Friday, July 11, 2008


Paul Krugman has a column in today's New York Times that does a pretty good job of summarizing the Democratic victory in reversing some of the damage Junior's adminsitration did to Medicare. I think Krugman makes some good points. here's some excerpts from his column:

"...Senate Democrats won a huge victory on Medicare.

News reports stressed the cinematic quality of the event: Ted Kennedy, who is fighting a brain tumor, made a dramatic appearance on the Senate floor, casting the decisive vote amid cheers from his colleagues. (Only one senator was absent: John McCain.)

But the vote was bigger than the theatrics. It was the first major health care victory that Democrats have won in a long time. And it was enormously encouraging for advocates of universal health care.

Ostensibly, Wednesday’s vote was about restoring cuts in Medicare payments to doctors. What it was really about, however, was the fight against creeping privatization. Democrats finally took a stand — and, thanks to Senator Kennedy, seem to have prevailed.

The story really begins in 2003, when the Bush administration rammed the Medicare Modernization Act through Congress, literally in the dead of night. That bill established large de facto subsidies for Medicare Advantage plans — plans in which Medicare funds are funneled through private insurance companies, rather than directly paying for care.

Since then, enrollment in these plans has been growing rapidly. This has had a destructive effect on Medicare’s finances: the fastest-growing type of Medicare Advantage plan, private fee-for-service, costs taxpayers 17 percent more per beneficiary than Medicare without the middleman. It also threatens to undermine Medicare’s universality, turning it into a system in which insurance companies cherry-pick healthier and more affluent older Americans, leaving the sicker and poorer behind.

What does this have to do with cuts in doctors’ fees? Well, legislation passed a decade ago makes such cuts automatic whenever the growth in Medicare spending exceeds an unrealistically low target. This year, the automatic cuts would have reduced doctors’ payments by more than 10 percent, a pay reduction so deep that many physicians would probably have stopped taking Medicare patients.

In previous years, payments to doctors were maintained through bipartisan fudging: politicians from both parties got together to waive the rules. In effect, Congress kept Medicare functioning by expanding the federal budget deficit.

This year, the Democratic leadership decided, instead, to link the “doctor fix” to the fight against privatization and offered a bill that maintains doctors’ payments while reining in those expensive private fee-for-service plans. Last month, the Senate took up this bill — but Democrats failed by one vote to override a Republican filibuster. And that seemed to be that: soon after that vote, Senators Max Baucus and Charles Grassley had another bipartisan fudge all ready to go.

But then Democratic leaders decided to play brinkmanship. They let the doctors’ cuts stand for the Fourth of July holiday, daring Republicans to threaten the basic medical care of millions of Americans rather than give up subsidies to insurance companies. Over the recess period, there was an intense lobbying war between insurance companies and doctors.

And when the Senate came back in session, it turned out that the doctors — and the Democrats — had won: Senator Kennedy was there to cast the extra vote needed to break the filibuster, a number of Republicans switched sides and the bill passed with a veto-proof majority."


Anonymous said...

I read the column, but I'm sticking to my rule: when it comes to the Democrats (including Obama), don't get your hopes up.

brian (baj) salchert said...

I agree with tpw, but thank you for
this because I didn't read the column
and I am on Medicare.
Also, thank you for your comments beneath Silliman's "I'm feeling feisty"
poetry post.
And (speaking of "and"):
War and Peace ?