Wednesday, February 8th, 2012

A Political Game of ‘Win the Docs’

By Mike Lillis
Monday, October 19, 2009 at 6:00 am

Sen. Debbie Stabenow (D-Mich.) (WDCpix)

With the nation’s insurers having dropped their support for the health reforms moving through Congress, Senate Democrats are taking daring steps to rally the backing of another powerful medical lobby: doctors.

The Senate this week is set to take up a $245 billion proposal, introduced hastily just a week ago by Sen. Debbie Stabenow (D-Mich.), to prevent scheduled pay cuts for doctors who treat Medicare patients – a long-term fix to the physician pay quandary that dwarfs the one-year patch contained in the Senate Finance Committee’s reform bill. The proposal has long been advocated by the American Medical Association, the nation’s largest physicians lobby, which has so far declined to endorse the broader Senate health bill. Although the group is also fighting Democrats over malpractice reform, the Stabenow bill would go a long way toward getting the doctors to support the top domestic priority of the Obama administration this year.

Illustration by: Matt Mahurin

Despite the allure of getting the AMA on board, however, the Democrats’ move is not without its pitfalls. For months, party leaders in Congress and the White House have vowed to keep the cost of health reform below $900 billion over 10 years, while also promising that the legislation won’t add “one dime” to the nation’s debt. The Stabenow bill, however, is not paid for, leaving Democrats in the uncomfortable position of claiming that a complete overhaul of the way doctors are paid under Medicare is somehow not a part of health care reform. That pickle has created an urgency: the faster Democrats can pass the physician pay measure, the better chance they have of distancing it from the broader reform effort.

Robert Blendon, professor of health policy at Harvard University, said the Democrats’ success in forging that divide likely “depends on the visibility of the issue.”

“So much attention is on putting the [Finance and HELP committee health reform] bills together that this could go under the radar,” said Blendon, an expert on the Clinton administration’s failed attempt to pass comprehensive health care reform in 1993. “[But] if it gets a lot of media attention, it’s going to be clear to anyone who reads the story that the additional $250 billion is in fact related to health reform.”

At issue is the so-called sustainable growth rate (SGR), a complex, 12-year-old formula designed to prevent Medicare doctor payments from bankrupting the program by indexing reimbursements to the growth of the economy. Because health care inflation has risen much faster than GDP in recent years, the SGR has called for physician cuts every year since 2002. Congress, however, has usually stepped in with temporary patches to prevent those cuts, which the AMA says would force doctors to drop Medicare patients.

Years of kicking the can down the road, though, has caused the cuts to compound. Indeed, next year, the SGR calls for a 21.5 percent reduction in physicians’ Medicare payments, with an additional 5.5 percent cut in each of the four years thereafter. The Finance bill provides roughly $11 billion to address 2010, but lends no long-term relief — a dance that sidesteps one of the most sensitive and expensive problems facing the entire health delivery system.

Enter the Stabenow bill — all 18 lines long — which scraps the SGR altogether, erases the accumulated cuts and provides a 0 percent pay update “for 2010 and each subsequent year.” That means in perpetuity. The idea is to have the broader health reform bill complement Stabenow’s proposal by creating a new physician payment formula that better reflects the true costs of treating Medicare patients.

Calls to AMA were not returned, but the group has launched an enormous ad campaign in support of the strategy.

That this fix costs roughly a quarter of a trillion dollars hasn’t dissuaded Democratic leaders. Instead they’re hoping that, by considering the doc-fix bill on a separate track, they can divorce it from the broader issue of health reform. Last Friday, Sen. Tom Harkin (D-Iowa), chairman of the Health, Education, Labor and Pensions Committee, told reporters just that.

“We’re doing the doc fix first so as not to get it confused with health care reform,” Harkin said. “We’re going to try to pass it as an emergency-type of spending so that it doesn’t … connect to the health care reform bill and figure in as a cost of it.”

Republicans, though, aren’t buying it. Although they acknowledge that the SGR is seriously flawed, they also want to cover the costs of fixing it. Sen. Charles Grassley (Iowa), the senior Republican on the finance panel, told The New York Times last week that Stabenow’s bill “undermines the president’s commitment to making sure health care reform won’t add a dime to the deficit when one of the most expensive problems in the Medicare program is removed from overall reform legislation.”

