01 July 2008

Medicare Fall-out

Burnt Orange Report, um, reports that the Texas Medical Association has rescinded its endorsement of Senator John Cornyn over his vote to block the fix to Medicare reimbursements. The Border Health Caucus has similarly expressed opposition.

While I doubt this will have much effect -- Cornyn has a decent lead over his Democratic opponent, Lt Col Rick Noriega -- it's not the message that you want to have out there if you are a republican in a competitive election in this anti-republican environment. More to the point, it's a rare and dramatic expression of how pissed off the medical lobby is at republican obstruction.


According to MyDD, the AMA, traditionally a GOP ally, is now running ads against vulnerable GOP senators in Texas, Mississippi, and Hew Hampshire. See the ad here.


I find this interesting from a political perspective. What we have here is a classic game of brinksmanship -- from both parties. The Democrats want to flex some political muscle, and they feel emboldened by the huge majority that the house bill passed by. The republicans, confident that the Dems will roll over, because, well, they always do, gambled that they could hold out for the Baucus-Grassley compromise. Who's to blame? It's equal shares, IMO. But just like when Gingrich and Clinton shut down the government in 1995, it's all about the posturing and public perception. I'd say that, this time, the Dems are looking better, and with the negative press and blowback from the medical lobby, I'd venture to guess that they'll peel off one or two more votes to pass the bill come July 7. Maybe Ted Kennedy will rise off his sickbed to cast the deciding vote -- great drama. Then we'll have to see if Bush is obstinate enough to veto it, as he has threatened.

As a matter of partisan politics, I of course want the democrats to win. But I would be remiss if I did not point out that there is also a substantive difference between the proposals that favors the bill that is currently on the table:

The cost of fixing the physician pay cut is estimated at about $6.8 billion. The house bill funds that by reducing the size of Medicare Advantage. The Baucus-Grassley compromise, I understand, funds that by reducing assistance given to low-income Medicare beneficiaries.*

Many Democrats view Medicare Advantage as, at best, an attempt to incrementally privatize Medicare, and at worst, a frank give-away to insurance companies. Conservatives contend that Medicare Advantage is a popular and successful experiment in market-based government-funded health care. Both may be correct. Still, I find it informative regarding the relative priorities of the parties that, while both factions want to curry favor with the doctors' lobby, the Democrats' first instinct is to preserve assistance for the poor, and the republicans' is to preserve free market reforms.

*There is also some difference involving medical supplies and competitive bidding that quite frankly, I don't understand.


  1. Just a comment giving you kudos on a relatively even handed post. No hyperbole, invective, or name calling.

    I bitched a bit when you sounded like Al Franken, so I figure I owe you a pat on the back when you are relatively fair and balanced.

    I can hear you grinding your teeth at the fair and balanced thing...

  2. Well, as long as you mean "fair and balanced" in the literal sense of the words, as opposed to the Orwellian sense used by Fox, I'll take that as a compliment.

    It's not that I wanted to be fair -- I initially was thinking there would be some partisan hay to be made from this kerfuffle, but the more I thought about it, the most I could really get was the "differing priorities" coda. And the truth is that the Dems did provoke the showdown -- the Grassley bill had been agreed on in principle before the House passed its bill. So I could hardly blame the GOP exclusively -- at least not without Catron jumping down my throat.

    So thanks for the kudos -- I may try being fair and balanced again someday.



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