10 July 2008

The Next Step

After seven years, the man in the Oval Office still manages to surprise me. I tend to assume that most people have a limit to their stubbornness, but apparently still-president Bush, in his petulance, intends to veto the Medicare Bill. Most people would have seen the handwriting on the wall. Most people would have seen the reasonable compromise on a critical issue. Most people wouldn't want to waste the last of their political capital on something like this. Most people wouldn't risk the humiliation of an override as they prepare to cede the White House.

But Bush is not most people. He is full of bluster and bravado and a childish refusal to have it any way other than his way. And it has worked well for him, one must admit, to the detriment of the nation and the world. So there is no reason I should be surprised, no reason at this time that any rational person would expect Bush to behave like a normal member of society.

So what happens now? A lot will depend on timing. The new rates are scheduled to begin on Tuesday. It would have to be remarkably quick for Bush to issue his veto and Congress to vote on the override by then, but it can happen. The outcome of that vote will be critical.

What I worry about most is if the veto is over-ridden, and the cuts are rescinded, but it takes another week or so. In that case, Medicare will already have handled several million July claims at the lower payment rate. EOBs will have gone out to beneficiaries, secondary insurances will have been billed, co-pays will have been collected. All that will have to be re-done, and it will be a nightmare for the billing offices. They'll need to recalculate everything, issue revised statements, issue refunds, confuse seniors with multiple differing bills for the same service. "Nightmare" may not be a strong enough word for it. It will consume countless hours of biller productivity, and will certainly disrupt cash flows.

McCain, as I have mentioned, hasn't bothered to show up to his day job to vote for either of the Medicare bills (or anything else since April). He did eventually say that he would have voted against the bill as passed. Somebody needs to ask him between now and next week whether he will vote to sustain Bush's veto (or whether he will vote at all).

My best guess is this: enough republicans in the senate still are Kool-aid drinkers and will support the President, and the veto will stand. Reid will not allow the other compromise legislation to come to a vote, and the cuts will go into effect. The Democrats will continue to blame Bush and the republicans for the cuts, and the AMA will swallow the bait and campaign vigorously against vulnerable republicans in the fall.

Prove me wrong, guys. Please.

Fun "profile in courage" on the GOP side: Texas senator "Big John" Cornyn delivered a blistering speech against the medicare bill and voted against it. After it was clear that the bill had sixty votes, he switched his vote to "yea." Way to stand for your principles, Big John. I'd count on him to vote with Bush on the veto, by the way.


  1. You are of course right about McCain not showing up for votes.

    At least Obama showed up to vote For FISA.

    It's not a flip-flop, it's just a pivot. Or something.



  2. Yeah, I saw a faux bumper sticker somewhere over in Left Blogistan that read "Obama '08 -- Get Disappointed by Someone New."

    I would have been pretty disillusioned by that if I had truly drunk the Kool-Aid and thought he was capable of walking on water. But I've always known that despite the rhetoric of him being the "most liberal" member of the Senate, he's actually very cautious and centrist. Anybody who hopes that President Obama will be a raging liberal will be very very disappointed indeed.

    The old saying in politics -- don't let the perfect be the enemy of the good.


  3. ShadowFax:

    There's also another saying: If you want to know about water, don't ask a fish!


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