Republicans are not alone. Moderate Democrats are also criticizing the proposal for lacking offsets. Sens. Kent Conrad (N.D.) and Evan Bayh (Ind.), for example, have already indicated that they plan to vote against the measure. And in the House, Speaker Nancy Pelosi (D-Calif.) last week reiterated her previous vow to support an SGR fix this year only if the bill follows is accompanied by pay-as-you-go rules.

The criticisms haven’t been lost on Senate Democratic leaders. Last Thursday, Senate Majority Leader Harry Reid (D-Nev.) scheduled a Monday cloture vote on the Stabenow bill, only to scrap that plan a day later for lack of support. GOP leaders, meanwhile, want to amend the bill by attaching offsets as well as provisions addressing medical malpractice reform.

The stalemate over the SGR fix comes as no surprise to health policy experts. “People have known for many, many years that this was a screwed up policy – that it doesn’t work at all,” said Leighton Ku, public health policy professor at George Washington University. The sticking point has not been whether to fix it, Ku added, but how to pay for it.

That the Democrats have chosen not to offset the Stabenow proposal means the bill likely won’t pass the Senate, according to Julius Hobson, former AMA lobbyist and now a senior policy analyst at the Washington law firm Bryan Cave. Hobson said the bill should get plenty of floor time, but probably won’t get the 60 votes likely needed to waive the Budget Act — a vote required to allow the unfunded proposal to proceed.

Asked about attaching offsets during the floor debate, Hobson pointed out that the broader health reform bill has already plucked the low-hanging fruit. “When you look at the Medicare bill,” Hobson said, “what offsets are left?”

Comments

14 Comments

Mike
Comment posted October 19, 2009 @ 11:08 am

Dosen't the Senate plan include those so-called savings in order to reach the 81 billion deficit reduction forecast by the CBO? It's a big shell game.

uponfurtherreview
Comment posted October 19, 2009 @ 1:39 pm

Anyone who's naive enough to believe that ObamaCare is an honest effort to cover Americans without health insurance probably also gets excited at the sight of an e-mail promising to share part of a Nigerian prince's $20 million fortune.

ObamaCare is simply this administration's latest naked power grab, following its takeover of the banking and automaking sectors (and soon to be followed by its attempted takeover of the energy companies in the guise of saving the planet).

That's why the so-called “public option” is so vital to politicians like Obama, Pelosi and Reid … because their main concern is giving government greater power over the lives of everyday Americans.

Face it — if this were really about insuring the uninsured, Democrats would simply design a federal program for the approximately 10 million American citizens who need and want it … instead of trying to force it on the rest of us who don't.

uberVU - social comments
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The Story of Health Care Reform in 2009: Sense of the Senate Regarding Medical Malpractice—Do Nothing | Thomas A. Sharon, R.N., M.P.H.
Pingback posted October 19, 2009 @ 5:43 pm

[...] A Political Game of ‘Win the Docs’ [...]

DOUGLASFIELD
Comment posted October 19, 2009 @ 6:10 pm

PRESIDENT OBAMA: THE AMERICAN PEOPLE AND OUR POORER ACTIVE DUTY U.S.MILITARY FAMILIES BACK HOME DESERVE TO BE ENLIGHTENED AND INFORMED ABOUT THE SPECIFIC FAMILY NAMES OF ALL THE NATIONAL & INTERNATIONAL SECERT BEHIND THE SCENE BILLIONAIRE HEALTH*CARE INSURANCE COMPANY(MAJORITY SHAREHOLDER INVESTORS) WHO ARE ATTEMPTING TO CONTROL THEIR FUTURE PROFITS AT THE EXPENSE OF CONTINUING THE SILENT DEATHS OF OUR 45,000 POORER AMERICANS YEARLY…

IT IS NOW VERY OBVIOUS TO MOST AMERICANS THAT CERTAIN U.S.CONGRESSIONAL LEADERS OF THE FREE WORLD HAVE ALREADY MADE UP THEIR MINDS TO SELL OUT OUR 45 MILLION MIDDLE CLASS AND WORKING POOR AMERICANS… 4 RE~ELECTION MONIES…

~ AND SO, MY FELLOW POOR AMERICAN SOLDIERS:ASK NOT WHAT YOUR COUNTRIES HEALTH*CARE INSURANCE COMPANIES CAN DO FOR YOU- ASK WHAT YOU CAN DO FOR YOUR COUNTRIES HEALTH*CARE INSURANCE COMPANIES ~

** OUR BRAVE AMERICAN ACTIVE DUTY U.S. MILITARY AROUND THE WORLD WHO ARE RISKING AND LOSING THEIR LIVES FOR ALL OF USA ALSO HAVE POORER PARENTS AND SIBLINGS BACK HOME WHO ARE DYING WITHOUT HEALTH*CARE**

*PRESIDENT OBAMA ~ PLEASE MAKE A SPECIAL POINT OF ASSURING OUR AMERICAN MILITARY WORLD-WIDE THAT YOU WILL FIGHT FOR THEIR LOVED ONES HEALTH*CARE BACK HOME ALSO!!!

