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"Doc fix" remains broken

By Shailagh Murray
Thirteen Democrats joined all 40 Republicans to block a permanent repeal of Medicare's payment formula for doctors, with lawmakers concluding the legislation's $247 billion 10-year price tag was too steep in an era of record deficits.

The so-called "doc fix" is a near-annual ritual in Congress aimed at preventing physicians from turning away Medicare patients because they are paid too little for the visits. A 1997 deficit-reduction law established federal spending targets that were linked to economic growth, but when medical costs continued to rise at a faster pace, the net effect was to require a huge yearly cut to doctor reimbursement rates. As of Jan. 1, 2010, doctors are scheduled for another 21 percent decrease.

While everyone in Congress agrees the payment formula is a failed model, producing the enormous sum needed to eliminate it has proven impossible. Instead, lawmakers have resorted to temporary fixes, like the one-year repeal that had been included in the Senate Finance Committee's version of health-care reform.

Senate Majority Leader Harry Reid (D-Nev.) brought permanent repeal to the floor at the behest of the American Medical Association, whose support Democrats are courting for their health-care reform efforts. Reid said he had been reassured that GOP support would be considerable. "I was told by various people we have 27 Republican votes," Reid told reporters Wednesday morning.

The AMA issued a terse statement after the vote. "Congress created the Medicare physician payment system, and Congress needs to fix this problem once and for all to fulfill its obligation to seniors, baby boomers and military families," the group said. "Permanent repeal of the Medicare physician payment formula is essential to comprehensive health system reform."

Although Republicans participated in talks to find ways to offset the $247 billion, no single revenue source gained the needed consensus, and GOP senators elected to turn Wednesday's vote into a referendum on deficit spending.

"Americans are increasingly alarmed by the expansion of our national debt and this spending binge that we're putting on the national credit card," said Senate Minority Leader Mitch McConnell (R-Ky.) "They're asking us to do what they've been doing: they want us to take out the scissors and cut the charge card."

By Web Politics Editor  |  October 21, 2009; 3:58 PM ET
Categories:  Health Reform  
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Now that their PAYOFF is in jeopardy, will the AMA join millions and millions and millions of doctors and other healthcare workers in opposing the horrific loony-left d-crat socialist healthcare debacle?

Posted by: LoonyLeft | October 21, 2009 4:22 PM | Report abuse

Excuse me, but aren't doctors our "priest class" and somehow have to be pampered and pandered to because they hold power of life and death? Doesn't everybody know this? Don't they attend doctor school with professors who earn such top dollar that their students are enormous? Don't they have to live at the tippy top of the economic ladder? When they whine about treating people on Medicare aren't they living pretty high on the hog? Do you even know where that term comes from? We have doctors in our family. They are the ones who can have everything, buy everything, go everywhere, and work part time. Would they work for less if Uncle Sam just paid off all their student loans? I haven't seen one of them for years. I know someone who does acupuncture and Chinese medicine very capably and does me more good than any of this high tech pill pushing mumbo jumbo. Even with doctors in our family, you see?

Posted by: GaiasChild | October 21, 2009 4:27 PM | Report abuse

The fact the doc fix bill didn't pass proves government management of prices and programs don't work. The congress is responsible for the patch work of laws and regulations that are causing helath care costs to rise. Finally some of the senate memebers had the good sense to say no more! The congress' only solution is to throw more money at failed programs. All we are going to get from so called reform is more bad legislation on top of already bad legislation. Now, what is going to happen to seniors who require the services of a doctor? We have tied ourselves into a knot! Any way we go from this point is going to be bad for us and the economy.

Posted by: saelij | October 21, 2009 4:27 PM | Report abuse

Hey Mitch McConnell, it was you and your GOP buddies that went on a spending binge. You just failed to pass the taxes to pay for it all. The Iraq war, remember that one where you sent 4000 Americans to their death for no good reason. Or maybe your remember all the deregulation that led to the meltdown of the economy. You get credit for that one as well. And what about all the other unfunded mandates? The Republican party went on a spending spree and did not provide the taxes to pay for it. The Republicans need to shut up about what fixing these problems will cost. They screwed the country up. Fixing it will not be without cost.

