Ever since I first heard that the House of Representatives was passing a bill that would eliminate the need for the doc-fix, I’ve been wondering two things. First, how in the world did this House find a bipartisan compromise solution to a truly vexing problem? Second, was the answer that the bill is a horrible capitulation on the Democrats’ part?
I’m generally pleased with the answers I found to both questions. Peter Sullivan’s column in The Hill provided a partial answer to how a compromise was reached. The key was really that the Democrats agreed not to insist on tax hikes in return for the Republicans not insisting on fully offsetting the cost of the reforms. I count that as a win for the Democrats, actually, as it means that they’ve broken the Tea Party insanity about deficit spending. Another key was that it was negotiated so secretly and quickly that it caught all the stakeholders by surprise that it was being negotiated at all.
Early this year, committee leaders asked House leadership for parameters they could look at on how to pay for SGR repeal. Boehner and Pelosi’s healthcare staffs began meeting in early February, laying the groundwork for the two leaders’ meeting in March.
The Boehner-Pelosi talk ushered in the final stretch of negotiations, with members of the Energy and Commerce and Ways and Means committees brought back into the picture. Pelosi met with the ranking members of those panels, Reps. Frank Pallone (D-N.J.) and Sander Levin (D-Mich.), the same day she met with Boehner.
Up until that point, the talks had been kept secret. Healthcare lobbyists and groups who have fought for years to end the SGR were completely in the dark.
For a while, it looked like abortion language might hold up an agreement, and Senate Finance ranking member Ron Wyden (D-OR) applied the brakes. But Pelosi was able to work out some compromise language on that as well and Wyden relented. With the House Pro-Choice Caucus on board, I don’t think there is anything to worry about on this front.
As for the actual bill, it won’t be finalized until the Senate gets finished working on their amendments and the two bills are reconciled. Yet, early signs are encouraging. The most significant thing is simply that it ends the submental budget ritual known as the “Doc-Fix.” Doctor reimbursement levels will be accounted for in a sane manner.
It’s important that the Republicans agreed to raise more revenue– despite the bill’s price tag, it only appears to cost more money because the Doc-Fix will actually be on the books for a change. It also provides incentives to move doctors and hospitals into pay-for-performance programs, which is most likely going to be a positive legacy of the bill.
If there are any potential problems, one might be that the slow growth of reimbursement fees will cause fewer doctors to treat Medicare patients. Yet, I think it will be harder to exclude Medicare than Medicaid patients. On this score, we’ll have to wait and see.
The final vote of 392-37 was resoundingly bipartisan, and the signs are positive that the Senate will pass it easily, too.
I’m still a little stunned that this Congress was able to pull this off.
WaPo on Bill Clinton’s clean-up for Hillary’s 2016 campaign
Looks as if the only ways that I won’t have to hear and see these two infecting the Democratic party with their neoliberalism and pro-warism is for me to either die or outlive them.
not Wapo.
This is a seemingly bold statement:
But should his, or any other non-Clinton, campaign fail to grow legs, will he help carry that crown for Clinton?
Way too much at stake not to. I think (hope?) you would agree that a choice between Hillary and any imaginable Republican nominee is no choice at all.
That doesn’t speak against the desirability of having a more progressive opponent to Hillary in the primaries. That is very desirable. However, to make as a litmus test for those Dem primary opponents “will you swear to refuse to endorse or support Hillary’s campaign if she wins the Dem nomination” would be dumb and should not/will not happen. The MSM will encourage that as a litmus test, but the MSM is not our friend and should be ignored on this issue by Democrats.
And Republicans that want to crown Jeb may also now be saying to the Cruz/Walker/Rand supporters, Way too much at stake. I think (hope?) you would agree that a choice between Jeb! and a Hillary nomination is no choice at all.
The current issue for rank-and-file Democrats and Republicans to decide on is whether or not the Clinton and Bush families are so exceptional and superior that we’ll shut up and accept the decision by the party elites and the moneybags they service that primaries are irrelevant. Expect there will be a bit more objection within Republican circles as to the past performance of Jeb and the Bush family prior presidents than there will be within Democratic circles. On this measure, GOP conservatives are more informed and rational even if there track record indicates that they will suck up and get in line behind the mushier conservative their party elites foist on them.
Democrats are either blind as to the Clinton track record or deluded that senior citizen Hillary will suddenly shift left after a lifetime of leaning right except for the issue of equal rights/opportunities for upper middle-class women.
