21% Medicare Reimbursement Cut Scheduled To Go Into Effect Today.

[mmonk]

Retiring Republican Senator and former baseball player Jim Bunning (KY) giving the standard Republican excuses that he doesn't want to pay for a bill that isn't paid for (despite massive deficit spending under Bush and Republican Presidents and Cheney's declaration that deficits don't matter) decided to use the parliamentary maneuver of unanimous consent to hold up a bill that provided out of work Americans unemployment benefits. The bill in question also had appropriations for medicare reimbursements. The bill would increase the deficit by $10 billion from 2010 to 2020 with $7 billion of it for Americans that lost their jobs under the current recession by extending benefits.

In discussing this issue, Emily Walker reported for Medpage Friday in, "Medicare Pay Cut Goes Into Effect on Monday
", that

Sen. Dick Durbin (D-Ill.) chastised the Hall of Fame pitcher for being the lone voice of dissent on the "extenders" package.

"Everyone acknowledges there is only one objection," Durbin said on the Senate floor Thursday night. "Everyone in this chamber acknowledges we are a caring and compassionate country, and we will, on an emergency basis, extend a helping hand to those who have lost their jobs."

Walker also reports,

The American Medical Association said that starting Monday, the 21% cut will force doctors to "consider the difficult decision to limit the number of Medicare and TRICARE patients they see in order to keep their practice doors open."

"Our message to the U.S. Senate is stop playing games with Medicare patients and the physicians who care for them," said AMA President J. James Rohack, MD, in a statement. "It is shocking that the Senate would abandon our most vulnerable patients, making them the collateral damage of their procedural games."

The problem arose from what is known as something called the sustainable growth rate formula or SGR which is a Medicare accounting scheme that ties Medicare Part B reimbursements to GDP. This formula has caused cuts in Medicare reimbursement nearly every year this decade and has been fought by the Medical industry for years. Just imagine if this formula was applied to the Military Industrial Complex or its 1000 + bases in around 135 countries and it's spending which is more than the next 10 nations combined or if it was applied to subsidies to big oil or the tax cuts that have been implemented steadily to the top income tax rate imposed by Republican Presidents. Maybe then there would be public money to spend on the well being of the public in hard times. Imagine if the foreign and US corporations that haven't been paying income taxes while doing business in the United States as was shown in a study by the GAO and reported in a Reuters article titled, "Study says most corporations pay no U.S. income taxes" had been doing so. Would we be so far in debt? Would we have enough to meet the basic quality of life needs for our citizens? I suppose that would interfere with someone's ideology or some politicians campaign war chest and I guess we just can't have that, can we? I expect the Senate will pass an appropriate extension when it returns to session. I doubt it is willing to face the heat if it didn't.

Also at Daily Kos

[annabanana]

1. How much do you want to bet that this will be laid at the feet

of the healthcare bill?

With all the confusing talk about "cuts to medicare" that they've got people terrified abourt.. coupled with a real-time reimbursement shortfall... The ground is well prepared.

[mmonk]

4. I agree we do have to watch this.

[annabanana]

2. We have to WATCH LIKE HAWKS for the misinformation about this

on MSM.

I fear it will be rampant.

[Biker13]

3. K&R

It's already hard enough to find a doctor who will accept new medicare patients. This won't help.

[mmonk]

6. Yes. A growing problem as politicians look for "savings"

in Medicare.

[customerserviceguy]

12. You mean

like both versions of HCR that were voted on by Congress?

Cutting Medicare while the baby boom is headed towards 65 is sheer madness.

[Hannah Bell]

5. They couldn't get an extension for UE passed by deadline to start sending out "terminated"

notices, but they could cut 1/5 of medicare payments.

And the banksters got their bailout $$$ on day one.

One sees where our leaders' priorities lie.

[1776Forever]

8. OMG are you so right on - Makes me ill!

:banghead:

[1776Forever]

7. Question: How can I declare myself a Corporation? Anyone have a St. Lucia address I could use?

:sarcasm:
:hide:

[mmonk]

9. I'm looking at the Caymans

[1776Forever]

10. I checked it out and there are Lawyers in St. Lucia that specialize in Offshore Corporations.

......Probate and Trusts, Litigation, Admiralty and Maritime Law, Offshore Corporations, Trusts...

[mmonk]

11. Ah. Interesting. The building that houses all those corporations

in the Caymans is probably crowded anyway. Or maybe not, just crowded with unanswered mail.

[postulater]

13. Here's what Wisconsin Medicare says on their website today.

There is no mention of the cut happening right away.