Posted by: buddecj | October 21, 2009 4:37 PM | Report abuse

that noise you're about to hear is the shoe dropping from the AMA opposing the public option.

Posted by: visionbrkr | October 21, 2009 4:48 PM | Report abuse

Congress kicks the can down the road again ..
at the expense of Medicare recipients ...
What will docs do ... what they have been doing ...
shorter appointment times ... IF the reimbursement rate is falling behind the cost to run a practice the time spent will be less so that docs can do volume to make it work ...or docs opt out of medicare and the folks promised care by Congress way back when can not find a doc that will see them or the ones that do ... wont spend the time needed to deliver a standard of care worthy of the US.

Posted by: AmericanSpirit | October 21, 2009 4:50 PM | Report abuse

I talked w/Bernie Madoff today. Told me he approves of the way in which congress diddles the taxpayers.

Posted by: Tupac_Goldstein | October 21, 2009 4:50 PM | Report abuse

boo hoo. now i can't buy that new range rover...

Posted by: physicianexec | October 21, 2009 5:40 PM | Report abuse

They still need to rejigger the system.

Some specialists won't see Medicare, but it's Family Practitioners, Internists who are paid the least and they are the doctors people ought to be seeing.

The medical profession has strangled a branch of itself so we can have all the Radiologists and Cardiologists and other "procedure" preforming staff -- while shortchanging those guys who think.

Lyndon Johnson handed the responsibility of assigning payment priorities over to the Docs years ago to get them onboard. At that time there were plenty of Family Doctors and fewer specialists. Ha - that changed.

Like every pre-med you ever knew in college they are a competitive lot and only looked out for themselves. Shortchanging the part of the profession that deals with chronic illnesses that cost big bucks.

When you can find somebody to amputate your foot but not to help you adjust your insulin you'll have the AMA to thank!


Posted by: RedBird27 | October 21, 2009 5:45 PM | Report abuse

What many fail to understand is doctors are not to be blamed for this. They have chosen this field to earn a good living and deservedly so. There is a minimum 8 years of higher education plus 1-8 years of residencies and fellowships depending on their specialty. Medicare pays nurses more than doctors for many procedures. Why should the government be able to tell doctors what they should accept. Obama -care will drive the class of medical care into the medi Ocre standards. Drug companies and medical instrumentation companies will not invest in new advancements if there is not money to be made. Our health care advances and break-throughs depend on that. Do you think it should be given away? You get what you pay for. Do we want to make a socialist country out of America? The Obama plan will mimic the same quality of care as Canada provides. Do you know how long they have to wait for appointments with a specialist? A year! If you need a hip replacement the wait is another year after your appointment with the specialist. I hear doctors discouraging young college students to go into medicine because they don't think the time put in is worth being in the field. The people hear who are criticizing doctors should ask themselves if they are willing and able to higher educate themselves in medical school for a minimum of 8 years of sleep deprivation and pass the boards. Secondly, then have the government and insurance companies pay you next to nothing and demand that you take medicare.

Posted by: golrh | October 21, 2009 5:57 PM | Report abuse

End the Wars ... have a public option .. end the expansion of empire and focus at home and all will be well for the people ... but all will not be well for the collectivist that want to rule a monolithic global society ...
the US Military is fighting the Wars for the Globalists collectivist that want One World everything ... We are a nation in crisis ... and most are unaware. But there is hope ...if the purse strings are removed making it work will be much more difficult ... as sound money will force any government spending to come from tax payers ... and not from the current fiat system of prommisary notes.
End the Fed.

Posted by: AmericanSpirit | October 21, 2009 6:11 PM | Report abuse

Medicare recipients tell Democrat Harry Reid in the Senate to tread lightly on doctor reimbursement rates. Write your Congressional Representatives! Alter to all senior citizens, retirees and all beneficiaries of Medicare health coverage.

Your doctors needs fair compensation from Medicare. Do not put our medical care in danger because of the Democrat agenda to socialize a national health-care for everyone regardless of their contribution or willingness to help pay for it.

