In the discussions that ensued about Senate passage of FISA, another big vote didn't get much attention: Medicare - specifically, a bill to reverse mandated cuts in doctors' reimbursement fees.
The Senate passed this bill with room to spare, overriding a second Republican filibuster. The first time it was brought to the floor, Democrats failed to get a majority and the bill was tabled. Companion legislation in the House passed by a wide margin. - more -
It was the surprise appearance by Sen. Ted Kennedy, however, that is widely viewed as instrumental in the bill's approval:
With Kennedy's dramatic and surprise appearance, he and fellow Democrats overcame a Republican procedural hurdle and, on a voice vote, passed the measure earlier approved by the House of Representatives.
Medicare covers not only seniors but also disabled individuals who receive Social Security Disability Insurance (SSDI) benefits. Since Kennedy was instrumental in Medicare's creation 40 years ago, it was absolutely fitting that he was present Wednesday to end Republican gridlock:
"Win, lose or draw, I wanted to be here. I wasn't going to take the chance that my vote could make the difference," Kennedy said after the vote.
UPDATE I: The particulars
On the surface the bill reverses a mandated 10.6 percent cut in doctors' fees that took effect July 1 when the bill failed its first Senate vote.
But President Bush has indicated he will veto the bill, even though it appears unlikely that he will prevail, given the number of Republican senators who voted with Democrats to reverse the cuts. In addition, the final vote was a veto-proof majority (69-30).
It gets complicated, however, because nine of these Republicans shifted their votes from "No" to "Yes" after Sen. Kennedy made his surprise appearance to vote on the measure. If they stand firm, there won't be a problem. However, this isn't a guarantee.
The other important "particular" is what passage of this bill signifies for the future of universal health care and the political and ideological differences embedded in its success (or failure).
George Bush and Republicans oppose the bill because it cuts subsidies to private Medicare plans and providers in order to pay for fee increases under the original Medicare plan.
Paul Krugman provides an excellent summary of the bill and stealth efforts by the Bush Administration to privatize Medicare in 2003.
UPDATE II: The bigger problem
Medicare's challenges are far from over. The reason these cuts came about is because of persistent efforts by Republicans to privatize the program, which diverted funds to subsidize private health care companies (Medicare Advantage Plan). When the original program hits a specified target cost increase (also mandated by Congress) that exceeds its funds, corresponding cuts in physician fees are automatically triggered. Krugman and hilzoy (Obsidian Wings) have more information on this.
And the publicity generated by the cuts (which put doctors and the AARP on the same side of a public relations war against Republicans) also generated stories about doctors across the country who are opting-out of the Medicare program because the fees don't keep pace with their rising costs and because they are, frankly, concerned about Medicare's future health (no pun intended).
Thus, privatization plus more doctors opting-out of the federal system equals an ongoing problem that Congress must find a way to solve permanantly. Otherwise Medicare will be nothing but a shell in which those in poor health and lacking funds will be dumped. See Krugman's article for an explanation of these effects on Medicare recipients.
NOTE: On a personal level I have a very deep stake in what happens to Medicare (as does my partner). I am already covered under Medicare and even though it isn't perfect, it is the only program that covered me without preconditions once I became disabled. Private Medicare health insurance is out of the question because of its cost and pre-existing conditions clauses.
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