"Fees Effective January 1, 2010 - February 28, 2010:
Legislation eliminated the proposed negative 20% update to the Medicare Physicians Fee Schedule and has provided for a zero percent update for the months of January and February 2010. In addition, there have been revisions to the Physician Fee Schedule Conversion Factor and Practice Expense Relative Value Units (RVUs).

The fees posted below reflect those revisions and the zero percent update. We will post the fees that are effective March 1, 2010 - December 31, 2010 once we receive them from CMS. "


http://www.wpsmedicare.com/part_b/fees/physician_fee_schedule/

[mmonk]

14. Thanks

[mmonk]

15. From a new article:

“We’re just four days from a Medicare meltdown in this great country. The effects of the Medicare disaster go far beyond Medicare patients. In fact, it could affect every single Texan. Here is why: Most health insurance companies base their payments to physicians on Medicare rates. In some cases, insurance companies reduce their rates every time Congress freezes or cuts physician Medicare rates. But they don’t bother to freeze the premiums our patients and their employers are paying.

“For the past nine years, the cost of running a doctor’s office has increased dramatically. At the same time, what the government pays your doctor to care for Medicare patients has not kept pace. The flawed payment system is unsustainable. Since 2001, physicians’ costs have gone up 20 percent more than physicians’ Medicare payments. In fact, come March 1, when the 21.2 percent cut goes into effect, physicians will receive less from Medicare than they currently receive from Medicaid. This is appalling because no one pays less than Medicaid.

[postulater]

16. Scary.

And Warren Buffet blames the increasing cost on doctor's doing too many procedures at too high a cost.

[Igel]

17. "the parliamentary maneuver of unanimous consent"?

Sorry, but it wasn't Bunning's call to use "the parliamentary maneuver of unanimous consent"--that was Reid's. When you do that, you'd better make damned sure that you have 100% of the votes on your side--or, failing that, you'd better make sure you want the bill to fail. Those are the only two ways to think about unanimous consent.

The problem is that under most parliamentary systems, it ups the ante: A single vote causes the bill to fail. It's why holds in the Senate are institutionalized: You put a hold on a bill it signals (a) your intent to vote against it and (b) your intent to filibuster. This means that the chair has the horribly onerous and utterly unreasonable task of actually allocating time for debate and then holding a vote. What's a chair to do when there are important hearings and press conferences to be held, and a recess is looming?

If Bunning put a hold on the bill--as some news stories say he did--then it's idiocy (possibly arrogant idiocy, but still idiocy) to call for passage by unanimous consent. If Bunning didn't put a hold on the bill, then Reid has an excuse for the first vote and Bunning was discourteous. Not unethical--placing holds and respecting them are traditional and show courtesy, but that's not part of an ethical system, AFAIK. Keep this instance in mind the next time you hear about holds in the Senate. (Of course, I guess the come back could be that the minority party in a Democratic Senate shouldn't have the right to vote against the interests of the majority party. Let's not go there.)

Even if there was no hold on the bill, the Senate doesn't abide by most parliamentary procedures that say once a vote has been held you can't call for reconsideration except under certain conditions and even then the person calling for reconsideration must have been on the winning side. 99-1 would make that 1 person--Bunning--the winner. Revotes are allowed on the condition that the import of the motion is substantively changed, usually by circumstances (without regard to the outcome of the vote--if a majority now say they're in favor but the import of the motion is unchanged, how the vote would go is utterly irrelevant.) Note that this is not the Senate's policy or procedure, where you can vote on the same language with the same import over and over again without hindrance.

Given that, the only reasonable thing to do is to bite the bullet: If the bill is so important, then you schedule debate and a normal vote. Hearings are cancelled since they're of of lesser importance; other legislation and resolutions and debates of lesser importance give way. If Bunning did place a hold on the bill, that's what Reid should have done on Thursday and Friday, or he should have held the Senate in session on Saturday and Sunday. Otherwise it seems that Reid's said that other things have lower priority. Given the "discussion" last Thursday, that means Friday would have been prime time for such a vote.

The problem is that although Reid set the vote up so a single person could keep the bill from passing, Reid then insisted on doing the same thing several times expecting a different outcome each time--and then failed to quickly take the steps necessary to actually avoid repeating the same outcome to avoid having the law lapse. Perhaps I'm missing something about Senate procedure that forced him to not schedule a debate/vote for 5-6 days, but he's shown incredibly alacrity and flexibility at times, redoing the Senate's schedule late one afternoon and having the new schedule take affect the next day.