Posted by: klausdmk | October 21, 2009 6:37 PM | Report abuse

Well...when the 27% cut of Medicare payments come, our pratice simply has to stop seeing Medicare patients. It's as simple as that. Why sell widgets when every widget that you sell cost you money? We have already been doing that for Medicaid patients. Now we have to do it for seniors too? Why stop there? May be we should stop taking Medicaid, too. Politicians and Americans will wake up to the realities of medical care rationing in no time. Stop playing these silly political games.

Posted by: ch2x2 | October 21, 2009 6:58 PM | Report abuse

By the way, for those of you who think the doctors will now be against health care reform and the public option, think again. When zero of the Republicans vote for a common sense fix in a wrongly formulated Medicare reimbursement adjustment rule, it means the Republicans make zero sense and are incapable of facing up to the realities.

Posted by: ch2x2 | October 21, 2009 7:06 PM | Report abuse

Now this was a "bi partisan" smack down of Harry Reid, leftists. That one vote Olympia Snowe nonsense was a joke, even for you..

Posted by: SMWE357 | October 21, 2009 7:08 PM | Report abuse

LoonyLeft and GaiasChild are amusing, pitiful but amusing.

Hopefully GaiasChild will have good luck with the acupuncturist when a surgery is needed. Then again, maybe not. Of course, the hatred shown by Gaias is typical of those that have not been successful in life. That said, it is difficult to be a success when one is a hater of success.

As for LoonyLeft - Loony is obviously against health care reform becaue Loony is just that LOOOOONY! I guess Loony was okay with the payoff to Haliburton, KBR and the others profiting from the Iraq debacle. The cost wasn't bad, $1 trillion in debt and 4,000 lives lost but such costs are not important to a conservative idiot-log.

Ya'll are not Americans and ya'll are not patriots - ya'll are just idiot-log losers.

Posted by: Freethotlib | October 21, 2009 7:16 PM | Report abuse

could always shut down one or more of the repuglican 100 year wars... as a revenue trade off.

Posted by: angriestdogintheworld | October 21, 2009 7:23 PM | Report abuse

Why do these inefficient Republic Party of No comrades, who only represent 10 percent of the US population, hate America so?

Seriously messed up.

Force a floor vote.

Posted by: WillSeattle | October 21, 2009 7:51 PM | Report abuse

The Dems can create a public option and give away free insurance to all.

BUT you can't make any Dr. accept it!

So good luck with that....

Posted by: RobParker | October 21, 2009 7:56 PM | Report abuse

Why do these inefficient Republic Party of No comrades, who only represent 10 percent of the US population, hate America so?

Seriously messed up.

Force a floor vote.

Posted by: WillSeattle | October 21, 2009 7:51 PM | Report abuse


Assuming Republicans were only 10% of the population (we're MUCH larger), then I say it's seriously messed up that Democrats STILL can't get anything done.

If you're tripped up by 10% of the population, then the Dems are much weaker and incompetent than previously thought.

Posted by: RobParker | October 21, 2009 7:59 PM | Report abuse

Well folks, there is another way you can save money for doctors -- and reduce health care costs across the board.

It is called : TORT REFORM!

Are you man and woman enough to take it on? Or, are your '$$$$$$$$Contributions from the ABA' just too great???????

Posted by: wheeljc | October 21, 2009 8:26 PM | Report abuse

I'm laughing through these comments. Is there something confusing about the wave of voices representing the majority of Americans in favor of public option? Forget the ridiculous "tort reform" idea. You can visit Texas to assess how destructive it worked there. Rev. Bookburn - Radio Volta

Posted by: revbookburn | October 21, 2009 8:39 PM | Report abuse

Well, now we're gettin' down to the nitty-gritty of it all. This is about JEALOUSY.

Sad how the libs are so jealous of people who make a lot of money - except for their darling trial lawyers, of course. Get a clue, if you don't like where you're at, go be a brain surgeon.

Posted by: magellan1 | October 21, 2009 9:20 PM | Report abuse

How many of us would stay in our job if the boss told us up front, today, that our salary is going to be cut 21% on January 1, 2010? And if you were foolish enough to stay in that job, would you still do so if the boss said that your pay would be cut every year after that? If someone offered you a job with a guaranteed annual pay cut, would you take it?

That's the position a doctor is in when you are covered by Medicare and want him to take you as a patient. What do you think the odds are?