~ PRESIDENT OBAMA AND U.S. SENATOR OLYMPIA SNOWE OF MAINE BOTH KNOW THAT ANY FUTURE HEALTH*CARE PLAN FOR OUR NEW AMERICA NEEDS TO ALSO ENCOMPASS ALL FAMILY MEMBERS(PARENTS & SIBLINGS) OF ACTIVE DUTY MILITARY MEMBERS…ANYTHING LESS WOULD BE UN*AMERICAN ~

**JUST MAYBE AMERICA NEEDS A FEW MORE REVOLVING DOORS IN OUR U.S. CONGRESS **

OUR COUNTRY COULD REALLY USE MANY MORE SINCERE AMERICANS LIKE THIS SPECIAL U.S.SENATOR OLYMPIA SNOWE FROM MAINE WHO CONSIDERS THIS COUNTRIES 45 MILLION POOR AMERICAN MEN WOMEN AND CHILDREN WITHOUT PROPER HEALTH CARE LIKE HER OWN FAMILY AHEAD OF HER ELECTED POLITICAL FAMILY **

45 MILLION POORER AMERICANS HAVE OBVIOUSLY BEEN TOUCHED BY AN ANGEL WITH THE PEOPLES U.S. SENATOR SNOWE OF MAINE.

LAWYERS FOR POOR AMERICANS THANKS THIS SPECIAL WOMEN FROM THE CARING STATE OF MAINE FOR SHOWING THE REST OF AMERICA THAT GODS VILLAGE OF ANGELICA BEINGS CAN EVEN BE HERE WITH US EVERY~DAY IN THE FLESH.
—————————————————————————————————————————————-

~ OUR U.S.CONGRESS AT LEAST DOES NOT DISCRIMINATE…THEY AFFORD POORER AMERICANS THE SAME EMERGENCY ONLY HEALTH*CARE THAT ILLEGAL ALIENS RECEIVE ~

AMERICA~LOVE IT OR LEAVE IT~ 45,000 DEAD POOR AMERICANS LEAVE U.S. EVERY*YEAR DUE TO 3rd WORLD HEALTH CONDITIONS ??

** POLITICS IN AMERICA IS VERY SIMPLE TO UNDERSTAND WHEN OUR MIDDLE~CLASS & WORKING POOR CITIZENS ARE ALL BEING FORCED 2 ALLOW BIG $$$ TO CONTROL THE PEOPLES HALLS OF THE U.S.CONGRESS..

~ SADLY,OUR VERY OWN AMERICAN HEALTH*CARE SATANIC VERSES HAS KEPT 45 MILLION POOR AMERICANS IN 3rd WORLD HEALTH CONDITIONS~

DON’T WORRY BE HAPPY ~ THE WORLDS SELECT BILLIONAIRES AND THEIR FRONT CORPORATIONS WILL ALL GET ON BOARD THE NEW HEALTH~TRAIN OF $$$…**ADDING 45 MILLION MORE AMERICAN CITIZENS TO THE CURRENT GIVEN PROFIT MARGINS + WITH A FUTURE AMNESTY PROGRAM (6 months) AFTER NEXT U.S.PRESIDENTIAL ELECTION = $$$$$$$$$………

WEALTH~CARE FOR ALL THE HEAVILY INVESTED INTERNATIONAL AND AMERICAN BILLIONAIRES IN THE CURRENT U.S.HEALTH FOR THE WEALTHY ONLY SYSTEM WILL NOT END ANYTIME SOON… IT WILL ONLY BE RE~ARRANGED TO MAKE SURE ALL THESE MEGA CAPITALISTS PROSPER IN JUST ANOTHER FASHION .

