For example, Texas premiums are, I believe, as high as ever. Tort reform might even be making things worse. One might reasonably expect that, by making borderline cases impossible to litigate, “tort reform” keeps negligent doctors in business longer and raises the cost of the settlements that finally end their careers.
I suspect that, if anything, there are more unreported malpractices than there are successful frivolous suits. The caring professional has to behave pretty outrageously before incompetence and/or negligence are obvious to the layman. Patients also tend to be forgiving of a doctor who makes a mistake–after all, he is better educated and takes professional risks we lay folk would be terrified to even think about. I personally know of cases where patients did not sue when a more knowledgeable physician or nurse would have.
Nobody has to pay a pro athlete anything. Doctors are another matter.