Medicare Showdown (New Eng Jour Med)

[pinto]

Published at www.nejm.org July 16, 2008

http://content.nejm.org/cgi/content/full/NEJMp0805760?query=TOC

Medicare Showdown
John K. Iglehart

In a stunning rebuke of President George W. Bush, the House and Senate voted July 15 in a strong bipartisan fashion to override a veto he had issued only hours earlier, erasing a scheduled reduction of 10.6% in the fees that Medicare pays physicians. At the risk of alienating the nation's doctors, Bush had vetoed the measure because he strongly objected to the way in which it covered the costs of eliminating the fee reduction: by cutting payments to private Medicare Advantage plans that contract with the Centers for Medicare and Medicaid Services to provide coverage to Medicare beneficiaries. The House voted 355 to 59 and the Senate immediately followed with a 70-to-26 vote to overturn the veto and block the physician-fee cut that would have taken effect immediately. A total of 153 House Republicans and 21 GOP senators joined all voting Democrats to overturn the veto, which required a two-thirds majority in both chambers. By Congress's action, the bill became law without Bush's signature.

<snip>

Bush's veto was a high-stakes gamble because both houses of Congress had approved the measure by veto-proof margins. On June 24, the House approved the bill by a surprisingly wide margin of 359 to 55, with 129 Republicans and every Democrat voting for it. Two weeks later, the Senate approved the same bill on a voice vote after Democrats secured 69 votes, 9 more than the 60 needed to invoke cloture, whereby debate is ended and an immediate vote is taken on the matter at hand. Days before, a similar motion had garnered only 58 votes. Senator John McCain (R-AZ) was the only senator to miss both votes. Some observers attributed the change of heart among some senators to a surprise appearance by Democrat Edward M. Kennedy of Massachusetts, who returned to a standing ovation in the Senate after a long absence for treatment of a brain tumor. "Win, lose, or draw, I wanted to be here," remarked Kennedy.

Bush's veto represented yet another move in an ongoing ideological struggle over the design of Medicare that has pitted the administration against Democrats since 2001. This philosophical conflict resurfaced because Democrats pressed their case that Medicare should reduce its payments to Medicare Advantage plans, which cost the program considerably more every year than it would spend for a similar group of patients to be treated under the traditional model, according to separate analyses by the Congressional Budget Office (CBO),2 the Government Accountability Office,3 and the Medicare Payment Advisory Commission (MedPAC).4

<snip>

Although the temporary fix for physician fees will alleviate the immediate concerns of many doctors, the remuneration problem remains unresolved for the longer term. No one is satisfied with the current formula by which Medicare calculates physician fees, but Congress has hesitated to act because of the hefty price tag that would be attached to any change deemed acceptable to both policymakers and physicians. Members of Congress have urged physician groups to develop their own proposals, but because any viable plan is certain to result in both winners and losers, organized medicine, too, has been reluctant to act. So for the time being, annual Band-Aids will continue to be the standard of care for Medicare's physician-payment woes.

The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved.


http://content.nejm.org/cgi/content/full/NEJMp0805760?query=TOC

[spag68]

1. Doctors deserve a good living wage

just like any other worker. Maybe they should get a really good living wage, as they devote many years of study and much money getting their education. That said if truly universal health care were the law of the land, and the profit motive of the paper pushing insurance company's were removed, we could afford to pay doctors much more.

[Enthusiast]

2. Why inject good sense into this?

How would the insurance industry continue to bilk the American consumer out of billions of dollars under your suggestion?