THE FINE ART OF DENYING 45 MILLION AMERICANS HEALTH~CARE IN OUR JUDEO~CHRISTIAN NATION IS NOT RACIST AT ALL… IT’S JUST OUR BEHIND THE SCENE WEALTHY ELITE CITIZENS USING THEIR TREMENDOUS WEALTH TO DIRECTLY INFLUENCE OUR U.S. CONGRESSIONAL REPRESENTATIVES IN KEEPING ALL THE little poor folk down *

AMERICAN RELIGIOUS LEADERS ALL ACROSS THE USA HAVE ALWAYS BEEN ABLE TO COUNT ON THEIR RELIGIOUS FLOCK TO CONTRIBUTE(TITHE)THEIR HARD EARNED MONIES TO THEIR MINISTRIES EVERY WEEK. THE MAJORITY OF AMERICANS ATTENDING RELIGIOUS SERVICES IN THE U.S. ARE MIDDLE~CLASS AND WORKING POOR CITIZENS WHO NOW DESPERATELY NEED THE HELP AND SUPPORT FROM THESE SAME U.S.RELIGIOUS LEADERS IN LOBBYING THE U.S.CONGRESS TO PROVIDE PROPER HEALTH~CARE FOR ALL POORER AMERICANS.

***THERE ARE CURRENTLY AN ESTIMASTED 45 MILLION MEN WOMAN AND CHILDREN WITHOUT HEALTH~CARE IN THE WEALTHIEST COUNTRY IN THE WORLD????

SILENT AMERICAN RELIGIOUS LEADERS WHO ALL HAVE HEALTH~CARE FOR THEMSELVES AND THEIR FAMILIES IS MUCH MORE FRIGHTENING THEN THE POSSIBLE DENIAL OF A FUTURE HEALTH~CARE PLAN FOR ALL…

**45,OOO AMERICANS DIE EACH YEAR IN THE WEALTHIEST COUNTRY IN THE WORLD DIRECTLY RELATED TO THEIR LACK OF PROPER HEALTH*CARE.

LAWYERS FOR POOR AMERICANS IS A WWW VOLUNTEER LOBBY FOUND WITH ANY SEARCH ENGINE. (424-247-2013)

Senate Vote On 'Doc Fix' Bill to revise formula on how Docs are Reimbursed For Medicaid. Bill Is Unfunded | The Centrist
Pingback posted October 21, 2009 @ 4:37 pm

[...] Whip Richard Durbin (D-Ill.), the upper chamber will vote this afternoon to bring to the floor a $245 billion proposal scrapping the formula by which doctors are paid to treat Medicare [...]

DOUGLASFIELD
Comment posted October 21, 2009 @ 6:26 pm

** SATANS WARRIORS IN OUR U.S.CONGRESS ARE PLAYING THE DEVILS ADVOCATE WITH 45 million POORER AMERICANS HEALTH & WELL BEING**

~ SADLY CERTAIN AMERICAN MILITARY SUPPORTERS IN OUR U.S. CONGRESS HAVE NOW BEEN BOUGHT OUT TO ABANDON THE HEALTH & WELFARE OF POORER MILITARY PARENTS AND SIBLINGS OF OUR ACTIVE DUTY WORLD~WIDE ENLISTED SOLDIERS….

~ A VOTE FOR AMERICAN HEALTH*CARE 4 OUR AMERICAN MIDDLE CLASS AND WORKING POOR CITIZENS,IS ALSO A CLEAR VOTE FOR OUR POORER AMERICAN MILITARY FAMILIES WHO OFFER UP THEIR CHILDREN TO SERVE IN OUR U.S. MILITARY FORCES WORLD~WIDE ~

PRESIDENT OBAMA ~ THE AMERICAN PEOPLE AND OUR ACTIVE DUTY U.S. MILITARY FAMILIES FROM POOR FAMILIES BACK HOME DESERVE TO BE ENLIGHTENED AND INFORMED ABOUT THE SPECIFIC FAMILY NAMES OF ALL THESE NATIONAL & INTERNATIONAL BEHIND THE SCENE BILLIONAIRE HEALTH*CARE INSURANCE COMPANIES(MAJORITY SHAREHOLDER INVESTORS) WHO ARE ATTEMPTING TO CONTROL THEIR FUTURE PROFITS OVER THE HORROR OF KNOWING THAT 45,000 POORER AMERICANS DYING EVERY YEAR DUE TO THE LACK OF PROPER HEALTH*CARE…