The number of physicians who are declining to take new Medicare patient is growing every day. So is the number of physicians who are opting out of Medicare entirely.

We all expect to be 65 some day. When that happens, we will be shopping for a doctor who accepts new Medicare patients. Which one of the 3 new patients calling for appointments does a doctor take now? The one who doesn't have Medicare.

This law would have fixed the problem for those of us who don't plan to die before we get to 65. It would not have paid the doctors more than they are getting now. It would have kept them from expecting pay cuts every year. That would have made accepting Medicare patients something other than financial suicide for physicians.

Posted by: yeu2 | October 21, 2009 9:53 PM | Report abuse

Now that people are beginning to see what healthcare provided by Obamaland would look like, they are unwilling to see it go like the H1N1 vaccines.
Coming in September, I mean October, I mean Novermber...well make that December...etc.

If you live until January they are likely to shoot you at dawn just for still being alive.

No one is taking new medicare patients as it is out there, and even Mayo ( a non profit) shut off exsisting Patients for general care.

The new medical mecca seems to be spawning elsewhere. A lot of people head out of Country for their replacements like New Zealand, because anywhere but Obamaland is better .

Obamaland Vs The USA

It appears that the people want no more from this Congress, and have a Petition of Redress No Confidence recall of them all to void all FED signatures 2009.
Bear Revolt is getting big teeth.

It does appear that Congress didn't consider cutting their salaries and the Oval office salary for screwing up so badly did they?

Posted by: dottydo | October 21, 2009 10:04 PM | Report abuse

Isn't it wonderful to see these Republicans clammering to stop excessive spending. Where were these guys during the Bush years? They spent our tax dollars like it was theirs. Remember the bridge to no where? The Republican Party really needs to get with the program. Heck they need a program. They haven't had an original idea in years.

Posted by: rymp | October 21, 2009 10:41 PM | Report abuse

General Practitioners (the lower end of physician earnings) in the U.S. makes twice as much as the average of other countries, mostly in Europe.

When I was a boy, doctors did house calls and lived in working class neighborhoods of the people they served. The offices were often on the first floor of the house they lived in.

We need to find the reasons doctors cost so much and work to reduce their expenses. We might also have financial aid programs to attract people into the profession who never think about money but always think about the science and the people, primarily with money being not a factor in their choice of careers.

We may be attracting the wrong kind of people into the health professions.

Posted by: owldog | October 21, 2009 11:32 PM | Report abuse

owldog ~
Those were the days when the doctor didn't have malpractice insurance and in a world when there weren't litigious people who are looking for hand outs. The advancement in modern medicine and the way of our times has evolved. As nice as the cozy down home office sounds it also could be limiting and not cost effective. Providing the most advanced medical treatments equipment and advanced technology is expensive for individual practices to own. Being close to medical centers where imaging and labs are allows patients quicker and better care.

I tell you what you can have that doctor that doesn't care if he makes money. The family practitioner that is in Europe paid half as much as our family practitioners. The best doctors will not be in those situations I guarantee you get what you pay for and that is how it should be. It is fully your choice... but don't ask me to pay for your insurance in any way and don't expect hand outs!
That is what Republicans believe! There are no victims here!
Happy and proud to say it!

Posted by: golrh | October 22, 2009 3:03 AM | Report abuse

golrh! All the hoopla about malpractice "reform" is really a PR campaign insurances companies invented to increase profits, and passing the costs to good doctors, when they should be refusing to insure some doctors.

THE "FRIVOLOUS" LAWSUIT - 5.2% of doctors are responsible for 55% of all lawsuits

"The total cost of malpractice constitutes just 0.46 percent of total healthcare expenditures, and settlements have grown modestly with inflation. While approximately 98,000 people die each year from negligent treatment, a mere 2 percent (2%) sue their physicians. As health policy analyst Maggie Mahar [author of "Money-Driven Medicine"] observed, 'A very small group of doctors are losing or settling malpractice lawsuits, but they are losing big.' Between 1990 and 2002, '5.2 percent (5.2%) of doctors were responsible for 55 percent (55%)' of all malpractice payouts."

from the book "Prescription for Real Healthcare Reform" by Howard Dean, MD, pp.90-91