I can say with complete honesty that I still think that HHH would have been better than Nixon, McGovern a lot better than Nixon, Carter better than Ford (but Carter war by far not the best nominee that could have been fielded in ’76), Carter and Mondale were much better options than Reagan, and Dukakis (what were we thinking?) slightly better than GHWB.
No doubts that Gore would have been better than GWB. By a wider margin than Carter was better than Ford. Not because Gore is/was essentially more liberal than Carter, but because GWB is dumber and more extreme than the guy “so dumb he can’t fart and chew gum at the same time.” Objectively, Kerry should have been better than GWB — that was the year the Supreme Court did matter — but otherwise may not have been all that different from the hamstrung GWB/Cheney in their second term. No contest between Obama and McCain and Romney. Mostly because Obama is saner than those two and therefore did less long-term damage than either of them would have done. And Palin a heartbeat away from the oval office was terrifying.
In retrospect there may not have been all that much difference between the Clinton and hypothetical Dole administrations. The difference between Clinton and a second GHWB term is more difficult to measure. Would a Democratic Senate have caved if GHWB dared to nominate two more justices like Thomas? Or would he have ended up appointing two more like Souter? Would Congress have flipped in 1994 if GHWB remained President? And his impediment to NAFTA and reduced capital gains taxes were removed? None of that can be known — but liberals lost huge legislative ground under Clinton and had to endure seemingly endless drama as well.
I’ll think about tomorrow when tomorrow comes. Right now as a Democrat I’m offended by the crowning of another Clinton who I don’t find acceptable for President.
Why do you consider yourself a Democrat when the last time they nominated the right candidate was 1948?
Why do you just make up shit about the position of others?
I made no comment about 1952-1964 Democratic presidential nominees. Would have voted for all of them but have no opinion as to whether or not I would have considered them the best choice. As it turned out, there wasn’t a choice in ’68. So, “right” doesn’t figure into the equation for that year. Had I been old enough to vote in the ’68 CA primary, would I have tossed away my vote on the by then hopeless McCarthy campaign? Or forced myself to choose between HHH and RFK? Don’t know that answer to that first question, but suspect I do for the second if I weren’t willing to be so cavalier in tossing away my vote.
Why am I a Democrat? It’s by default. By 1964 the GOP had made itself clear as to where they stood on discrimination against minorities and women, opposed unions and a fair deal for working class folks, and were more extreme in their support of using war to resolve international conflicts than even the Democrats were. (Nuking Vietnam was more than a little bit popular among Republicans.) With time, the GOP has become much worse than it was fifty years ago. For a while after that, Democrats become somewhat better than they had been. It was only in those smokeless backrooms that they became worse on multiple issues important to New Deal/Great Society/anti-imperialist Democrats.
In 1992 I voted in opposition to GHWB’s agenda but not for the stopped clock Republican loon. My guy, Tom Harkin, was knocked out early as the media fell for Tsongas. Jerry Brown’s support for a flat income tax demonstrated his unsuitability. But the CA primary was irrelevant. The general election had been decided earlier by others — the choice was GHWB, maybe not GHWB, or maybe the loon.
The Democratic party hasn’t been the social democratic party of your dreams, ever, not in the ’48-64 time frame, and not since.
You’re trapped in a bad marriage.
The Democratic party hasn’t been the social democratic party of your dreams, ever, not in the ’48-64 time frame, and not since.
There you go again! Further projections on to me not based on anything I’ve said, think, nor believe.
All I’ve ever claimed is that the Democratic Party implemented positive changes for large numbers of US residents in the period from 1933 through the mid to late seventies. Lincoln and the radical Republicans were similarly more morally civic minded in the mid 19th century. Both had deep flaws, but compared to the alternatives were on the right side of human beings and both sprung from earlier and largely unsuccessful efforts to do the same.
IOW, we suffer no illusions about what the Democratic Party is, or has been. We are also not nihilists who insist on third parties except where possible (such as Sawant in Seattle).
But we support the Democrats because they can be pressure to do the right thing some of the time, whereas no amount of public pressure from the left and/or center will move the Republicans. I don’t think this will ever change. The party must die for us to have an actual politics again.
Things cancel out. For every person who looks at Hillary Clinton and sees Rosa Luxemburg, there’s one who looks at her and sees Margaret Thatcher.
And so the balance of the universe is maintained.
The Doc-Fix was stupid. Congress passed a law to restrain spending and for twenty years passed a “fix” to negate it. If the annual fix is finally gone, I’m glad.
