JustinC: October 2009 Archives

Just about every year a formula glitch threatens to cut payments to doctors who treat seniors and the disabled. And just about every year Congress cancels the cut. This year lawmakers are complaining about the bill because it's not paid for. But, despite what both Republicans and Democrats are claiming, that's nothing new.

Permanent Fix Falls Short

Rather than do another one or two year patch for the Medicare doctor pay cut problem, Senate Democrats had wanted to fix the problem permanently. But their bill couldn't even make it to the Senate floor -- it fell short on its first procedural test last Wednesday by 13 votes. The reason cited by virtually every opponent was that the bill's $250 billion, ten-year cost wasn't paid for with other spending cuts or increased taxes.

New Hampshire Republican Senator Judd Gregg is among the opponents of the bill. "We've only done yearly fixes in this area, the doctor fix, because it's a pretty difficult number to always pay for, but we have always paid for it," he said on CNN last Sunday.

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"I've concluded, with the support of the White House, Senators Dodd and Baucus, that the best way to move forward is to include a public option with the opt-out provision for states," Mr. Reid said at a news conference.

"Under this concept, states will be able to determine whether the public option works well for them and will have the ability to opt out if they so choose. I believe that a public option can achieve the goal of bringing meaningful reform to our broken system."

Pressed on whether he could advance the bill with the public option included, Mr. Reid said he believed Senate Democrats would remain united to do so. "I believe we clearly will have the support of my caucus to move to this bill and start legislating," he said.

But other Democrats were not so sure. Even as liberal groups quickly began heaping praise on Mr. Reid for his decision to support a government-run plan, some Democrats on Capitol Hill privately expressed worries that he did not have firm commitments from all 60 Senate Democrats.

Drug makers struck a deal with the White House and Finance Committee leaders in June on concessions that would save the government an estimated $80 billion in health-care costs over 10 years, with the hope of staving off new government price controls on prescription drugs. In recent weeks, that deal has protected pharmaceutical companies from having to make greater concessions sought by some senators...

Hospital companies struck a deal to forgo $155 billion over a decade, partly through lower government reimbursements for treating people without insurance. But hospitals say the Finance bill doesn't go far enough to thin the ranks of the uninsured. Some important Democrats, including Finance Committee Chairman Max Baucus, are signaling their desire to widen coverage in the bill.

The American Academy of Family Physicians predicts that the shortage of family doctors will reach 40,000 in the next 10 years, as medical schools send about half the needed number of graduates into primary care medicine. The overall shortage of doctors is expected to grow to nearly 160,000 by 2025, according to the Association of American Medical Colleges. 

"I don't see anything in the legislation that will greatly increase the primary care pipeline," said Dr. Russell Robertson, chairman of the Council on Graduate Medical Education, which advises Congress. In addition to making sure patients have access to care, increasing the number and proportion of primary care doctors is crucial to lowering health costs, he said. Primary care doctors make up about a third of all physicians, though in most industrialized nations they make up half.