Posted by: owldog | October 22, 2009 3:21 AM | Report abuse

Here are the facts. Medicare will go bankrupt by 2018, therefore spending cannot continue at this pace. The real issue is not what is being paid medical providers on a line item basis. It is the level of frequency and intensity in physician prescribing that has driven Medicare Part B above its annual target. Therefore, we need to control those factors and not just cut payments across the board for services. As for physicians complaining they are not making enough to keep their doors open; we need to ask that person some questions. Where do you practice? Are you primary care or a specialist? Are you running your practice efficiently? Are you at full capacity with your practice? What is you net income compared to other like professions? Once we have answers to these questions, then we can determine whether that individual is really dealing with a personal crisis.

Layton Lang
Dallas, Texas

Posted by: laytonlang | October 22, 2009 10:05 AM | Report abuse

As some of these comments reflect, defeating the "doc fix" has less to do with the deficit than health care reform. The GOP still thinks they can starve various constituencies out of their support for any Democratic proposal. The reality is that people like their doctors a lot more than they like their insurers. Punishing medical professionals for political purposes is short sighted and dumb. If Congress really wanted to attack the deficit, they'd start looking at the military budget, instead of social programs. Killing a few more obsolete weapons programs would go a long way to starting to fix what ails the national budget.

Posted by: Koko3 | October 22, 2009 10:37 AM | Report abuse

just design an entirely new business model, from the ground up, for the health care system and be done with this crap.

take the congress and all lobbyists out of the process and it will be DONE and ready to roll in 12 months!

any 9th. grade problem solving class, from maine to california, could do a better, fairer and faster job than washington.

Posted by: boblesch | October 22, 2009 11:13 AM | Report abuse

What people fail to realize is 1) Congress is/would be borrowing money to pay for this as they have been for years. It would be nice if enough of our politicians consistently realized sooner or later we will not be able to support their spending binges (vote buying) with credit. 2) Physicians being people in a capitalist society act like capitalists. They, more or less, decide how much they want to make and since they provide essential goods and services with demand always outstripping supply , price accordingly. 3) The Government reimbursement rates (dictated by government fiat) are absurdly low so higher private health insurance payments (higher because they must negotiate rather than dictate) and private pay (highest because individuals have no clout) make up for this. 4) However, an extremely interesting point is the lack of supply in our capitalist society. It would seem with the more than adequate rewards of a medical career, that supply should be more in balance with demand which would moderate costs. Bottom line is who controls (and/or who should/can control) the process?

Posted by: thinking1962 | October 22, 2009 12:17 PM | Report abuse

Doctors cannot expect to continually receive a larger share of our federal budget, especially at a time of severe deficits and in light of Medicare’s projected insolvency. Therefore, Senator Stabenow’s bill to pay physicians a further $240 billion dollars was unsustainable and foolish. Accordingly, it should not be viewed as a test vote for the broader question of health care reform. For instance, America’s procedural specialty physicians, across the board, earn incomes that place them firmly within the top 1% of our nation’s wage earners, and only the most poorly run and inefficient medical offices could possibly lose money treating Medicare patients.We are a group of specialty physicians who advocate for higher primary care reimbursement with compensatory lower specialty care compensation. This is a sustainable compromise to the question of proper Medicare funding for doctors and will also improve our nation’s health by increasing the supply of primary care doctors by closing the yawning divide between primary care and specialty physician salaries.

Learn more with links to studies and data that support our position@

James Rickert, MD
The Society for Patient Centered Orthopedics

Posted by: jrickert1123 | October 22, 2009 9:03 PM | Report abuse

"As of Jan. 1, 2010, doctors are scheduled for another 21 percent decrease.

While everyone in Congress agrees the payment formula is a failed model, producing the enormous sum needed to eliminate it has proven impossible"

But Goldman Sachs is paying out bonuses that could cover the costs involved.

Ask your doctor how he likes dealing with Medicare and he will tell you that it is hell and they even backcharge years later without telling the doctor why. The system is a ponzi scheme, unfunded and ready to be further ruined by Obamacare reducing the options for doctors to use in treating their older patients.

Yes the Congress giveth and Obama taketh away.

Posted by: mharwick | October 25, 2009 6:46 AM | Report abuse

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