For spending restraint, I’d favor a law that said a health care provider could not charge Medicare more than the best price they give to any commercial insurance network. And I’d INCLUDE prescription drug prices. No government fiats that Congress does an annual fix on, just, since we have a large for-profit industry enshrined by the ACA anyway, using the market to set prices and ensuring that the government gets the best deal.
A clause like that used to be standard in Defense contracts for common items.
Many policymakers know that healthcare costs for US senior citizens (average annual costs/beneficiary) are significantly higher than what is consumed in countries with a universal healthcare system. So much higher that a similar cost in those countries would crush their UHC system. In part because a larger proportion of their populations are >64 years old.
It’s known and yet, policymakers are helpless to correct this gross imbalance. So, we’ll just wait and hope the problem corrects itself or the “system” crashes in twenty or so years when current policymakers are no longer around. Boomers dying earlier than the two generations that preceded them would be a self-correcting phenomenon.
Can’t argue with you, yet any solution that depends on my dying early leaves me cold (pun intended).
A major part of the difference in HC costs between the USA & Europe, although certainly not the only difference, is that physician salaries in the USA are double those in Europe. The provision that the annual doc-fix negated was intended to cure that, but obviously the political will does not exist to thwart the AMA and their political
bribescontributions.The difference isn’t doctors’ salaries in general. US primary care doctors don’t earn more and many earn less than their counterparts in countries with UHC. Generally, they have more GPs and the people are seen more often by their GPs than in the US.
It’s all the specialists and the for-profit (corporate, doctor owned, or in-house, for-profit hospitals) specialty care clinics that drive up the cost in the US. And with no discernible value wrt to life expectancy and general health and well-being.
Other biggies in the US are the medical device and equipment and drug manufacturers.
Should be noted that med school costs Mich more in America compared to other countries so post educational debt is another incentive to charge big bucks.
All higher education costs more in the US than other countries with developed economies. That’s an incentive for Wall St. to charge more.
US med schools have long been an impediment to UHC. Keep the supply of doctors low, they can charge more. And the more doctors can charge, the more medical schools can charge. It’s a vicious cycle that maintains the status quo.
Also an incentive for brain drain; ie, “smartest/brightest” to go into finance.
About doctors being restricted in supply in Med School, that is true. However, you can’t increase the supply of doctors being trained if you don’t increase the number of spots in residency.
I don’t see why we don’t just train civilian doctors like we train military doctors…
And of course the insane residency demands because who wouldn’t want a doctor that’s been up 24 hours? The older generation did it, uphill both ways too! Amiright?
Residency openings are a function of the number of med school graduates.
I don’t see why we don’t just train civilian doctors like we train military doctors…
We do. The military provides a portion of the residency spots.
As long as we keep trying to fix the high cost of healthcare at the end point — when people access care — all the reasons why it costs so much cannot be solved.
Residency openings are a function of the number of med school graduates.
Are you sure? I mean, of course they’re a function, to a degree, but from what I’ve seen from my doctor friends there are more med school spots than residency spots, usually by a significant margin. Of course, the same people who control the number of residency spots also control the number of med school spots…
Technically, “Congress” sets the number of residency spots by allocating a certain amount of Medicare funding, but it’s the doctors themselves who choose how to spend this money and they do a poor job of it.
Boo’s brother has the goods.
So, where do those med school graduates go if they don’t get accepted for residency?
The rest that you cite is additional evidence of essentially privatized medicine. Dumping more public dollars into the equation, changes nothing. Might even make it worse because apparently increasing the supply of the highest compensated specialists also increases the compensation of those specialists beyond the rate of general inflation and the rate of primary care doctor compensation increases.
While probably not true, in advance of WWII when industrialists were informed that they had to increase production of military vehicles, weapons, supplies, etc., they said that they couldn’t supply both the military and consumers. To which FDR responded, you won’t be making consumer goods.
I don’t know where they go…wait a year?
The rest, as usual, is spot-on.
Hmm, I am not so sanguine that abortion situation was taken care of. Was the Hyde amendment made perpetual? That was another hurdle mentioned. And is or isn’t it permissible to use revenue to pay for legal abortions for the trafficked?
Look forward to being pleasantly surprised, if those are not still in the bill.
Oops. Separate bills.
“as it means that they’ve broken the Tea Party insanity about deficit spending”
I think you have this part somewhat wrong. The Tea Party seems fine with deficit spending that they favor like most DOD spending. It would have been remarkably sane had the Tea Party agreed to a funding allocation for the doc-fix.
“Democrats view it is a victory that two-thirds of the deal is not paid for”
Perhaps you are echoing this quote but the victory is that Republicans agreed to pass the legislation at all.